A rare case of post COVID-19 hemophagocytic lymphohistiocytosis in a pediatric patient

Introduction/Objective Hemophagocytic Syndromes are a cluster of disorders related to cytotoxic dysfunction of T/NK-cells and are mainly subdivided into Primary (familial) and Secondary (acquired) forms, with the latter usually linked to patients with viral infections; including EBV, CMV among many others. A myriad of other causes have been associated with hemophagocytic lymphohistiocytosis (HLH), most notably systemic inflammatory conditions; especially Juvenile Rheumatoid Arthritis and hematolymphoid malignancies particularly T/NK-cell lymphomas. Methods/Case Report A previously healthy 7-year-old boy, presented to the ER with fever and a skin rash over both lower limbs of 1 week duration. Two weeks prior he was tested for COVID-19 and was found to be positive. Physical examination further revealed slightly palpable liver and spleen. CBC was done and exhibited pancytopenia, further testing showed elevated LDH, hyperferritinemia and hypertriglyceridemia. However, serological testing for rheumatological conditions was unremarkable. Imaging studies were done and were noncontributory. Subsequently, a bone marrow aspirate and biopsy were done. The bone marrow aspirate showed afew histiocytes engulfing red blood cells and nuclear debris (hemophagocytic cells), complete trilineage maturation and normal M:E ratio of 3:1. Trephine biopsy was hypocellular for age and estimated at about 70%, composed of myeloid and erythroid precursors with various degrees of maturation. Megakaryocytes were adequate in number and showed normal morphology. Extensive histiocytic infiltration as highlighted by CD68 immunostain and focal phagocytosis were identified. CD34 highlighted <5% blasts, PAS special stain showed no fungal elements and no fibrosis was evident by Reticulin special stain. The background was devoid of lymphoid aggregates or granulomas. Stainable iron stores were depleted. No sideroblasts were identified. The patient was treated with corticosteroid and showed marked improvement and was discharged after 3 days. Results (if a Case Study enter NA) NA Conclusion Hemophagocytic lymphohistiocytosis can be a critical sequela of COVID-19 infection. Suggested mechanisms include impaired/delayed T-cell response and elevated levels of several inflammatory cytokines. Clinical suspesion is important in the diagnosis of these cases. Further study of this correlation is needed as we explore clinical sequelae of COVID-19 infection.

Adenoid basal carcinoma with adenoid cystic-like features—a rare diagnostic dilemma

Introduction/Objective Adenoid basal carcinoma (ABC) of the cervix is a rare, indolent tumor with no known metastatic potential. The tumor is composed of small nests of bland, basaloid cells, which do not elicit a desmoplastic response within the surrounding stroma. Cystic and clear cell change, as well as glandular differentiation, are not unusual. As such, it is important to differentiate ABC from adenoid cystic carcinoma (ACC), particularly on account of the aggressive clinical course of the latter. We herein present a rare case of ABC with adenoid cystic-like features. Methods/Case Report A 74-year-old woman with an incidental ABC, diagnosed on an excisional procedure performed for a prior diagnosis of a high grade squamous intraepithelial lesion. Subsequent hysterectomy revealed a tumor composed of nests of basaloid cells, extending into the outer third of the cervical wall, but exhibiting no peri- tumoral desmoplasia. Cribriforming associated with increased mitotic activity was focally present and showed increased Ki-67 labeling compared to the solid nests of tumor. PAS special stain highlighted rare pseudolumina with basement membrane-like material. While these features were concerning for an ACC—the lack of any significant cytologic atypia, destructive stromal invasion, and a clinically apparent lesion—was consistent with an ABC with so- called adenoid cystic-like features. Results (if a Case Study enter NA) NA Conclusion Making an accurate diagnosis requires clinicopathologic correlation and awareness of histologic overlap. Additionally, adenoid cystic-like morphology in ABCs is a little-studied phenomenon, which necessitates further research to shed light on potential clinical implications.

COVID-19 Bimodal Clinical and Pathological Phenotypes

Background Patients with coronavirus disease-2019 (COVID-19) present varying clinical complications. Different viral load and host response related to genetic and immune background are probably the reasons for these differences. We aimed to sought clinical and pathological correlation that justifies the different clinical outcomes among COVID-19 autopsies cases. Methods Minimally invasive autopsy was performed on forty-seven confirmed COVID-19 patients from May-July, 2020. Electronic medical record of all patients was collected and a comprehensive histopathological evaluation was performed. Immunohistochemistry, immunofluorescence, special stain, western blotting and post-mortem real-time reverse transcriptase polymerase chain reaction on fresh lung tissue were performed. Resultss We show that 5/47 (10,6%) patients present a progressive decline in oxygenation index for acute respiratory distress syndrome (PaO2/FiO2 ratio), low compliance levels, interstitial fibrosis, high α-SMA+ cells/protein expression, high collagens I/III deposition and NETs(P<0.05), named as fibrotic phenotype (N=5). Conversely, 10/47 (21,2%) patients demonstrated progressive increase in PaO2/FiO2 ratio, high pulmonary compliance levels, preserved elastic framework, increase thrombus formation and high platelets and D-dimer levels at admission (P<0.05), named as thrombotic phenotype. While 32/47 (68,1%) had a mixed phenotypes between both ones. Conclusions We believe that categorization of patients based on these two phenotypes can be used to develop prognostic tools and potential therapies since the PaO2/FiO2 ratio variation and D-dimer levels correlate with the underlying fibrotic or thrombotic pathologic process, respectively; which may indicate possible clinical outcome of the patient.

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.

