AIM： To determine the most frequent etiologies of hepatic epithelioid granulomas, and whether there was an association with chronic hepatitis C virus （HCV）. METHODS： Both a retrospective review of the pathol- ogy ...AIM： To determine the most frequent etiologies of hepatic epithelioid granulomas, and whether there was an association with chronic hepatitis C virus （HCV）. METHODS： Both a retrospective review of the pathol- ogy database of liver biopsies at our institution from 1996 through 2006 as well as data from a prospective study of hepatic fibrosis markers and liver biopsies from 2003 to 2006 were reviewed to identify cases of hepatic epithelioid granulomas. Appropriate charts, liver biopsy slides, and laboratory data were reviewed to determine all possible associations. The diagnosis of HCV was based on a positive HCV RNA. RESULTS： There were 4578 liver biopsies and 36 （0.79%） had at least one epithelioid granuloma. HCV was the most common association. Fourteen patients had HCV, and in nine, there were no concurrent condi- tions known to be associated with hepatic granulomas. Prior interferon therapy and crystalloid substances from illicit intravenous injections did not account for the finding. There were hepatic epithelioid granulomas in 3 of 241 patients （1.24%） with known chronic HCV enrolled in the prospective study of hepatic fibrosis markers. CONCLUSION： Although uncommon, hepatic granu- Iomas may be part of the histological spectrum of chronic HCV. When epithelioid granulomas are found on the liver biopsy of someone with HCV, other clini- cally appropriate studies should be done, but if nothing else is found, the clinician can be comfortable with an HCV association.展开更多
Bacillus Calmette-Guerin(BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer.BCG-induced disseminated infection,though rare,has been associated with the histolo...Bacillus Calmette-Guerin(BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer.BCG-induced disseminated infection,though rare,has been associated with the histological finding of epithelioid granulomas in different organs,including the liver.We report the case of an adult patient with multi-organ failure,who developed sepsis,acute respiratory failure and acute hepatic failure with encephalopathy whose liver biopsy confirmed the presence of atypical,granulomatous-like lesions.Recovery was observed only after empirical therapy for Mycobacterium bovis with isoniazid,rifampicin,ethambutol and steroids was introduced.This case highlights the importance of a thorough patient assessment in order to exclude other more common causes of hepatic granulomas and to confirm diagnosis.Histological findings may be non-specific when the liver is involved in BCGinduced disseminated infection.展开更多
The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging(MRI). Prior to apicoectomy, 11 patients with...The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging(MRI). Prior to apicoectomy, 11 patients with radiographically confirmed periapical lesions underwent dental MRI, including fat-saturated T2-weighted(T2 wFS) images, non-contrast-enhanced T1-weighted images with and without fat saturation(T1 w/T1 wFS), and contrast-enhanced fat-saturated T1-weighted(T1 wFS+C) images. Two independent observers performed structured image analysis of MRI datasets twice. A total of 15 diagnostic MRI criteria were evaluated, and histopathological results(6 granulomas and 5 cysts) were compared with MRI characteristics. Statistical analysis was performed using intraclass correlation coefficient(ICC), Cohen’s kappa(κ), Mann–Whitney U-test and Fisher’s exact test. Lesion identification and consecutive structured image analysis was possible on T2 wFS and T1 wFS+C MRI images. A high reproducibility was shown for MRI measurements of the maximum lesion diameter(intraobserver ICC = 0.996/0.998; interobserver ICC = 0.997), for the "peripheral rim" thickness(intraobserver ICC = 0.988/0.984; interobserver ICC = 0.970), and for all non-quantitative MRI criteria(intraobserver-κ = 0.990/0.995; interobserver-κ = 0.988). In accordance with histopathological results, six MRI criteria allowed for a clear differentiation between cysts and granulomas:(1) outer margin of lesion,(2) texture of "peripheral rim" in T1 wFS+C,(3)texture of "lesion center" in T2 wFS,(4) surrounding tissue involvement in T2 wFS,(5) surrounding tissue involvement in T1 wFS+C and(6) maximum "peripheral rim" thickness(all: P < 0.05). In conclusion, this pilot study indicates that radiation-free dental MRI enables a reliable differentiation between periapical cysts and granulomas in vivo. Thus, MRI may substantially improve treatment strategies and help to avoid unnecessary surgery in apical periodontitis.展开更多
Perifollicular granuloma is a unique histologic feature and whether it is associated with immunoglobulin G4(IgG 4)-related disease is controversial. We report a case of a 38-year-old man who presented with worsening l...Perifollicular granuloma is a unique histologic feature and whether it is associated with immunoglobulin G4(IgG 4)-related disease is controversial. We report a case of a 38-year-old man who presented with worsening left eye pain, proptosis, tearing, gritty sensation, blurred vision and multiple lymphadenopathy. An axillary lymph node resection showed reactive follicular and interfollicular lymph node hyperplasia, and increased eosinophils and plasma cells(at least 80% of Ig G+ plasma cells were positive for IgG 4). A distinct feature was the presence of multifocal, perifollicular histiocytic granulomas, which formed a wreath around the entire follicles. The human herpes virus 8 was not detected by immunohistochemistry. In addition, an extensive panel of special stains, immunohistochemistry, and flow cytometry was negative for lymphoma, fungal, or mycobacterial infection. The findings were suggestive of IgG 4-related sclerosing disease-associated lymphadenopathy. Further laboratory testing showed a significant increase of serum immunoglobulin E(> 23000 IU/mL) and slight increase of total Ig G, but normal serum Ig G4. Even though perifollicular granuloma is a nonspecific histopathologic feature and can be seen in other diseases, such as nodular lymphocyte predominant Hodgkin lymphoma, Ig G4-related lymphadenopathy should be listed in the differential diagnoses of benign reactive lymph nodes, especially when perifollicular granuloma and plasmacytosis coexist.展开更多
BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography(CT)images has been reported for the differentiation between ameloblastomas and central giant cell granulomas(CGCGs).AIM To de...BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography(CT)images has been reported for the differentiation between ameloblastomas and central giant cell granulomas(CGCGs).AIM To describe differentiating multidetector CT(MDCT)features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors.Histogram analysis was used to compare the extent of enhancement of the soft tissue.Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis(P<0.05).RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed.Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle.CGCGs were multilocular(58.3%),with a mixed lytic sclerotic appearance(75%).Soft tissue component was present in 91%of CGCGs,which showed hyperenhancement(compared to surrounding muscles)in 50%of cases,while the remaining showed isoenhancement.Matrix mineralization was present in 83.3%of cases.Ameloblastomas presented as a unilocular(66.7%),lytic(60.6%)masses with solid components present in 81.8%of cases.However,the solid component showed isoenhancement in 63%.No matrix mineralization was present in 69.7%of cases.Quantitatively,the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis(P<0.05),with a minimum enhancement of>49.05 HU in the tumour providing 100%sensitivity and 85%specificity in identifying a CGCG.CONCLUSION A multilocular,lytic sclerotic lesion with significant hyperenhancement in soft tissue,which spares the angle of the mandible and has matrix mineralization,should indicate prospective diagnosis of CGCG.展开更多
BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simpl...BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simple to overlook and misdiagnose.Because of the disease's rarity,there is presently no standardized treatment principle.There are few accounts of such occurrences affecting the axis among children.We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone.CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation,a 6-year-old boy was brought to our hospital.Following a careful evaluation,the pathology indicated a strong likelihood of an axial EG.Ultimately,we decided to treat the boy with posterior pedicle screw fixation and local steroid injections.CONCLUSION EGs of the upper cervical spine are quite uncommon in children,and they are exceedingly easy to overlook or misdiagnose.Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.展开更多
BACKGROUND Sperm granuloma is a rare disease in clinical andrology and its incidence is still unclear worldwide.According to the existing literature,sperm granuloma often occurs unilaterally.Clinical and ultrasound fe...BACKGROUND Sperm granuloma is a rare disease in clinical andrology and its incidence is still unclear worldwide.According to the existing literature,sperm granuloma often occurs unilaterally.Clinical and ultrasound features are similar to epididymal tuberculosis,chronic epididymitis and other diseases.Sperm granuloma is usually diagnosed based on postoperative histopathological and immunohistochemical examination.CASE SUMMARY A 46-year-old man was admitted to the hospital due to the presence of a left scrotal mass for 3 mo and aggravation of pain for 1 wk.The lesions at both sites were surgically resected.Postoperative pathological examination showed that the left spermatic cord mass and the right epididymal mass were consistent with sperm granuloma.The sperm granulomas then recurred 3 mo after surgery.There is little change in the local mass so far.CONCLUSION The case report is helpful for our understanding of this disease.In clinical diagnosis,it should be distinguished from epididymal tuberculosis,chronic epididymitis and other diseases.Color Doppler ultrasound can be used as a preferred examination method but postoperative pathological examination is still needed for diagnosis.展开更多
An experimental model of hepatic Schistosoma japonicum egg granuloma was established in C57BL/6 mice sensitized with soluble egg antigen(SEA) by direct injection of vital egg suspension into the spleen. The mice infec...An experimental model of hepatic Schistosoma japonicum egg granuloma was established in C57BL/6 mice sensitized with soluble egg antigen(SEA) by direct injection of vital egg suspension into the spleen. The mice infected with cercariae of Schistosoma japonicum in abdominal skin were used for comparative studies. The results showed that morbidity of hepatic Schistosoma japonicum egg granulomas in the group sensitized with SEA was 100% and that the morphology, cellular constituents, developing process and the diameter and size of the egg granulomas in the group sensitized with SEA were similar to those of the group infected with cercariae. The authors suggest that this experimental model is a useful and appropriate tool for the study on egg granulomas of Schistosoma japonicum.展开更多
