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.

Clinical diagnosis and treatment of primary thyroid tuberculosis: a retrospective study

ABSTRACT BACKGROUND: Primary thyroid tuberculosis (PTT) is an uncommon type of extrapulmonary tuberculosis, which is caused by Mycobacterium tuberculosis. It does not have specific clinical manifestations, and most cases are diagnosed through postoperative histopathological examination. OBJECTIVE: To evaluate the diagnostic pattern and management strategy among patients with primary thyroid tuberculosis. DESIGN AND SETTING: Retrospective study on patients with primary thyroid tuberculosis in the First Hospital of Jilin University (Changchun, China). METHODS: Between March 2015 and June 2020, nine cases of PTT were diagnosed and treated in the Department of Thyroid Surgery of the First Hospital of Jilin University. Age at diagnosis, primary symptoms, preoperative biopsy, operation method, pathological classification, acid-fast staining test, anti-TB therapy and prognosis were registered in order to explore the appropriate protocol for diagnosis and treatment of this disease. RESULTS: None of the patients was diagnosed with thyroid tuberculosis before surgery. All the patients underwent surgery. Granulomatous changes or caseous necrosis in thyroid tissue were found through postoperative histopathological evaluation. Polymerase chain reaction (PCR) results for Mycobacterium tuberculosis were positive in all patients. Most patients had a good prognosis after surgery and anti-tuberculosis drug therapy. CONCLUSION: PTT is a rare disease. It is important to improve the preoperative diagnosis. Preoperative diagnostic accuracy relies on increased awareness of the disease and appropriate use of preoperative diagnostic methods, such as PCR detection, fine-needle aspiration cytology, acid-fast bacillus culture, ultrasound and blood sedimentation. PCR detection of M. tuberculosis is recommended as the gold standard for diagnosis.

Wolf′s isotopic response manifesting as granulomatous inflammation after disseminated herpes zoster: a case report / 中华皮肤科杂志

A 65-year-old male patient, who had a history of chronic lymphocytic leukemia for 3 years, presented with erythematous swelling of the right cheek for 20 days and scattered papules on the back and upper extremities for 10 days. Twenty days prior to the presentation, the patient was hospitalized for disseminated herpes zoster. Skin examination showed diffuse dark red swollen plaques in the facial area under the right eyelid as well as on the right auricle and external acoustic meatus, with a sense of infiltration on palpation; scattered brown crusts were left behind at the sites of healed herpes zoster lesions, and scattered depressed scars were observed among these crusts; scattered infiltrative, mung bean- to soybean-sized, light red papules with a smooth surface were seen on the back of the neck, back and upper limbs. Histopathological examination of the facial skin lesions revealed nodular infiltration of epithelioid cells, lymphocytes and many multinucleated giant cells in the dermis and subcutaneous adipose tissue; immunohistochemical staining showed positive staining for CD68, CD20, CD79a, CD3, CD2, CD10, CD5 and Bcl-2, scattered positive staining for Ki-67, and negative staining for CD23, cyclin D1, Bcl-6, multiple myeloma oncogene 1, CD21, CD35 and myeloperoxidase. The patient was diagnosed with Wolf′s isotopic response manifesting as granulomatous inflammation after disseminated herpes zoster. The patient was treated with intravenous drips of methylprednisolone at a dose of 40 mg/d, and the skin lesions were gradually improved and subsided. No recurrence was observed during 4 years of follow-up.

Actinomycosis of male breast: a rare case report

Actinomyces is a commensal of gastrointestinal and genital tract that may cause subacute or chronic granulomatous inflammation. Primary actinomycosis of breast is an extremely rare disease. It may present as a mass or as discharging fistulae. It is often diagnosed after biopsy. It may mimic inflammatory carcinoma or mastitis. Treatment is with a prolonged course of antibiotic. Authors present a case of a 70-year-old male with a palpable breast lump, that was suspected to be malignant. Wide local excision was performed, histopathology confirmed the diagnosis of actinomycoses breast. Patient was given antibiotics post operatively.

