A case report of Linguatula serrata in human throat from Tehran,central Iran

A case of linguatulosis due to Linuatula serrata, a zoonotic pentastomid parasite in throat of a 28 years old woman from Tehran is described. After removal of the parasites the patient was discharged without any further complaining.     

Histological evidence for inoculative action of immature Linguatula serrata in lymph nodes of intermediate host

The histopathological examination of 11 mesenteric lymph nodes from adult sheep infected with immature stages of Linguatula serrata revealed acute and chronic lesions with the presence of bacterial colonies and yeast cells. Bacteria were mainly present in acute, hemorrhagic, or necrotic lesions while yeast cells were seen mostly in the structure of chronic granulomas.     

The status of Linguatula serrata infection of stray dogs in Shiraz, Iran

Linguatula serrata is one of the parasitic zoonoses causing visceral and nasopharyngeal linguatulosis in human beings. Recently, L. serrata found a more public health importance, and new cases of human infection is reported from different parts of Iran including the Fars Province. Infected vegetables, fruits, and water resources with eggs of the mature parasite excreted via carnivores’ (especially stray dogs) nasopharyngeal secretions or feces is the main source of infecting human beings. However, consumption of infected improperly cooked viscera of the intermediate hosts including sheep, goats, cattle, or other herbivores containing the larval stages of this parasite is the other potential source of infection of human beings. Therefore, the present study was undertaken to investigate the prevalence of this parasite in stray dogs of Shiraz, the capital city of the Fars Province in Southern part of Iran. In a cross-sectional study, 85 stray dogs including 48 males and 37 females were captured at different parts of Shiraz city and the nasopharyngeal area, nasal turbinates, sinuses, eusthasian tubes, and brain were examined for L. serrata. The adult parasites were collected and fixed, cleared, and stained using formalin, alcohol, azocarmine, and lactophenol. A total of 65 (76.5%) dogs were infected with L. serrata. Age, sex, weight, and geographical locations did not have significant effects in the prevalence rate of this parasite. The number of parasites recovered from each dog ranged from 1 to 19 with an average of 4.06 per infected dog. The maximum length and width of the mature Linguatula were 80 and 10 mm for female parasites and 20 and 3 mm for the male ones, respectively. From the above results, it could be concluded that the rate of infection in dogs and possibly other carnivores, herbivores, and man is high in this locality, and strict control measures should be conducted to overcome the risk of infection with this zoonotic disease.     

Hepatic granuloma in a man from North America caused by a nymph of Linguatula serrata

A calcified nodule on the liver of a 62-year-old man from North Carolina, USA, contained a degenerated nymph of Linguatula serrata. The nodule was incidentally discovered at laparotomy for malignant lymphoma and cholelithiasis. The cuticle was all that remained of the parasite, but sclerotized openings and large spines on the cuticle proved the parasite was L. serrata, a pentastomid arthropod. Anatomic location and size of the parasite indicated that it was consistent with the nymphal stage of L. serrata. This is the fifth confirmed infection of humans from North America by a pentastomid parasite.     

Polypoid gastrointestinal stromal tumor of small bowel metastasizing to mesenteric lymph nodes: a case report

Gastrointestinal stromal tumor (GIST) is the commonest gastrointestinal mesenchymal tumor, which rarely metastasizes to lymph nodes. Therefore, unlike cases of adenocarcinoma, lymphadenectomy is seldom warranted. We describe an unusual case of a polypoid GIST of the small bowel which metastasized to the regional mesenteric lymph nodes at the time of primary surgery. The patient was a 79-year-old female who presented with partial bowel obstruction and anemia. The presented case has three unusual features, as the tumor was grossly pedunculated, microscopically pleomorphic, and featured mesenteric lymph node metastasis at the time of diagnosis.     

Serine protease activity demonstrated in the larval stage of the pentastomid Linguatula serrata

Linguatula serrata is a cosmopolitan parasite whose intermediate hosts are cattle, goats, sheep, and other ruminants. The adult form is found in the nasal airways, frontal sinuses, and tympanic cavity of canines and felines, and it produces hemorrhages and breathing difficulties. To elucidate if L. serrata produces enzymes that are capable of degrading tissues from the intermediate host, proteolytic activities in larval products were studied. Using the zymography technique, one major protease was detected in parasite in vitro-released products with an approximate molecular weight of 75 kDa. This enzyme was inhibited with phenylmethylsulfonyl fluoride, suggesting that it is a serine protease, which was also shown to degrade type I collagen. The serine protease exhibited maximal activity at alkaline pH and temperatures varying from 37 to 45°C. To gather evidence about the physiological roles of the enzyme, further biochemical and functional studies are suggested.     

