IgA Vasculitis Following COVID-19 Vaccination.

As new variants of SARS-CoV-2 continue to emerge worldwide, countries are striving to fully vaccinate their population in a bid to prevent severe disease, subsequent hospitalizations, and the associated strain on their healthcare systems and death. In this context, there is growing evidence of rare, potential side effects associated with COVID-19 vaccines. IgA vasculitis is a systemic, IgA-mediated vasculitis characterized by palpable purpura, arthralgia, abdominal pain, and renal involvement. It is the most common type of vasculitis in childhood, sporadically affecting the adult population. However, there have been multiple reports of IgA vasculitis following vaccination against COVID-19. Herein, we present the case of a 72-year-old patient with palpable purpura that developed two weeks after receiving the Pfizer BioNTech vaccine. Laboratory investigations revealed elevated serum creatinine (2.6 mg/dL), macroalbuminuria (8.6 g/24 h), and macroscopic hematuria. Histopathological examination confirmed necrotizing vasculitis, and a diagnosis of IgA vasculitis was established. Considering the clinical presentation, the laboratory and histopathological findings, and the time interval between the vaccination and the development of symptoms, we strongly believe that IgA vasculitis in this patient arose as a side effect of the Pfizer BioNTech vaccine.

Unusual localization of a primary pleomorphic malignant fibrous histiocytoma on the mitral valve: a case report and review of the literature.

INTRODUCTION: It has been reported that cardiac malignant fibrous histiocytomas occur more frequently in the left side of the heart, especially in the left atrium, but rarely invade the mitral valve. We present a case with a giant malignant fibrous histiocytoma with an unusual localization involving almost the entire left atrium, mitral valve, and left superior pulmonary vein. CASE PRESENTATION: We describe the case of a 54-year-old woman from Kosovo admitted to our emergency department with dyspnea. A transthoracic echocardiography demonstrated a giant mass localized on her left atrium. Our patient underwent emergent total surgical removal of the mass. The mass extended between her left superior pulmonary vein, and extended to her left atrium and the posterior mitral valve leaflet. We formulated a surgical plan for total separation of the mass from the endocardium. Total removal was performed and her left side pulmonary veins were entirely freed from the mass. We then performed a mitral valve replacement. The differential diagnosis included other masses of the left atrium, including thrombi, vegetations, and cardiac tumors. Postsurgical histopathologic results showed a pleomorphic malignant fibrous histiocytoma. Six monthly follow-up cardiac and abdominal sonographic examinations revealed no tumor recidivism. CONCLUSION: We reviewed 90 cases with malignant fibrous histiocytoma reported in the literature. Our case was especially unusual because of the primary location in the mitral valve, the pleomorphic variant, and the dimensions and extension. Complete surgical resection is mandatory to ameliorate symptoms and to obtain histologic information.

Primary Cardiac Synovial Sarcoma Originating From the Mitral Valve Causing Left Ventricular Outflow Tract Obstruction.

An 11-year-old boy was admitted with complaints of syncope and convulsion. Echocardiogram revealed a mass measuring 2 × 4 cm related to the mitral subvalvular apparatus. The mass, which appeared to be attached to the anterolateral papillary muscle, protruded into the left ventricular outflow tract causing intermittent obstruction. The patient underwent surgical excision of the mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At six months following the operation, a small mass measuring 1 × 1 cm was detected in the left ventricle. The patient underwent reoperation consisting of radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was cardiac synovial sarcoma. One year after surgery, the patient is doing well.

Surgical excision of a giant calcified amorphous tumour of the right ventricle and right pulmonary artery.

A cardiac calcified amorphous tumour (CCAT) is a rare non-neoplastic intracavitary mass with unknown causes. We describe a 32-year old male presenting with progressive dyspnoea, cough and oedemas. The transthoracic echocardiography and contrast-enhanced angio-computed tomography demonstrated a 4 × 10 cm calcified mass into the right ventricle and total occlusion of the right pulmonary artery. The patient underwent successful total removal of the mass through a transverse right ventriculotomy, and right pulmonary embolectomy. Histopathological examination of mass confirmed the diagnosis of a CCAT. The postoperative course was uneventful. To our knowledge, this is the first reported case with a confirmed diagnosis of CCAT at two different locations and the third undergoing a combined approach aiming at total mass excision.

Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation.

The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the most frequently found tumor occurring in the cardiac valves. With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. The PFEs have been found most often on valve leaflets, chordae tendineae, and both ventricles. We describe an interesting case of the PFE originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE.

Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation.

