ABSTRACT
OBJECTIVES: The aim of this study was to assess the use of muscle biopsy for histopathological confirmation of small vessel vasculitis (SVV) or medium vessel vasculitis (MVV). METHOD: Muscle biopsies were performed for all consecutive cases of suspected SVV or MVV seen at Tokyo Metropolitan Tama Medical Centre between February 2012 and May 2014 except those for which a skin or renal biopsy was indicated. RESULTS: Forty-nine patients underwent muscle biopsies. All patients were followed for a minimum of 6 months. Diagnosis of SVV or MVV was made in 35 patients. An unrelated condition was diagnosed in 11 patients and no diagnoses were made in three patients. Of the 35 patients in whom SVV or MVV was diagnosed, positive muscle biopsies were obtained in 20 patients [15 microscopic polyangiitis (MPA), three polyarteritis nodosa (PAN), and two eosinophilic granulomatosis with polyangiitis (EGPA)], while other findings led to the same diagnosis in 15 (seven MPA, four GPA, three PAN, and one rheumatoid vasculitis). The sensitivity of the muscle biopsy was 57% [20/35; 95% confidence interval (CI) 50-57]. Of 13 patients presenting with peripheral neuropathy, the muscle biopsy demonstrated vasculitis in nine patients, with 75% sensitivity (9/12; 95% CI 69-75). There were no complications in the procedure apart from delayed wound healing in one patient. CONCLUSIONS: Muscle biopsy is a safe method that offers a high diagnostic yield for SVV or MVV, especially in patients with vasculitic neuropathy.
Subject(s)
Churg-Strauss Syndrome/pathology , Microscopic Polyangiitis/pathology , Polyarteritis Nodosa/pathology , Quadriceps Muscle/pathology , Rheumatoid Vasculitis/pathology , Aged , Aged, 80 and over , Biopsy , Churg-Strauss Syndrome/diagnosis , Cohort Studies , Female , Humans , Japan , Male , Microscopic Polyangiitis/diagnosis , Middle Aged , Polyarteritis Nodosa/diagnosis , Prospective Studies , Quadriceps Muscle/blood supply , Rheumatoid Vasculitis/diagnosis , Sensitivity and Specificity , Systemic Vasculitis/diagnosis , Systemic Vasculitis/pathologyABSTRACT
Sclerosing mucoepidermoid carcinoma (SMEC) with eosinophilia is a rare but distinctive tumor usually affecting the thyroid. SMEC involvement of salivary gland is exceptional, with only six cases in the literature. We present here the first case of an intermediate-grade SMEC, arising from the intraoral minor salivary glands. A particularly interesting finding is the cytoplasmic accumulation of eosinophilic hyaline granules in carcinoma cells, similar to aberrant zymogen-like granules previously described in salivary sclerosing polycystic adenosis.
Subject(s)
Carcinoma, Mucoepidermoid/pathology , Gingival Neoplasms/pathology , Salivary Gland Neoplasms/pathology , Salivary Glands, Minor/pathology , Adenoma/pathology , Adult , Cytoplasm/ultrastructure , Eosinophils/pathology , Humans , Hyalin/ultrastructure , Male , Sclerosis , Secretory Vesicles/ultrastructureABSTRACT
Bilateral congenital deafness was observed in a 9-year-old girl with recurrent meningitis. A careful workup, including polytomograph, CT scanning and Radioisotope (RI)-cisternography revealed an inner ear dysplasia of the Mondini type, viz. dilation of the lateral semicircular canal, vestibule and cystic degeneration of cochlea on both ears. RI-cisternography demonstrated an abnormal accumulation of radioisotope in the left mastoid region, suggesting spontaneous cerebrospinal fluid (CSF) otorrhea. At exploratory tympanotomy of the left ear, the CSF leak was found from a round defect in the center of the stapedial foot plate. The CSF leak was treated successfully by packing the vestibule with temporal fascia. Spontaneous CSF otorrhea is seldom the cause of meningitis but has to be considered especially if associated with a dead ear and with recurrent meningitis. The diagnosis and management are discussed.
Subject(s)
Cerebrospinal Fluid Otorrhea/complications , Meningitis, Haemophilus/etiology , Meningitis, Pneumococcal/etiology , Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/pathology , Child , Deafness/congenital , Female , Humans , Meningitis, Haemophilus/diagnosis , Meningitis, Haemophilus/pathology , Meningitis, Pneumococcal/diagnosis , Meningitis, Pneumococcal/pathology , RecurrenceABSTRACT
A new method for testing Eustachian tube function using an otoadmittance meter (Tubotympanometry) is reported. The otoadmittance meter is set for the aural reflex test, namely in the position of Y-T- recording. The patient is asked to carry out deep breathing. Valsalva's maneuvre, normal breathing, and swallowing in succession. In normal 40 ears, three types of the tubotympanogram were classified. In type A, observed in 32 ears, the graph shows no changes during deep breathing, a sudden downward deflection with Valsalva's maneuvre, a return to a level after the maneuvre and on repeated swallowing the graph returns to the initial level in stepwise. In type B, observed in 5 ears, the graph returns to the initial level directly after Valsalva's maneuvre without swallowing. This indicates a slightly patent tube, even though in the normal range. Type C was observed in 3 ears of patients who failed to perform Valsalva's maneuvre correctly. In the case of a patent tube, the graph shows a remarkable fluctuation synchronizing with inspiration and expiration. In the case of an occluded tube, the graph shows slower recovery after Valsalva's maneuvre and no complete return to the initial level even after repeated swallowing. In another case of occluded tube, the graph was deflected upward by Valsalva's maneuvre and showed no change on deglutition. The greatest advantage of this test is the simplicity of the equipment and of the test procedure.
