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1.
Ocul Oncol Pathol ; 2(4): 230-233, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27843901

ABSTRACT

PURPOSE: To report a case of iris non-Hodgkin lymphoma initially thought to be uveitis-glaucoma-hyphema (UGH) syndrome. METHODS: We reviewed the clinical, radiographic, and histopathologic findings in a patient with recurrent hyphemas and increased ocular pressure who eventually was found to have a rapidly growing iris mass. RESULTS: An 89-year-old man with a history of cataract extraction and mantle cell lymphoma developed recurrent hyphema, which was subsequently revealed to be due to an iris mass. A biopsy revealed non-Hodgkin lymphoma that could not be formally subclassified but was suspicious for mantle cell lymphoma. The tumor showed a partial response to ibrutinib. CONCLUSION: Iris lymphoma can masquerade as a cause of recurrent hyphema after cataract extraction. Ophthalmologists should be aware of this presentation, especially in patients with a history of lymphoma.

2.
J Cutan Pathol ; 43(9): 759-65, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27220356

ABSTRACT

Recent studies suggest cutaneous squamous cell carcinomas (SCCs) of the leg, particularly those occurring multiply in sun exposed skin of nonimmunosuppressed women, are a distinct clinical subtype. There are few reports of the histopathologic features of this subtype. A retrospective chart review of 4 patients with multiple SCCs on the leg was performed and a total of 35 biopsies from the legs examined. Histopathologically, the tumors lacked adjacent actinic keratosis (AK) and often had adjacent basaloid retiform proliferations. Most lesions (all but one) were well differentiated and about 40% could be classified histopathologically as keratoacanthoma. Perineural invasion was absent in all but one case. Using the American Joint Committee on Cancer (AJCC) staging criteria for SCC, 21 tumors were Stage I, and 9 Stage II. During 7-10 years of follow-up, no recurrence or metastasis occurred. Patients with multiple SCCs on the lower extremities can have a range of histopathologic features, from keratoacanthoma-like to well-differentiated SCC.


Subject(s)
Carcinoma, Squamous Cell/pathology , Neoplasms, Multiple Primary/pathology , Skin Neoplasms/pathology , Aged , Aged, 80 and over , Female , Humans , Leg , Male , Middle Aged
3.
J Clin Neurosci ; 31: 205-7, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27095686

ABSTRACT

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare pigmented craniofacial tumor of newborns and infants. We report the imaging findings of a 3-month old male patient with a maxillary MNTI. Detailed discussion on imaging features on various magnetic resonance sequences and CT scan are included. Characteristic radiographic appearance is also described. MNTI, of neural crest origin, display a biphasic population of melanin containing cells and neuroblastic cells, within a moderately vascularized fibrous stroma. The child underwent complete surgical excision with no evidence of recurrence at one year follow up. MNTI is an unusual tumor occurring in early childhood with a predilection for the maxilla. Clinical findings, CT scan and MRI may allow a preoperative diagnosis.


Subject(s)
Maxillary Neoplasms/diagnostic imaging , Neuroectodermal Tumor, Melanotic/diagnostic imaging , Diagnosis, Differential , Humans , Infant , Magnetic Resonance Imaging , Male , Maxillary Neoplasms/pathology , Neuroectodermal Tumor, Melanotic/pathology , Tomography, X-Ray Computed
4.
Oxf Med Case Reports ; 2015(4): 272-5, 2015 Apr.
Article in English | MEDLINE | ID: mdl-26634144

ABSTRACT

Guillain-Barré syndrome (GBS) is an immune-mediated disorder characterized by acute polyneuropathy, ascending paralysis and post infectious polyneuritis. Two-thirds of patients present with a history of recent upper respiratory tract or gastrointestinal infection. The clinical history, neurologic examination and laboratory assessment allow for a straightforward diagnosis in the majority of cases. However, primary biliary cirrhosis (PBC) is known to cause clinically detectable muscular weakness. It is therefore critical to differentiate between PBC-associated muscular weakness and GBS-induced paralysis. Here, we report a patient with a longstanding history of PBC who developed progressive weakness and respiratory failure due to GBS, which clinically mimicked PBC myopathy. This is the first reported association between GBS and PBC.