Histopathological Review and Distribution of Granulomatous Inflammatory Disorders in Makurdi, North Central Nigeria

Granulomatous inflammation is a pattern of chronic inflammation characterized by the presence of granulomas consisting of microscopic aggregates of macrophages transformed into epithelioid cells surrounding by a collar of lymphocytes and occasioned plasma cells. The study aimed to determine the distribution by tissue site, histological patterns of granulomatous inflammatory disorders in Benue State University Teaching Hospital (BSUTH), Makurdi over a 5-year period. This was a 5 year (March 2013 – February 2018) retrospective study of all cases diagnosed as granulomatous inflammatory disorders on Haematoxylin and Eosin-stained sections at the Anatomical pathology Department. Ziehl-Neelsen special stain was also done on all specimens. A total of two hundred and thirty-six (236) cases of granulomatous inflammatory disorders were diagnosed, analysed and categorized based on the tissue site, on Haematoxylin and Eosin-stained sections; Ziehl-Neelsen special stain was done on all cases. The most common sites were cervical lymph nodes, appendix, skin, testicular tissues etc with the Eyelid been the least common site.

SIGNIFICANCE OF MAST CELLS IN BENIGN AND MALIGNANT CONDITIONS OF PROSTATE

Introduction: Mast cells are the one of the component of defense immunity of our body.Aims of the study:Role of mast cell in benign and malignant condition of prostate.Materials & methods:Total number of cases is 32.Out of 32 cases,24 cases are Benign (BPH) and 8 cases are malignant. Special stain ie.Toluidine blue has been done in all the 32 cases, as toluidine blue stain will highlight the mast cells accurately.The number of mast cells per 10 high power fields in both benign and malignant conditions was compared using statistical tools.Results: Proportion of mast cell in benign lesions is 0.58 while in malignancy is 0.63.Since the p-value was > 0.05,the results were considered as statistically insignificant. Discussion: In the present study, it is found that there is no statistical significant increase in the number of mast cells. Conclusion: Hence probably mast cells may not play any protumorogenic role in cases of prostatic malignancy.

Histopathological Changes in Helicobacter pylori Associated Gastritis and Scope of Special Stain and Immunohistochemistry as Diagnostic Aids

BACKGROUND Helicobacter pylori associated chronic gastritis plays a vital role in the development of majority of gastric adenocarcinomas and most gastric MALT (Mucosa Associated Lymphoid Tissue) lymphomas. Many diagnostic methods are available for the identification of this organism. However, in gastroenterology practice, histopathological examination of biopsy samples provides visual identification of the pathogen and the associated mucosal changes with special stains like Giemsa. The aim of this study was to evaluate the efficacy of three stains H & E- (Haematoxylin and Eosin), Giemsa and IHC (Immunohistochemistry) in the identification of H. pylori. Associated histologic changes were noted and the relationship between the degree of colonisation and the activity and chronicity of gastritis were analysed. METHODS 585 gastric biopsies taken from dyspeptic patients were evaluated for gastritis, based on updated Sydney System. In 250 randomly selected cases, three staining methods were used. RESULTS Out of 585 cases, 413 (70.60 %) had features of chronic gastritis. Mild chronic gastritis was the commonest finding and is seen in most cases of mild H. pylori colonisation. When activity was monitored, mild activity was the most frequent finding [225 (38.46 %)]. Majority of the severe activity cases showed severe H. pylori colonisation. 13.16 %, 4.79 % and 7.35 % showed intestinal metaplasia, atrophy and dysplastic changes respectively. Out of 250 cases, H & E and Giemsa stains showed 45.6 % and 57.2 % positivity while IHC demonstrated maximum number of positivity (156 cases - 62.4 %). Sensitivity and specificity of H & E was found to be 77.90 % and 98.95 %, positive predictive value was 99.13 % and negative predictive value was 69.18 %. For Giemsa stain, sensitivity was 91.67 %, specificity was 100 %, positive predictive value was 100 % and negative predictive value was 87.85 %. DISCUSSION H. pylori gastritis was a frequent finding in dyspeptic patients in southern part of India. When chi-square test was done, a significant statistical relationship between the severity of H. pylori colonisation, activity and chronicity of gastritis was noted. P value was < 0.001. With the use of special stain, Giemsa and ancillary techniques like IHC, the detection rate of H. pylori was enhanced considerably. CONCLUSIONS With increasing number of H. pylori in the mucosa, there was increase in the chronicity and activity of gastritis. Although immunohistochemistry revealed more cases of H. pylori, Giemsa can be a cost-effective substitute, because of its high specificity and positive predictive value. KEYWORDS H. pylori Gastritis, Giemsa, Haematoxylin and Eosin Stain, Immunohistochemistry

Vaping Induced Pathological Changes In The Lung Comparing With Imaging Finding-A Case Report Study

Vaping Associated Pulmonary Injury (VAPI) is a group of respiratory symptoms like shortness of breath and tachypnea and, oftentimes, it is associated with non-specific symptoms like generalized fatigue, body ache, fever, nausea, diarrhea, vomiting and chills. This entity has been previously categorized as a diagnosis of exclusion and best described as an exogenous lipoid pneumonia, or chemical pneumonitis. Exogenous lipoid pneumonia has characteristic finding in histology where inhaled fatty substances are recognized with special stain versus endogenous lipoid pneumonia, which is due to airway obstruction giving histology look of cholesterol crystals and accumulated debris. Here we describe the onset of an exogenous cause of lipoid pneumonia in an otherwise healthy patient using cannabis-containing products. We explore, similarities in the clinical case, identify common clinical features, characteristic radiologic findings along with cytological changes in the lungs.