Childhood lichenoid granulomatous stomatitis: a case report and literature review / 口腔疾病防治

Objective@#To investigate the classification, clinical manifestations, diagnosis, differential diagnosis and treatment of oral lichenoid lesions and provide a reference for clinical practice.@*Methods@#Hospital ethical approval and patient informed consent were obtained. We report a case of oral lichenoid lesion in children and review the diagnosis and treatment of oral lichenoid damage in the literature.@*Results@#The patient experienced repeated rupture of the dorsal surface of the tongue with pain for more than 3 years. There was a large area of tongue back surface erosion with an irregular shape, surrounded by pearly-white lines. The left erosive area was accompanied by tissue hyperplasia, which was approximately 1.5 cm × 2.0 cm, with tough texture and broad masses. The pathological diagnosis of the patient was oral lichenoid lesion. After biopsy of the dorsal surface of the tongue, the pathological diagnosis of the patient was granulomatous inflammation. The final diagnosis of lichenoid granulomatous stomatitis was made on the basis of the patient's intraoral damage features, systemic history, medication history and histopathological findings. A review of the literature suggests that oral lichenoid lesions have an unknown etiology and need to be clinically differentiated from oral lichen planus, oral lichenoid drug reactions, oral lichenoid contact damage and chronic ulcerative stomatitis. The clinical treatment of oral lichen planus is based on the topical and/or systemic use of glucocorticoids.@*Conclusion@#There are still no uniform criteria for the classification and diagnosis of oral lichenoid lesions. They rely mainly on history taking, clinical manifestations and histopathological findings, and the treatment is mainly based on the topical and/or systemic use of glucocorticoids.

A unique coexistence of a plurihormonal pituitary adenoma with granulomatous hypophysitis

Dual pathology in the pituitary gland is a unique phenomenon. Coexistence of a pituitary adenoma with primary hypophysitis has been reported rarely with very few cases in the literature. Among the primary hypophysitis, primary granulomatous subtype has been proposed to be idiopathic and autoimmune in nature. Plurihormonal pituitary adenomas produce hormones of more than one different pituitary cell lineage. Pituitary adenoma with a single hormonal content has been documented with concurrent primary granulomatous hypophysitis. The present case describes the unique coexistence of a plurihormonal adenoma showing somatotroph, lactotroph, and corticotroph lineage with primary granulomatous inflammation in the sellar region in a 36-year-old woman.

Doença granulomatosa crônica: características clínicas, seguimento e terapêutica de cinco pacientes pediátricos / Chronic granulomatous disease: clinical characteristics, follow-up, and therapy of 5 pediatric patients

Introdução: A doença granulomatosa crônica (DGC) é caracterizada por um defeito na capacidade microbicida das células fagocíticas (monócitos e neutrófilos), com alta mortalidade se não diagnosticada precocemente. Os pacientes apresentam infecções recorrentes ou graves, suscetibilidade a granulomas em órgãos profundos, doenças autoimunes e doença inflamatória intestinal. Objetivo e Método: Relato de aspectos clínicos e do tratamento de cinco pacientes com doença granulomatosa crônica. Resultados: Cinco pacientes, três meninos, medianas de idade no início dos sintomas e diagnóstico de 8 meses e 48 meses, respectivamente, foram estudados por um período de 10 anos. Pneumonia (5/5) e doença micobacteriana (3/5) foram as manifestações iniciais mais comuns. Alterações pulmonares foram observadas em todos os casos. Mutações nos genes CYBB e NCF1 foram identificadas em três casos. Antibioticoprofilaxia foi instituída em todos os pacientes e três foram submetidos ao transplante de células tronco-hematopoiéticas (TCH), aos 7, 18 e 19 anos e com sobrevida atual entre 4 a 5 anos. Conclusão: O monitoramento cuidadoso de infecções graves com tratamento imediato foi crucial para a sobrevivência. O TCH, mesmo ao final da adolescência, promoveu a cura da DGC em três pacientes.