BACKGROUND Foreign body granuloma(FBG)is a well-known type of granulomatous formation,and intraabdominal FBG(IFBG)is primarily caused by surgical residues.Multifocal IFBGs caused by gastrointestinal perforation is an ...BACKGROUND Foreign body granuloma(FBG)is a well-known type of granulomatous formation,and intraabdominal FBG(IFBG)is primarily caused by surgical residues.Multifocal IFBGs caused by gastrointestinal perforation is an extremely rare and interesting clinicopathological condition that resembles peritoneal dissemination.Here,we present a case of IFBGs mimicking peritoneal dissemination caused by bowel perforation and describe the value of intraoperative pathological examinations for rapid IFBG diagnosis.CASE SUMMARY An 86-year-old woman with an incarcerated femoral hernia was admitted to the hospital and underwent operation.During the operation,the incarcerated ileum was perforated during repair due to hemorrhage necrosis,and a small volume of enteric fluid leaked from the perforation.The incarcerated ileum was resected,and the femoral hernia was repaired without mesh.Four months later,a second operation was performed for an umbilical incisional hernia.During the second operation,multiple small,white nodules were observed throughout the abdominal cavity,resembling peritoneal dissemination.The results of peritoneal washing cytology in Douglas’pouch and the examination of frozen nodule sections were compatible with IFBG diagnosis,and incisional hernia repair was performed.CONCLUSION IFBGs can mimic malignancy.Intraoperative pathological examinations and operation history are valuable for the rapid diagnosis to avoid excessive treatments.展开更多
In this report, we present two cases of bronchial foreign body granulomas caused by the suture ties used in bronchial surgery for esophageal cancer. Both of them was hospitalized as ＂tumor transfer or an invasion＂, ...In this report, we present two cases of bronchial foreign body granulomas caused by the suture ties used in bronchial surgery for esophageal cancer. Both of them was hospitalized as ＂tumor transfer or an invasion＂, but pathological examination of the neoplasms indicated an inflammatory granuloma showing reaction to the foreign body. These two cases give us an attention that the neoplasms in tracheal or bronchial was not only the invasion or transfer of the primary tumor, but also the Dossibilitv of aranuloma develooment due to the suraical sutures.展开更多
Recombination-activating gene 1(RAG1)mutations in humans vary in residual recombination activity and result in heterogeneous clinical phenotypes[1,2].In recent years,RAG deficiency with a milder clinical course and de...Recombination-activating gene 1(RAG1)mutations in humans vary in residual recombination activity and result in heterogeneous clinical phenotypes[1,2].In recent years,RAG deficiency with a milder clinical course and delayed presentation has been reported.These patients present with generalized granulomas,severe complications after viral infections,hypogammaglobulinemia,and various autoimmune manifestations(such as cytopenias,vitiligo,psoriasis,myasthenia gravis,and Guillain-Barre syndrome)[3-17].展开更多
Background:Pyogenic granuloma(PG)is a benign vascular skin lesion that occurs in children.Although,sclerotherapy is a common treatment for patients with PG,all the previous studies have been case reports or series.At ...Background:Pyogenic granuloma(PG)is a benign vascular skin lesion that occurs in children.Although,sclerotherapy is a common treatment for patients with PG,all the previous studies have been case reports or series.At present,no reports have compared the efficacy of the two different sclerosing agents,polidocanol and bleomycin,in the treatment of PG.Therefore,we aimed to compare the cure rates and adverse reactions associated with these two agents in sclerotherapy for PG in children.Methods:This retrospective analysis included children<18 years of age with PG undergoing cutaneous treatment at our hospital between January 2016 and January 2022.Two sclerosing agents,polidocanol and bleomycin,were topically injected.The efficacy and incidence of adverse reactions were compared between the two groups.Results:A total of 117 children with PG were divided into the polidocanol(n=52)and bleomycin(n=65)groups.Lesions disappeared after one injection in 38 children,two in 11 children,and three in 3 children in the polidocanol group.A similar phenomenon was observed after one injection in 53 children,two injections in 8 children,and three injections in children in the bleomycin group.The single-injection cure rate was not significantly different between the two groups(P>0.05).The rate of adverse reactions was significantly different between the two groups(P<0.05).No severe complications occurred,and no recurrences were detected during the 6-12 months of postoperative follow-up period.Conclusion:This study showed that both polidocanol and bleomycin are safe and effective sclerosing agents for treatment of PG in children.The incidence of adverse reactions to polidocanol was lower than that to bleomycin.We recommend sclerotherapy with polidocanol as a first-line treatment for PG,as it is suitable for application in hospitals at various levels.展开更多
Objective This study aimed to investigate the therapeutic effects and underlying mechanisms of the combination of Yinchenhao decoction(YCHD)and praziquantel(PZQ)in a Schistosoma japonicum(S.japonicum)-induced mouse mo...Objective This study aimed to investigate the therapeutic effects and underlying mechanisms of the combination of Yinchenhao decoction(YCHD)and praziquantel(PZQ)in a Schistosoma japonicum(S.japonicum)-induced mouse model of schistosomiasis.Methods Six-week-old male BALB/c mice were randomly divided into five groups:control group,infected group,infected-PZQ group(I-PZQ),infected-YCHD group(I-YCHD),and infected-PZQ+YCHD group(I-PZQ+YCHD).The mice were infected with S.japonicum cercariae in infected group,I-PZQ group,I-YCHD group,and I-PZQ+YCHD group(n=6 per group)and maintained for 63 days.From day 43 to day 63 postinfection,the mice received PZQ(150 mg/kg,intragastric gavage),YCHD(10 mL/kg,intragastric gavage),or a combination of both.The control and infected groups received equal amounts of sterile double-distilled water for the same period.At the end of the experiment,the mice were anesthetized with pentobarbital sodium and sacrificed.Serum alanine transaminase(ALT)and aspartate transaminase(AST)levels were measured.Network pharmacology analysis was used to predict the targets of YCHD in the treatment of schistosomiasis.Histopathological analysis,Western blotting,immunofluorescence,quantitative polymerase chain reaction and flow cytometry were employed to evaluate liver pathology and molecular changes.Results Compared with the other groups,the I-PZQ+YCHD group presented significantly decreased serum ALT and AST levels(P<0.001).The I-PZQ+YCHD group exhibited