Septal pyogenic granuloma: a continuing riddle

<p class="abstract">Pyogenic granuloma (PG) is a benign vascular lesion of the skin and mucous membranes commonly affecting the head and neck but less common in the nasal septum. Septal PG and can present with epistaxis and nasal obstruction. It is also called a lobular capillary hemangiomas (LCH) as histologically, pyogenic granuloma consists of circumscribed aggregates of capillaries arranged in lobules. Granulomatous lesions like Wegners granulomatosis, sarcoidosis and also tumours like squamous cell carcinoma, malignant melanoma can all mimic a septal PG. Surgical excision is the treatment of choice and diagnosis can be confirmed by histopathological examination. Complete resection can decrease the rates of recurrence. Here we reported a case of pyogenic granuloma of the nasal septum in a young female patient.</p>

Oxidized Phospholipids in Control of Endothelial Barrier Function: Mechanisms and Implication in Lung Injury

Earlier studies investigating the pathogenesis of chronic vascular inflammation associated with atherosclerosis described pro-inflammatory and vascular barrier disruptive effects of lipid oxidation products accumulated in the sites of vascular lesion and atherosclerotic plaque. However, accumulating evidence including studies from our group suggests potent barrier protective and anti-inflammatory properties of certain oxidized phospholipids (OxPLs) in the lung vascular endothelium. Among these OxPLs, oxidized 1-palmitoyl-2-arachdonyl-sn-glycero-3-phosphocholine (OxPAPC) causes sustained enhancement of lung endothelial cell (EC) basal barrier properties and protects against vascular permeability induced by a wide variety of agonists ranging from bacterial pathogens and their cell wall components, endotoxins, thrombin, mechanical insults, and inflammatory cytokines. On the other hand, truncated OxPLs cause acute endothelial barrier disruption and potentiate inflammation. It appears that multiple signaling mechanisms triggering cytoskeletal remodeling are involved in OxPLs-mediated regulation of EC barrier. The promising vascular barrier protective and anti-inflammatory properties exhibited by OxPAPC and its particular components that have been established in the cellular and animal models of sepsis and acute lung injury has prompted consideration of OxPAPC as a prototype therapeutic molecule. In this review, we will summarize signaling and cytoskeletal mechanisms involved in OxPLs-mediated damage, rescue, and restoration of endothelial barrier in various pathophysiological settings and discuss a future potential of OxPAPC in treating lung disorders associated with endothelial barrier dysfunction.

Giant Frontotemporal Cavernous Malformation in a 2-Month-Old Infant: A Case Report and Review of the Literature

<b><i>Introduction:</i></b> Cavernous malformations in the pediatric population are exceedingly rare, especially in infants. Giant cavernous malformations (GCM) are even more rare and have a diameter &#x3e;4 cm. The onset of symptoms predominantly occurs in adulthood, but the rate of hemorrhage is significantly higher in the pediatric population. Similar to non-GCM, GCM can be misidentified as tumors on imaging due to their tumefactive pattern with edema. Here, we present a rare case of a right frontotemporal GCM in a 2-month-old girl, the youngest recorded case in the existing literature. <b><i>Case Presentation:</i></b> A previously healthy 2-month-old girl presented to the emergency department following an increasing frequency of seizure-like activity that began 3 days prior to presentation. Magnetic resonance imaging of the brain with and without contrast characterized a large (5.8 × 4.3 × 4.2 cm) heterogeneous lesion of the right temporal lobe with diffuse scattered blood products of various ages seen throughout the lesion. She underwent a right-sided craniotomy where a gross total excision was achieved. Pathology confirmed the diagnoses of a GCM. The patient’s seizures subsequently resolved, and she continues to do well postoperatively. <b><i>Discussion/Conclusion:</i></b> GCM can be mistaken for tumors due to their large size, cystic nature, and surrounding edema, but a vascular lesion should always remain in the differential diagnosis before operating, even in infants. Surgery is generally recommended in patients that present with a symptomatic hemorrhage, recurrent hemorrhages, persistent seizures despite medical management, or progressively worsening neurological deficits if the GCM is in a safe location. It has been shown that 70–99% of patients undergoing surgery with successful removal of the GCM can achieve seizure freedom 2 years postoperatively. Complete surgical excision of this infant’s GCM was successful in treating her neurologic symptoms; therefore, pathological confirmation of this lesion is critical and should prompt a complete surgical excision.