Prevalence of follicular lymphoma in situ in consecutively analysed reactive lymph nodes

Henopp T, Quintanilla‐Martínez L, Fend F & Adam P
(2011) Histopathology 59 , 139–142 Prevalence of follicular lymphoma in situ in consecutively analysed reactive lymph nodes Aims: Follicular lymphoma (FL) in situ is defined as strongly bcl‐2‐positive B cells in germinal centres of morphologically inconspicuous lymph nodes. The prevalence and biological and clinical significance of this lesion are still not clear. Therefore we aimed at the detection of the prevalence of this phenomenon in an unselected series of lymph nodes, as a surrogate for the normal population. Methods and results: All 1294 reactive lymph nodes from unselected consecutive surgical specimens of 132 patients in a 3‐month period were stained for bcl‐2 protein. The t(14;18) translocation was investigated by fluorescence in‐situ hybridization (FISH) analysis. FL in situ was identified in 22 lymph nodes in 3/132 patients (2.3%) without evidence or history of malignant lymphoma, and confirmed by detection of the t(14;18) translocation by FISH. Interestingly, in one patient, a lymph node excised 2 years before also contained FL in situ. Conclusions: We found a prevalence of 2.3% for FL in situ lesions in an unselected series of lymph nodes, as a surrogate for the normal population. Taking into account the incidence of manifest FL, the risk of progression of this lesion is probably limited. It can be speculated that some FL in situ lesions do indeed represent an early step in lymphomagenesis, whereas others persist without further progression to overt FL. The underlying mechanisms, however, remain to be elucidated.     

Prevalence of occult metastases in axillary sentinel lymph nodes of breast carcinoma

Recently, sentinel lymph node biopsy (SLNB) has been accepted as a standard method of assessment of axillary lymph nodes in breast cancer patients with no clinical lymphadenopathy. There is no standard pathologic method to evaluate sentinel lymph nodes. The purpose of this study is to evaluate the frequency of occult lymph node metastasis in sentinel lymph nodes via serial sectioning and immunohistochemical study with cytokeratin and its relationship with other clinicopathologic factors. Paraffin-embedded blocks of axillary sentinel lymph nodes of breast cancer patients, biopsied in 2005-2009 and reported as negative, were reviewed with 3 μm sections, H and E staining and immunohistochemical study with an epithelial cytokeratin marker. Clinicopathologic data and relapse, if occurred was recorded and its relationship with occult metastasis was statistically analyzed. Sixty-eight sentinel pathology blocks of 66 patients (65 women and one man, median age 49 years) were investigated. Four cases (5.8%) of occult metastases were found, one by HE staining, and three cases with IHC (1 micrometastasis, 2 isolated tumor cells). Accuracy of reported cases was 94.1% upon re-examination. Sixty-four patients were followed after surgery and adjuvant therapy (range: 6-38 months, median: 21 months). No relapse was reported. There was no significant statistical relationship between occult metastasis and disease-free survival. Although 4 cases (5.8%) of sentinel lymph nodes were positive in the complementary study, with a median follow-up of 21 months, we found no difference in disease-free survival between these patients and others. To show a significant, however small, difference, one needs further research with a greater number of patients and longer follow-up.     

Phylogenetic position of Linguatula arctica and Linguatula serrata (Pentastomida) as inferred from the nuclear 18S rRNA gene and the mitochondrial cytochrome c oxidase subunit I gene

Genomic DNA was isolated from a Linguatula serrata female expelled from a dog imported to Norway from Romania and from four Linguatula arctica females collected from semi-domesticated reindeer from northern Norway and subjected to PCR amplification of the complete nuclear 18S rRNA gene and a 1,045-bp portion of the mitochondrial cytochrome c oxidase subunit I gene (cox1). The two species differed at two of 1,830 nucleotide positions (99.9 % identity) of the complete 18S rRNA gene sequences and at 102 of 1,045 nucleotide positions (90.2 % identity) of the partial cox1 sequences. The four isolates of L. arctica showed no genetic variation in either gene. The new cox1 primers may facilitate the diagnosis of various developmental stages of L. arctica and L. serrata in their hosts. In separate phylogenetic analyses using the maximum likelihood method on sequence data from either gene, L. arctica and L. serrata clustered with members of the order Cephalobaenida rather than with members of the order Porocephalida, in which the genus Linguatula is currently placed based on morphological characters. The phylogenetic relationship of L. arctica, L. serrata and other pentastomids to other metazoan groups could not be clearly resolved, but the pentastomids did not seem to have a sister relationship to crustaceans of the subclass Branchiura as found in other studies. A more extensive taxon sampling, including molecular characterisation of more pentastomid taxa across different genera, seems to be necessary in order to estimate the true relationship of the Pentastomida to other metazoan groups.     