improved pathological changes in the liver,as evidenced by reduced area of single granuloma(P<0.01),granuloma area(P<0.01),and Ishak score of liver fibrosis(P<0.01).Network pharmacology analysis suggested that YCHD may alleviate schistosomiasis-related liver injury through the modulation of the endoplasmic reticulum stress(ERS)pathway.Western blot analysis revealed that ERS-related markers,including glucose-regulated protein 78(GRP78),inositol-requiring enzyme 1 alpha(IRE1α),X-box binding protein 1(XBP-1),and C/EBP homologous protein(CHOP),were significantly downregulated in the I-PZQ+YCHD group(P<0.05).Furthermore,the I-PZQ+YCHD group presented reduced hepatocyte apoptosis(P<0.05),diminished hepatic macrophage infiltration(P<0.05)and downregulated expression of proinflammatory cytokines(TNF-α,IL-1βand IL-6)(P<0.05).Conclusion YCHD combined with PZQ reduced schistosomiasis-associated hepatic granulomatous inflammation and fibrosis by inhibiting hepatic apoptosis and ERS.展开更多
Pterygium,a common ocular surface disorder characterized by the abnormal growth of conjunctival tissue onto the cornea,often necessitates surgical excision as its primary treatment.While effective,pterygium surgery is...Pterygium,a common ocular surface disorder characterized by the abnormal growth of conjunctival tissue onto the cornea,often necessitates surgical excision as its primary treatment.While effective,pterygium surgery is frequently associated with a spectrum of postoperative complications that significantly impact patient prognosis and quality of life.This comprehensive review systematically analyzes the classification,underlying pathophysiological mechanisms,and associated risk factors of these complications,with a particular focus on less commonly explored entities such as postoperative granuloma(PPG),corneal dellen,and scleral necrosis,alongside the more prevalent issue of recurrence.We delineate these complications based on their temporal presentation(early,intermediate,and late),and provide an in-depth analysis of general and specific contributing factors,including surgical trauma,individual patient characteristics,surgical technique,and perioperative management.Furthermore,this review synthesizes advancements in preventive strategies and therapeutic interventions,encompassing refined surgical techniques[e.g.,femtosecond laser-assisted pterygium surgery(FLAPS),pterygium extended removal followed by extended conjunctival transplant(P.E.R.F.E.C.T.)technique,Tissue Tuck technique],judicious application of adjuvant therapies[e.g.,mitomycin C(MMC),5-fluorouracil(5-FU),corticosteroids,anti-vascular endothelial growth factor(VEGF)agents],and optimized postoperative care protocols.By consolidating current evidence and identifying future research priorities,this review aims to provide ophthalmologists with a valuable theoretical foundation to guide individualized surgical planning,dynamic postoperative management,and ultimately minimize complications and improve patient satisfaction.展开更多
Introduction: Conjunctival granulomas are tumor pathologies of various origins. A foreign body, whatever its nature, is often involved in its genesis. To date, there is very little data on foreign body conjunctival gr...Introduction: Conjunctival granulomas are tumor pathologies of various origins. A foreign body, whatever its nature, is often involved in its genesis. To date, there is very little data on foreign body conjunctival granulomas, the prevalence would be approximately 10% and their underestimation is probably linked to the inconsistency of their clinical presentation. Patient and Observations: We report a case of conjunctival granuloma caused by a metallic foreign body that went unnoticed in a young boy, the interest of rigor on primary protection measures for high-risk occupations, and of the strict application of the diagnostic protocol relating to ocular trauma. Discussion: foreign body granulomas, despite their usually harmless nature, can jeopardize the anatomical and functional prognosis of the affected eye. Only a detailed interview and a meticulous clinical examination allow the diagnosis to be made and the distinction to be made with conjunctival granulomas of different causes. Conclusion: the possibility of the involvement of a foreign body in the genesis of conjunctival granulomas must impose the rigorous application of diagnostic and therapeutic protocols.展开更多
BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biop...BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.展开更多
基金Supported by The grant from the National Center for Research Resources, NIH, USPHS, No. M01 RR 00073
文摘AIM： To determine the most frequent etiologies of hepatic epithelioid granulomas, and whether there was an association with chronic hepatitis C virus （HCV）. METHODS： Both a retrospective review of the pathol- ogy database of liver biopsies at our institution from 1996 through 2006 as well as data from a prospective study of hepatic fibrosis markers and liver biopsies from 2003 to 2006 were reviewed to identify cases of hepatic epithelioid granulomas. Appropriate charts, liver biopsy slides, and laboratory data were reviewed to determine all possible associations. The diagnosis of HCV was based on a positive HCV RNA. RESULTS： There were 4578 liver biopsies and 36 （0.79%） had at least one epithelioid granuloma. HCV was the most common association. Fourteen patients had HCV, and in nine, there were no concurrent condi- tions known to be associated with hepatic granulomas. Prior interferon therapy and crystalloid substances from illicit intravenous injections did not account for the finding. There were hepatic epithelioid granulomas in 3 of 241 patients （1.24%） with known chronic HCV enrolled in the prospective study of hepatic fibrosis markers. CONCLUSION： Although uncommon, hepatic granu- Iomas may be part of the histological spectrum of chronic HCV. When epithelioid granulomas are found on the liver biopsy of someone with HCV, other clini- cally appropriate studies should be done, but if nothing else is found, the clinician can be comfortable with an HCV association.
