Basal cell carcinoma-clinico-pathological study in Eastern India in correlation with different risk factors

Objectives: To study the histological variants and mimickers of basal cell carcinoma (BCC) alongwith different risk factors among a group of patients from eastern India. Methods: The specimen for the study was sent by the dermatology department for histopathology after skin biopsy. Results: Out of 42 patients, 15 patients studied were males and the rest of the cases were females. The male to female ratio was 0.55:1. Maximum (15 cases) cases were in the age group of 50–59 years. Apart from sunlight, chronic arsenic exposure is an important risk factor of BCC. Basal cell hyperplasia and squamous cell carcinoma are the histological differential diagnosis of nodular BCC and basosquamous BCC. Conclusion: BCC is a disease of the older age group and with female preponderance in our study. Nodular basal cell carcinoma was the most common histologic type of basal cell carcinoma. The face was the most common site for BCC followed by the scalp. UV radiations and Arsenic do play role in the pathogenesis of BCC. CD10 helps differentiate superficial BCC from basal cell hyperplasia.

Hiperplasia difusa idiopática de células neuroendocrinas pulmonares/tumorlets / Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia/tumorlets

Resumen La hiperplasia difusa idiopática de células neuroendocrinas es una entidad extremadamente infrecuente caracterizada por una proliferación generalizada de células neuroendocrinas, sin proceso primario que lo justifique, generalmente, aunque también están descriptas formas asintomáticas. Se describen los casos de dos mujeres y un hombre, edad promedio 63 años (rango 57-71) que consultaron por presentar nodulillos pulmonares bilaterales. Promedio de seguimiento: 1 año, 3 meses (rango 1 mes-3 años). Las dos mujeres presentaban tos, disnea progresiva y obstrucción al flujo aéreo en el estudio espirométrico, fueron tra tadas por asma y enfermedad pulmonar obstructiva crónica respectivamente con poco alivio de los síntomas. El tercer paciente, varón, consultó por hallazgo incidental en una tomografía de tórax, de nódulos pulmonares, con razonable sospecha de enfermedad metastásica de origen desconocido. En sendas biopsias se diagnosticaron: en el primer y tercer caso hiperplasia neuroendócrina difusa idiopática-tumorlets; y en el segundo caso tumor carcinoide típico e hiperplasia neuroendocrina difusa idiopática. En el primer caso los síntomas se controlaron con tratamiento broncodilatador máximo. La segunda paciente tuvo en el postoperatorio, insuficiencia respiratoria que requirió asistencia respiratoria mecánica y fibrilación auricular con alta respuesta ventricular, interpretados ambos signos como síndromes paraneoplásicos, que respondieron favorablemente a la administración empírica de octeotride. El tercer paciente se halla asintomático y en control. La hiperplasia difusa de células neuroendó crinas representa un desafío diagnóstico. La biopsia pulmonar en pacientes con nodulillos pulmonares múltiples, bilaterales e historia clínica de tos y disnea progresiva debe ser considerada para confirmar esta entidad.

Abstract Diffuse idiopathic hyperplasia of neuroendocrine cells is an extremely rare condition. It is a widespread proliferation of neuroendocrine cells, without primary process justifying it. Usually symptomatic in most cases, asymptomatic forms are also described. We describe three cases, 2 women and 1 man, average age 63 years (range 57-71) who presented with bilateral pulmonary nodules. Average follow-up: one year and three months (range 1 month-3 years). The two women had cough, progressive dyspnea and airflow obstruction in the spirometry, and were treated for asthma and chronic obstructive pulmonary disease, respectively, with little relief of symptoms. The remaining patient consulted for diagnosis of pulmonary nodules of unknown cause and a suspicion of metastatic disease. The biopsies diagnostic were: in the first and third case diffuse idiopathic hyperplasia of euroendocrine cells - tumorlets; and in the second case typical carcinoid tumor and diffuse idiopathic hyperplasia of neuroendo crine cells. The first patient controlled the symptoms with maximum bronchodilator therapy. The second patient presented immediate postoperative severe bronchospasm and respiratory failure which required ventilatory as sistance, atrial fibrillation with rapid ventricular response (both signs interpreted as paraneoplastic syndromes) which responded favorably to the empirical octeotride management. The third patient is asymptomatic and in control. The diffuse neuroendocrine cell hyperplasia represents a diagnostic challenge because of the rarity of this condition. Lung biopsy in patients with multiple, bilateral pulmonary nodules and clinical history of cough and progressive dyspnea should be considered to confirm this entity.

