Anisakis pegreffii Larvae in Sphyraena viridensis and Description of Granulomatous Lesions

The aim of the present study was to describe gastric granuloma caused by Anisakis pegreffii in Sphyraena viridensis caught in the central Mediterranean Sea. Sixty-eight S. viridensis specimens were collected from different fish markets on the east coast of Sicily. Coelomic organs were observed both macroscopically and with the aid of stereomicroscope. Parasite specimens and lesioned tissues were collected for identification, histological and molecular analyses. Twelve specimens (p = 17.6%) were positive for the presence of nematode larvae, morphologically identified as larvae of Anisakis sp., with values of mean abundance and mean intensity of 0.9 and 4.8, respectively. One large female specimen showed massive parasite infection associated with nodular lesions of the gastric wall. By histology, several nematode larvae encysted through the gastric wall were found. The parasite bodies were surrounded by a granulomatous reaction made up of macrophages, epithelioid cells, some lymphocytes and an external connective sheet. Molecular analysis of 18S rRNA and cox2 genes from Anisakis sp. collected larvae, identified them as A. pegreffii. The lesions here described, though macroscopically superimposable on human eosinophilic granuloma, microscopically showed significant differences in the inflammatory cells involved and in the type of immune reaction.

Gastric Eosinophilic Granuloma Related to Anisakiasis Resected by Laparoscopic and Endoscopic Cooperative Surgery

Background: Anisakiasis-related gastric eosinophilic granuloma is rare. Case Report: Herein, we report a patient with anisakiasis-related gastric eosinophilic granuloma who was treated with laparoscopic and endoscopic cooperative surgery (LECS). A 59-year-old woman was presented to our hospital for further examination of a gastric lesion that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy showed a submucosal tumor-like lesion in the lower body of the stomach. Endoscopic ultrasonography showed a heterogeneous hypoechoic submucosal mass lesion in the submucosal layer measuring 10 mm, without evidence of deep involvement. Under a clinical diagnosis of gastrointestinal stromal tumor, the patient underwent LECS. Gross appearance of the resected specimen revealed a 1.5×1.0 cm submucosal tumor-like lesion. Microscopic examination revealed necrosed insects consistent with the characteristics of gastric anisakiasis, around which prominent eosinophilic infiltration and granulomas were observed. This prompted a diagnosis of gastric eosinophilic granuloma related to anisakiasis. Conclusion: To the best of our knowledge, this is the second case of gastric eosinophilic granuloma related to anisakiasis resected by LECS in the English medical literature. LECS might be a useful procedure for minimally invasive therapeutic diagnosis.

P097 Diagnostic dilemma of acquired non-traumatic spinal deformation: Pott's disease; histiocytosis or psoriatic rheumatism? About a case

Background Non-traumatic acquired spinal deformities represent a separate entity within the axial pathologies in children. Their causes are variable (neurological, muscular, infectious, especially Pott's disease, inflammatory or tumoral). The etiological diagnosis can be clinically oriented by pain, medical history, especially rheumatic. The contribution of the CT scan is crucial, as it localizes the lesion, specifies its nature, but above all it helps the histological diagnosis by guided biopsies. Our case illustrates the difficulties in diagnosing the aetiology of spinal acquired deformity in a girl with a multi-evocative context. Observation A 14 years-old girl complains for a few months of a dorso-lumbar spinal pain and a vicious attitude. Her medical history includes femoral thrombophlebitis and psoriasis. She had no trauma or fever. Clinically, the general state is preserved, with no local inflammatory signs, a kyphotic attitude with an analgesic lumbar support was noted. The rest of the locomotor exam was normal. CT scan shows cancellous body geodes with a double mirror. Discussion Acquired spinal deformities are always secondary to general disease. The fever may point to bacterial infections, especially tuberculosis (Pott's disease), but also non-infectious causes such as a rheumatic disease. For our patient, psoriasis argues for the latter possibility. However, the rarity of isolated disco-vertebral involvement and the severity of the lytic lesions are against this diagnosis. The histopathological exam showed an eosinophilic granuloma, confirming the histiocytosis X diagnosis. The cortico-response strengthen the diagnosis. The course was marked by the bone remodeling with the posture correction. Conclusion A clinical, radiological, and histological analysis allow the etiological orientation in front of acquired spinal deformity.