INTRODUCTION: The papillary fibroelastoma (PFE) is a rare and benign primary cardiac tumor, and the mostly frequently found tumor occurring in cardiac valves. CASE PRESENTATION: We describe a 52 year old female presenting a history of 2 weeks of fever due to wound infection after breast's surgery. A preoperative echocardiography demonstrated a mass >1cm(2) originating from the anterior leaflet of the mitral valve mimicking vegetation. The patient underwent successful surgical removal of the PFE. The histologic evaluation demonstrated a PFE. DISCUSSION: With the introduction of echocardiography, the diagnosis of these tumors in living patients has been reported sporadically. PFE have been found most often on valve leaflets, chordae tendineae, and both ventricles. The differential diagnosis of PFE includes other cardiac tumors, thrombus, vegetation, and Lambl's excrescences. CONCLUSION: To summarize, we report a PFE of the anterior leaflet of the mitral valve. The diagnosis was confirmed by histopathological examination after surgical removal. Finally, careful echocardiographic analyses during evaluation of valvular masses are strongly recommended for differential diagnosis.

Primary cardiac synovial sarcoma originating from the mitral valve causing left ventricular outflow tract obstruction.

An 11-year-old boy was admitted due to different episodes of syncope and convulsion. Echocardiogram revealed a mass of 2 × 4 cm originating from the mitral subvalvular apparatus and more precisely from the antero-lateral papillary muscle, protruding in the left ventricle outflow tract causing intermittent obstruction. The patient underwent surgical excision of the left sided mass. Pathology confirmed the diagnosis of primary synovial sarcoma. At 6 months after the operation a small mass in the left ventricle of 1 × 1 cm was detected. The patient underwent reoperation consisting in radical resection of the subvalvular apparatus and mitral valve replacement. Histology confirmed that the mass was a cardiac synovial sarcoma. At 1 year after surgery the patient is doing well.

Dysplasia in Gastric Mucosa and its Reporting Problems.

BACKGROUND: The recognition, terminology used and histopathologic evaluation of two essential elements in gastric carcinogenesis, atrophy and dysplasia, are characterized by controversy. MATERIALS AND METHODS: One hundred fifteen cases, with slides and their histopathologic reports from the archive of the Laboratory of Pathology were studied for the diagnostic value, reporting of dysplasia, interobserver variability, the relation of dysplastic lesions with inflammation, atrophy and metaplasia. After retrospectively studying the histopathologic reports from the archive we distributed the cases according to endoscopic and histopathologic diagnosis, together with the reexamination of the slides. The comparison of the median values of the numeric variables was made with the Mann-Whitney test (non-parametric equivalent of the Student's "t" test). RESULTS: The endoscopic clinical diagnosis were: malignancy/suspicious for malignancy 88 cases (76%) and non-neoplastic diagnosis (like ulcer or gastritis) 27 cases (24%). From the reexamination of the cases it resulted that there is no difference in reporting the malignancy, but there is a difference in the cases reported as dysplasia (p = 0.001) and negative for neoplasia (p = 0.063, borderline). CONCLUSION: Clinicians and pathologists can feel directly the discrepancy called "interobserver variability" and should be assured that the use of guidelines will cause a lowering of this variability.

A giant cardiac malignant peripheral nerve sheath tumor presenting with total obstruction of the superior vena cava.

A 16-year-old boy presenting with dyspnea, facial swelling, cyanosis, and fatigue was found to have a tumor involving the heart, causing superior vena cava and brachiocephalic venous trunk total obstruction. This was diagnosed as malignant peripheral nerve sheath tumor, a rare sarcoma of the heart. The patient underwent successful resection of the tumor, and reconstruction of the superior vena cava and right atrium. Immunohistochemistry was utilized to establish the diagnosis. The details of the patient's clinical course and imaging findings with morphologic and immunohistochemistry data are reported.

Cystic benign teratoma of the neck in adult.

Teratomas are embryonal neoplasms that arise when totipotential germ cells escape the developmental control of primary organizers and give rise to tumors containing tissue derived from all three blastodermic layers. Teratomas have been reported to occur in various sites and organs. Teratoma of the cervical neck are relatively rare in adulthood. It usually extends from the neck to the thoracic cavity causing local mass effect. In most of the cases intrauterine diagnosis is possible by ultrasound. Because of dyspnea due to mass effect, this condition is treated promptly after birth. However cases of teratoma in adulthood with supraclavicular localization have been reported rarely in the literature. The presented case is of a 25-year-old female with a cervical mass. Histological examination revealed a benign mature teratoma. The patient has been disease free for more than nine years after surgical removal of a neck teratoma.