Taquipnea persistente de la infancia: hiperplasia de células neuroendocrinas, una revisión / Persistent tachypnea of infancy: neuroendocrine cell hyperplasia, a review

La hiperplasia de células neuroendocrinas de la infancia (HCNEI) constituye una de las enfermedades intersticiales más frecuentes en pediatría. Tanto su etiología como los mecanismos fisiopatológicos involucrados son inciertos. Suele presentarse en pacientes por lo demás sanos, durante los primeros meses de vida con taquipnea, retracciones costales, rales e hipoxemia. En la tomografía axial computada de tórax de alta resolución (TACAR) presenta imágenes características en vidrio esmerilado de distribución central y zonas de atrapamiento aéreo. Para el diagnóstico, además de la clínica y la TACAR, podemos recurrir a la biopsia en casos atípicos. Los hallazgos histológicos reflejan una arquitectura pulmonar normal y un aumento en el número de células neuroendocrinas. El manejo global es con medidas de sostén, ya que no se cuenta con un tratamiento específico. La sintomatología suele mejorar con la edad y el pronóstico es favorable.

Neuroendocrine cell hyperplasia of infancy (NEHI) is one of the most common interstitial lung diseases of childhood. The etiology and pathophysiological mechanisms involved are uncertain. It usually presents in otherwise healthy patients during the first months of life with tachypnea, rib retractions, crackles, and hypoxemia. High-resolution chest computed tomography (HRCT) shows ground-glass opacities of central distribution and areas of air trapping. For diagnosis purposes, in addition to clinical and HRCT features, a lung biopsy is indicated for atypical cases. Histological findings reflect normal architecture and an increased number of neuroendocrine cells. The management consists of supportive and preventive care, since there is no specific treatment. Symptoms usually improve with age and the prognosis is favorable.

Granuloma periférico de células gigantes asociado a un implante: informe de un caso clínico con seguimiento a 5 años / Implant-associated peripheral giant cell granuloma: a case report with 5-year follow-up

Objetivo: Presentar la respuesta clínica a largo plazo del tratamiento de un granuloma periférico de células gigantes en un implante oseointegrado en el maxilar inferior. Caso clínico: Un paciente de 60 años, de sexo masculino, sin antecedentes sistémicos, concurrió por una lesión con márgenes definidos, de color rojizo morado y consistencia blanda sobre los tejidos blandos en la cara vestibular de un implante colocado en zona de 46. Se realizó la escisión quirúrgica de la lesión, se procesó el tejido extirpado y se envió al laboratorio. El estudio anatomopatológico confirmó el diagnóstico de granuloma periférico de células gigantes. La lesión recidivó dos veces. En la tercera extirpación se realizó la implantoplastía de la superficie del implante. La cicatrización no presentó inconvenientes. Hasta el último control, a los 5 años, no volvió a haber recidiva. Conclusión: En este caso clínico, se logró mantener la salud periimplantaria durante 5 años luego de la eliminación de un granuloma periférico de células gigantes. No obstante, este tuvo que ser removido en tres oportunidades debido a la alta recidiva (AU)

Aim: To evaluate the long-term clinical response to the treatment of a peripheral giant cell granuloma in an osseointegrated implant in the lower jaw. Clinical case: A 60-year-old male patient, with no systemic medical problems, presented a soft tissue lesion located at the buccal aspect of an implant placed in the 46 area. The lesion had defined reddish-purple margins and soft consistency. Surgical excision of the lesion was performed, processed and sent to the laboratory. The histopathology confirmed the diagnosis of peripheral giant cell granuloma. The lesion recurred twice. During the third surgical removal an mplantoplasty of the implant surface was performed. The healing was uneventful and there was no recurrence until the last control at 5 years. Conclusion: In this clinical case, perimplantar gingival health was maintained for 5 years after the surgical removal of a giant cell peripheral granuloma. However, it had to be removed three times, demonstrating a high recurrence (AU)

Single Circulating Blast in the Peripheral Blood Film in Normal Individuals and Patients of Non-neoplastic Haematological Disorders and Non-hematological Neoplasms/Disorders- A Study at a Tertiary Care Centre