Disseminated Tuberculosis Presenting as Gastric Outlet Obstruction

@#A 12-year-old female had a three-year history of fever, non-bilious vomiting and abdominal pain. Upper gastrointestinal series showed a filling defect at the duodenum. Esophagogastroduodenoscopy exhibited circumferential mass extending from the duodenal bulb to the 2nd part of the duodenum which on histology disclosed chronic granulomatous inflammation. Chest X-ray suggested miliary tuberculosis; endotracheal tube aspirate was PCR positive for Mycobacterium tuberculosis. Patient was diagnosed as disseminated tuberculosis of the duodenum and lungs. Quadruple anti-tuberculosis medication was started but patient succumbed to nosocomial sepsis.

Relative value of immunohistochemistry in detection of mycobacterial antigen in suspected cases of tuberculosis in tissue sections.

Background: The diagnosis of tuberculosis (TB) depends on identifi cation of the infecting organism. The diagnosis presents as a challenge due to its diverse clinical presentation and low yield of acid-fast bacilli (AFB) in tissue sections. Aim: The aim of the present study is immunohistochemical localization of tubercle bacilli or their components that persist in the granulomas, but have lost the property of staining with acid-fast stain, assess the advantage of immunostaining over conventional Ziehl–Neelsen (ZN) staining and further to study the staining pattern on immunohistochemistry (IHC). Materials and Methods: The study population comprised 100 suspected cases of TB. Tissue sections from these were subjected to hematoxylin and eosin, ZN and IHC staining using polyclonal antibody to Mycobacterium tuberculosis followed by a comparative analysis of the results. Cases of lepromatous leprosy were used as a positive control. Results: Acid-fast bacilli were identifi ed by ZN stain in 23% of cases. IHC identifi ed 72% cases. In the present study, IHC had higher sensitivity (95.56%) and negative predictive value (96.43%), but lower specifi city (35.06%) and positive predictive value (30.56%) than ZN stain which had the sensitivity, specifi city, positive predictive value and negative predictive values of 30.56%, 96.43%, 95.65% and 41.56% respectively. Conclusion: Immunohistochemistry is a simple and sensitive technique for localization of tubercle bacilli and their components on tissue sections. It can be easily incorporated in routine histopathology laboratory and serve as an effi cient diagnostic adjunct to conventional ZN staining. This will help reduce the practice of prescribing empirical antitubercular treatment based on clinical suspicion alone.

Laryngeal Histoplasmosis: report first case in Colombia / Histoplasmosis laríngea: reporte de primer caso en Colombia

Laryngeal histoplasmosis is a fungal infection that is frequent in Colombia. Laryngeal histoplasmosis usually occurs in immunocompromised patients through the dissemination of the fungus from the lungs to other organs. Histoplasmosis isolated laryngeal (primary) is rare. If a patient presents with a history of immunosuppression by renal transplant, primary laryngeal histoplasmosis with supraglottic granulomatous inflammation that was treated with amphotericin B and Itraconazole, with complete resolution of laryngeal lesions.

Histoplasmosis es una infección fúngica que es frecuente en Colombia. La histoplasmosis laríngea por lo general se presenta en pacientes inmunocomprometidos por la difusión del hongo desde los pulmones a otros órganos. La enfermedad laríngea aislada (primaria) es rara. Se presenta el caso de un paciente con antecedente de inmunosupresión por trasplante renal, con histoplasmosis laríngea primaria que produjo inflamación granulomatosa supraglótica, tratado con Anfotericina B e Itraconazol, con resolución completa de las lesiones laríngeas.

