Change seen in histological pattern in patients with lupus nephritis with positive antiphospholipid serology

Background: it is debatable whether a repeat renal biopsy during lupus nephritis [LN] flare is helpful in guiding the treatment and predicting prognosis

Objective: to determine the value of serial renal biopsies in detecting histological changes in patients with lupus nephritis with APL antibodies

Study design, settings and Duration: this cross sectional retrospective study was conducted at King Saud University Medical City Riyadh, Kingdom of Saudi Arabia [KSA] during May 2013 to August 2017

Patients and Methods: patients having diagnosis of systemic lupus erythematosus [SLE] with positive APL antibodies and who underwent two or more renal biopsies for various indications were included into the study. The histological features of serial renal biopsies were compared. Renal biopsies were reassessed with light microscopy, immunofluorescence and electron microscopic studies and were categorized according to ISN/RPS 2004 classification. Data was analyzed using chi-square test to assess the differences between categorical study variables

Results: a total of 15 patients with LN having positive APL antibodies were included. The mean age of the patients was 38 +/- 10.5 years, and the disease duration was 160 +/- 9 months. The Interval between the two biopsies was 73.5 +/- 48 months. Antiphospholipid syndrome nephropathy [APSN] was noted in 4 [26%] patients at time of the first renal biopsy and in 9 [60%] on repeat biopsies. Thrombotic microangiopathy [TMA] which is the hallmark of APSN was detected in the repeat biopsy in two patients Change in the histological class was frequent and was seen in 12 out of the 15 patients while patients with proliferative LN class switching to non-proliferative class was rare

Conclusion: histological changes are common in serial biopsies in patients with lupus nephritis with positive APL serology. Repeat renal biopsies led to change in immunosuppression treatment in more than half of patients on average

Histological features of antiphospholipid nephropathy in patients with systemic lupus erythematosus

To determine the histological features of renal biopsies of Systemic Lupus Erythematosus [SLE] patients with and without antiphospholipid antibodies in Saudi population. Cross-sectional, comparative study. King Khalid University Hospital, Riyadh, Saudi Arabia, from January to December 2013. Consecutive SLE patients admitted to King Khalid University Hospital, Riyadh for renal biopsy for evaluation of proteinuria or deterioration of renal function were recruited. SLE patients with renal involvement were divided in two groups. Group one included patients with positive APS antibodies and group two included patients with negative APS antibodies. The histological features of renal biopsies of the two patients groups were compared. Data was analyzed using simple statistical analysis. The mean age of APS antibodies-positive patients was 30.37 +/- 10.714 years while mean age of APS negative patients was 33.62 +/- 11.717 years [p=0.224]. Twenty five [83.33%] patients were females and 5 [16.67%] patients were males in APS positive patients while 42 [89.36%] were females and 5 [10.63%] were males in group two. Acute lesions like thrombotic microangiopathy were in 2 [6.7%] of APS positive patients while chronic lesions like focal cortical atrophy was found in 6 [20%] and fibrous intimal hyperplasia was found in 9 [30%]. Other significant histological findings in APS antibodies positive group were glomerular basement membrane wrinkling in 12 [40%], glomerular double wall contour in 17 [56.7%], fibrous adhesions in 11 [36.7%] patients with APS antibodies. Systemic Lupus Erythematosus [SLE] patients with positive APS antibodies has specific histological findings suggesting an important role of APS antibodies in the pathogenesis of APS nephropathy

Eyelid angiokeratoma

Angiokeratoma is a rare, usually acquired muco-cutaneous wart-like vascular lesion that is frequently reported in the scrotum. Bleeding may occur if angiokeratoma is excoriated or traumatized. We report an exceedingly rare solitary eyelid angiokeratoma in an otherwise normal middle aged male. Our case represents the second case in the English peer reviewed literature since 1966, when the first case of eyelid angiokeratoma was reported

Mimicry of Minute Pulmonary Meningothelial-like Nodules to Metastatic Deposits in a Patient with Infiltrating Lobular Carcinoma: A Case Report and Review of the Literature

Minute pulmonary meningothelial-like nodules (MPMNs) are incidentally found lesions in lung resection specimens and autopsies. MPMNs have been associated with neoplastic and non-neoplastic pulmonary conditions and occasionally with extrapulmonary diseases. We report a case of a female patient presenting with invasive lobular carcinoma of the breast and MPMNs, masquerading as metastatic deposits. We describe the morphological, immunohistochemical and ultrastructural features of MPMNs and emphasize the importance of their recognition for proper staging and treatment of patients. To our knowledge, this is the first case in the English literature describing this coexistence.

Spontaneous regression of pulmonary Lymphangion-Hemangiomatosis / Lymphangio-Haemangiomatosis

Pulmonary capillary haemangiomatosis and pulmonary lymphangiomatosis are both rare and are usually fatal disorders. The combined disorder has not been described before. In this report, we describe a case of combined haemangiomatosis of the chest wall and pulmonary lymphangiomatosis with involvement of the left clavicle, humerus and scapula and spontaneous resolution of lung changes

Granulomatous lobular mastitis: a clinicopathological study of 12 cases

We report 12 cases of granulomatous labular mastitis occurring in young women, between ages 30 and 47 years, diagnosed at King Faisal Specialist Hospital and Research Centre [KFSH and RC] from 1987 to 1995. The disease was unilateral in 10 cases, while there was a history of involvement of the contralateral breast in two patients. At the time of diagnosis, two patients were lacting, two were pregnant, and two were pregnant and lactating. Histopathological examination in all cases revealed centrilobular granulomas and microabscess formation. Immunohistochemical staining in seven cases for T and B cell markers showed a predominance of T cells in the infiltrate in all cases. The treatment comprised surgical removal of the mass, dibridement and antibiotics in some of the cases. In one patient referred from another nstitution, mastectomy had been performed on the basis of an erroneous histopathological diagnosis of carcinoma. Preoperative diagnosis was carcinoma n seven cases and benign disease in the remaining five cases. Follow-up of the patients was uneventful in all cases. Granulomatous lobular mastitis is a rare inflammatory disease of the breast, which may clinically and pathologically mimic carcinomas leading to misdiagnosis resulting in unnecessary surgery