Introduction: The blasts in the peripheral blood is usuallyassociated with a haematological disorder. Study aimed tosee if a single blast seen in a peripheral blood film of healthyindividuals and patients of non-neoplastic haematologicaldisorders and non-hematological neoplasms/disorders didhave any clinical significance.Material and Methods: The period of study was from 2014to 2018 conducted at a tertiary care hospital. The study wasdone exclusively on Peripheral Blood Films. The films werestained with Leishman stain. An occasional blast was detectedin some healthy subjects and patients of non-neoplastichaematological disorders and non-hematological neoplasms/disorders.Result: The routine smears were analyzed with caution afterthe first case of a patient of Iron Deficiency Anemia revealeda clear-cut Blast. In the period of 4 years from 2014 to 2018,a total of 23 cases of apparently normal individuals or patientswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1% on oneseparate occasion.Conclusion: A careful morphological examination in theperipheral smears of few normal individuals and individualswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1%Blast on one separate occasion. The cells were clear cutblasts with a large size, fine nuclear chromatin, one to twonucleoli with round to slightly irregular nuclear contours anda mild amount of pale agranular cytoplasm. On thoroughinvestigations of these individuals there was no evidence ofa neoplastic haematological disorder. Therefore a single blastin a peripheral blood seen in a healthy individuals or patientswith benign haematological disorder and non-neoplasticneoplasms/disorders may not always indicate a neoplasticprocess.

An Adult Case of Bartter Syndrome Type III Presenting with Proteinuria

Bartter syndrome (BS) I-IV is a rare autosomal recessive disorder affecting salt reabsorption in the thick ascending limb of the loop of Henle. This report highlights clinicopathological findings and genetic studies of classic BS in a 22-year-old female patient who presented with persistent mild proteinuria for 2 years. A renal biopsy demonstrated a mild to moderate increase in the mesangial cells and matrix of most glomeruli, along with marked juxtaglomerular cell hyperplasia. These findings suggested BS associated with mild IgA nephropathy. Focal tubular atrophy, interstitial fibrosis, and lymphocytic infiltration were also observed. A genetic study of the patient and her parents revealed a mutation of the CLCNKB genes. The patient was diagnosed with BS, type III. This case represents an atypical presentation of classic BS in an adult patient. Pathologic findings of renal biopsy combined with genetic analysis and clinicolaboratory findings are important in making an accurate diagnosis.

Peripheral giant cell granuloma: a case report

Peripheral giant cell granuloma (PGCG) is a non neoplastic reactive lesion of the gingiva, originating from the periosteum or periodontal membrane following local irritation or chronic trauma. PGCG manifests as a red-purple growth located in the gingiva or edentulous alveolar margins. The lesion can develop at any age, shows a slight female predilection. Usually, they cause one or the other problem in eruption or alignment of teeth, but may also present without disturbing the normal occlusion or eruption pattern. Management of these teeth depends on the symptoms. Presented here is a case of PGCG in relation to the lower right first premolar in a 10 year old child.

STAT6 Expression and IL-13 Production in Association with Goblet Cell Hyperplasia and Worm Expulsion of Gymnophalloides seoi from C57BL/6 Mice

In intestinal helminth infections, Th2 immune respones are generally associated with mucin secretion for worm expulsion from the host intestine. In particular, IL-4 and IL-13 are the important cytokines related with intestinal mucus production via STAT6 signalling in nematode infections. However, this perspective has never been studied in Gymnophalloides seoi infection. The present study aimed to observe the STAT6 signalling and cytokine responses in C57BL/6 mice, a mouse strain resistant to infection with this trematode. The results showed that worm expulsion occurred actively during days 1-2 post-infection (PI), when goblet cells began to proliferate in the small intestine. The STAT6 gene expression in the mouse spleen became remarkable from day 2 PI. Moreover, G. seoi infection induced a significant increase of IL-13 from day 4 PI in the spleen of infected mice. Our results suggested that goblet cell hyperplasia and worm expulsion in G. seoi-infected mice should be induced by STAT6 signalling, in which IL-13 may be involved as a dominant triggering cytokine.

Impacto de diferentes fontes proteicas sobre o desenvolvimento celular hepático de ratos recém-desmamados submetidos à dieta restritiva seguida de recuperação alimentar / Impact of different protein sources on the development of hepatic cells in newly-weaned rats submitted to a restriction diet followed by food repletion

The aim of this study was to evaluate the effect of different protein sources with different amino-acid profiles on liver cell development in "Wistar" rats submitted to a food restriction and recovery model. The food restriction model was based on a 50% ingestion restriction for the rats fed with the control diet (21 days) and "ad libitum" recovery (a period of 21 days). The protein sources used in this study were: Yeast autolysate (YA), whey protein concentrate from bovine milk (WPC), a mixture containing the YA and WPC in the proportion of 64:36 (protein base), commercial casein (CC) which was used as the experimental treatment (EC) and control treatment (CP). The following parameters were evaluated in this study: the amino-acid profile of the protein sources, the development of liver cells (liver weight and growth rates - RNA, DNA, protein), weight and number of hepatocytes in the whole organ. The results showed that the treatment with (YA) was the most affected by the food restriction, showing an incomplete (leucine-deficient) amino-acid profile, a lower development of liver cells, lower growth of the liver due to a lower growth by cellular hyperplasia (number of cells), lower capacity of cell division and DNA synthesis. However, it showed a higher ability for RNA synthesis, thus indicating that growth in the restricted phase was mainly due to increase in the size of hepatocytes (cell hypertrophy). During the repletion period, all food treatments showed normal liver development, i.e. cell growth and organ hyperplasia and hypertrophy.

