Clinical and Histopathological Spectrum of Adult Gastrointestinal Inflammatory Neuropathy

Gastrointestinal inflammatory neuropathy, namely, eosinophilic myenteric ganglioneuronitis (EMG) and lymphocytic ganglioneuronitis (LG), is a form of chronic intestinal pseudo-obstruction and results from the infiltration of the myenteric plexus by eosinophils and lymphocytes, respectively. The literature related to the clinicopathological features of adult inflammatory neuropathy is scarce. We aim to elucidate the clinical and histological details of 7 cases of inflammatory neuropathy (EMG, n = 4, and LG, n = 3) and compare the features of EMG and LG retrospectively. There was no difference between these two entities in terms of clinical, hematological, or biochemical parameters. Histologically, almost all cases (n = 6/7) showed accompanying elements of ganglion cell vacuolization, mesenchymopathy, and partial/complete desmosis in addition to the disease-defining pathology. Besides, all cases of EMG showed infiltration of the inner circular muscle of muscularis propria by eosinophils. Two cases of LG showed additional muscular pathology pertaining to the muscularis propria. Inflammatory infiltration of the myenteric plexus is pathognomonic for the diagnosis of gastrointestinal inflammatory neuropathy although additional features in the form of ganglion cell vacuolization, reduction in the number of ganglia, desmosis, mesenchymopathy, and inflammation of the muscularis propria (eosinophils in EMG) can be seen. The pathologists need proper awareness along with judicious use of special and immunostains for clinching the diagnosis.

Larvicidal Activity and Histopathological Effect of Averrhoa bilimbi Fruit Extract on Aedes aegypti from Surabaya, Indonesia

Averrhoa bilimbi has been long thought to have biological activity. The aim of this study was to determine the activity of primary and secondary metabolites from A. bilimbi fruit extract on Aedes aegypti larvae mortality and midgut histopathology. Experiment was performed to third-instar Ae. aegypti larvae collected from Surabaya, which then exposed to A. bilimbi crude fruit extract at various concentration for 24 hours. After exposure, larvae were evaluated of its mortality and fixed in 2.5% neutral buffer formalin before processed and sectioned into histological slides and stained with hematoxylin-eosin (HE). Statistical analysis was performed using Spearman rank correlation to determine histopathological damage on midgut of Ae. aegypti larvae. Phytochemical screening of A. bilimbi crude fruit extract found that it contained saponins, tannins, and terpenoids. Minimum concentration able to induce mortality on Ae. aegypti larvae (LC50) was 977 ppm, while LC90 was at 1380 ppm. Severe alteration of larvae midgut was found after 24 hours exposure to 2000 ppm extract. Features of damage mostly found in larvae midgut were disruption of the microvilli, columnar cell vacuolization, epithelial nucleus crossed midgut lumen, and basal membrane damage. Damage caused by fruit extract in midgut of Ae. aegypti third instar larvae inhibited development of larvae. This study reported first finding of histopathological effect of A. bilimbi fruits extract on Ae. aegypti larvae midgut. Result of study was expected to contribute to better understand extract bioactivity of this plant to be applied as natural larvicide for Ae. aegypti.

Topographical Evaluation of Penile Lichen Sclerosus Reveals a Lymphocytic Depleted Variant, Preferentially Associated With Neoplasia: A Report of 200 Cases

Since the seminal study of Hart and Helwig in 1975, there are few detailed pathological studies of lichen sclerosus (LS). The aims of this study were to provide a detailed histopathological description of penile LS, as well as to explore its relationship with penile intraepithelial neoplasia (PeIN) or invasive carcinoma. We evaluated 200 patients and designed a topographical approach for the histological evaluation focusing in alterations of the following anatomical layers: squamous epithelium, lamina propria, dartos, and corpus spongiosum. We documented the quantity and topographical location of stromal lymphocytes. The prevalent lesions found were epithelial hyperplasia, atrophy, PeIN, basal cell vacuolization, lamina propria sclerosis, and variable patterns of lymphocytic infiltration. Various unique patterns of stromal sclerosis were described: perivascular, globular, linear, and solid fibrosis/hyalinization; any of them were found to be diagnostic for LS. The variation in the topography and density of lymphocytes was determinant for the identification of LS morphological variants: lichenoid, band-like, lymphocytic depleted, and mixed. A major finding was the identification of the variant designated as lymphocytic depleted LS, which we considered as the morphological prototype of LS associated with penile neoplasia. The detailed description of this complex lesion presented in this study may help pathologists in practice to identify and better define LS. The identification of the special variants suggests a role of the stromal lymphocytes in the process of carcinogenesis. Confirmation of the observations with more studies is necessary to determine the significance of these findings.

Protease activation during in vivo pancreatitis is dependent on calcineurin activation

The premature activation of digestive proenzymes, specifically proteases, within the pancreatic acinar cell is an early and critical event during acute pancreatitis. Our previous studies demonstrate that this activation requires a distinct pathological rise in cytosolic Ca2+. Furthermore, we have shown that a target of aberrant Ca2+ in acinar cells is the Ca2+/calmodulin-dependent phosphatase calcineurin (PP2B). In this study, we hypothesized that PP2B mediates in vivo protease activation and pancreatitis severity. To test this, pancreatitis was induced in mice over 8 h by administering hourly intraperitoneal injections of the cholecystokinin analog caerulein (50 μg/kg). Treatment with the PP2B inhibitor FK506 at 1 and 8 h after pancreatitis induction reduced trypsin activities by greater than 50% ( P < 0.005). Serum amylase and IL-6 was reduced by 86 and 84% relative to baseline ( P < 0.0005) at 8 h, respectively. Histological severity of pancreatitis, graded on the basis of pancreatic edema, acinar cell vacuolization, inflammation, and apoptosis, was reduced early in the course of pancreatitis. Myeloperoxidase activity from both pancreas and lung was reduced by 93 and 83% relative to baseline, respectively ( P < 0.05). These data suggest that PP2B is an important target of the aberrant acinar cell Ca2+ rise associated with pathological protease activation and pancreatitis.

Mycotoxic porcine nephropathy and spontaneous occurrence of ochratoxin A residues in kidneys of slaughtered swine

In order to find information on the occurrence of mycotoxic porcine nephropathy in Serbia, during a six month period (2006/2007) samples of kidney from individual healthy slaughtered pigs were collected (n=90) and analyzed by HPLC for ochratoxin A. In addition, histological examinations were carried out. The incidence of OTA in kidney was 33,3% and varied between 0.17-52.5 ng/g. Histopathological examination of kidneys confirmed tubulopathies with oedema and cell vacuolization. In addition, hemorrhages and necrosis of proximal kidney tubules cells were found. These findings indicate that it is likely that most of the kidney injury is related to ochratoxin A and other nephrotoxic compounds which enhance the toxicity of OTA.