6.
J Cutan Pathol ; 42(7): 465-70, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25757612

ABSTRACT

Perineural granulomas in cutaneous sarcoidosis have been rarely reported and their clinical significance has yet to be evaluated. Recently, a 27-year-old male presented with multiple pink papules on the flank and lower back, accompanied by a painful, burning sensation. Biopsies revealed well-defined granulomas, consistent with sarcoidosis, in the dermis and involving small cutaneous nerves. We hypothesized that perineural granulomas may be an under-recognized feature of cutaneous sarcoidosis and may be responsible for sensory disturbances. We reviewed cases from 29 consecutive patients with cutaneous sarcoidosis. Perineural granulomas were identified in 18/29 (62%) patients and in 22/40 (55%) biopsies. Perineural granulomas were identified in 7/9 biopsies from the proximal upper extremity, 1/3 from the distal upper extremity, 7/12 from the head and the neck, including 4/4 from the nose, 5/9 from the back, 1/2 from the flank and 1/1 from the proximal lower extremity and 0/4 from the distal lower extremity. The anatomical distribution is similar to sarcoidosis small-fiber neuropathy (SSFN), in which sarcoidosis patients without evident skin lesions experience sensory disturbances of unknown etiology involving the face, the proximal extremities and the trunk. Our results indicate perineural granulomas in cutaneous sarcoidosis are more common than previously appreciated, primarily involve the head, the proximal upper extremities and the back, and may be responsible for neurological manifestations.


Subject(s)
Granuloma/pathology , Sarcoidosis/pathology , Skin Diseases/pathology , Adult , Biopsy , Female , Humans , Male
7.
World J Gastrointest Endosc ; 7(1): 73-6, 2015 Jan 16.
Article in English | MEDLINE | ID: mdl-25610537

ABSTRACT

Russell bodies are eosinophilic intracytoplasmic globules which are likely the result of disturbed secretion of immunoglobulins that accumulate within the plasma cell. Russell body collections have been identified within the stomach, known as Russell body gastritis. Similar lesions within the duodenum are referred to as Russell body duodenitis, which is rare. Several Russell body gastritis case reports are associated with Helicobacter pylori. However, the etiology of Russell body duodenitis remains unclear. Here we report the first case of Russell body duodenitis with immunoglobulin light chain restriction in a background of peptic duodenitis.

8.
J Cutan Pathol ; 41(10): 771-4, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25039972

ABSTRACT

OBJECTIVE: A foreign body giant cell (FBGC) reaction may occur in response to implanted xenogenic biomaterials. Here we report a FBGC reaction to the recently introduced xenogenic biomaterial, tarSys™, used for correction of lower eyelid retraction. METHOD: A retrospective chart review of two patients with FBGC reaction to tarSys™ implantation was performed. RESULTS: Two patients (aged 51, 58 year) with lower eyelid retraction underwent surgical implantation of tarSys™ spacer grafts for correction. Both patients subsequently experienced chronic swelling requiring graft removal. Examination of the specimens showed a palisading FBGC reaction around acellular pink fibrillar material. CONCLUSION: A FBGC reaction may follow implantation of the tarSys™ xenograft.


Subject(s)
Biocompatible Materials/adverse effects , Eyelids/surgery , Foreign-Body Reaction/pathology , Heterografts/transplantation , Biocompatible Materials/administration & dosage , Eyelids/pathology , Female , Giant Cells, Foreign-Body/immunology , Giant Cells, Foreign-Body/pathology , Graft Rejection/diagnosis , Humans , Male , Middle Aged , Retrospective Studies
9.
Am J Dermatopathol ; 35(6): 650-4, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23392133

