Increased number of pulmonary megakaryocytes in COVID-19 patients with diffuse alveolar damage: an autopsy study with clinical correlation and review of the literature.

Pulmonary megakaryocytes participate in the pathogenesis of lung damage, particularly in acute lung injury. Although megakaryocytes are not mentioned as a characteristic histologic finding associated to pulmonary injury, a few studies reveal that their number is increased in diffuse alveolar damage (DAD). In this autopsy study, we have observed a relevant number of pulmonary megakaryocytes in COVID-19 patients dying with acute lung injury (7.61 ± 5.59 megakaryocytes per 25 high-power fields vs. 1.14 ± 0.86 for the control group, p < 0.05). We analyzed samples of 18 patients, most of whom died after prolonged disease and use of mechanical ventilation. Most patients showed advanced DAD and abnormal coagulation parameters with high levels of fibrinogen, D-dimers, and variable thrombocytopenia. For comparison, pulmonary samples from a group of 14 non-COVID-19 patients dying with DAD were reviewed. They showed similar pulmonary histopathologic findings and an increase in the number of megakaryocytes (4 ± 4.17 vs. 1.14 ± 0.86 for the control group, p < 0.05). Megakaryocyte count in the COVID-19 group was greater but did not reach statistical significance (7.61 ± 5.59 vs. 4 ± 4.17, p = 0.063). Regardless of the cause, pulmonary megakaryocytes are increased in patients with DAD. Their high number seen in COVID-19 patients suggests a relation with the thrombotic events so often seen these patients. Since the lung is considered an active site of megakaryopoiesis, a prothrombotic status leading to platelet activation, aggregation and consumption may trigger a compensatory pulmonary response.

Perineal nodular induration ("Biker's nodule"): report of two cases with fine-needle aspiration cytology and immunohistochemical study.

Perineal nodular induration (PNI) is a fibroblastic pseudotumor that presents almost exclusively in male cyclists. It develops in the soft tissues of the perineum immediately posterior to the scrotum, as a bilateral or single, central or lateralized mass. Although well known to sport medicine specialists, it is a scarcely documented entity in the pathology literature. We present 2 cases of PNI with fine-needle aspiration cytology and immunohistochemistry. They consisted of a paucicellular fibroblastic proliferation containing CD34-reactive spindle and epithelioid cells, small foci of fibrinoid degeneration, numerous blood vessels, and entrapped groups of mature fat cells. Our cases show that the histopathological features of PNI are more varied than those previously described and its immunohistochemical profile is wider. A central cystic focus and a zonal pattern are not consistent features of this entity. The lesional cells can express CD34, a hitherto unreported immunohistochemical finding.

Trichilemmoma arising in the nasal vestibule: report of three cases with special emphasis on the differential diagnosis.

Trichilemmoma is a benign cutaneous epithelial tumor with differentiation towards cells of the outer hair root sheath and usually presents as a small papule on the face of middle-aged or older adults. We herein report three cases of trichilemmoma located in the nasal vestibule, including two of the conventional type and one of the desmoplastic variant. To our knowledge, only one case of trichilemmoma arising in the nasal vestibule has been previously reported. Trichilemmoma must be included in the differential diagnosis of epithelial lesions arising in this location. This is particularly important in the case of the desmoplastic trichilemmoma, a tumor that resembles invasive carcinoma such as desmoplastic squamous cell carcinoma, sclerosing basal cell carcinoma, and trichilemmal carcinoma. The circumscription of the lesion, the architectural pattern of epithelial cell cords and small nests merging with a desmoplastic stroma in the central area of the tumor, the expression of CD34, and the lack of an obvious squamous differentiation or basaloid foci favor the diagnosis of desmoplastic trichilemmoma. All these features help to rule out the diagnosis of carcinoma with significant clinical implications.

Genital seborrheic keratoses are human papillomavirus-related lesions. A linear array genotyping test study.