Introduction: Chronic granulomatous disease (CGD) is characterized by a defective microbicidal capacity of phagocytic cells (monocytes and neutrophils) with high mortality if not early diagnosed. Patients have recurrent or severe infections and are susceptible to granulomas in visceral organs, autoimmune diseases, and inflammatory bowel diseases. Objective and Method: To report the clinical features and treatment of 5 patients with CGD. Results: Five patients, 3 boys, with median ages at symptom onset and diagnosis of 8 months and 48 months, respectively, were followed for 10 years. Pneumonia (5/5) and mycobacterial disease (3/5) were the most common initial manifestations. Pulmonary changes were observed in all cases. Mutations in the CYBB and NCF1 genes were identified in 3 cases. All patients received antibiotic prophylaxis. Three patients underwent a hematopoietic stem cell transplant (HSCT) at 7, 18, and 19 years, with current survival of 4 to 5 years. Conclusion: Careful monitoring for severe infection with prompt treatment was crucial for survival. Even though HSCT was performed in late adolescence, it promoted the cure of CGD in 3 patients.

Abscesos cerebrales por Dermacoccus nishinomiyaensis como primera manifestación de enfermedad granulomatosa crónica / Dermacoccus nishinomiyaensis brain abscesses as the first manifestation of chronic granulomatous disease

La enfermedad granulomatosa crónica es una inmunodeficiencia primaria poco frecuente, que secaracteriza por defectos en alguna de las subunidades del complejo enzimático nicotinamida adeninadinucleótido fosfato oxidasa, que ocasiona un déficit en la generación de anión superóxido por losfagocitos. Dentro de este grupo, la forma ligada al X es la más frecuente. Se reporta el caso de una paciente de sexo femenino de 2 años con enfermedad granulomatosa crónica autosómica recesiva, con mutación en gen CYBA, quien presentó manifestación inicial de la enfermedad con abscesos cerebrales ocasionados por un germen oportunista (Dermacoccus nishinomiyaensis). Esta infección permitió la sospecha diagnóstica temprana, por lo que recibió el tratamiento y la profilaxis en forma oportuna. Actualmente, se encuentra libre de infecciones, a la espera del trasplante de células progenitoras hematopoyéticas.

Chronic granulomatous disease is a rare primary immunodeficiency characterized by defects in one of the subunits of the nicotinamide adenine dinucleotide phosphate oxidase enzyme complex, which causes a deficiency in the capacity of phagocytes to generate superoxide anion. Within this group, the X-linked form is the most frequent. Here we report the case of a 2-year-old female patient with autosomal recessive chronic granulomatous disease, with a mutation in the CYBA gene, whose initial manifestation was brain abscesses caused by an opportunistic microorganism (Dermacoccus nishinomiyaensis). The infection led to an early diagnostic suspicion, so treatment and prophylaxis were administered in a timely manner. Currently, she is infectionfree, awaiting hematopoietic progenitor cell transplantation.

Melkersson Rosenthal Syndrome: A Case Report

Introduction: Melkersson-Rosenthal Syndrome (MRS) is a rare neuro-mucocutaneous condition. It mainly includes three triads as orofacial swelling, facial palsy and fissured tongue. All of the classical triad may not be seen at the same time, as symptoms may appear in different interval of time and has a recurrence. MRS is diagnosed based on oligosymptomatic when two or more clinical features are present or monosymptomatic cases when there evidence of a non-necrotising, granulomatous cheilitis in patients with isolated facial or lip edema can be noted in biopsy. Case Presentation: In this case report a 18 year old male patient all the three classic clinical characteristic features as granulomatous cheilitis, unilateral facial muscle palsy and a fissured tongue are seen. The clinical features of this rare condition along with treatment procedure are presented. Conclusion: Oral corticosteroids are the mainstay in the treatment of MRS. Intralesional triamcinolone acetonide used in oro-facial edema. In recurrent cases of MRS need second-line immunosuppressants like methotrexate and thalidomide. In refractory recurrent facial nerve palsies Surgical decompression of the facial nerve may be considered.