文摘Bacillus Calmette-Guerin(BCG) intravesical instillation has been adopted in the treatment of patients with superficial bladder cancer.BCG-induced disseminated infection,though rare,has been associated with the histological finding of epithelioid granulomas in different organs,including the liver.We report the case of an adult patient with multi-organ failure,who developed sepsis,acute respiratory failure and acute hepatic failure with encephalopathy whose liver biopsy confirmed the presence of atypical,granulomatous-like lesions.Recovery was observed only after empirical therapy for Mycobacterium bovis with isoniazid,rifampicin,ethambutol and steroids was introduced.This case highlights the importance of a thorough patient assessment in order to exclude other more common causes of hepatic granulomas and to confirm diagnosis.Histological findings may be non-specific when the liver is involved in BCGinduced disseminated infection.
基金supported by a grant from the Dietmar Hopp Foundation (grant number: 23011228 grant holders: A.J. and S.H.)receive funding from a postdoctoral fellowship of the Medical Faculty of the University of Heidelberg
文摘The purpose of this pilot study was to evaluate whether periapical granulomas can be differentiated from periapical cysts in vivo by using dental magnetic resonance imaging(MRI). Prior to apicoectomy, 11 patients with radiographically confirmed periapical lesions underwent dental MRI, including fat-saturated T2-weighted(T2 wFS) images, non-contrast-enhanced T1-weighted images with and without fat saturation(T1 w/T1 wFS), and contrast-enhanced fat-saturated T1-weighted(T1 wFS+C) images. Two independent observers performed structured image analysis of MRI datasets twice. A total of 15 diagnostic MRI criteria were evaluated, and histopathological results(6 granulomas and 5 cysts) were compared with MRI characteristics. Statistical analysis was performed using intraclass correlation coefficient(ICC), Cohen’s kappa(κ), Mann–Whitney U-test and Fisher’s exact test. Lesion identification and consecutive structured image analysis was possible on T2 wFS and T1 wFS+C MRI images. A high reproducibility was shown for MRI measurements of the maximum lesion diameter(intraobserver ICC = 0.996/0.998; interobserver ICC = 0.997), for the "peripheral rim" thickness(intraobserver ICC = 0.988/0.984; interobserver ICC = 0.970), and for all non-quantitative MRI criteria(intraobserver-κ = 0.990/0.995; interobserver-κ = 0.988). In accordance with histopathological results, six MRI criteria allowed for a clear differentiation between cysts and granulomas:(1) outer margin of lesion,(2) texture of "peripheral rim" in T1 wFS+C,(3)texture of "lesion center" in T2 wFS,(4) surrounding tissue involvement in T2 wFS,(5) surrounding tissue involvement in T1 wFS+C and(6) maximum "peripheral rim" thickness(all: P < 0.05). In conclusion, this pilot study indicates that radiation-free dental MRI enables a reliable differentiation between periapical cysts and granulomas in vivo. Thus, MRI may substantially improve treatment strategies and help to avoid unnecessary surgery in apical periodontitis.
基金Supported by Department of Pathology,the University of Texas Health Science Center at Houston,United States
文摘Perifollicular granuloma is a unique histologic feature and whether it is associated with immunoglobulin G4(IgG 4)-related disease is controversial. We report a case of a 38-year-old man who presented with worsening left eye pain, proptosis, tearing, gritty sensation, blurred vision and multiple lymphadenopathy. An axillary lymph node resection showed reactive follicular and interfollicular lymph node hyperplasia, and increased eosinophils and plasma cells(at least 80% of Ig G+ plasma cells were positive for IgG 4). A distinct feature was the presence of multifocal, perifollicular histiocytic granulomas, which formed a wreath around the entire follicles. The human herpes virus 8 was not detected by immunohistochemistry. In addition, an extensive panel of special stains, immunohistochemistry, and flow cytometry was negative for lymphoma, fungal, or mycobacterial infection. The findings were suggestive of IgG 4-related sclerosing disease-associated lymphadenopathy. Further laboratory testing showed a significant increase of serum immunoglobulin E(> 23000 IU/mL) and slight increase of total Ig G, but normal serum Ig G4. Even though perifollicular granuloma is a nonspecific histopathologic feature and can be seen in other diseases, such as nodular lymphocyte predominant Hodgkin lymphoma, Ig G4-related lymphadenopathy should be listed in the differential diagnoses of benign reactive lymph nodes, especially when perifollicular granuloma and plasmacytosis coexist.