Lesões granulomatosas encontradas em bovinos abatidos para consumo / Granulomatous lesions found in cattle slaughtered for meat production

Com o objetivo auxiliar profissionais médico-veterinários no reconhecimento das lesões de bovinos encontradas na linha de inspeção de carnes em matadouros frigoríficos, três condições granulomatosas de bovinos foram pesquisadas e suas semelhanças e diferenças avaliadas. Essas três condições granulomatosas foram actinobacilose (causada por Actinobacillus lignieresii), actinomicose (causada por Actinomyces bovis) e mastite estafilocócica (causada por Staphylococcus aureus). Em 505 lesões encontradas em bovinos abatidos para consumo humano, 40 eram uma dessas três lesões granulomatosas: 24 eram actinobacilose, 10 eram actinomicose e seis eram mastite estafilocócica. De um modo geral, os aspectos macro e microscópicos dessas três lesões eram bastante semelhantes, mas suas localizações ajudavam a presumir sua etiologia. A. lignieresii afetou tecidos moles, principalmente língua e linfonodos da cabeça; A. bovis afetou o tecido ósseo, principalmente o da mandíbula; e S. aureus teve a glândula mamária como o tecido alvo. Histologicamente, os granulomas resultantes da infecção por qualquer um desses três agentes continham uma estrutura amorfa, eosinofílica, com clavas irradiadas, localizada centralmente; essa estrutura era rodeada por neutrófilos íntegros e degenerados, que, por sua vez, eram cercados por um manto de macrófagos epitelioides e ocasionais células gigantes multinucleadas. Esses mantos de macrófagos eram irregularmente infiltrados por linfócitos e plasmócitos que tendiam a se acumular na periferia da lesão, que era cercada por uma cápsula de tecido conjuntivo...

In order to help professionals of veterinary medicine in recognizing bovine lesions found during meat inspection at slaughterhouses, three granulomatous conditions of cattle were researched and their morphological similarities and differences were assessed. These three granulomatous conditions were actinobacillosis (caused by Actinobacillus lignieresii), actinomycosis (caused by Actinomyces bovis) and staphylococcal mastitis (caused by Staphylococcus aureus). Out of 505 lesions found in cattle slaughtered for human consumption, 40 were one of the three granulomatous conditions: 24 were actinobacillosis, 10 were actinomycosis and six were staphylococcal mastitis. Overall the gross and histological features of these three diseases are quite similar but their location helps give away the etiology. A. lignieresii affected soft tissues, mainly those of tongue and lymph nodes of the head region; A. bovis affected bone tissue mainly that of the mandible; and S. aureus main targeted tissue was the mammary gland. Histologically the granuloma resulting from the infection with either one of these three causal agents contained centrally located amorphous, eosinophilic, club like structures surrounded by viable and dead neutrophils. These were surrounded by a mantle of epithelioid macrophages and occasional multinucleated giant cells. These macrophage mantles were irregularly infiltrate by lymphocytes and plasma cells which tended to accumulate to the periphery of the lesion which, in turn, was fenced by a fibrous connective capsule. Given the employment of adequate techniques the causative the agent could be seen within or surrounding the clublike structures in each the three types of granulomatous lesions. In the case of staphylococcal mastitis, intralesional cocci were observed both in HE and Gram stained preparations, in the latter as gram-positive cocci...

Imaging presentation of pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation / 中华消化外科杂志

Pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation is rarely seen.The clinical symptoms of this disease are unspecific.Combination of X-ray radiography,computed tomography and gastroscopy could make definite diagnosis.Differential diagnosis between pylorus obstruction and peptic ulcer,gastric cancer and duodenal obstruction should be done before operation.On April 13,2012,a patient with pylorus obstruction caused by foreign bodies in the gastric anrum and granulomatous inflammation was treated at the Second Hospital of Jiaxing,the imaging characteristics of the disease were summarized to provide referrence for the diagnosis and treatment of this disease.

Granulomatous inflammation in Acanthamoeba sclerokeratitis.