Treatment and Management Experience of Idiopathic Granulomatous Mastitis in a Low-income Country / Experiência de tratamento e manejo da mastite granulomatosa idiopática em um país de baixa renda

Abstract Objective Reporting our experience of the management and treatment of Idiopathic granulomatous mastitis (IGM) in a low-income country by describing patients characteristics and therapy with emphasis on conservative surgical excision and postoperative care as the cornerstone of treatment. Methods A retrospective cohort of women with histopathological diagnosis of IGM from 2014 to 2018 at Instituto Nacional Materno Perinatal in Lima, Peru. Patients' characteristics, clinical presentation, treatment, management, postoperative care, and follow-up were analyzed. Results Thirty-eight patients with histopathological diagnosis of IGM were identified. Their average age was 35.9 years and 23 (60.5%) reported previous use of hormonal contraceptives. Nine (23.7%) patients had chronic mastitis with previous treatment. The time from the onset of symptoms to the first clinic consult was 5.1 months on average. Twenty-one (55.3%) patients had the lesion in the right breast, with a mean size of 6.9 cm. Conservative surgical excision was performed in all patients. Additionally, 86.8% required corticosteroids and 78.9% were treated with antibiotics. Complete remission was obtained at 141 days on average (range 44 to 292 days). Six (15.8%) women reported ipsilateral recurrence and 5 (13.2%), contralateral. The latency time was 25.5 months on average. Conclusion The conservative surgical treatment demonstrated and close follow-up made for a high cure rate, but with recurrence similar to that reported in the literature. Use of gloves is an alternative to manage post operative wounds in a low-income country. The most frequent adverse effect was breast surgical scar.

Sarcoidosis cutánea. Presentación de un caso

La sarcoidosis es una enfermedad granulomatosa sistémica de causa desconocida, con mayor prevalencia en el sexo femenino, entre los 20 a 40 años de edad; caracterizada por la formación de granulomas no caseificantes en distintos órganos. La afectación cutánea de forma exclusiva es rara, pues se describe solo en el 4-5 % de los pacientes, ya que las lesiones en piel pueden aparecer antes o después del compromiso sistémico, o bien coincidir con este. Se presenta el caso de una paciente de 35 años con lesiones en piel de cuatro años de evolución. Considerando el cuadro clínico y la histopatología, se concluyó con el diagnóstico de sarcoidosis cutánea, crónica y asintomática. Se trata de una enfermedad muy polimorfa en sus manifestaciones cutáneas, lo cual la convierte en una gran simuladora, y su diagnóstico constituye un reto para el dermatólogo.

Sarcoidosis is a systemic granulomatous disease of unknown cause, with a higher prevalence in females, between 20 and 40 years of age; characterized by the formation of non-caseating granulomas in different organs. Exclusive skin involvement is rare, as it is described in only 4-5% of patients, since skin lesions may appear before or after systemic involvement, or coincide with it. The case of a 35-years-old patient with skin lesions of four years of evolution is presented. Considering the clinical case and histopathology, the diagnosis of chronic and asymptomatic cutaneous sarcoidosis was concluded. It is a very polymorphic disease in its skin manifestations, which makes it a great simulator, and its diagnosis constitutes a challenge for the dermatologist.

Granulomatous anterior uveitis following mRNA-based COVID-19 vaccination: A case report

A 23-year-old patient presented with complaints of redness, pain, photophobia, and blurred vision in the right eye 15 days after she received the third dose of BNT162b2 vaccination. Ocular examination revealed 2+ cellular reactions in the anterior chamber and mutton fat keratic precipitate with no vitritis or retinal alterations. Active uveitis findings regressed with corticosteroid and cycloplegic eye drops. We present a case of unilateral granulomatous anterior uveitis following the BNT162b2 vaccination, with no etiologic factor in uveitis work-up and no previous history of uveitis before vaccination. This report demonstrates a potential causal association of coronavirus disease 2019 (COVID-19) vaccine with granulomatous anterior uveitis.

