Asteroid bodies and calcium oxalate crystals: two infrequent findings in fine-needle aspirates of parotid sarcoidosis.

We have studied 3 cases of sarcoidosis involving the parotid gland by means of fine-needle aspiration cytology (FNAC). The main findings were noncaseating granulomas, multinucleated giant cells (MGCs), and lymphocytes. In one case MGCs contained asteroid bodies and in another case we observed calcium oxalate crystals (COCs) over both stromal fragments and MGCs. Although nonpathognomonic for sarcoidosis, these 2 findings may help in the diagnosis of this condition. However, both are easily overlooked and must be borne in mind when viewing noncaseating granulomas. Sarcoid granulomas displaying COC must be differentiated from foreign-body granulomas. The aforementioned cytological findings must be assessed in conjunction with clinical findings. Nevertheless, in most cases the diagnosis of sarcoidosis is made by exclusion.     

Cross-regulatory role of interferon-gamma (IFN-gamma), IL-4 and IL-10 in schistosome egg granuloma formation: in vivo regulation of Th activity and inflammation.

This study examined the relationship of IL-4, IL-10 and IFN-gamma with regard to the local granuloma (GR) and draining lymph node (LN) response to Schistosoma mansoni eggs. Synchronized GR were induced in naive and schistosome-infected mice at the vigorous (8 weeks) and late chronic (20 weeks) stages. In LN cultures, IL-10 and IFN production peaked on day 4 and was greatest for 8 week-infected mice. All GR cultures contained IFN, but compared with naive mice IL-10 production was accelerated at 8 weeks and abrogated at 20 weeks, consistent with expansion and abatement of Th2 activity. Cytokine neutralization was performed in egg-challenged, naive mice that were adoptively sensitized with lymphoid cells from 8 week-infected donors. GR size, GR macrophage tumour necrosis factor (TNF) production and egg antigen-elicited IL-2, IL-4, IL-5, IL-10 and IFN were examined on day 4 of GR formation. Anti-IFN augmented GR area by 40%, increased local IL-4 and IL-10, but decreased IFN and TNF production. In corresponding LN cultures, IFN decreased by about 50%, while IL-2, IL-4, IL-10 and IL-5 increased by nearly two-, four-, five- and six-fold, respectively. Anti-IL-10 did not affect GR size or GR cytokines, but abrogated GR area by 40%, along with a reduction in local IL-4 and TNF production. In LN, IL-4 depletion reduced IL-4 and IL-5 by 60-70% and increased IFN levels. These results support the notion of a cross-regulatory network in which IFN inhibits Th2 and IL-10 inhibits Th1 cells. IL-4 fosters Th2 cells differentiation in LN, but also performs a critical recruitment function in the eosinophil-rich schistosome egg-induced GR, whereas IFN contributes to enhanced GR macrophage function.     

慢性血吸虫病孕鼠肝脏病变的计量分析

目的:了解慢性血吸虫病孕鼠肝脏的病变程度.方法:以日本血吸虫尾蚴感染小鼠,在感染后100d(慢性期),雌雄小鼠交配使其受孕,在妊娠早期及分娩后取材,以图像分析仪对肝内虫卵肉芽肿进行体视学分析,同时观察孕期小鼠存活状况及虫荷.结果:各组间虫荷差异无显著性意义,但受孕组病鼠死亡明显增多,感染产后组小鼠的肝脏虫卵肉芽肿面积较感染未合笼组明显缩小(P＜0.05),其肉芽肿纤维面积也较感染早孕组及感染未合笼组显著缩小(P＜0.01).结论:妊娠期合并慢性血吸虫病使病变加重可能与免疫抑制有关.     

Visceral Manifestation of Cat Scratch Disease in Children. A Consequence of Altered Immunological State?