This report describes the histopathological findings in a patient with Acanthamoeba sclerokeratitis (ASK). A 58-year-old patient with ASK underwent enucleation and sections of the cornea and sclera were subjected to histopathology and immunohistochemistry with monoclonal mouse antihuman antibodies against T cell CD3 and B cell CD20 antigens. Hematoxylin and Eosin stained sections of the cornea revealed epithelial ulceration, Bowman's membrane destruction, stromal vascularization, infiltration with lymphocytes, plasma cells, and granulomatous inflammation with multinucleated giant cells (MNGC). The areas of scleritis showed complete disruption of sclera collagen, necrosis and infiltration with neutrophils, macrophages, lymphocytes, and granulomatous inflammation with MNGC. No cyst or trophozoites of Acanthamoeba were seen in the cornea or sclera. Immunophenotyping revealed that the population of lymphocytes was predominantly of T cells. Granulomatous inflammation in ASK is probably responsible for the continuance and progression of the scleritis and management protocols should include immunosuppressive agents alongside amoebicidal drugs.

Syphilid Showing a Histological Pattern of Granulomatous Inflammation / 대한피부과학회지

Syphilid represents a great variety of clinical and histological patterns. As such, sometimes it is difficult to make a differential diagnosis from other skin diseases. The histopathologic findings of syphilid are different, according to the clinical types; macular, maculopapular, papulosquamous, and nodular type. Characteristically, there is a marked perivascular infiltration of plasma cells and lymphocytes with endothelial cell swelling in the dermis. Herein, we report a case of syphilid showing the unusual histological pattern of granulomatous inflammation. A 45-year-old male presented with erythematous papules on the scalp, trunk, arms and inguinal area for 2 months. The biopsy specimen showed a chronic granulomatous inflammation with multinucleated giant cells in the dermis. Serologic test for syphilis showed a strong positive, and the patient was diagnosed with secondary syphilis. He was treated with benzathine penicillin G and the skin lesions have successfully disappeared.

Doença granulomatosa sistêmica em bovinos no estado de Santa Catarina associada ao pastoreio de ervilhaca peluda (Vicia villosa) / Systemic granulomatous disease in cattle in Santa Catarina, Brazil, associated with grazing of vetch (Vicia villosa)

Spontaneous intoxication in three dairy cows grazing pasture contaminated with Vicia villosa in two different farms was reported. Hyperthermia, skin alopecia and pruritus were the main clinical signs. Macroscopically, gray to white up to 5cm nodules were detected, especially in kidney and lymph nodes, which correspond to mild to severe multifocal granulomatous infiltrate. This is the first report of systemic granulomatous disease due to consumption of hairy vetch in the State of Santa Catarina, Brazil.

Granulomatous myelitis associated with hemorrhagic syndrome due to consumption of Vicia villosa by cattle / Mielite granulomatosa associada à síndrome hemorrágica devido ao consumo de Vicia villosa em um bovino

An unusual case of spontaneous Vicia villosa poisoning affected a 6-year-old Holstein cow. Although the most striking findings included a generalized hemorrhagic condition associated with granulomatous myelitis, histological lesions typically seen with the vetch-associated systemic granulomatous syndrome were also present. Prominent gross findings were bloody nasal and oral discharges, disseminated hemorrhages, and bloody feces. Generalized hemorrhages associated with infiltration of numerous organs by lymphocytes, plasma cells, macrophages, multinucleated giants cells, and eosinophils were the main microscopic findings. Anti-CD68 immunostaining confirmed the presence of moderate histiocytic infiltrate and multinucleated giant cells in the bone marrow. These changes in the bone marrow probably caused the generalized hemorrhagic changes described here.