El objetivo de este estudio fue evaluar el efecto que diversas fuentes de proteínas con diferentes perfiles de aminoácidos ejercían en el desarrollo de las células hepáticas en ratas "Wistar" sometidas a restricción y reposición de la ingestión de alimentos. El modelo de restricción alimentar consistía en disminuir 50% del consumo de los animales control (período de 21 días) y la recuperación con ingestión "ad libitum" (período de 21 días). Las fuentes de proteínas utilizadas en este estudio fueron: autolisado de levadura (ATL); concentrado proteico de suero de leche bovino (CPL); mezcla de CPL y ATL, en la proporción de 64:36 (base proteica), caseína comercial (CC), que fue utilizada como tratamiento experimental (CE) y como estándar (CP). Fueron evaluados el perfil de aminoácidos de las proteínas, el desarrollo de la célula hepática (peso del hígado y las tasas de crecimiento: ARN, ADN y proteína total), el peso y número de hepatocitos en el órgano. Los resultados mostraron que el grupo tratado con (ATL) fue el más afectado por el proceso de restricción de alimentos, la proteína presenta un perfil incompleto de aminoácidos(deficiente en leucina). Había menor desarrollo de las células del hígado, menor crecimiento del hígado debido a un menor crecimiento por hiperplasia celular (número de células), menor capacidad de división celular y de síntesis de ADN, sin embargo, mostraron una mayor capacidad para sintetizar ARN indicando que el crecimiento en la fase de restricción se debió principalmente al aumento en el tamaño de los hepatocitos (hipertrofia celular). Durante la fase de recuperación alimentar de todos los tratamientos hubo un desarrollo hepático normal, o sea crecimiento de las células y del órgano por hiperplasia e hipertrofia.

O objetivo deste estudo foi avaliar o efeito de diferentes fontes proteicas com diferentes perfis de aminoácidos sobre o desenvolvimento celular hepático de ratos "Wistar" submetidos à restrição e recuperação alimentar. O modelo de restrição alimentar foi baseado na restrição de 50% da ingestão dos animais controle (período de 21 dias), e recuperação ad libitum (período de 21 dias). As fontes proteicas utilizadas neste estudo foram: autolisado de levedura (ATL), concentrado proteico de soro de leite bovino (CSL), mistura contendo CSL e ATL na porcentagem de 64:36 (base proteica), caseína comercial (CC), a qual foi utilizada como tratamento experimental (CE) e como tratamento padrão (CP). Avaliouse, neste estudo, o perfil de aminoácidos das fontes proteicas, o desenvolvimento celular hepático (peso do fígado e dos índices de crescimento - RNA, DNA, proteína total), peso dos hepatócitos e número de hepatócitos em todo órgão. Os resultados mostram que o tratamento com (ATL) foi o mais afetado pelo processo de restrição alimentar, apresentando um perfil de aminoácido incompleto (deficiência em leucina); apresentou menor desenvolvimento celular hepático; menor crescimento do fígado em função do menor crescimento por hiperplasia celular (número de células), menor capacidade de divisão celular e síntese de DNA. Entretanto, apresentou maior capacidade de síntese de RNA, indicando que o crescimento na fase de restrição ocorreu principalmente por aumento no tamanho dos hepatócitos (hipertrofia celular). Durante o período de restauração alimentar todos os tratamentos apresentaram desenvolvimento hepático normal, ou seja, crescimento de células e do órgão por hiperplasia e hipertrofia.

