COVID-19 Autopsies: A Case Series from Poland

This paper presents autopsy findings of 3 COVID-19 patients randomly selected for post-mortem from two tertiary referral Polish hospitals. Analysis of macroscopic, histopathological findings with clinical features was performed. All 3 deceased patients were Caucasian males (average age 61 years, range from 56 to 68 years). Using real-time polymerase chain reaction assay, the patients were confirmed (antemortem) to have severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Two patients were obese, and 1 patient had type 2 diabetes mellitus. The medical history of 1 patient included hemorrhagic pancreatitis, gangrenous cholecystitis, <i>Acinetobacter baumanii</i> sepsis, and cholecystectomy. Pulmonary embolism was diagnosed in 2 patients. At autopsy, in 1 case, the lungs showed bilateral interstitial pneumonia with diffuse alveolar damage (DAD), while in another case, interstitial pulmonary lymphoid infiltrates and enlarged atypical pneumocytes were present but without DAD. Microthrombi in lung vessels and capillaries were observed in 2 cases. This study revealed thrombotic complications of COVID-19 and interstitial pneumonia with DAD presence as the main autopsy findings in patients with SARS-CoV-2 infection that was confirmed antemortem with molecular tests. Autopsy studies using tissue sections handled in accordance with <i>SARS</i>-CoV-2 biosafety guidelines are urgently needed, especially in the case of subjects who were below the age of 60.

APRIL-producing eosinophils are involved in gastric MALT lymphomagenesis induced by Helicobacter sp infection

The roles of the inflammatory response and production of a proliferation-inducing ligand (APRIL) cytokine in gastric mucosa-associated lymphoid tissue (MALT) lymphomagenesis induced by Helicobacter species infection are not clearly understood. We characterized the gastric mucosal inflammatory response associated with gastric MALT lymphoma (GML) and identified APRIL-producing cells in two model systems: an APRIL transgenic mouse model of GML induced by Helicobacter infection (Tg-hAPRIL) and human gastric biopsy samples from Helicobacter pylori-infected GML patients. In the mouse model, polarization of T helper 1 (tbet), T helper 2 (gata3), and regulatory T cell (foxp3) responses was evaluated by quantitative PCR. In humans, a significant increase in april gene expression was observed in GML compared to gastritis. APRIL-producing cells were eosinophilic polynuclear cells located within lymphoid infiltrates, and tumoral B lymphocytes were targeted by APRIL. Together, the results of this study demonstrate that the Treg-balanced inflammatory environment is important for gastric lymphomagenesis induced by Helicobacter species, and suggest the pro-tumorigenic potential of APRIL-producing eosinophils.

A Systematic Approach to the Cutaneous Lymphoid Infiltrates: A Clinical, Morphologic, and Immunophenotypic Evaluation

Context.— The evaluation of cutaneous lymphoid infiltrates, both neoplastic and inflammatory, occurs very frequently in routine dermatopathologic examination and consultation practices. The “tough” cutaneous lymphoid infiltrate is feared by many pathologists; skin biopsies are relatively small, whereas diagnostic possibilities are relatively broad. It is true that cutaneous lymphomas can be difficult to diagnose and that in many circumstances multiple biopsies are required to establish a correct diagnostic interpretation. As a reminder, one should understand that low-grade cutaneous lymphomas are indolent disorders that usually linger for decades and that therapy does not result in disease cure. It is also important to remember that in most circumstances, those patients will die from another process that is completely unrelated to a diagnosis of skin lymphoma (even in the absence of specific therapy). Objective.— To use a clinicopathologic, immunophenotypic, and molecular approach in the evaluation of common lymphocytic infiltrates. Data Sources.— An in-depth analysis of updated literature in the field of cutaneous lymphomas was done, with particular emphasis on updated terminology from the most recent World Health Organization classification of skin and hematologic tumors. Conclusions.— A diagnosis of cutaneous lymphoid infiltrates can be adequately approached using a systematic scheme following the proposed ABCDE system. Overall, cutaneous T- and B-cell lymphomas are rare and “reactive” infiltrates are more common. Evaluation of lymphoid proliferations should start with a good sense of knowledge of the clinical presentation of the lesions, the clinical differential considerations, and a conscientious and appropriate use of immunohistochemistry and molecular tools.

Hallazgos clínico patológicos de la enfermedad de Marek en aves de combate

Descripción de los casos. Se analizaron siete casos clínicos de doce aves de combate de diferentes edades, estos casos fueron documentados entre 2015 y 2016. El diagnóstico presuntivo fue la enfermedad de Marek, porque expresaron signos de esta enfermedadHallazgos clínicos e interpretación. Los signos clínicos fueron principalmente respiratorios, circulatorios y nerviosos. La observación histopatológica reveló cambios celulares importantes con infiltrado linfoide en diferentes tejidos, mayoritariamente en pulmón, hígado, encéfalo, nervios, intestino, riñón y bazo, con lo que se diagnosticó enfermedad de Marek.Tratamiento y evolución. Se desconoce si se aplicó tratamiento.Pruebas de laboratorio. En el estudio histopatológico, los cortes se incluyeron en formol al 10 % con tinciones de rutina. Las muestras analizadas fueron tejido perineural, encéfalo, nervio ciático braquial, pulmón, corazón, hígado, duodeno, páncreas, riñón, bazo, ciegos, bolsa de Fabricio y piel de los senos infraorbitarios. Se determinó la severidad y virulencia del virus infectante según el criterio de infiltrado linfocitario definido en las pruebas de laboratorio.Relevancia clínica. Debido a que la crianza de aves de combate se realiza en pequeña y mediana escala, y bajo métodos tradicionales, el virus de la enfermedad de Marek persiste en estas aves. Por lo tanto, se requiere el diseño y la implementación de programas especiales de vacunación, incluyendo la producción de vacunas en una presentación adecuada para pequeños avicultores. Clinical and pathological findings of Marek’s disease in fighting cocksCases report. Seven clinical cases of twelve fighting cocks of different ages, were analyzed, this cases were documented between 2015 and 2016. The presuntive diagnosis was Marek’s disease, because they expressed signs of this diseaseClinical findings. The clinical signs were mainly respiratory, circulatory and nervous. Histopathological observation revealed major cell changes with lymphoid infiltrates in different tissues, mostly in the lung, liver, brain, nerves, bowel, kidney, and spleen, leading to the diagnosis of Marek’s disease.Treatment and evolution. Whether treatment was applied is unknown.Laboratory tests. In the histopathological study, the cuts were included in 10 % formaldehyde with routine stains. The samples analyzed were perineural tissue, brain, sciatic brachial nerve, lung, heart, liver, duodenum, pancreas, kidney, spleen, blind, bursa of Fabricius and skin of infraorbital sinuses. The severity and virulence of the infecting virus was determined according to the lymphocyte infiltrate criterion defined in the laboratory tests.Clinical relevance. Because the breeding of fighting cocks is realized in small to medium scale and under traditional methods, the Marek’s disease virus persists in these birds. Therefore the design and implementation of special vaccination programs are required, including the production of vaccines in a presentation suitable for small flocks.Keywords. fighting cocks, Marek´s disease, tumor, vaccination