Rosácea Granulomatosa: una variante infrecuente en la infancia / Granulomatous Rosacea: A variant infrequent in childhood

RESUMEN La rosácea es una dermatosis inflamatoria crónica de la piel, caracterizada por la presencia de eritema, telangiectasias, pápulas y pústulas en la región centro facial. Dentro de sus variantes, la forma granulomatosa es un cuadro clínico comunicado con escasa frecuencia en la infancia. Se presenta una paciente de sexo femenino, de 9 años de edad, quien presenta enrojecimiento facial y lesiones quísticas de tamañosvariables. Se decide realizar biopsia cutánea profunda, en la que se observó en lámina histológica, con técnica de H-E, al 40X: infiltrado inflamatorio severo perivascular superficial y profundo, a predominio linfo-plasmocitario, leucocitos polimorfonucleares e histiocitos, formando granulomas. Se instaura tratamiento tópico y sistémico, con resolución satisfactoria del cuadro clínico, con lo que mejora su calidad de vida.

ABSTRACT Rosacea is a chronic inflammatory dermatosis of the skin, characterized by the presence of erythema, telangiectasias, papules and pustules in the central facial region. Among its variants, the granulomatous form is a clinical picture rarely reported in childhood. A 9-year-old female patient is presented, who presents facial redness and cystic lesions of variable sizes, it was decided to perform a deep skin biopsy where it was observed in histological plate, with the H-E technique, at 40X; Superficial and deep perivascular severe inflammatory infiltrate, predominantly lymphoplasmacytic, polymorphonuclear leukocytes, and histiocytes, forming granulomas. Topical and systemic treatment was established with satisfactory resolution of the clinical picture, improving their quality of life.

Clinicopathological features of cystic neutrophilic granulomatous mastitis / 中华普通外科杂志

Objective:To investigate the etiology, clinical manifestations, clinicopathological features of cystic neutrophil granulomatous mastitis (CNGM).Methods:From Jan 2019 to Dec 2020, 95 CNGM cases diagnosed by biopsy pathology at Chongqing Hospital of Traditional Chinese Medicine and Chongqing Liangping District Hospitol of Traditional Chinese Medicine were reviewed.Results:There were 95 female patients, aged 21 to 50 years, with a median age of 32 years. Laboratory examination showed that 56% (53/95) cases had elevated rheumatoid antibody level, 27 % (26/95) had increased level of serum thyroid antibody, 15% (14/95) had elevated antineutrophil antibody, 35% (33/95) had increased ESR, 38% (36/95) had increased C-reactive protein. The positive rate of Gram-stained bacilli was 82% (78/95). Histology: pyogenic granuloma with lobule of breast as the center, the center of granuloma was cystic vacuole.Immunohistochemistry showed that the inflammatory cells in and around granuloma were mainly CD3 + cells, and CD4 + cells were more than CD8 + cells. Conclusions:The cystic neutrophilie granulo matous mastitis is a rare type of idiopathic granulomatous mastitis. The diagnosis of CNGM is dependent on its specific pathological features.

Analysis of clinical features of 147 cases of ANCA-associated vasculitis / 中华风湿病学杂志