Controversy exists about the meaning of human papillomavirus (HPV) detection in seborrheic keratosis (SK). To clarify the pathogenic contributing role of HPV in the development of genital SK, we have studied 40 genital SKs, 20 extragenital SKs, and 20 non-SK genital lesions by polymerase chain reaction for HPV, using a Linear Array Genotyping test that detects 37 genital HPV types. Twenty-eight of the 40 genital SK specimens (70%) were positive for HPV. Twenty-seven of the 28 positive cases (96%) contained HPV6, one of them associated to HPV18 and HPV35 (4%), and the remaining lesion (4%) harbored HPV55. However, HPV was detected in only 2/20 extragenital SK samples (10%) and in 1/20 non-SK genital lesions (5%). Our results support a pathogenic relationship between HPV and genital SK by showing: 1) a high rate of virus detection in these lesions, with a strong predilection for HPV6, and 2) scarcity of genital HPV types in most of the remaining non-SK cutaneous genital lesions and in the extragenital SKs. HPV cannot be found in a minority of genital SKs using highly sensitive techniques, and therefore, other presently unknown factors may also be implied in the pathogenesis of these lesions.

Complicaciones quirúrgicas de la cirugía submaxilar / Surgical complications of submandibular gland excision

Introducción: La submaxilectomía es el tratamiento de elección en afección crónica resistente a tratamiento médico o en sospechas tumorales. El objetivo de este estudio es evaluar la morbilidad actual de la submaxilectomía. Material y método: Estudio retrospectivo sobre las submaxilectomías realizadas en un hospital universitario entre 2004 y 2010. Resultados: Se realizaron 29 submaxilectomías, 44,8% (13) por sialoadenitis crónica, 37,9% (11) por tumores submaxilares y en 17,2% (5) casos por tumores adyacentes a la glándula. El tiempo medio de ingreso posquirúrgico fue de dos días. Las complicaciones fueron más numerosas en los casos de submaxilectomía por etiología inflamatoria. Se evidenciaron dos casos (6,8%) de paresia marginal leve, una por etiología tumoral y otra por etiología inflamatoria. Conclusión: A pesar de que la parálisis marginal es una de las complicaciones más relevantes de esta cirugía, en nuestra experiencia la submaxilectomía es una técnica segura (AU)

Introduction and objectives: Submandibular gland excision is the treatment of choice in chronic pathology resistant to medical treatments or in oncological cases. The aim of this study was to analyse its current postoperative complications. Material & Methods: Retrospective study on submandibular gland excisions performed at our University Hospital between 2004 and 2010. Results: A total of 29 submandibular gland excisions were performed: 44.8% (13) for chronic sialadenitis, 37.9% (11) for salivary gland neoplasm and 17.2% (5) for adjacent tumours. Median length of hospital stay was 2 days. Complications were more common after gland excision due to inflammatory causes. There were only 2 cases of paralysis of the marginal facial nerve branch (6.8%); 1 was due to neoplastic pathology and 1, from inflammatory pathology. Conclusion: Despite marginal facial nerve paresis being one of the most relevant issues after submandibular gland excision, this type of surgery is a safe technique in our experience (AU)

Surgical complications of submandibular gland excision.

INTRODUCTION AND OBJECTIVES: Submandibular gland excision is the treatment of choice in chronic pathology resistant to medical treatments or in oncological cases. The aim of this study was to analyse its current postoperative complications. MATERIAL & METHODS: Retrospective study on submandibular gland excisions performed at our University Hospital between 2004 and 2010. RESULTS: A total of 29 submandibular gland excisions were performed: 44.8% (13) for chronic sialadenitis, 37.9% (11) for salivary gland neoplasm and 17.2% (5) for adjacent tumours. Median length of hospital stay was 2 days. Complications were more common after gland excision due to inflammatory causes. There were only 2 cases of paralysis of the marginal facial nerve branch (6.8%); 1 was due to neoplastic pathology and 1, from inflammatory pathology. CONCLUSION: Despite marginal facial nerve paresis being one of the most relevant issues after submandibular gland excision, this type of surgery is a safe technique in our experience.

[Surgical management of salivary gland tumours]. / Tratamiento quirúrgico de los tumores de glándulas salivales.

INTRODUCTION AND OBJECTIVES: Salivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007. MATERIAL AND METHODS: This study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions and cervicotomies), final pathology findings, and course with at least one year follow-up. RESULTS: Forty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 sub-mandibular tumours (6%), 1 palatal tumour (2%) and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were revision parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomy complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Frey's syndrome (2%). CONCLUSIONS: Parotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthin's tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series.