Granuloma periférico de células gigantes: reporte de un caso / Peripheral giant cells granuloma: a clinical case report

El granuloma periférico de células gigantes (GPCG) es una lesión pseudotumoral exofítica poco frecuente en cavidad oral, localizado principalmente en el maxilar inferior en zona de premolares y molares, sangrante y de crecimiento rápido, asociado a factores irritativos o agresión (extracción, traumatismo, placa, sarro, obturación desbordante, infección crónica, impactación alimentaria, etc.). Su tratamiento es la excisión quirúrgica, retirando los factores irritativos. Dentro de sus diagnósticos diferenciales se encuentran el tumor pardo del hiperparatiroidismo, el querubismo y el quiste óseo aneurismático, que tienen el mismo patrón histológico del granuloma periférico de células gigantes. Se reporta caso clínico de paciente femenino de 52 años de edad que acudió a consulta odontológica en la Facultad de Odontología de la Universidad de Cartagena, por presentar una lesión tumoral ubicada en encía vestibular y lingual zona de anteroinferiores asociada con abundante placa bacteriana y cálculos subgingivales. Se le realizó la escisión quirúrgica de la lesión, exodoncia de los dientes involucrados por la marcada pérdida ósea, curetaje y se envió a patología donde se confirmó diagnóstico de granuloma periférico de células gigantes.

The peripheral giant cell granuloma (PGCG) is a pseudotumoral exophytic lesion, very rare in oral cavity, it is primarily located in the premolar and molar area of the mandible, it usually presents bleeding and rapid growth, also, is associated with aggression or irritating factors (extraction, trauma, plaque, tartar, faulty restorations, chronic infection, food impaction, among others). Its treatment consists of surgical excision, removing the irritating factors. Within its differential diagnosis are the hyperparathyroidism brown tumor, cherubism and aneurysmal bone cyst, which have the same histological pattern as the peripheral giant cell granuloma. This is a description of a clinical case of a female patient, age 52 who attended the College of Dentistry of the University of Cartagena because she presented a tumor located in the vestibular and lingual gingival area of anterior and lower zone associated with abundant bacterial plaque and subgingival calculus. The surgeon made the surgical excision of the lesion, extraction of teeth affected by the marked bone loss, and curettage. The sample was sent to the pathology lab which confirmed the diagnosis of peripheral giant cell granuloma.

Efeitos das emissões geradas pela queima dos canaviais sobre a superfície ocular / Effects of sugar cane burning emissions on the ocular surface

Efeitos adversos das emissões geradas pela queima da cana-de-açúcar representa um problema que afeta principalmente os países em desenvolvimento. Estudos prévios têm demonstrado que, durante o período de queima, há um aumento das admissões hospitalares e atendimentos de emergência nas cidades do Brasil próximas às plantações de cana. Entretanto, até o momento, não há estudos que avaliaram os efeitos sobre a superfície ocular. O presente trabalho avalia o impacto causado pela queima da cana sobre a superfície ocular em cortadores de cana e na população da região de Tatuí-SP. Vinte e dois cortadores de cana e dezenove voluntários do perímetro urbano de Tatuí-SP, localizada no Estado de São Paulo, foram recrutados para o estudo. Medidas ambientais das concentrações de material particulado de 2,5 Vm (MP2,5), temperatura e umidade foram mensuradas durante os períodos de queima e entre safra. Ao mesmo tempo, avaliações histológicas e clínicas da superfície ocular, tais como, citologia de impressão da região tarsal, tempo de rotura do filme lacrimal (TRFL), teste de Schirmer I, colorações vitais por rosa bengala e fluoresceína, biomicroscopia e sintomas oculares foram realizadas durante os dois períodos. Níveis de MP2,5 durante a atividade de corte da cana queimada foi 3,5 vezes mais elevados do que o limite de 25Vg/m3 sugerido pelo órgão de regulamentação. Nas avaliações oculares, observamos que os valores médios das áreas coradas por ácido periódico de Schiff (PAS) das amostras dos cortadores foram menores durante o período de queima (57±6,8%) do que na entre safra (64,3±12%; p=0,014) e quando comparadas com as amostras dos voluntários da cidade (63,9±6.8%; p=0,009). Modelo de regressão não-linear revela uma forte associação entre os valores médios das áreas PAS positivas e os anos de trabalho no corte da cana queimada. Detectamos um aumento nas áreas PAS positivas conforme os anos de trabalho acumulados no corte da cana queimada durante o período...