Objective:To analyze the clinical characteristics of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).Methods:A retrospective study was conducted on AAV patients with long-term follow-up in the rheumatology outpatient clinic of Peking Union Medical College Hospital between February 2015 and February 2022. The demographic characteristics, clinical manifestations, concurrent events, treatment, and prognosis of the three clinical subtypes of AAV were collected and analyzed.Results:There were 71, 45, and 31 cases of granulomatous polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatous polyangiitis (EGPA), respectively, among 147 patients. The ANCA positivity rates in the three groups were 91.5%, 95.6%, and 19.4% ( χ2=76.68, P<0.01), respectively. The upper respiratory tract and lungs were the most frequently affected organs in GPA and EGPA, and the kidneys and lower respiratory tract were the main organs involved in MPA. In addition, cardiac and neurological involvement and thrombosis rates were significantly higher in EGPA patients than in GPA and MPA (12.9%, 9.7%, 41.9% and 19.4%, respectively; χ2=8.51、7.13、7.54、0.02, P<0.05) .The median follow-up time for the three groups of patients was 43, 28, and 46 months respectively.Relapse was more common in patients with GPA and EGPA (up to 59.2% and 64.5%; χ2=11.26, P=0.004), with the lungs and ENT being the most common relapse organs (GPA of 61.9% and 40.5%, EGPA of 55.0% and 50.0%), the lungs and kidneys were the most common manifestations in MPA relapse (64.3% and 60.0%, respectively). The main therapeutic agents were glucocortoid (95.9%), cyclophosphamide (71.4%), methotrexate (54.4%), tripterygium wilfordiz (34.0%),mycophenolate mofetil (31.3%), azathioprine (29.3%), leflunomide (19.0%), rituximab (19.0%), and tacrolimus/cyclosporine (8.8%). There were 6 deaths (4.1%) occurred during the follow-up period of this study. Conclusion:The clinical features of AAV are similar to those reported in the literature and relapses are common>he vast majority of patients need to be treated with glucocorticoid combined with immunosuppressive agents.

Efficacy of local injection of triamcinolone acetonide combined with surgery in the treatment of mass-type granulomatous mastitis / 西安交通大学学报(医学版)

【Objective】 To analyze the efficacy and safety of intralesional triamcinolone acetonide in the treatment of mass granulomatous mastitis (GLM). 【Methods】 Retrospective analysis was made on 67 patients with GLM who were treated in Xijing Hospital from July 2021 to May 2022 and met the inclusion criteria. Among them, 31 patients were treated with local injection of triamcinolone acetonide, while 36 ones were treated with oral methylprednisolone. All the included patients underwent surgical treatment after their condition met the surgical criteria, and the follow-up period lasted for up to six months after surgery. The two groups were compared in improvement of symptoms and signs, treatment time, clinical effectiveness and safety, and recurrence rate. 【Results】 The effective rate of triamcinolone acetonide group and methylprednisolone group was 100%, but the clinical cure rate was significantly higher in triamcinolone acetonide group than in methylprednisolone group in stratified analysis (P<0.05). The improvement time of symptoms and signs in triamcinolone acetonide group was significantly shorter than that in methylprednisolone group (P<0.05). The incidence of side effects in triamcinolone acetonide group was also significantly reduced compared to methylprednisolone group (P<0.05). Follow-up for half a year showed no recurrence in both groups. 【Conclusion】 Compared with the traditional oral methylprednisolone group, local injection of triamcinolone acetonide in the treatment of mass granulomatous mastitis can rapidly relieve clinical symptoms and signs, shorten treatment time, and has higher efficiency and fewer side effects. Local injection of hormone combined with surgery is effective in treating mass granulomatous mastitis with low recurrence rate.

Research progress on diagnosis and treatment of granulomatous lobular mastitis / 中国临床药理学与治疗学

Granulomatous lobular mastitis (GLM) is a rare form of chronic inflammatory breast disease which may be sometimes difficult to distinguish from breast cancer. The cause of GLM is unknown, but may be associated with autoimmunity, abnormal hormone levels and infection. While GLM has no specific clinical manifestations, the diagnosis is principally established by histopathology. Therapeutic options for GLM range from observation to various medical treatments, such as steroids, immunosuppressants, and antibiotics, to surgical intervention. However, there are still many difficulties in the clinical diagnosis and treatment of GLM, and there is still no unified diagnosis and treatment consensus. So, we accomplished the present review through reviewing GLM-related domestic and foreign literature, aiming to provide the basis for rational clinical diagnosis and treatment.