Tratamiento quirúrgico de los tumores de glándulas salivales / Surgical management of salivary gland tumours

Introducción y objetivos: Los tumores derivados del tejido salival son el 3% de los tumores de cabeza y cuello. El objetivo de este estudio es analizar una serie de tumores derivados de tejido salival que han requerido tratamiento quirúrgico en nuestro hospital en el periodo 2004–2007. Material y método: Revisión retrospectiva de 49 tumores derivados de glándulas salivales mayores o menores o de estirpe salival de localización ectópica. Se analizan datos relativos a la historia clínica, pruebas complementarias, datos quirúrgicos (submaxilectomías, parotidectomías y otras intervenciones), anatomopatológicos y de evolución del paciente, con un seguimiento mínimo de 1 año. Resultados: De los 49 tumores salivales, 43 (87%) eran parotídeos; 3 (6%), submaxilares; uno en mucosa oral palatina, y 2 ectópicos cervicales. El 16% de los tumores fueron malignos. La punción aspirativa con aguja fina tuvo una sensibilidad del 40% y una especificidad del 100%. De las parotidectomías, 40 (93%) fueron parotidectomías primarias, y 3 (7%), revisiones de parotidectomías; en 35 (81%) casos fueron parotidectomías superficiales o parciales, y en 8 (19%) fueron totales. Las complicaciones posquirúrgicas en las parotidectomías fueron similares a las descritas en la literatura: parálisis facial permanente tras parotidectomía superficial (5%), necrosis o dehiscencia de herida quirúrgica (13%), hemorragia postoperatoria (4%), fiebre o sobreinfección de la herida (7%), sialoceles transitorios (44%) y síndrome de Frey (2%). Conclusiones: Los tumores parotídeos son los más frecuentes, siendo en su mayoría benignos. En nuestra serie el tumor de Whartin es más frecuente que en otras series. Las complicaciones precoces y tardías de las parotidectomías son poco habituales, aunque en nuestra serie el sialocele es una complicación transitoria frecuente (AU)

Introduction and objectives: Salivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007. Material and methods: This study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions and cervicotomies), final pathology findings, and course with at least one year follow-up. Results: Forty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 sub-mandibular tumours (6%), 1 palatal tumour (2%) and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were revision parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomy complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Frey's syndrome (2%). Conclusions: Parotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthin's tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series (AU)

Superficial acral fibromyxoma: report of 4 cases with CD10 expression and lipomatous component, two previously underrecognized features.

Superficial acral fibromyxoma (SAF) is an uncommon tumor of the superficial soft tissues of acral extremities in middle-aged adults, firstly described in a series of 37 cases by Fetsch et al. in 2001. Since then, just a few case reports have been published. It is histologically characterized by a slightly to moderately cellular proliferation of spindled and stellate-shaped bland fibroblastic cells, arranged in a random, loose storiform, or fascicular growth pattern, within a myxoid, myxocollagenous, or collagenous stroma, with a prominent vasculature. The cells express CD34, CD99, and, frequently, epithelial membrane antigen. We report 4 cases that show clinical, morphological, and immunohistochemical characteristics of SAF and, additionally, exhibit two features rarely documented in previous publications, such as CD10 expression and a lipomatous component. Three of our 4 cases express CD10. The single previously reported case tested for CD10 was also positive. One of our cases contains mature fat cells intermingled with the spindle cells throughout the lesion. This finding has not been documented before in SAF. Our small series shows that SAF frequently expresses CD10 and occasionally can have a lipomatous component.

Angiomyxolipoma (vascular myxolipoma) of subcutaneous tissue.

Three cases of angiomyxolipoma (vascular myxolipoma) have been published to date. We report an angiomyxolipoma located in the subcutaneous tissue of the scalp. Histologically, it consisted of an admixture of paucicellular myxoid areas and mature fat tissue, both containing numerous dilated blood vessels with hyalinized thin walls. The cells in the myxoid areas expressed CD34. This lesion requires differential diagnosis with other benign fat tissue tumors, especially myxoid spindle cell lipoma, superficial angiomyxoma, myxoid liposarcoma, and low-grade myxofibrosarcoma.