Summary A 12-year-old girl with a 2-month history of fever and abdominal pain was admitted to our hospital. Ultrasound and CT scans of the abdomen showed multiple hypoechoic lesions of liver and spleen. Screening for zoonosis revealed high positive titers to Bartonella henselae. T-cell deficiency was demonstrated and remained almost unchanged during a follow-up of 11 months. A review of the literature shows that disseminated visceral affection is a rare presentation of cat scratch disease (CSD) in childhood and adolescence. Further immunological investigations are needed in more patients with CSD to confirm whether an altered imunological state may be responsible for the atypical visceral manifestation of CSD. Received: May 18, 1999 · Revision accepted: January 19, 2000     

Does tumour necrosis factor‐α inhibitor infliximab induce histological resolution of pulmonary sarcoid granulomas?

Background: Sarcoid granuloma formation involves the orchestration of cytokines and chemokines, which modulate the host's immune response to the antigen stimulus. The release of cytokines enhances expression of the pro‐inflammatory cytokine tumour necrosis factor‐α (TNF), which plays a crucial role in the formation of sarcoid granuloma, being released from T‐lymphocytes and alveolar macrophages. Objective: The aim of this study was to evaluate the effect of infliximab in a case of pulmonary sarcoidosis using a histological approach. Materials and Methods: A 44‐year‐old man with biopsy verified chronic pulmonary sarcoidosis being resistant to treatment with corticosteroids and cell cycle inhibitors. Persisting disease activity was confirmed by declining lung function tests and a positive fluorine‐18‐fluorodeoxyglucose–positron emission tomography scan. The patient was treated with a single course of infliximab 3‐mg/kg body weight; 11 days later, a single lung transplantation was performed. Immunohistological staining with the macrophage marker CD68 was performed on lung tissue and mediastinal lymph node tissue from both the initial diagnostic evaluation (prior to infliximab) as well as from the explanted lung (after infliximab). Results: Biopsy specimens from lung and mediastinal lymph nodes prior to infliximab demonstrated sarcoid granulomas, and staining with CD68 showed dense infiltration by macrophages (epithelioid cells) in the central part of the granulomas. In contrast, biopsies from the explanted lung after infliximab demonstrated acellular sarcoid granulomas with central amorphous masses, and staining with CD68 showed complete absence of macrophages. Conclusions: In this patient, the TNF inhibitor infliximab appeared to induce resolution of sarcoid granulomas starting with disappearance of macrophages probably caused by cell lysis or apoptosis. Please cite this paper as: Milman N, Andersen CB, Baslund B, Loft A and Iversen M. Does tumour necrosis factor‐α inhibitor infliximab induce histological resolution of pulmonary sarcoid granulomas? The Clinical Respiratory Journal 2007; 1:106–113.     

Incidence rate of injection-site granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues for the treatment of prostatic cancer

PURPOSE: Granulomas resulting from the administration of luteinizing hormone-releasing hormone analogues (LH-RH analogues) are thought to be very rare. We report on our clinical experience with injection-site granulomas that result from the administration of LH-RH analogues, and we evaluate the incidence rate of these granulomas. MATERIALS AND METHODS: We used the clinical records of 118 patients who were administered LH-RH analogues in 2005. We describe the clinical data of patients who experienced injection-site granulomas and evaluated the incidence rate. RESULTS: Five patients demonstrated injection-site granulomas due to LH-RH analogue administration. The incidence rate was 4.2% (5 of 118 patients). Most of the granulomas occurred after the first or second administration of 11.25mg of leuprorelin acetate. CONCLUSION: The occurrence of granulomas resulting from the administration of LH-RH analogues was thought to be very rare. Our study, however, revealed a higher incidence rate than expected, especially for leuprorelin acetate.     

Schloffer's tumor: Case report and review of the literature

INTRODUCTION

The so-called Schloffer tumor (ST) is a rare inflammatory pseudotumor. It usually appears several years after abdominal surgery or trauma.

