1/18. Intra-abdominal fibrosis after systemic and intraperitoneal therapy containing fluoropyrimidines.BACKGROUND: Intra-abdominal and retroperitoneal fibrosis has been described as secondary to intraperitoneal (IP) administration of several chemotherapeutic agents, including carboplatin, mitoxantrone, and the combination of 5-fluorouracil and cisplatin. The IP administration of floxuridine (FUDR) is an effective and minimally toxic treatment for patients with metastases to the peritoneum. An increasing number of patients with colorectal, gastric, or ovarian carcinoma are treated with IP chemotherapy. methods: The authors report two patients with metastatic colon carcinoma who experienced severe intra-abdominal fibrosis presenting as an intra-abdominal mass mimicking recurrence in one patient and diffuse encasement of the bowel in the other, after the administration of IP FUDR and leucovorin. RESULTS: Two patients with Stage III colon adenocarcinoma received postoperative adjuvant 5-fluorouracil and levamisole. They subsequently presented with a rise in carcinoembryonic antigen level and isolated liver metastasis. They underwent hepatic lobectomy with postoperative intra-arterial hepatic FUDR and systemic 5-fluorouracil and leucovorin. They each had an intra-abdominal recurrence, which was resected and treated with postoperative IP FUDR and leucovorin. They then presented with a diffuse pattern of IP fibrosis with no tumor identified. CONCLUSIONS: IP FUDR and leucovorin therapy can be associated with diffuse IP fibrosis, which in this study caused an intra-abdominal mass that was indistinguishable from recurrent malignancy in one patient and encasement of the bowel in the other.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/18. Occult thyroid pathology in a child with acquired immunodeficiency syndrome. Case report and review of the drug-related pathology in pediatric acquired immunodeficiency syndrome.A 11-year-old boy with acquired immunodeficiency syndrome (AaS), Varicella-zoster virus (VZV) infection and long-term antiviral treatment suffered from a disorder of contractility of the left ventricle of the heart. Following severe unmanageable vomiting, the patient died and the postmortem examination showed marked involution of the lymphatic system, multiple foci of fibrosis of both ventricles of the heart, and regressive changes of the thyroid gland. Biochemical values of the thyroid gland function were, however, not altered. Neither human immunodeficiency virus-related p24 antigen, nor VZV dna sequences were found in the thyroid gland. Regressive changes of the thyroid gland can probably occur before its function fails. By analyzing the possible etiologies, the endocrine toxicity of a long-term antiviral treatment should be taken into account.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
3/18. The occurrence of various collagen diseases in one family: a sister with ISSc, PBC, APS, and SS and a brother with systemic lupus erythematosus.We encountered siblings who had collagen diseases and related symptoms. Case 1 was a 53-year-old woman who had limited cutaneous systemic sclerosis (ISSc) associated with primary biliary cirrhosis (PBC), antiphospholipid antibody syndrome (APS), and subclinical sjogren's syndrome (SS). Case 2 was a 48-year-old man, her younger brother, with systemic lupus erythematosus (SLE) that developed at 32 years of age. Investigation of their family revealed that their mother had Raynaud's phenomenon, arthritis, and subclinical sjogren's syndrome, and that another younger brother of Cases 1 and 2 had Raynaud's phenomenon and general fatigue. HLA analysis revealed that the sister and brother had some identical hla antigens in common, including A2, A33 (19), B67, B44 (12), Cw7, DR2, DR6, DR52, and DQ1. The sister, brother and their mother had common hla antigens including A2, B67, Cw7, DR2, and DQ1. Although Cases 1 and 2 shared the same HLA system, they presented different phenotypes of collagen disease.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
4/18. Atypical decubital fibroplasia with unusual histology.A case of atypical decubital fibroplasia with unusual histology arising in the buttock of a 68-year-old bed-ridden male in presented. The lesion measuring 5.4 cm in greatest dimension was histologically characterized by a proliferation of fibroblasts with oval to spindle nuclei and dense fibrous stroma with focal hyalinization and calcification. Ganglion-like fibroblastic cells and multinucleated giant cells of osteoclast type were also observed. There were numerous elastic fibers within and adjacent to the proliferating stromal cells. The proliferating stromal cells were positive for vimentin and collagen type iv but negative for CAM 5.2, epithelial membrane antigen, desmin, alpha-smooth muscle actin, muscle actin, HHF35, S-100 protein and CD34. Ultrastructurally, they were of a fibroblastic nature. The hypercellularity, lack of zones of fibrinoid necrosis, lack of lobulation and the presence of multinucleated giant cells were different from the originally described lesion. This condition represents a variant of atypical decubital fibroplasia. Pathogenic factors of this lesion are considered to be chronically repeated pressure and associated intermittent ischemia. The recognition of the lesion and its distinction from a sarcoma is essential.