Interpreting the full blood count

The full blood count (FBC) is one of the most commonly requested blood tests in medical practice and can provide a wealth of useful information about a patient’s general state of health, as well as highlighting abnormalities which indicate systemic or sinister pathologies. This article seeks to explore the different parameters of the FBC, and how these relate to some more common clinical presentations, as well as their relation to morphological findings seen on the blood film. As with most investigations, differential diagnoses suggested by any individual laboratory tests are wide and are most valuable when combined with history and examination.

Morphological Characteristics of Idiopathic Inflammatory Myopathies in Juvenile Patients

Background: In juvenile idiopathic inflammatory myopathies (IIMs), morphological characteristic features of distinct subgroups are not well defined. New treatment strategies require a precise diagnosis of the subgroups in IIM, and, therefore, knowledge about the pathomorphology of juvenile IIMs is warranted. Methods: Muscle biopsies from 15 patients (median age 8 (range 3–17) years, 73% female) with IIM and seven controls were analyzed by standard methods, immunohistochemistry, and transmission electron microscopy (TEM). Detailed clinical and laboratory data were accessed retrospectively. Results: Proximal muscle weakness and skin symptoms were the main clinical symptoms. Dermatomyositis (DM) was diagnosed in 9/15, antisynthetase syndrome (ASyS) in 4/15, and overlap myositis (OM) in 2/15. Analysis of skeletal muscle tissues showed inflammatory cells and diffuse upregulation of MHC class I in all subtypes. Morphological key findings were COX-deficient fibers as a striking pathology in DM and perimysial alkaline phosphatase positivity in anti-Jo-1-ASyS. Vascular staining of the type 1 IFN-surrogate marker, MxA, correlated with endothelial tubuloreticular inclusions in both groups. None of these specific morphological findings were present in anti-PL7-ASyS or OM patients. Conclusions: Morphological characteristics discriminate IIM subtypes in juvenile patients, emphasizing differences in aetiopathogenesis and supporting the notion of individual and targeted therapeutic strategies.

Epidemiological analysis of intramuscular hemorrhage of respiratory and accessory respiratory muscles in fatal drowning cases

The postmortem diagnosis of drowning death and understanding the mechanisms leading to drowning require a comprehensive judgment based on numerous morphological findings in order to determine the pathogenesis and epidemiological characteristics of the findings. Effortful breathing during the drowning process can result in intramuscular hemorrhage in respiratory and accessory respiratory muscles. However, the characteristics of this phenomenon have not been investigated. We analyzed the epidemiological characteristics of 145 cases diagnosed as drowning, in which hemorrhage, not due to trauma, was found in the respiratory muscles and accessory respiratory muscles. Hemorrhage was observed in 31.7% of these cases, and the incidence did not differ by gender or drowning location. The frequency of hemorrhage was significantly higher in months with a mean temperature below 20°C than in months above 20°C, suggesting a relationship between the occurrence of hemorrhage and low environmental temperature. Moreover, the frequency of hemorrhage was significantly higher in the elderly (aged ≥65 years) compared to those <65 years old. In the elderly, the weakening of muscles due to aging may contribute to the susceptibility for intramuscular hemorrhage. Moreover, these intramuscular hemorrhages do not need to be considered in cases of a potential bleeding tendency due to disease such as cirrhosis or medication such as anticoagulants. Our results indicate that intramuscular hemorrhage in respiratory and accessory respiratory muscles can serve as an additional criterion to differentiate between fatal drowning and other causes of death, as long as no cutaneous or subcutaneous hematomas above the muscles with hemorrhages are observed. In addition, the epidemiological features that such intramuscular hemorrhage is more common in cold environments and in the elderly may provide useful information for the differentiation.

Comparative Analysis of Anal Colposcopy with Histology in the Follow-Up of Patients under Treatment for Anal Condyloma

Objectives To compare morphological abnormalities on anal colposcopy against histology to determine anal high-grade squamous intraepithelial lesions (HSILs). Methods This is a retrospective data assessment of HIV-negative and HIV-positive patients undergoing outpatient follow-up. The sample comprised 54 patients presenting acetowhite lesions on anal colposcopy. Acetowhite lesions were classified according to their morphology into punctation, verrucous, mosaic, ulcerated, or hypervascularized, and biopsies of these specimens were classified as anal HSIL, low-grade squamous intraepithelial lesion (LSIL), or normal. The data were analyzed using SPSS for Windows version 13.0 (SPSS Inc., Chicago, IL, USA). The results were analyzed using the nonparametric Mann-Whitney test, the Fisher exact test and the chi-squared parametric test. A 95% confidence interval (CI) was used and a level of significance < 5% was adopted for all statistical tests. Results Fifty-four patients (50 males, 80% HIV + ) with biopsied acetowhite lesions were assessed. There were 31 punctation lesions, 1 classified as HSIL (3.2%; 95%CI: 0–40.0), 17 verrucous lesions, 3 HSIL (17.7%; 95%CI: 0–10.7), and 1 ulcerated, classified as HSIL (100%), and 4 mosaic and 1 atypical vessel lesion, all classified as LSIL. The results showed no association of presence of anal HSIL with positivity for HIV infection or with counts above or below 500/µl in HIV+ patients. Statistical analysis was performed using the Mann-Whitney nonparametric test, the Fisher exact test, and the chi-squared parametric test. Conclusion The comparison of morphological findings on anal colposcopy against histology revealed no morphological pattern suggesting anal HSIL.