Successful Outcome After Intralesional Curettage for Spindle Cell Hemangioma of Fibula in an Infant: A Case Report

Spindle cell hemangioma (SCH), a non-neoplastic reactive vascular lesion, rarely locates in bones. We herein report a successful case of intralesional curettage for an infant with SCH of fibula. An 11-month-old boy was admitted to our center with a painless mass in the right proximal calf. Preoperative digital radiograph demonstrated a massive vascular lesion with an irregular bone destruction of proximal fibula. The lesion was removed via the intralesional curettage approach and pathologically diagnosed as SCH. The patient gained bone structure recovery of right proximal fibula. Two years after the surgery, he experienced no local recurrence. For the management of SCH of fibula with partial bone destruction, we suggest early-stage intralesional curettage as its safety and effectiveness.

Evaluation of Patients with Vertigo by Cranial Magnetic Resonance Imaging (MRI)

Background: Vertigo is a symptom that neurologists and otologists are confronted with. Magnetic resonance image (MRI) is used for imaging. Objective: To determine the diagnostic yield of MRI in patients with vertigo and to Identify the most common causes. Patients and Methods: This observational study involved 110 vertigo complaining patients attending the MRI unit of Rizgary teaching hospital examined by 0.2 Tesla MRI between June 2007 and September 2008.Collected variables divided into Group 1 (normal MRI) and Group 2 (abnormal MRI) analysed and compared. Results: Group 1= (70%) and Group 2=(30%), abnormal MRI findings in male patients was (59.6%), in female (40.4%,) the commonest abnormalities were cerebellopontine angle (CPA) space occupying lesions (SOL) (9.2%), cerebellar SOL (7.4%), 4th ventricle SOL (7.4%) and deep white matter ischemia (7.4%), most of patients with vascular problems were more than 50 years. In (35.4%) of patients, vertigo was less than one month duration, (50%) of which had abnormal MRI findings. Out of seven patients with normal MRI, 5 patients showed vascular lesion on magnetic resonance angiography (MRA). Conclusion: MRI remains important diagnostic tool for evaluation of vertigo and MRA is necessary when vascular origin is suspected.

Arteriovenous Malformation in the Auricle in a 59-Year-Old Woman

Arteriovenous malformation (AVM) is a vascular lesion with a direct communication between an artery and a vein without a capillary system. AVM primarily occurs in the intracranial area, but can also occur in the extracranial area. If there is a tender mass with pulsation or recurrent bleeding in the auricle, AVM should be considered even though it rarely occurs in the auricle. AVM in the ear should be managed carefully because the skin is thin in the ear, the cartilage could be involved, and progressive growth or inappropriate management could cause bleeding, infection, and cosmetic problems such as deformity. I present a case of a 59-year-old woman with AVM in the auricle.

Angioma sepiginosus: two cases in children and review of literature

Angioma serpiginosum (AS) is a rare benign vascular lesion that typically arises in early childhood, with a prevalence in female, and then grow up over a period of months/years. It is characterized by small asymptomatic purple-red dots that cluster together and they do not disappear on diascopy. It is mainly localized on the arms but some cases on face and neck have been reported. The etiology of AS is unknown, dermoscopy may aid in the diagnosis but usually the biopsy is necessary. We report 2 cases: one male and one female with angioma serpiginosum, aged 13 and 8 years old.

Capillary Hemangioma of the Testis: A Case Report and Literature Review

Introduction/Objective Testicular capillary hemangioma is a rare benign vascular tumor and typically occurs in patients younger than 20 years. Study suggests that the mean age of these patients is usually 25.1 ± 22.7 years. We report a case of a 63-year-old man who underwent an uncomplicated radical orchiectomy for scrotal irritation and testicular fullness. Methods/Case Report Clinically he was found to have a large testicular mass. Ultrasound showed cystocele and an intratesticular tumor. Increased LDH was also found. Gross examination showed a single large cystic cavity containing yellow-colored fluid and a well-circumscribed tan-brown nodule measuring 2.5 × 1.8 × 1.0 cm within the testicular parenchyma. There was no extension into the tunica albuginea. Microscopic examination showed groups of capillaries of varying sizes in a lobular arrangement with bland spindle-like endothelial cells lining these capillary structures. The circumscribed vascular lesion was well-demarcated from the testicular parenchyma by a fibrous 0.1-cm pseudocapsule. The benign nature of this lesion was suggested by the lack of any mitotic activity, anaplasia, or dysplasia. Immunohistochemical staining was strongly positive for endothelial markers (CD31 and CD 34), and negative for mesothelial (WT1) and lymphatic markers (D2-40), excluding an adenomatoid tumor. Based on these characteristic morphological and immunohistochemical findings, the diagnosis of testicular capillary hemangioma was made. After 6 months of follow-up, the patient was well without any clinical evidence of recurrence. Results (if a Case Study enter NA) NA Conclusion While rarity of testicular capillary hemangioma impedes significant changes in how we approach adult testicular masses, the possibility of a benign tumor should always be in mind to consider. This is especially pertinent when patients fall outside the typical age range for germ-cell tumors, and for patients with a solitary testicular mass.