Cerebrospinal fluid inflammatory cytokine profiles of patients with neurotropic parasitic infections

@#The pathogenesis of chronic parasitic central nervous system (CNS) infections, including granulomatous amoebic meningoencephalitis (GAE), cerebral toxoplasmosis (CT), and neurocysticercosis (NCC), is primarily due to an inflammatory host reaction to the parasite. Inflammatory cytokines produced by invading T cells, monocytes, and CNS resident cells lead to neuroinflammation which underlie the immunopathology of these infections. Immune molecules, especially cytokines, can therefore emerge as potential biomarker(s) of CNS parasitic infections. In this study, cerebral spinal fluid (CSF) samples from suspected patients with parasitic infections were screened for pathogenic free-living amoebae by culture (n=2506) and PCR (n=275). Six proinflammatory cytokines in smear and culture-negative CSF samples from patients with GAE (n = 2), NCC (n = 7), and CT (n = 23) as well as control (n = 7) patients were measured using the Multiplex Suspension assay. None of the CSF samples tested was positive for neurotropic free-living amoebae by culture and only two samples showed Acanthamoeba 18S rRNA by PCR. Of the six cytokines measured, only IL-6 and IL-8 were significantly increased in all three infection groups compared to the control group. In addition, TNFa levels were higher in the GAE and NCC groups and IL-17 in the GAE group compared to controls. The levels of IL-1b and IFNg were very low in all the infection groups and the control group. There was a correlation between CSF cellularity and increased levels of IL-6, IL-8, and TNFa in 11 patients. Thus, quantifying inflammatory cytokine levels in CSF might help with understanding the level of neuroinflammation in patients with neurotropic parasitic diseases. Further studies with clinico-microbiological correlation in the form of reduction of cytokine levels with treatment and the correlation with neurological deficits are needed.

Dermoscopy of cutaneous sarcoidosis: a cross-sectional study

Abstract Background Although traditionally used for the diagnosis of skin tumors, in the past few years dermoscopy as a clinical diagnostic aid for inflammatory and infectious skin manifestations has also received more and more attention. The clinical variability of cutaneous sarcoidosis (CS) often makes its correct diagnosis challenging. Dermoscopy can be used as an auxiliary examination method. Objective Our aim was to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of CS. Methods This was a retrospective analysis of 39 CS clinical and dermoscopic images collected in the Department of Dermatology, Huashan Hospital Affiliated with Fudan University from August 2013 to February 2021. Results Retrospective dermoscopic evaluation revealed small grouped, translucent orange globular structures in all 39 cases. Variable diameter linear vessels were found in 38 cases. A central scar-like area was seen in 26 cases. Bright white streaks were seen in 30 cases. The follicular plugs were seen in 15 cases. Study limitations First, the number of cutaneous sarcoidosis cases the authors collected is small. Second, due to the lack of a control group, the sensitivity and specificity of the proposed criteria were not calculated. Finally, since our study mainly includes suspicious lesions that were biopsied for diagnostic purposes, there may be a selection bias. Conclusion Lesions showing on dermoscopy grouped translucent orange ovoid structures associated with linear vessels should raise the suspicion of CS. Central scar-like areas and bright white streaks are also helpful in the diagnosis of CS.

Subacute thyroiditis and rapidly developing goiter in a 16-year-old female: a case report / Tiroiditis Sub-aguda asociada a bocio nodular en una paciente de 16 años; reporte de un caso

Subacute thyroiditis (SAT) is an inflammatory disease of the thyroid gland with multiple etiologies and clinical features, often challenging to recognize. The classic presentation is the painful, granulomatous thyroiditis (DeQuervain's) characterized by diffuse swelling of the gland, usually preceded by an upper respiratory tract infection. A painless variant, also referred to as autoimmune subacute thyroiditis, has been documented and is strongly linked to postpartum state, reported following ~10% of pregnancies. It can be differentiated from the former by the presence of anti-thyroid antibodies, which classifies it as an autoimmune thyroiditis. Any spontaneous development of painful swelling of the thyroid gland warrants a complete work up that includes thyroid hormones, thyroid autoimmune panel, acute phase reactant titers, and, if available, imaging that may lead to the diagnosis of an inflammatory or infectious cause of thyroiditis.