The Contribution of Historical and Morphological Studies on Herbarium Specimens to a Better Definition of Chara pelosiana Avetta (Charales, Charophyceae)

The lectotype of Chara pelosiana Avetta 1898 was designated in 2000 by Langangen, who merged the species with Chara fibrosa Agardh ex Bruzelius. Chara pelosiana belongs to the section Agardhia Wood, but the true identity of the species has yet to be confirmed. The purpose of this work is to show some historical and morphological findings regarding this enigmatic species, on the basis of the analysis of herbarium specimens. The original material, which was studied by Avetta, is missing in Italian herbaria, but portions of it have been found in the Herbarium of Jena. Historical research on botanists related with this species resulted in the discovery of several specimens to be considered “original material”, and new unpublished localities in Northern Italy. Morphological observations have been made on portions of herbarium specimens as a contribution to unveil the taxonomic identity of this taxon. The specimens are diplostichous with ecorticate branchlets, have stipulodes in a single row, one or two per branchlet, and spine cell up to 1 mm long.

Lung lesions caused by COVID-19 in comparison with bacterial pneumonia and influenza pneumonia: pathomorphological features

This review aimed to summarize the literature data regarding the pathomorphology of lung lesions in COVID-19 and compare it with lung lesions in bacterial pneumonia and pneumonia caused by influenza virus. The analysis of scientific literature containing studies of domestic and foreign authors of different years related to morphology and anatomical pathology of lung injury was carried out. Special attention was paid to the data devoted to COVID-19 obtained between 2019 and 2021. Based on the study, the main aspects of lung lesions were identified and grouped into blocks depending on the etiology of the process. The review collects and summarizes information on etiology, pathogenesis and stages of disease development, outcomes and morphological picture during the autopsy of patients with bacterial pneumonia, influenza pneumonia and COVID-19 pneumonia. The common features and differences in the course, outcomes and typical morphological findings, most characteristics for each of the diseases were presented in the table. There is a great similarity of morphological findings in influenza pneumonia and COVID-19 pneumonia despite the background of the difference in their epidemiology. Most Russian and foreign authors agree that a key factor in the pathogenesis of the development of COVID-19 is the presence of a specific receptor-mediated pathway of penetration into the cells of the respiratory epithelium. According to most authors, the main morphological difference that determines the severity and unfavorable outcome of COVID-19 is angiopathy and microthrombosis of the pulmonary capillary bed, which aggravate the typical picture of viral pneumonia.

Novel attempt at discrimination of a bullet-shaped siphonophore (Family Diphyidae) using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-ToF MS)

One major difficulty in identifying the gelatinous bodied bullet-shaped Siphonophore, Diphyids, is that their shape is deformed following ethanol fixation. Ethanol often is preferred over other fixatives, since samples fixed in ethanol can be used for molecular studies that can supplement morphological findings. To overcome this problem, we obtained protein mass spectra of ten species of Diphyidae found in the waters of the Kuroshio Current (Northwest Pacific and South Coast of South Korea) to test whether MALDI-ToF MS could be used as a methodology for species identification. In addition, a number of morphological characteristics that can be used with ethanol-treated samples was summarized. Concatenated phylogenetic analysis was also performed to determine the phylogenetic relationship by obtaining partial sequences of four genes (mtCOI, 16S rRNA, 18S rRNA, and ITS regions). Based on our integrative analysis, MALDI-ToF MS was evaluated as a potentially fast, inexpensive, and accurate tool for species identification along with conventional morphological and DNA barcoding for Diphyidae.

Alterations in Choroidal Volume and Determinants of Choroidal Volume and Visual Acuity in Entire Macula-involved Myopic Retinoschisis

Background To evaluate alterations in the choroidal volume (CV) of eyes with entire macula-involved myopic retinoschisis (MRS) and to investigate predictive factors for CV and visual acuity. Methods This cross-sectional observational study recruited 32 MRS eyes, 52 non-MRS highly myopic eyes, and 55 emmetropic eyes. Retinal and choroidal morphological findings were obtained using SD-OCT. The CV of the three groups was compared, and factors associated with CV and BCVA were analyzed. Results The macular CV was significantly lower in MRS eyes than in emmetropic eyes (P < 0.0001) and in non-MRS highly myopic eyes (P < 0.05). The difference in CV for MRS eyes among the superior (0.34 ± 0.16 mm3), inferior (0.33 ± 0.17 mm3), nasal (0.27 ± 0.12 mm3) and temporal (0.34 ± 0.21 mm3) quadrants was not significant (P = 0.3755). Multivariate regression analysis showed that the total macular CV in MRS eyes was negatively correlated with axial length (P = 0.0459), decreasing by 0.19 mm3 for each millimeter of axial length. Refractive error and defects in the ellipsoid zone (EZ) were associated with BCVA in logMAR units (P = 0.0075 and 0.0002, respectively); BCVA decreased by 0.027 logMAR units for each diopter of myopia. The total macular retinal volume (RV) in MRS eyes with EZ defects was higher than that in eyes with intact or partially continuous EZs (P = 0.0460). Conclusion In MRS eyes, the choroid is thinner, the total macular CV deceases as the axial length increases, and the severity of myopia and the integrity of the EZ, associated with the schisic extent are predictors of visual acuity, and the decrease of the macular CV is not the influencing factor of the visual function.

Cystic pancreatic lesions: MR imaging findings and management

Cystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.