文摘BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography(CT)images has been reported for the differentiation between ameloblastomas and central giant cell granulomas(CGCGs).AIM To describe differentiating multidetector CT(MDCT)features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors.Histogram analysis was used to compare the extent of enhancement of the soft tissue.Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis(P<0.05).RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed.Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle.CGCGs were multilocular(58.3%),with a mixed lytic sclerotic appearance(75%).Soft tissue component was present in 91%of CGCGs,which showed hyperenhancement(compared to surrounding muscles)in 50%of cases,while the remaining showed isoenhancement.Matrix mineralization was present in 83.3%of cases.Ameloblastomas presented as a unilocular(66.7%),lytic(60.6%)masses with solid components present in 81.8%of cases.However,the solid component showed isoenhancement in 63%.No matrix mineralization was present in 69.7%of cases.Quantitatively,the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis(P<0.05),with a minimum enhancement of>49.05 HU in the tumour providing 100%sensitivity and 85%specificity in identifying a CGCG.CONCLUSION A multilocular,lytic sclerotic lesion with significant hyperenhancement in soft tissue,which spares the angle of the mandible and has matrix mineralization,should indicate prospective diagnosis of CGCG.
基金Supported by the Natural Science Foundation of Fujian Province,No.2021J01546the Innovation and Entrepreneurship Star Fund Project of Zhangzhou,No.ZCZZ[2019]17.
文摘BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simple to overlook and misdiagnose.Because of the disease's rarity,there is presently no standardized treatment principle.There are few accounts of such occurrences affecting the axis among children.We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone.CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation,a 6-year-old boy was brought to our hospital.Following a careful evaluation,the pathology indicated a strong likelihood of an axial EG.Ultimately,we decided to treat the boy with posterior pedicle screw fixation and local steroid injections.CONCLUSION EGs of the upper cervical spine are quite uncommon in children,and they are exceedingly easy to overlook or misdiagnose.Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.
文摘BACKGROUND Sperm granuloma is a rare disease in clinical andrology and its incidence is still unclear worldwide.According to the existing literature,sperm granuloma often occurs unilaterally.Clinical and ultrasound features are similar to epididymal tuberculosis,chronic epididymitis and other diseases.Sperm granuloma is usually diagnosed based on postoperative histopathological and immunohistochemical examination.CASE SUMMARY A 46-year-old man was admitted to the hospital due to the presence of a left scrotal mass for 3 mo and aggravation of pain for 1 wk.The lesions at both sites were surgically resected.Postoperative pathological examination showed that the left spermatic cord mass and the right epididymal mass were consistent with sperm granuloma.The sperm granulomas then recurred 3 mo after surgery.There is little change in the local mass so far.CONCLUSION The case report is helpful for our understanding of this disease.In clinical diagnosis,it should be distinguished from epididymal tuberculosis,chronic epididymitis and other diseases.Color Doppler ultrasound can be used as a preferred examination method but postoperative pathological examination is still needed for diagnosis.
文摘An experimental model of hepatic Schistosoma japonicum egg granuloma was established in C57BL/6 mice sensitized with soluble egg antigen(SEA) by direct injection of vital egg suspension into the spleen. The mice infected with cercariae of Schistosoma japonicum in abdominal skin were used for comparative studies. The results showed that morbidity of hepatic Schistosoma japonicum egg granulomas in the group sensitized with SEA was 100% and that the morphology, cellular constituents, developing process and the diameter and size of the egg granulomas in the group sensitized with SEA were similar to those of the group infected with cercariae. The authors suggest that this experimental model is a useful and appropriate tool for the study on egg granulomas of Schistosoma japonicum.
文摘BACKGROUND Foreign body granuloma(FBG)is a well-known type of granulomatous formation,and intraabdominal FBG(IFBG)is primarily caused by surgical residues.Multifocal IFBGs caused by gastrointestinal perforation is an extremely rare and interesting clinicopathological condition that resembles peritoneal dissemination.Here,we present a case of IFBGs mimicking peritoneal dissemination caused by bowel perforation and describe the value of intraoperative pathological examinations for rapid IFBG diagnosis.CASE SUMMARY An 86-year-old woman with an incarcerated femoral hernia was admitted to the hospital and underwent operation.During the operation,the incarcerated ileum was perforated during repair due to hemorrhage necrosis,and a small volume of enteric fluid leaked from the perforation.The incarcerated ileum was resected,and the femoral hernia was repaired without mesh.Four months later,a second operation was performed for an umbilical incisional hernia.During the second operation,multiple small,white nodules were observed throughout the abdominal cavity,resembling peritoneal dissemination.The results of peritoneal washing cytology in Douglas’pouch and the examination of frozen nodule sections were compatible with IFBG diagnosis,and incisional hernia repair was performed.CONCLUSION IFBGs can mimic malignancy.Intraoperative pathological examinations and operation history are valuable for the rapid diagnosis to avoid excessive treatments.