Tiroiditis Subaguda, es una enfermedad inflamatoria de la glándula Tiroides que tiene muchas etiologías y características clínicas, y frecuentemente difícil de reconocer. La presentación clásica es: tiroiditis granu-lomatosa dolorosa caracterizada de hinchazón difusa de la glándula del Tiroides, usualmente precedida de una infección respiratoria de las vías áreas superior (como una infección viral). Existe una variante sin dolor, tam-bién referida como tiroiditis subaguda autoinmune, ha sido documentado y es muy ligada al estado postparto, en un 10% de los embarazos. La Tiroiditis postparto Puede ser diferenciada de la anterior por la presencia de anticuerpos lo que la clasifica como una tiroiditis auto-inmune. Cualquier desarrollo espontaneo de una hin-chazón dolorosa de la tiroides garantiza su evaluación de una manera formal, que incluye las hormonas del tiroides, panel tiroideo de autoinmunidad títulos de los factores que reaccionan agudamente, y si está disponible imágenes como una ultrasonografía que conlleva al di-agnóstico de una Tiroiditis inflamatoria o de origen in-feccioso.

Presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática / Clinical presentation and radiological findings of patients with histopathological diagnosis of idiopathic granulomatous mastitis

INTRODUCCIÓN. La mastitis granulomatosa idiopática es una patología inflamatoria benigna de mama con clínica y hallazgos imagenológicos no específicos; usualmente confundida con cáncer de mama. El síntoma más frecuente es una masa mamaria palpable. El diagnóstico es histopatológico. OBJETIVO. Describir el perfil demográfico, presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1130 y muestra de 49 datos de historias clínicas electrónicas de pacientes con diagnóstico histológico de mastitis granulomatosa idiopática con el código CIE10 N61x Trastornos Inflamatorios de la mama, atendidas en la Unidad Técnica de Imagenología del Hospital de Especialidades Carlos Andrade Marín en la ciudad de Quito entre enero 2019 hasta diciembre 2021. El criterio de inclusión fue la confirmación histopatológica de mastitis granulomatosa idiopática. Los criterios de exclusión: antecedentes de neoplasia maligna de mama, antecedentes de HIV, patología inflamatoria sistémica como granulomatosis de Wegener, sarcoidosis, infecciones granulomatosas crónicas como tuberculosis, brucelosis, histoplasmosis, sífilis y reacciones a cuerpos extraños como material de implantes mamarios. Se analizaron datos demográficos, presentación clínica, hallazgos mamográficos, ecográficos y la categorización BIRADS. Se efectuó un análisis univarial; para las variables cualitativas se realizó frecuencias y porcentajes; para las variables cuantitativas se realizó medidas de tendencia central. La información recolectada fue analizada en el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS La mediana de la edad fue 36 años. El 94,00% de pacientes tenían por lo menos un hijo; 77,50% presentaron con una masa palpable; 55,10% se acompañaron de signos inflamatorios; 16,00% asociaron fístulas y 24,40% presentaron secreción. Solo 1 caso presentó afectación bilateral. CONCLUSIÓN En este estudio, la mastitis granulomatosa idiopática afecta a mujeres en edad reproductiva sin antecedentes de malignidad quienes presentan una masa mamaria palpable que puede estar acompañada de signos inflamatorios, colecciones y fístulas. La realización de una biopsia core eco guiada, para confirmar su diagnóstico.