The adverse effects of particle emissions produced by sugar cane burning represent a problem that affects mostly developing countries. Previous studies have shown that, during the burning period, there is an increase in respiratory hospital admissions and emergency room visits in communities surrounded by sugar cane plantations in rural cities of Brazil. However, until this date, no previous studies have evaluated the effects on the ocular surface. The aim of the present work is to study the impact of the sugar cane burning on the ocular surface of cane workers and the people at the city of Tatuí, near the burning crops. Twenty-two healthy sugar cane workers and nineteen volunteers from Tatuí region located at the State of Sao Paulo, Brazil, were recruited to the study. Measurements of the average concentrations of particulate matter 2.5 Vm, temperature and humidity were done during the burning and non-burning periods. Concurrently, histological and clinical assessments of the ocular surface such as, inferior tarsal impression cytology, tear film break-up time, Schirmer´s I test, fluoresce in and rose bengal staining, biomicroscopy and eye irritation symptoms were evaluated during the two periods. PM2.5 exposure levels in the crops during the activity of burnt cane cutting were 3.5-fold higher than the suggest limit of 25Vg/m3 proposed by governmental regulation. On ocular assessments, we observed that the average of periodic acid-Schiff (PAS) positive areas of sugar cane workers samples were lower during the burning (mean 57%, SD 6.8) than the non-burning period (mean 64.3%, SD 12; p=0.014) and the downtown volunteers samples (mean 63.9%, SD 6.8; p=0.009). A non-linear regression model reveals a strong relationship between average PAS positive areas and years working in sugar cane harvesting. We noticed an increase in PAS positive areas as long as the years accumulated in sugar cane harvesting...

The Role of Neutrophils and Epidermal Growth Factor Receptors in Lipopolysaccharide-Induced Mucus Hypersecretion / 결핵

BACKGROUND: Goblet cell hyperplasia is a critical pathological feature in hypersecretory diseases of the airways. A bacterial infection of the lung is also known to induce inflammatory responses, which can lead to the overproduction of mucus. Recently, mucin synthesis in the airways has been reported to be regulated by neutrophilic inflammation-induced epidermal growth factor receptor (EGFR) expression and activation. In addition, it was reported that migration of the activated neutrophils is dependent on the matrix metalloproteinases (MMPs), especially MMP-9. In this study, bacterial lipopolysaccharide (LPS)-induced goblet cell hyperplasia and mucus hypersecretion by EGFR cascade, resulting from the MMPs-dependent neutrophilic inflammation were investigated in the rat airways. METHODS: Pathogen-free Sprague-Dawley rats were studied in vivo. Various concentrations of LPS were instilled into the trachea in 300microliter PBS (LPS group). Sterile PBS (300microliter) was instilled into the trachea of the control animals (control group). The airways were examined on different days after instilling LPS. For an examination of the relationship between the LPS-induced goblet cell hyperplasia and MMPs, the animals were pretreated 3 days prior to the LPS instillation and daily thereafter with the matrix metalloproteinase inhibitor (MMPI; 20 mg/Kg/day of CMT-3; Collagenex Pharmaceuticals, USA). The neutrophilic infiltration was quantified as a number in five high power fields (HPF). The alcian blue/periodic acid-Schiff (AB/PAS) stain were performed for the mucus glycoconjugates and the immunohistochemical stains were performed for MUC5AC, EGFR and MMP-9. Their expressions were quantified by an image analysis program and were expressed by the percentage of the total bronchial epithelial area. RESULTS: The instillation of LPS induced AB/PAS and MUC5AC staining in the airway epithelium in a time- and dose-dependent manner. Treatment with the MMPI prevented the LPS-induced goblet cell hyperplasia significantly. The instillation of LPS into the trachea induced also EGFR expression in the airway epithelium. The control airway epithelium contained few leukocytes, but the intratracheal instillation of LPS resulted in a neutrophilic recruitment. A pretreatment with MMPI prevented neutrophilic recruitment, EGFR expression, and goblet cell hyperplasia in the LPS-instilled airway epithelium. CONCLUSION: Matrix metalloproteinase is involved in LPS-induced mucus hypersecretion, resulting from a neutrophilic inflammation and EGFR cascade. These results suggest a potential therapeutic role of MMPI in the treatment of mucus hypersecretion that were associated with a bacterial infection of the airways.

The Role of Neutrophils and Epidermal Growth Factor Receptors in Lipopolysaccharide-Induced Mucus Hypersecretion / 결핵