文摘In this report, we present two cases of bronchial foreign body granulomas caused by the suture ties used in bronchial surgery for esophageal cancer. Both of them was hospitalized as ＂tumor transfer or an invasion＂, but pathological examination of the neoplasms indicated an inflammatory granuloma showing reaction to the foreign body. These two cases give us an attention that the neoplasms in tracheal or bronchial was not only the invasion or transfer of the primary tumor, but also the Dossibilitv of aranuloma develooment due to the suraical sutures.
基金This study was supported by the Public Welfare Scientific Research Project of China(No.201402012)the National Natural Science Foundation of China(No.81974255).
文摘Recombination-activating gene 1(RAG1)mutations in humans vary in residual recombination activity and result in heterogeneous clinical phenotypes[1,2].In recent years,RAG deficiency with a milder clinical course and delayed presentation has been reported.These patients present with generalized granulomas,severe complications after viral infections,hypogammaglobulinemia,and various autoimmune manifestations(such as cytopenias,vitiligo,psoriasis,myasthenia gravis,and Guillain-Barre syndrome)[3-17].
文摘Background:Pyogenic granuloma(PG)is a benign vascular skin lesion that occurs in children.Although,sclerotherapy is a common treatment for patients with PG,all the previous studies have been case reports or series.At present,no reports have compared the efficacy of the two different sclerosing agents,polidocanol and bleomycin,in the treatment of PG.Therefore,we aimed to compare the cure rates and adverse reactions associated with these two agents in sclerotherapy for PG in children.Methods:This retrospective analysis included children<18 years of age with PG undergoing cutaneous treatment at our hospital between January 2016 and January 2022.Two sclerosing agents,polidocanol and bleomycin,were topically injected.The efficacy and incidence of adverse reactions were compared between the two groups.Results:A total of 117 children with PG were divided into the polidocanol(n=52)and bleomycin(n=65)groups.Lesions disappeared after one injection in 38 children,two in 11 children,and three in 3 children in the polidocanol group.A similar phenomenon was observed after one injection in 53 children,two injections in 8 children,and three injections in children in the bleomycin group.The single-injection cure rate was not significantly different between the two groups(P>0.05).The rate of adverse reactions was significantly different between the two groups(P<0.05).No severe complications occurred,and no recurrences were detected during the 6-12 months of postoperative follow-up period.Conclusion:This study showed that both polidocanol and bleomycin are safe and effective sclerosing agents for treatment of PG in children.The incidence of adverse reactions to polidocanol was lower than that to bleomycin.We recommend sclerotherapy with polidocanol as a first-line treatment for PG,as it is suitable for application in hospitals at various levels.
基金supported by the National Natural Science Foundation of China(No.81802036 and No.81876182).
文摘Objective This study aimed to investigate the therapeutic effects and underlying mechanisms of the combination of Yinchenhao decoction(YCHD)and praziquantel(PZQ)in a Schistosoma japonicum(S.japonicum)-induced mouse model of schistosomiasis.Methods Six-week-old male BALB/c mice were randomly divided into five groups:control group,infected group,infected-PZQ group(I-PZQ),infected-YCHD group(I-YCHD),and infected-PZQ+YCHD group(I-PZQ+YCHD).The mice were infected with S.japonicum cercariae in infected group,I-PZQ group,I-YCHD group,and I-PZQ+YCHD group(n=6 per group)and maintained for 63 days.From day 43 to day 63 postinfection,the mice received PZQ(150 mg/kg,intragastric gavage),YCHD(10 mL/kg,intragastric gavage),or a combination of both.The control and infected groups received equal amounts of sterile double-distilled water for the same period.At the end of the experiment,the mice were anesthetized with pentobarbital sodium and sacrificed.Serum alanine transaminase(ALT)and aspartate transaminase(AST)levels were measured.Network pharmacology analysis was used to predict the targets of YCHD in the treatment of schistosomiasis.Histopathological analysis,Western blotting,immunofluorescence,quantitative polymerase chain reaction and flow cytometry were employed to evaluate liver pathology and molecular changes.Results Compared with the other groups,the I-PZQ+YCHD group presented significantly decreased serum ALT and AST levels(P<0.001).The I-PZQ+YCHD group exhibited improved pathological changes in the liver,as evidenced by reduced area of single granuloma(P<0.01),granuloma area(P<0.01),and Ishak score of liver fibrosis(P<0.01).Network pharmacology analysis suggested that YCHD may alleviate schistosomiasis-related liver injury through the modulation of the endoplasmic reticulum stress(ERS)pathway.Western blot analysis revealed that ERS-related markers,including glucose-regulated protein 78(GRP78),inositol-requiring enzyme 1 alpha(IRE1α),X-box binding protein 1(XBP-1),and C/EBP homologous protein(CHOP),were significantly downregulated in the I-PZQ+YCHD group(P<0.05).Furthermore,the I-PZQ+YCHD group presented reduced hepatocyte apoptosis(P<0.05),diminished hepatic macrophage infiltration(P<0.05)and downregulated expression of proinflammatory cytokines(TNF-α,IL-1βand IL-6)(P<0.05).Conclusion YCHD combined with PZQ reduced schistosomiasis-associated hepatic granulomatous inflammation and fibrosis by inhibiting hepatic apoptosis and ERS.