Clinical and imaging features of tumors in the scapula

Background: Scapula is a small irregular-shaped flat bone, which may suffer from a variety of tumors or tumor-like lesions. Because the imaging manifestations are complex and changeable, correct imaging diagnosis is difficult. Introduction: At present, there are few related radiology literatures, and it is necessary to fully analyze the imaging signs of different types of benign and malignant tumors in scapula to guide clinical treatment. This study was to investigate clinical and imaging presentations of tumors and tumor-like lesions in the scapula so as to increase the diagnostic accuracy of diseases in the scapula. Methods: Patients with scapular tumors confirmed by pathology were enrolled. The imaging and clinical data were analyzed. Result: Among 108 patients, benign tumors were in 53 (49.1%) cases, intermediate in seven (6.5%), and malignant in 48 (44.4%) involving 16 diseases. Osteochondroma was the first benign tumors in 45 cases accounting for 84.9% of all benign scapular tumors followed by chondroma in four cases (7.5%). The intermediate tumors were mainly eosinophilic granuloma in four cases. Metastatic tumors were the commonest malignant tumor (27 cases or 56.2% of all malignant tumors), followed by chondrosarcoma (in 13 cases). Except for the one case of chondroblastoma in which the lesion involved the glenoid cavity, all the other cartilaginous tumors were located in the scapular body and processes. The type of lesions in the bony processes is the same as in the scapular body, the common lesions in the central area of body were malignant tumors, and the commonest lesions in the glenoid area were metastasis. Common imaging features of malignant scapular tumors were ill-defined margins, cortical destruction and soft tissue involvement. The imaging features of chondrosarcoma lack specificity except calcification. Benign lesions usually had clear boundary and marginal sclerosis. Conclusion : A wide variety of benign and malignant tumors may occur in the scapula with mostly cartilaginous and metastatic tumors, and the location and distribution of lesions are similar in the scapula to those in the long bones.

Eosinophilic Granuloma: A Rare and Often Benign Condition Presenting as a Lump on the Head, which was Easily Treated

Eosinophilic granuloma is a localized, non-invasive form of Langerhans cell histiocytosis. It usually develops in the long bones and is more frequent in children under the age of 10 years. It is very rare in adults. We present the case of a young woman admitted to hospital for persistent refractory left parietal headache, later revealed to be caused by an eosinophilic granuloma.

Pediatric Musculoskeletal Radiology

Chapter 14 examines radiologic images for common and uncommon pediatric musculoskeletal disorders. These include pediatric fractures such as buckle fractures; bowing and greenstick fractures; growth plate, stress, and elbow fractures; avulsion injuries of the pelvis and hip; knee injuries; and nonaccidental trauma. The chapter goes on to look at infection and inflammation, including osteomyelitis, septic arthritis, transient synovitis, and juvenile idiopathic arthritis. Congenital and developmental disorders covered include developmental dysplasia of the hip, slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, Blount disease, congenital foot deformities, scoliosis, neurofibromatosis, osteogenesis imperfecta, osteopetrosis, and dwarfism. Metabolic disorders include rickets, scurvy, lead poisoning, Gaucher disease, and mucopolysaccharidoses. Neoplastic and other aggressive lesions include osteosarcoma, Ewing sarcoma, osteoid osteoma, eosinophilic granuloma, osteochondroma, enchondroma, nonossifying fibromas/fibrous cortical defects, fibrous dysplasia, aneurysmal bone cysts, and unicameral (simple) bone cysts.

Fifty-millimeter abscess in the ileum caused by perforation from anisakiasis successfully treated with conservative therapy without drainage

ABSTRACT Intestinal anisakiasis is not only a rare but also a difficult to diagnose parasitic disease. The symptoms are not specific and are often severe and abrupt; therefore, patients are sometimes diagnosed as having surgical abdomen. The clinical imaging findings are remarkable, including ascites, enteritis, ileus, eosinophilic granuloma and sometimes perforation. We experienced a case of intestinal anisakiasis diagnosed on the basis of the Anisakis-specific immunoglobulin A level from paired sera and treated successfully with conservative therapy, although ileum perforation was complicated by a 50-mm abscess. Even the large abscess could be treated without drainage in thiscase.