Morphologic changes of the small intestine and lymph nodes in alpha-chain disease

Literature and original data are reported on a case of alpha-chain disease associated with small intestine lymphoma in a male patient aged 20. The disease manifested clinically with chronic diarrhea, malabsorption, hypoproteinemia, hypocalcemia, cachexia, discretely detected alpha-chain monomer. Morphologically, there was lymphoplasmacyte infiltration of the intestinal mucosal layer; capsule collagenization, clustering immunoblasts among microlymphocytes, a pronounced macrophagal reaction, intercellular crystalloid and lymph masses, follicular pattern disappearance, sites of cellular polymorphism revealed in an axillary lymph node. The latter finding evidenced for developing immunoblastic sarcoma.     

Migration of newly formed small lymphocytes from bone marrow to lymph nodes during primary immune response

Selective DNA labelling of bone marrow cells in vivo was used to determine the effect of antigenic stimulation on the migration of small lymphocytes from bone marrow to popliteal lymph nodes. Following footpad injection of keyhole limpet haemocyanin (KLH) in guinea-pigs the regional nodes showed an early increase in weight and cellularity together with a progressive increase in cell proliferation. When [³H]thymidine was injected into tibial and femoral marrow 2 days before KLH administration the DNA radioactivity of the KLH-stimulated nodes increased rapidly and always exceeded that of contralateral nodes. Simultaneously, in radioautographic sections of lymph nodes labelled small lymphocytes, indicative of an origin from marrow precursors, appeared throughout the cortex, post-capillary venules, subcapsular sinus, medullary cords and sinuses. In KLH-stimulated nodes the number of labelled small lymphocytes per section was higher than in contralateral nodes, especially in the cortex, and some of these cells appeared in germinal centres. Labelled large blast cells and macrophages were also increased in numbers. Similar changes were observed in lymph nodes of parental strain rats following intramyeloid [³H]thymidine administration and footpad injection of lymphoid cells from F1 hybrid rats. The results demonstrate that, during the early response of lymph nodes to various antigens, local changes in cell traffic include an enhanced accumulation of newly formed small lymphocytes, putative virgin B lymphocytes, generated in the bone marrow prior to the antigenic stimulation.     

Langerhans cell sarcoma involving gallbladder and peritoneal lymph nodes: a case report

Langerhans cell sarcoma (LCS) is a rare proliferation of Langerhans cells with overtly malignant cytologic features and spreads aggressively. LCSs show a multiorgan involvement, including skin, lymph nodes, lung, and bone. The authors report an LCS in a 74-year-old woman that involved the gallbladder and the peritoneal lymph nodes. Imaging revealed a tumor in the gallbladder and the peritoneal lymph nodes. The tumor cells were positive for CD1a, S-100 protein, and Langerin (CD207). Although the ultrastructural analysis failed to demonstrate any Birbeck granules, the histomorphological and immunohistochemical findings supported the diagnosis of LCS. After surgical resection, she showed no recurrent or metastatic signs for 8 months without any other adjuvant therapy. This is the first case of LCS involving the gallbladder and the peritoneal lymph nodes. This report also includes a review of the literature concerning this rare disease.     

Endocrine inactive pituitary carcinoma metastasizing to cervical lymph nodes: a case report

A 64-year-old woman experienced an episode of disorientation in relation to time, place, and people, as well as of visual defect and impaired balance. Physical examination showed a bitemporal hemianopsia and truncal ataxia. Computerized tomography of the skull revealed a sellar mass consistent with the diagnosis of pituitary adenoma. The patient progressively lost consciousness and died. At postmortem examination, a pituitary neoplasm with arachnoid metastases was present. Metastatic cervical lymph nodes were also detected. Histologic aspects of the primary tumor and of lymph node metastases were quite similar. Immunohistochemical investigation revealed the epithelial origin of the neoplasm and failed to disclose endocrine activity. At ultrastructural examination, the cells of the primary tumor and of the metastases lacked specific granules. These findings support the evidence of a primary metastasizing pituitary carcinoma.