Um bovino Holandês de seis anos naturalmente intoxicado pela Vicia villosa apresentou lesões não comumente encontradas nessa intoxicação. Embora a lesão mais evidente fosse hemorragia generalizada associada à mielite granulomatosa, as lesões granulomatosas típicas da intoxicação pela ervilhaca também estavam presentes histologicamente. Os principais achados macroscópicos foram hemorragias nasal e oral, hemorragias generalizadas e fezes com sangue. Lesões hemorrágicas generalizadas associadas com infiltrado inflamatório de linfócitos, plasmócitos, macrófagos, células gigantes multinucleadas e eosinófilos foram os principais achados microscópicos encontrados. O teste imuno-histoquímico anti-CD68 confirmou a presença de infiltrado moderado de macrófagos e de células gigantes multinucleadas na medula óssea. As alterações na medula óssea provavelmente constituem a causa da hemorragia generalizada descrita nesse caso.

A Case of Sarcoidosis That Was Initially Misdiagnosed as Nontuberculous Mycobacteria Pulmonary Disease / 결핵및호흡기질환

There are several respiratory diseases that show chronic granulomatous inflammation for the histologic finding. Among them, sarcoidosis and tuberculosis are not easy to differentiate when the clinical and radiological features present similar patterns. The increasing incidence of nontuberculous mycobacteria pulmonary disease is making it more difficult for clinicians to arrive at a proper diagnosis. A 69 year old male patient visited our hospital with chronic cough as his chief compliant. His radiologic findings were multiple enlarged mediastinal lymphadenpathies with innumerable micronodules and multiple patch infiltrations. The spleen biopsy finding showed chronic granulomatous inflammation, and Mycobacterium avium was identified on the bronchoscopic culture. Because of these findings, we treated him with drugs for nontuberculous mycobacteria disease other than sarcoidosis. However, during the treatment, his symptoms and radiological features became aggravated. Thus, we reviewed the radiologic and pathologic findings and decided to treat him with steroid, which relieved his symptoms and improved the radiologic findings. We report here on a case of sarcoidosis that was initially misdiagnosed as nontuberculous mycobacteria pulmonary disease.

Cerebral aspergillosis presenting as a mass lesion

Fungal infections of the central nervous system (CNS) are almost always a surprising finding. Their presentation is usually subtle, often without any diagnostic characteristics, and they are frequently mistaken for pyogenic abscesses, or brain tumors. Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients. It may present in several forms, including meningitis, mycotic aneurysms, infarcts and a tumoral form. We report an intracranial granuloma due to Aspergillus fumigatus involving the anterior cranial fossa and the frontal lobe. The clinical symptoms began one year before admission. Final diagnosis was made after craniotomy. The patient was treated with an extensive excision of the cerebral mass and medical antifungal therapy (intravenous amphotericin B), but she failed to respond to these treatments and died.

Two Cases of Delayed Skin Reaction by Sea Urchin / 대한피부과학회지

Sea urchin granuloma is a chronic granulomatous skin lesion caused by injury with sea urchin. Two types of sea urchin reaction have been noted: immediated and delayed. It has been known to form granuloma in most cases of delayed reaction histopathologically. However, 30% of cases are non-granulomatous inflammation. We describe two cases of delayed skin reaction by sea urchin. One showed a predominant inflammatory reaction with features of non-specific chronic inflammation. We recommend to use other name for delayed reaction of sea urchin rather than 'sea urchin granuloma'.

A case of neurosarcoidosis without systemic involvement

Sarcoidosis is a multisystem disorder of unknown cause. The involvement of the nervous system occurs 5% to 27% of patients with sarcoidosis, and neurosarcoidosis without systemic involvement is rare and difficult to diagnose. We present a case of 58-year-old woman with clinical features of multiple cranial and peripheral polyneuropathy with noncaseating granulomatous inflammation. Extensive testing for occult systemic sarcoidosis was negative. Sural nerve biopsy showed several perineural noncaseous granulomatous inflammation with prominent epithelioid cells. Oral steroid therapy led to some improvement. We report a patient with multiple cranial and peripheral polyneuropathy without systemic involvement, suspected sarcoidosis.