BACKGROUND: Goblet cell hyperplasia is a critical pathological feature in hypersecretory diseases of the airways. A bacterial infection of the lung is also known to induce inflammatory responses, which can lead to the overproduction of mucus. Recently, mucin synthesis in the airways has been reported to be regulated by neutrophilic inflammation-induced epidermal growth factor receptor (EGFR) expression and activation. In addition, it was reported that migration of the activated neutrophils is dependent on the matrix metalloproteinases (MMPs), especially MMP-9. In this study, bacterial lipopolysaccharide (LPS)-induced goblet cell hyperplasia and mucus hypersecretion by EGFR cascade, resulting from the MMPs-dependent neutrophilic inflammation were investigated in the rat airways. METHODS: Pathogen-free Sprague-Dawley rats were studied in vivo. Various concentrations of LPS were instilled into the trachea in 300microliter PBS (LPS group). Sterile PBS (300microliter) was instilled into the trachea of the control animals (control group). The airways were examined on different days after instilling LPS. For an examination of the relationship between the LPS-induced goblet cell hyperplasia and MMPs, the animals were pretreated 3 days prior to the LPS instillation and daily thereafter with the matrix metalloproteinase inhibitor (MMPI; 20 mg/Kg/day of CMT-3; Collagenex Pharmaceuticals, USA). The neutrophilic infiltration was quantified as a number in five high power fields (HPF). The alcian blue/periodic acid-Schiff (AB/PAS) stain were performed for the mucus glycoconjugates and the immunohistochemical stains were performed for MUC5AC, EGFR and MMP-9. Their expressions were quantified by an image analysis program and were expressed by the percentage of the total bronchial epithelial area. RESULTS: The instillation of LPS induced AB/PAS and MUC5AC staining in the airway epithelium in a time- and dose-dependent manner. Treatment with the MMPI prevented the LPS-induced goblet cell hyperplasia significantly. The instillation of LPS into the trachea induced also EGFR expression in the airway epithelium. The control airway epithelium contained few leukocytes, but the intratracheal instillation of LPS resulted in a neutrophilic recruitment. A pretreatment with MMPI prevented neutrophilic recruitment, EGFR expression, and goblet cell hyperplasia in the LPS-instilled airway epithelium. CONCLUSION: Matrix metalloproteinase is involved in LPS-induced mucus hypersecretion, resulting from a neutrophilic inflammation and EGFR cascade. These results suggest a potential therapeutic role of MMPI in the treatment of mucus hypersecretion that were associated with a bacterial infection of the airways.

A Case of Dermatofibroma associated with Follicular Basal Cell Hyperplasia / 대한피부과학회지

Various epidermal changes may be present in the overlying epidermis of dermatofibroma. Follicular basal cell hyperplasia is a relatively rare epidermal change found in 2-23% of dermatofibroma and it should be differentiated from basal cell carcinoma. We report a case of dermatofibroma associated with focal basal cell hyperplasia and a review of the literature.

Pulmonary Lymphangiomyomatosis (One Case and Review of the Literature) / 实用放射学杂志

Objective To improve the diagnosis and treatment of pulmonary lymphangiomyomatosis (PLAM). Methods The clinical data of 1 PLAM case in our hospital was analysed, along with a review of the related literatures.Results PLAM was a rare diffuse interstitial plumonary disease of unknown cause, which was oiraracterized by recurrent spontaneous pneumothorax shortness of breath (dyspnea) with physical activity, haemopthsis and chylothorax. Radiological appearances were extensive bilateral linear pattern, and honeycomb pattern in the end. High resolution CT scan (HRCT) showed multiple thin walled cysts distributed evenly throughout the bilateral lung fields with normal intervening lung parenchyma. Pathological characters were abnormal, pervasice multiplication of smooth muscle of cell in and around the small airway, lymphatic and small blood vessels. Immunohistochemical test showed HMB45(+).Conclusion It should be considered the probability of PLAM when women of childbearing ages have some clinical manifestations as follows, the increasing dyspnoea that can not be relieved similar to emphysema, high- resolution CT scan (HRCT) shows multiple thin walled cysts distributed evenly throughout the bilateral lung fields with normal intervening lung parenchyma, and recurrent pneumothorax or chylothorax. The optimal confirm diagnostic method is lung tissue biopsy.

A Case of Islets Cell Hyperplasia Diagnosed by Selective Arterial Calcium Stimulation Test / 대한내분비학회지

We report a 40-year-old female patient with clinical findings suggestive of insulinoma. Although imaging studies did not reveal any tumors in the pancreas, a selective arterial calcium stimulation test(SACI), procedurally simpler and more effective than transhepatic pancreatic venous sampling, was performed. And then near total pancreatectomy was carried out because the possibility of small insulinoma could not be completely excluded. Grossly, the surgically removed pancreas did not reveal any tumors. However, the pancreas exhibited islets cell hyperplasia. To our knowledge, this is the first reported authentic case in a Korean adult of islet-cell hyperplasia diagnosed by selective arterial calcium stimulation test.