PRESENTATION OF CASE

A 32-year-old man was referred to our hospital complaining of a painful mass in the left hypochondrium, postprandial distension and a weight loss of about 14 kg. He had had a left inguinal hernioplasty without mesh the previous year. Ultrasonography of the abdomen showed a 2 cm × 2 cm hypoechoic lesion in contact with the abdominal wall. Computerized tomography of the abdomen showed a heterogeneous mass in the great omentum.Laparoscopic exploration revealed an omental mass firmly attached to the abdominal wall. A great deal of purulent fluid spread during the procedure. Due to the difficult exploration, the procedure converted to hand assisted laparoscopy. We find an omental tumor involving the stomach and the transverse colon. Inside the mass there were purulent material and non-absorbable sutures. A drain was left inside the cavity of the abscess. Histological examination showed chronic inflammation.

DISCUSSION

ST characteristically presents a central chronic abscess containing non-absorbable sutures. It has been described after appendectomy, hernioplasty, hysterectomy, gastrectomy or colonic resections. Although benign, its progressive growth and infiltrating behavior resemble malignant tumors.

CONCLUSION

We suggest that a mini-invasive approach should always be performed. The interesting thing about this case is the appearance of the tumor in a place far away from the previous surgical site. A simple drainage and removal of suture material solves the problem of these patients.     

Metal deposition in post-surgical granulomas of the urinary tract

Fourteen cases of post-surgical granulomatous inflammation of the urinary tract were studied to investigate the possible deposition in the tissues of metals derived from the diathermy instruments used. The granulomas showed central necrosis, palisaded histiocytes and giant cells. On electronmicroscopy both amorphous material and electrondense particles were seen in the granulomas. The former appeared to be necrotic tissue. The particles were metallic in nature. Energy dispersive analysis of X-rays showed the presence of tungsten, iron, copper, nickel, chromium, zinc and vanadium. Tungsten particles were always pure. Other single particles contained two or more of the remaining elements, indicating the presence of alloy metals. Analysis of the diathermy instruments showed the cutting loops to be pure tungsten and the 'rollerballs' to be of nickel silver containing copper, zinc, nickel, manganese and iron. Both the loops and balls are supported on stainless steel wires containing iron, chromium, nickel, manganese, molybdenum, copper and vanadium. It is proposed that metallic fragments from the instruments were deposited in the tissues during the surgical procedures and elicited an immunological reaction with granuloma formation. Tungsten is probably inert but nickel, chromium, copper and zinc are immunogenic. Under certain circumstances both nickel and chromium may also be carcinogenic.     

Sarcoidosis Presenting as Cold Thyroid Nodules: Report of Two Cases

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.     

Testicular seminoma metastasizing to the parotid gland: report of a case

BACKGROUND: Among salivary glands, the parotid gland is the most common site for secondary neoplastic involvement, and carcinomas and melanomas are the two most common secondary tumors. METHODS: We present a case of testicular seminoma metastasizing to the parotid gland. The patient, who had a remote history of testicular seminoma, was initially seen with a parotid mass. A primary parotid lesion was anticipated, and excisional biopsy was performed. The diagnosis of testicular seminoma metastasizing to the parotid gland was established on the basis of histologic findings and was confirmed by immunohistochemical analysis. RESULTS: Metastatic and primary seminomas have the same morphologic features and cellular composition, and granulomatous reaction is often present in both neoplasms. Extragonadal seminoma often occurs in the midline (presacral, retroperitoneal, anterior mediastinal, and pineal regions); when present in any other locations, the tumor should be considered to be metastatic. Placenta alkaline phosphatase is a useful immunohistochemical stain to confirm the diagnosis, and cytokeratin immunohistonegativity rules out carcinomas or epithelioid sarcomas. CONCLUSIONS: To our knowledge, this is the first published case of metastatic testicular seminoma to the parotid gland. Cytomorphologic features of seminoma and the presence of granulomatous giant cells are important diagnostic clues. Two other neoplasms with granulomatous reactions, nasopharyngeal carcinoma and epithelioid sarcoma, should be considered in the differential diagnosis.