文摘Pterygium,a common ocular surface disorder characterized by the abnormal growth of conjunctival tissue onto the cornea,often necessitates surgical excision as its primary treatment.While effective,pterygium surgery is frequently associated with a spectrum of postoperative complications that significantly impact patient prognosis and quality of life.This comprehensive review systematically analyzes the classification,underlying pathophysiological mechanisms,and associated risk factors of these complications,with a particular focus on less commonly explored entities such as postoperative granuloma(PPG),corneal dellen,and scleral necrosis,alongside the more prevalent issue of recurrence.We delineate these complications based on their temporal presentation(early,intermediate,and late),and provide an in-depth analysis of general and specific contributing factors,including surgical trauma,individual patient characteristics,surgical technique,and perioperative management.Furthermore,this review synthesizes advancements in preventive strategies and therapeutic interventions,encompassing refined surgical techniques[e.g.,femtosecond laser-assisted pterygium surgery(FLAPS),pterygium extended removal followed by extended conjunctival transplant(P.E.R.F.E.C.T.)technique,Tissue Tuck technique],judicious application of adjuvant therapies[e.g.,mitomycin C(MMC),5-fluorouracil(5-FU),corticosteroids,anti-vascular endothelial growth factor(VEGF)agents],and optimized postoperative care protocols.By consolidating current evidence and identifying future research priorities,this review aims to provide ophthalmologists with a valuable theoretical foundation to guide individualized surgical planning,dynamic postoperative management,and ultimately minimize complications and improve patient satisfaction.
文摘Introduction: Conjunctival granulomas are tumor pathologies of various origins. A foreign body, whatever its nature, is often involved in its genesis. To date, there is very little data on foreign body conjunctival granulomas, the prevalence would be approximately 10% and their underestimation is probably linked to the inconsistency of their clinical presentation. Patient and Observations: We report a case of conjunctival granuloma caused by a metallic foreign body that went unnoticed in a young boy, the interest of rigor on primary protection measures for high-risk occupations, and of the strict application of the diagnostic protocol relating to ocular trauma. Discussion: foreign body granulomas, despite their usually harmless nature, can jeopardize the anatomical and functional prognosis of the affected eye. Only a detailed interview and a meticulous clinical examination allow the diagnosis to be made and the distinction to be made with conjunctival granulomas of different causes. Conclusion: the possibility of the involvement of a foreign body in the genesis of conjunctival granulomas must impose the rigorous application of diagnostic and therapeutic protocols.
基金Supported by the National Natural Science Foundation of China,No.82170103Natural Science Foundation of Fujian Province,No.2024J011325+1 种基金Young People Training Project from Fujian Province Health Bureau,No.2020GGB057 and No.2023QNB008Xiamen Medical and Health Guidance Project,No.3502Z20224ZD1060,No.3502Z20214ZD1043,and No.3502Z20224ZD1058.
文摘BACKGROUND To evaluate the diagnostic utility of endobronchial ultrasound(EBUS)-guided mediastinal lymph node fenestration biopsy in atypical sarcoidosis using fine biopsy forceps[i.e.,EBUS-transbronchial forceps biopsy(TBFB)].CASE SUMMARY In this case series,two atypical sarcoidosis cases admitted in 2024 were retrospectively analyzed,both of whom lacked classical clinical manifestations.After chest computed tomography/positron emission tomography-computed tomography imaging and serum angiotensin-converting enzyme testing,EBUStransbronchial needle aspiration was performed using a 21-G needle.Subsequently,tissue sampling was performed at the enlarged puncture site by means of a 1.2-mm fine biopsy forceps.At the same time,bronchoalveolar lavage fluid lymphocyte subset analysis was conducted.CONCLUSION Both cases demonstrated non-caseating granulomatous inflammation on histopathology,elevated serum angiotensin-converting enzyme levels,and markedly increased CD4/CD8 ratios in bronchoalveolar lavage fluid.Case 1 was observed after confirmation of stage II sarcoidosis,whereas case 2 required glucocorticoid therapy due to the involvement of multiple systems.EBUS-TBFB can be used to make a definitive pathological diagnosis.For radiologically atypical sarcoidosis,EBUS-TBFB improves diagnostic accuracy by obtaining larger histological samples,thereby addressing the limitations of transbronchial needle aspiration cytology.This approach significantly improves differential diagnostic efficacy and holds substantial clinical relevance for broader adoption.