Adenoid Basal Cell Tumor of the Prostate: A case report

Adenoid basal cell tumor of the prostate is a rare tumorous lesion that can be misdiagnosed as adenocarcinoma of the prostate. The malignant potential of adenoid basal cell tumor remains uncertain due to small number of reported cases. This 66-year-old man presented with symptoms of urinary tract obstruction. Under the impression of benign prostatic hyperplasia, a transurethral resection of the prostate (TURP) was performed. The patient was alive with no evidence of recurrence or metastasis 15 months after TURP. Microscopically, most of the lesions were composed of nodular collections of small nests of basaloid cells with peripheral palisading, and clusters of tumor cells forming cribriform pattern. Multiple areas of basal cell hyperplasia and atypical basal cell hyperpalsia were also observed. The coexistence of basal cell hyperplasia, atypical basal cell hyperpalsia, and adenoid basal cell tumor with cribriform pattern in this case supports a morphologic continuum from the benign hyperplastic lesion to malignant neoplasia.

The Effect of dexamethasone on airway goblet cell hyperplasia and inflammation in TiO2-treated sprague-dawley rats / 결핵

BACKGROUNDS: The pathophysiology of chronic airflow obstruction, such as bronchial asthma, is characterized by mucus hypersecretion, goblet cell hyperplasia(GCH), smooth muscle hypertrophy, cells infiltration. In fatal asthma patients, one findings is mucus hypersecretion due to GCH. However, the mechanisms of GCH in these hypersecretory diseases remain still unknown. In this study, a rat model was rapidly induced with GCH by instillation of TiO2 intratracheally. We intend to confirm GCH and association of concomitant inflammatory cells infiltration and to observe the effect of potent antiinflammatory agent, that is dexamethasone, on GCH with inflammatroy cells. METHODS: Twenty-one-8-weeks-old male Sprague-Dawley rats were divided into three groups. Endotoxin-free water was instilled intratracheally in group 1(control) ; TiO2 was instilled in the group 2 ; and dexamethasone was injected intraperitoneally to group 3 before TiO2 instillation. After 120 hours, all rats were sacrificed, and trachea, bronchi, and lungs were resected respectively. These tissues were made as paraffin blocks and stained as PAS for goblet cells and Luna stain for eosinophils. We calculated the ratio of goblet cell to respiratory epithelium and number of infiltrated eosinophils from each tissue. RESULTS: (1) Fraction of goblet cells was significantly increased in group 2 than in group 1 in the trachea and in the main bronchus. (10.19±11.33% vs 4.09±8.28%, p<0.01 and 34.09±23.91% vs 3.61±4.84%, p<0.01, respectively). (2) Eosinophils were significantly increased in the airway of group 2 than that of group 1. (5.43±3.84% vs 0.17±0.47 in trachea and 47.71±16.91 vs 2.71±1.96 in main bronchi). (3) There was significant difference in the decrease of goblet cells and eosinophils(r=0.719, p=0.001). (4) There was significant difference in the decrease of goblet cells after dexamethasone infection between group 2 and group 3 (p<0.01). Also, infiltration of eosinophils was suppressed by dexamethasone. CONCLUSION: We made an animal model of TiO2-induced goblet cell hyperplasia. GCH was observed mainly in the main bronchi with concomitant eosinophilic infiltration. Both goblet cell hyperplasia and eosinophilic infiltration were suppressed by dexamethasone. This animal model may serve as a useful tool in understanding of the mechanism of GCH in chronic airway diseases.

Islet cell hyperplasia of the pancreas presenting as hyperinsulinemic hypoglycemia in an adult

A 72-year-old man who had suffered several episodes of syncope was diagnosed as having hyperinsulinemic hypoglycemia. Although imaging studies and percutaneous transhepatic portal venous sampling did not reveal the existence of any tumors in the pancreas, distal pancreatectomy was performed because the possibility of a small pancreatic endocrine tumor could not be completely rejected. External examination of the surgically removed pancreas did not reveal any tumors. Microscopically, the pancreas exhibited diffuse islet cell hyperplasia without nesidioblastosis. The patient remains euglycemic and has tolerated 24-hour fasting without any medication for a period of 10 months after the operation.

A Case with Severe Bone Disease Due to Primary Hyperparathyroidism Caused by Parathyroid Chief Cell Hyperplasia / 대한내과학회지

The routine screening of patients for hypercalcemia has increased the incidence of hyperpa-rathyroidism, But, Primary hyperparathyroidism is relatively rare disease in korea. Especially, primary hyperparathyroidism caused by parathyroid chief cell hyperplasia has not been reported. The numbers of patients with bone disease, renal stones, other severe complication has declined, but the numbers of patients with psychiatric and neuromuscular disturbance or with asymptomatic disease has increased. We experienced a case with severe bone diseases due to primary hyperparathyroidism caused by parathyroid chief cell hyprepiasia which was confirmed through the mearsurement of serum calcium and parathyroid hormone, neck CT scanning and surgical exploration and which was managed by total parathyroidectomy with autotransplantation.