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/18. Progressive subretinal fibrosis and blindness associated with multifocal granulomatous chorioretinitis: A variant of sympathetic ophthalmia.OBJECTIVE: To report a case of bilateral progressive subretinal fibrosis and blindness with multifocal granulomatous chorioretinitis occurring after intraocular surgery. We propose that this is a variant of sympathetic ophthalmia. DESIGN: Clinicopathologic case report. methods: The left enucleated globe was examined by histopathologic methods. The patient's sera were subjected to immunohistochemical studies against retinal antigens, and collagen 2 types in areas of fibrosis were identified. polymerase chain reaction was used to test for herpes virus dna in microdissected, formalin-fixed, paraffin-embedded tissue. RESULTS: The enucleated globe demonstrated histopathologic features similar to an entity previously described as progressive subretinal fibrosis with multifocal granulomatous chorioretinitis. The patient's sera demonstrated antibodies directed against retinal photoreceptors and pigment epithelium. Polymerase chain reaction for herpes virus was negative. Immunohistochemical studies demonstrated types III, IV, V, and VI collagen in areas of fibrosis. CONCLUSIONS: The clinical history along with the histopathologic and immunohistochemical findings suggest that progressive subretinal fibrosis with multifocal granulomatous chorioretinitis may represent a variant of sympathetic ophthalmia and that retinal autoimmunity may play a role in its pathogenesis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/18. Giant hydronephrosis with increased carbohydrate antigen 19-9 both in serum and fluid.We report a case of right giant hydronephrosis. A 68-year-old man was admitted to our hospital with chief complaints of general fatigue, loss of appetite and a one-year history of progressive fullness on whole abdomen. Abdominal computed tomography scan exhibited a huge, homogeneous, low density mass originating from the right kidney. We performed right percutaneous nephrostomy and drained over 6,500 ml bloody fluid. Cytological examination of the drained fluid revealed atypical nuclear appearance defined as class III. Increased values of carbohydrate antigen 19-9 were observed both in the fluid as well as in the serum. We performed right nephrectomy. Macroscopic appearance of the resected kidney showed marked stenosis at the portion of ureteropelvic junction. Histological analysis of the stenotic portion demonstrated marked fibrosis without findings of malignancy.- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
7/18. Reactive nodular fibrous pseudotumors of the gastrointestinal tract: report of 8 cases.Eight cases of reactive nodular fibrous pseudotumor of the gastrointestinal tract are presented. The patients included 6 males and 2 females between the ages of 1 and 68 years (mean age 41.5 years). Three tumors involved the small intestine, and 5 of the investigated lesions were located in the large bowel. Of these, 2 originated in the sigmoid colon, 1 in the cecum, 1 in the appendix, and 1 in the large bowel not otherwise specified. The tumors' size varied from 3 to 10 cm in the greatest diameter (mean 6.2 cm). Histologically they were composed of stellate or spindle shaped cells resembling fibroblasts arranged haphazardly or in intersecting fascicles, embedded in a collagen-rich stroma, with sparse intralesional mononuclear cells frequently arranged in lymphoid aggregates. Immunohistochemically, the lesions were positive for vimentin (7/7), smooth muscle actin (8/8), muscle-specific actin (5/7), cytokeratins AE1/AE3 (6/7), and CAM 5.2 (1/7), and antigen CD68 (1/7). No case (0/8) reacted positively with antibody to CD117 (c-kit). Genetically no substitutions, deletions, or insertions occurred in exon 11 in all analyzed samples. Likewise, no deletions or insertions in part of exon 9 were observed. Ultrastructurally the tumor cells revealed features typical of myofibroblasts. According to the morphologic, immunohistochemical, and ultrastructural features mentioned above, especially to the positivity of low-molecular-weight cytokeratins, we propose this lesion to be related to a proliferation of multipotential subserosal cells rather than ordinary myofibroblasts or fibroblasts.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/18. Middle ear mucosa in Ramsay Hunt syndrome.We report two patients with Ramsay Hunt syndrome, together with histopathologic findings of the middle ear mucosa near the facial canal. An attempt was made to find specific antigens of varicella zoster virus (VZV) and herpes simplex virus (HSV) by an immunofluorescence method. Histopathologic examination revealed inflammation of the middle ear mucosa. Specific VZV antigens were demonstrated in the cytoplasm and nucleus of elliptically shaped cells and round cells, but no specific antigens of HSV were found. The findings suggest a pathogenetic relationship between VZV infection and inflammatory changes in the middle ear mucosa.- - - - - - - - - - ranking = 3keywords = antigen (Clic here for more details about this article) |
9/18. Histopathologic and immunohistopathologic features of subretinal fibrosis and uveitis syndrome.We studied histopathologic and immunohistopathologic features of an eye from a patient who had hypopigmented choroidal lesions with subsequent development of progressive subretinal fibrotic tissue associated with minimal signs of vitreal inflammation. A 24-year-old woman had a rapid and severe onset of the disease, which led to blindness within a few months despite treatment with corticosteroids and cyclophosphamide. Histopathologic studies disclosed a marked gliotic retina and thick subretinal fibrotic tissue as well as a granulomatous lymphocytic infiltration in the choroid. Electron microscopy demonstrated that the subretinal tissue was derived from retinal pigment epithelial cells. The immunoperoxidase staining showed similar proportions of T and B lymphocytes, indicating a relative increase of B cells. There was a predominance of the helper/inducer T lymphocyte subset in the infiltrating area. The Muller cells in the retina expressed class II antigens of the major histocompatibility complex.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/18. Histoplasmoma, pleural fibrosis, and slowly enlarging pleural effusion in an asymptomatic patient.A slowly enlarging pleural effusion and significant pleural fibrosis occurred in an asymptomatic patient with a subpleural histoplasmoma. The pleural disease may be a reaction to antigen diffusing into the pleural space from the histoplasmoma. In selected patients, resection of the histoplasmoma may be necessary to prevent impairment of ventilation from pleural fibrosis.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
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