Painful unilateral gynecomastia with identification of the cause of the pain: A case report

A 69-year-old man presented with a one-month history of a painful mass in the right breast. Pathologic evaluation of the excision of the mass revealed a proliferation of both glandular and stromal elements consistent with gynecomastia. In addition, histologic examination revealed peripheral nerves in the deep portion of the specimen were entrapped in the proliferative changes associated with gynecomastia. It is proposed that the expansile proliferation led to compressive pressure on the nerves and caused the pain associated with gynecomastia.

Incidental Findings of Appendiceal Diverticulitis Presenting as Acute Appendicitis

Diverticulosis of the appendix (DA) is a rare pathological finding that clinically imitates acute appendicitis and is most commonly found in adult males with chronic abdominal pain. It has a higher rate of perforation compared to acute appendicitis (84% vs 12%, P<0.01), and is consequently associated with a higher rate of mortality. Appendiceal diverticulitis has been found to have a significant association with incidental appendiceal neoplasms, therefore elective prophylactic appendectomy is recommended to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm. Meticulous gross examination in addition to thorough histological examination of the entire appendectomy specimen by pathologists is essential in order to identify diverticula. We present two female patients with signs and symptoms consistent with acute appendicitis, they were found to have appendiceal diverticulitis on pathologic evaluation.

COVID-19: Unilateral Involvement of Transplanted Lung, Sparing Contralateral Fibrotic Lung

Introduction: Organ transplant recipients might be more likely to develop COVID-19, as they receive long-term immunosuppressives and have comorbidities. Case Presentation: Herein, we reported the case of a 32-year-old man with unilateral lung transplantation due to unclassifiable lung fibrosis on pathologic evaluation who presented with cough, fever, and headache. After evaluation with RT-PCR test and chest CT scan, COVID-19 in the previously transplanted lung was diagnosed. However, the other non-transplanted fibrotic lung was not involved. Conclusions: Lack of COVID-19 involvement in the fibrotic lung tissue in our case without any other risk factors might be related to the fact that the lung with underlying diseases was less susceptible to COVID-19 as unhealthy lungs have lower ACE2 receptors, or it might be related to genetic differences between the donor and recipient.

Headache, Radicular Pain, and Enhancing Lesions

A 37-year-old right-handed woman sought care for a dull headache present for 6 months, which was followed by the development of radicular pain in the left leg radiating down the back of her leg into her foot, with associated left foot numbness. Magnetic resonance imaging of the lumbar spine showed an enhancing lesion within the conus. She was referred for neurosurgical evaluation and underwent magnetic resonance imaging of the entire neuraxis, which showed an enhancing lesion in the left cerebellum. She underwent a left cerebellar debulking surgical procedure. Postoperative diplopia developed for approximately 1 month and then subsequently resolved. She walked with a walker after surgery, with progressive deterioration in gait. Two months after surgery a postural tremor developed in the left arm and leg. She was referred for neurologic evaluation. Pathologic evaluation of cerebellar tissue showed foamy histiocytes and xanthomatous cells that stained positive for CD68 (KP1). Staining for CD1a was negative. Tissue immunohistochemistry for the BRAF V600E sequence variation was negative. No hyponatremia was detected. Positron emission tomography/computed tomography of the body from vertex to toes indicated hypermetabolism in the distal femur and proximal tibia. Examination and imaging findings were consistent with a diagnosis of multifocal Erdheim-Chester disease. The patient was initially treated with pegylated interferon, with clinical and radiographic progression. She was subsequently treated with vemurafenib and dexamethasone, with continued radiologic progression. Treatment with radiotherapy and cladribine were also unsuccessful. At that point, next-generation sequencing of cerebellar tissue showed a BRAF V471F sequence variation. She was then treated with trametinib, which resulted in a decrease in size of the cerebellar lesion and growth stabilization of the conus lesion. Histiocytic neoplasms are a heterogeneous group of multisystem disorders, primarily including Erdheim-Chester disease, Langerhans cell histiocytosis, and Rosai-Dorfman disease. Although initially thought to represent inflammatory processes, recent insights into their genomic architecture have shown that they are derived from macrophage-lineage neoplasms.

Murine SEC24D can substitute functionally for SEC24C during embryonic development

The COPII component SEC24 mediates the recruitment of transmembrane cargos or cargo adaptors into newly forming COPII vesicles on the ER membrane. Mammalian genomes encode four Sec24 paralogs (Sec24a-d), with two subfamilies based on sequence homology (SEC24A/B and C/D), though little is known about their comparative functions and cargo-specificities. Complete deficiency for Sec24d results in very early embryonic lethality in mice (before the 8 cell stage), with later embryonic lethality (E7.5) observed in Sec24c null mice. To test the potential overlap in function between SEC24C/D, we employed dual recombinase mediated cassette exchange to generate a Sec24cc-d allele, in which the C-terminal 90% of SEC24C has been replaced by SEC24D coding sequence. In contrast to the embryonic lethality at E7.5 of SEC24C-deficiency, Sec24cc-d/c-d pups survive to term, though dying shortly after birth. Sec24cc-d/c-d pups are smaller in size, but exhibit no other obvious developmental abnormality by pathologic evaluation. These results suggest that tissue-specific and/or stage-specific expression of the Sec24c/d genes rather than differences in cargo export function explain the early embryonic requirements for SEC24C and SEC24D.

