Caseous Necrosis of Mitral Annulus: a new feature of drug-induced valvular heart disease? Case series

Background Drug-induced valvular heart disease (DI-VHD) is a well-defined condition associated with specific pathology features. However, clinical presentations may broadly vary and thereby make DI-VHD diagnosis more challenging. Case summary We report two patients with a history of benfluorex administration, who developed extensive mitral calcific lesions which evolved towards caseous necrosis. Discussion Prospective follow-up over several years of these two patients who initially had typical DI-VHD findings provided monitoring evidence of extensive calcifications and subsequent caseous necrosis. These reports suggest a link between calcific heart injury and benfluorex exposure. The diagnosis of DI-VHD may be overlooked at this late stage.

Tubercular Tenosynovitis of Extensor Tendons of Ankle : A Case Report

Introduction:India being an endemic region for Tuberculosis (TB) has a high incidence of musculoskeletal TB with various presentations. Tenosynovitis is a rare presentation and few cases have been reported involving the hand and wrist but isolated involvement of extensor tendons at the ankle is even rarer and unreported. Case Report:Thirty-five-year-old female patient presenting with a dumbbell-shaped swelling over the anterolateral aspect of right ankle with mild dull aching pain. MRI revealed altered signal intensities surrounding the extensor tendons at the ankle without the involvement of the joint. Surgical debridement was done and six-month ATT was given. Gross specimen revealed rice bodies and histopathological examination showed caseous necrosis and epitheloid cell granulomas. Conclusion:Tuberculosis TB being endemic can have varied presentations, early diagnosis can be made if clinical suspicion for TB is considered. ATT is the mainstay of treatment, but surgical debridement is necessary for extensive lesions with compressive symptoms. Keywords:Tuberculosis, tenosynovitis, rice bodies, dumbbell dumbbell-shaped mass.

Imaging findings of prostate tuberculosis by transrectal contrast-enhanced ultrasound and comparison with 2D ultrasound and pathology

Objectives: This study aimed to investigate the contrast-enhanced ultrasound (CEUS) appearances of prostate tuberculosis (PTB) and its correlation with histopathology. Methods: Clinical, transrectal ultrasonography (TRUS) and CEUS data of 12 PTB patients confirmed by pathology were retrospectively analyzed, and compared to the pathological findings to identify the pathological structures corresponding to different image enhancement areas. Results: No specific characteristics could be found for the clinical appearances. Enlarged gland, hypoechoic lesions and calcification due to PTB could be found by TRUS, which were also non-specific. CEUS showed hypo- or non-enhanced lesions with varying size, which were related to different pathological stages of PTB. The incidence rate of non-enhanced lesions was 83.3%. The detection rate of suspected lesion by CEUS was significantly higher than that by TRUS (χ2 = 8.000, p = 0.005). Histopathology showed that the hypoenhanced area consisted of tuberculous granulomas, caseous necrosis and incomplete destruction of the glands, while the non-enhanced area consisted of caseous or liquified necrosis. Conclusion: CEUS could improve the detection rate of PTB lesions, and the diversity of its manifestations was related to different pathological structures. An enlarged, soft gland with non-enhanced on CEUS may provide valuable information for the diagnosis of PTB, but it is not a substitute for biopsy due to the diversity of CEUS findings. Advances in knowledge: When the lesions of prostate gland are unclear in TRUS examination, CEUS is an ideal option for the detection of lesions, which is conducive to targeted guidance of biopsy areas.

Photogallery. Sarcoidosis (part 1)

Sarcoidosis (synonym: BenierBeckSchaumann disease, benign granulomatosis, chronic epithelioid cell reticuldoendotheliosis) ― is a multisystem disease from the group of granulomatosis, of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis fibrosis in the tissues of various organs. Taking into account the variety of clinical lesions, there are three main forms: extrathoracic, intrathoracic, mixed (generalized).

TO STUDY THE CYTOMORPHOLOGICAL PATTERNS OF TUBERCULAR LYMPHADENOPATHY AND ITS HISTOPATHOLOGICAL CORRELATION

INTRODUCTION: Tubercular lymphadenopathy is one of the common clinical problems. Practically diagnosis of tuberculosis sometimes creates a challenge to the pathologist and clinician. A combined approach of cytology with aid of special stain and histopathological evaluation helps to conrm the diagnosis. AIM -The present study was carried out to evaluate the different cytological patterns of tuberculous lymphadenitis along with utility of special stain like Acid fast stain and further histopathological evaluation. MATERIAL AND METHOD: Smears from 833 cytologically diagnosed cases of tubercular lymphadenitis were prepared and stained with Hematoxylin and Eosin (H&E), Giemsa and Acid-fast stain. All the smears were categorized into four cytomorphological patterns and correlated with 250 histopathologically available cases. RESULT: Tuberculosis is the major cause of lymphadenopathy. Majority of cases (63 %) were in their second to third decades of life, with male to female ratio of 1:1.4. Cervical region was the most common site of involvement (83.5 %). Smear revealed epithelioid granulomas with caseous necrosis in maximum cases (46.9 %). AFB positivity was seen highest in smear revealing necrosis only with or without epithelioid cell (93,8 %). histopathological correlation was seen in 248 cases out of 250 available cases. CONCLUSION: FNAC has been proved very safe, highly sensitive, and rst line investigation in diagnosing tubercular lymphadenitis. The approach to tubercular lymphadenitis attains completeness with cytopathological, Acid Fast stain and histopathological evaluation.

Primary oral tuberculosis in an immunocompetent patient

Primary tuberculosis of the tongue is very rare. The chronic ulceration is commonly misdiagnosed as a cancerous lesion. We report the case of a 44 years old immunocompetent woman who presented with a lingual chronic painful ulceration. The biopsy of the lesion showed a granulomatous inflammation, with caseous necrosis in the center. The ulceration healed after a 6 month tuberculosis treatment. Keywords: Tuberculosis; oral; immunocompetence; ulcer.

A case of chronic cough due to sarcoidosis

Sarcoidosis is a multisystemic, chronic granulomatous disease of unknown aetiology that often affects the lungs. Diagnosis and treatment of sarcoidosis can be strenuous. Patients may be asymptomatic or experience cough, dyspnoea, fatigue, unintentional weight loss or night sweats. Computed tomography is valuable in the diagnosis of sarcoidosis. The typical histopathological lesion of sarcoidosis is granuloma without caseous necrosis in the involved organs. As tuberculosis is endemic in our region, clinicians should not forget this great mimicker. The cornerstone of treatment of sarcoidosis is corticosteroids but newer agents such as steroid-sparing agents and biological agents are available. We report a case of pulmonary sarcoidosis presenting with chronic cough.

Photogallery. Sarcoidosis (part 2)

Sarcoidosis (synonym: BenierBeckSchaumann disease, benign granulomatosis, chronic epithelioid cell reticuldoendotheliosis) ― is a multisystem disease from the group of granulomatosis, of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis fibrosis in the tissues of various organs. Taking into account the variety of clinical lesions, there are three main forms: extrathoracic, intrathoracic, mixed (generalized). We are publishing the second part of our photo gallery.

Disseminated Mycobacterium tuberculosis following renal transplant: A case report

Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.