INTRODUCTION. Idiopathic granulomatous mastitis is a benign inflammatory breast pathology with nonspecific clinical and imaging findings; usually mistaken for breast cancer. The most frequent symptom is a palpable breast mass. The diagnosis is histopathologic. OBJECTIVE. To describe the demographic profile, clinical presentation and radiographic findings of patients with histopathologic diagnosis of idiopathic granulomatous mastitis. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1130 and sample of 49 data from electronic medical records of patients with histological diagnosis of idiopathic granulomatous mastitis with ICD10 code N61x Inflammatory disorders of the breast, attended at the Technical Imaging Unit of the Carlos Andrade Marín Specialties Hospital in the city of Quito between January 2019 and December 2021. The inclusion criterion was histopathological confirmation of idiopathic granulomatous mastitis. Exclusion criteria: history of malignant breast neoplasia, history of HIV, systemic inflammatory pathology such as Wegener's granulomatosis, sarcoidosis, chronic granulomatous infections such as tuberculosis, brucellosis, histoplasmosis, syphilis and reactions to foreign bodies such as breast implant material. Demographic data, clinical presentation, mammographic and ultrasound findings and BIRADS categorization were analyzed. Univariate analysis was performed; frequencies and percentages were used for qualitative variables; measures of central tendency were used for quantitative variables. RESULTS. The median age was 36 years. 94,00% of patients had at least one child; 77,50% presented with a palpable mass; 55,10% were accompanied by inflammatory signs; 16,00% were associated with fistulas and 24,40% presented with discharge. Only 1 case presented bilateral involvement. CONCLUSION. In this study, idiopathic granulomatous mastitis affects women of reproductive age with no history of malignancy who present with a palpable breast mass that may be accompanied by inflammatory signs, collections and fistulas. The performance of an echo-guided core biopsy to confirm the diagnosis.

Role of FNAC in head and neck region lymphadenopathy - A tertiary care centre experience

Background: FNAC (Fine Needle Aspiration Cytology) is a well accepted technique and plays an important role in early diagnosis of head and neck lesions. It is a safe and inexpensive outdoor procedure. Materials and methods: This study was carried out over a period of 9 months (January 2021 to September 2021). A total of 60 patients with head and neck lymphadenopathy were subjected to FNAC at a tertiary care centre in Vadodara, Gujarat. All reports were recorded and data was entered and analyzed using Microsoft excel. Results: In the present study, the various causes of head and neck lymphadenopathy were classified according to cytomorphological patterns. Among the diagnostic outcome, overall prevalence of granulomatous lymphadenitis was 35% (21 cases), reactive hyperplasia was 26.67% (16 cases), secondary metastases were 18.33% (11 cases), lymphoma was 10% (6 cases) and acute non-specific lymphadenitis was 10% (6 cases). Conclusion: FNAC is simple, quick, inexpensive and safe diagnostic procedure which also is an useful adjunct to histopathology.

Aortoarteritis: A rare pulmonary-renal disease

Takayasu arteritis (TAK) is an autoimmune disease majorly affecting young females. It alters the vascular wall, resulting in stenosis, occlusion, or dilatation. It has no distinct clinical manifestation. Here, we present the case of an 18-year-old girl who presented with generalized tonic-clonic seizure and hypoxia. Blood investigations showed deranged urea and creatinine values. Computed tomography angiography revealed bilateral artery occlusion, decreased kidney size, and pulmonary artery dilatation, confirming generalized vascular disease that caused hypertension and ischemic nephropathy in the patient. Our case represents a rare autoimmune disease, leading to pulmonary hypertension and renal artery stenosis. TAK should be considered as a differential diagnosis in young female patients presenting with pulmonary as well as renal signs and symptoms, especially if there is discrepancy in blood pressure levels in all limbs.

Gallbladder tuberculosis: A rare case report with review of literature

Gallbladder tuberculosis (TB) is a rare disease, and it might be challenging to distinguish it from gallbladder cancer on clinical history and radiology. It frequently mimics carcinoma in patients who initially appear with a gallbladder mass. Gallbladder TB is only identified after histology of the resected specimen since radiography lacks pathognomic characteristics. Here, we describe a unique case of gallbladder TB that was incidentally identified when a 49-year-old lady was being evaluated for suspected gallbladder cancer. Histology of the gallbladder exhibits necrotizing granulomatous inflammation with the presence of numerous pink-colored, curved, and beaded acid-fast bacilli that were recognized on the Ziehl-Neelsen stain.