Cutaneous Metastasis in a Previously Known Case of Ovarian Dysgerminoma: A Case Report

Introduction: Cutaneous metastasis is an uncommon manifestation that mostly occurs in patients with previous gastrointestinal or gynecological malignancies. Local recurrence usually can be seen in surgical incisions. Dysgerminomas are rare ovarian tumors that usually have local invasions, but metastases are infrequent. Here, we described a case of dysgerminoma and cutaneous metastasis in the surgical incision. Case Presentation: The patient was a 39-year-old woman previously known as ovarian dysgerminoma, who had undergone surgery one year ago. Ultrasound examination a year after surgery showed a 35 × 33 millimeters hypoechoic solid tumor in the left ovary and another 3 masses with similar echo pattern and vascularity were found in the surgical incision. Magnetic resonance imaging (MRI) findings were compatible with cutaneous metastasis of pervious dysgerminoma. Pathologic evaluation and Immunohistochemistry (IHC) confirmed dysgerminoma's skin metastasis. She received chemotherapy due to the recurrence of malignancy. Conclusions: Local recurrence and metastases (even in the skin) should be kept in mind and the clinician must examine the surgical site skin in patients with a history of malignancy.

A STUDY OF MORPHOLOGY AND GROSS ANOMALIES IN FULL-TERM PLACENTAE

Background: Placenta is an important connecting organ between the mother and fetus. It provides nutrition, gas exchange, waste removal, immune support, and endocrine functions. Since variations of the placenta result in effects on fetal development and neonatal survival it is the area of interest to be studied by anatomists, pathologists, and obstetricians. We in the current studied the placental morphology, variations, and abnormalities of the human placenta. Methods: The samples comprised of a collection of placentae in the Department of Anatomy of Prathima Institute of Medical Sciences, Karimnagar. Samples were collected after delivery, placentae were mopped to remove any clotted blood, and then weighed with 10 cm of the umbilical cord. The specimen is fixed in 10% formalin immediately over 24-48 hours and then subjected to thorough gross examination. Results: Out of n=60 placentae studied the mean weight of the placenta was found to be highest at 38 weeks of gestation with a mean surface area of 964.46 cm2 and mean weight of 463.75 Kgs. N=49(81.67%) were normal maternal conditions and history of abortions and pre-eclampsia was in n=2 cases each and oligohydramnios in n=3 cases. Among the fetal abnormalities Anencephaly, Macrostomia, MS/TS/Cerebellar hypoplasia, and holoprosencephaly with single nostril was found in n=1(1.67%) cases each. Conclusion: Examination of the placenta performed in the delivery room provides information that may be important to the care of both mother and infant. The findings of this assessment should be documented in the delivery records. The placenta should be submitted for pathologic evaluation if an abnormality is detected. Keywords: Placenta, Morphological Variations, Anencephaly, oligohydramnios, Macrostomia.

Clinical Impact of Unexpected Para-Aortic Lymph Node Metastasis in Surgery for Resectable Pancreatic Cancer

Radiologically identified para-aortic lymph node (PALN) metastasis is contraindicated for pancreatic cancer (PC) surgery. There is no clinical consensus for unexpected intraoperative PALN enlargement. To analyze the prognostic role of unexpected PALN enlargement in resectable PC, we retrospectively reviewed data of 1953 PC patients in a single tertiary center. Patients with unexpected intraoperative PALN enlargement (group A1, negative pathology, n = 59; group A2, positive pathology, n = 13) showed median overall survival (OS) of 24.6 (95% CI: 15.2–33.2) and 13.0 (95% CI: 4.9–19.7) months, respectively. Patients with radiological PALN metastasis without other metastases (group B, n = 91) showed median OS of 8.6 months (95% CI: 7.4–11.6). Compared with group A1, groups A2 and B had hazard ratios (HRs) of 2.79 (95% CI, 1.4–5.7) and 2.67 (95% CI: 1.8–4.0), respectively. Compared with group A2, group B had HR of 0.96 (95% CI: 0.5–1.9). Multivariable analysis also showed positive PALN as a negative prognostic factor (HR 2.57, 95% CI: 1.2–5.3), whereas positive regional lymph node did not (HR 1.32 95% CI: 0.8–2.3). Thus, unexpected malignant PALN has a negative prognostic impact comparable to radiological PALN metastasis. This results suggests prompt pathologic evaluation for unexpected PALN enlargements is needed and on-site modification of surgical strategy would be considered.