ABSTRACT

Previous clinical and experimental studies suggested that invasion of the brain by metastatic melanoma may follow the external surfaces of vascular channels, that is, angiotropic extravascular migratory metastasis. Such angiotropic invasion seemss analogous to that of neoplastic glial invasion of the nervous system. We, therefore, have retrospectively investigated 20 primary melanoma cases and their respective metastatic brain lesions. The following parameters were analyzed in each primary melanoma: presence of angiotropism, Breslow thickness, Clark level, mitotic rate, sentinel lymph node (SLN) status, and time interval between the primary lesion and the metastasis. The metastatic brain lesions were examined for the presence of angiotropism. Of the 20 cases, 14 showed angiotropism in the primary lesion. The angiotropic group had a significantly deeper Breslow thickness (median 4.4 mm vs. 1.4 mm, P < 0.01) and was more mitotically active (median 11 vs. 4.7 mitoses/mm, P = 0.04). Interestingly, the angiotropic group had an average time lapse of 33 months from the primary lesion to the brain metastasis, whereas the nonangiotropic group had a 57-month time interval. Although the Kaplan-Meier analysis failed to show a survival difference in this small cohort (P = 0.235), there was a trend toward significance. Seven of 20 brain metastases showed angiotropism; however, no significant correlation between angiotropism in the primary melanomas and the corresponding metastatic lesions could be demonstrated. Indeed, angiotropism in the brain metastases was difficult to assess because the available material were generally small partial biopsy samplings and many showed conspicuous necrosis. Ten melanoma patients underwent SLN biopsy. The 3 of 6 positive cases in the angiotropic group had an average time lapse of 32 months from the primary lesion to the brain metastasis, whereas the 4 positive SLN biopsies in the nonangiotropic group had an average of 63 months. This preliminary study of angiotropism in primary melanomas and their corresponding brain metastasis shows a striking trend suggesting that angiotropism in primary melanomas may predict the rapid development of brain metastases. This study also has demonstrated the difficulty in studying angiotropism in melanoma brain metastases because of small sample sizes and abundance of necrotic tissue. The authors are in the process of collecting larger and more representative numbers of melanoma brain metastases for further investigations.


Subject(s)
Brain Neoplasms/secondary , Cell Movement , Melanoma/secondary , Skin Neoplasms/pathology , Brain Neoplasms/mortality , Chi-Square Distribution , Female , Humans , Kaplan-Meier Estimate , Lymph Nodes/pathology , Lymphatic Metastasis , Male , Melanoma/mortality , Middle Aged , Mitotic Index , Necrosis , Neoplasm Invasiveness , Predictive Value of Tests , Prognosis , Retrospective Studies , Sentinel Lymph Node Biopsy , Skin Neoplasms/mortality , Skin Neoplasms/surgery , Time Factors
10.
PLoS One ; 7(5): e36609, 2012.
Article in English | MEDLINE | ID: mdl-22570731

ABSTRACT

Prenatal stress, psychologically and metabolically, increases the risk of obesity and diabetes in the progeny. However, the mechanisms of the pathogenesis remain unknown. In adult mice, stress activates NPY and its Y2R in a glucocorticoid-dependent manner in the abdominal fat. This increased adipogenesis and angiogenesis, leading to abdominal obesity and metabolic syndrome which were inhibited by intra-fat Y2R inactivation. To determine whether stress elevates NPY system and accelerates adipogenic potential of embryo, here we "stressed" murine embryonic stem cells (mESCs) in vitro with epinephrine (EPI) during their adipogenic differentiation. EPI was added during the commitment stage together with insulin, and followed by dexamethasone in the standard adipogenic differentiation medium. Undifferentiated embryonic bodies (EBs) showed no detectable expression of NPY. EPI markedly up-regulated the expression NPY and the Y1R at the commitment stage, followed by increased Y2R mRNA at the late of the commitment stage and the differentiation stage. EPI significantly increased EB cells proliferation and expression of the preadipocyte marker Pref-1 at the commitment stage. EPI also accelerated and amplified adipogenic differentiation detected by increasing the adipocyte markers FABP4 and PPARγ mRNAs and Oil-red O-staining at the end of the differentiation stage. EPI-induced adipogenesis was completely prevented by antagonists of the NPY receptors (Y1R+Y2R+Y5R), indicating that it was mediated by the NPY system in mESC's. Taken together, these data suggest that stress may play an important role in programming ESCs for accelerated adipogenesis by altering the stress induced hormonal regulation of the NPY system.


Subject(s)
Adipogenesis/drug effects , Embryonic Stem Cells/drug effects , Embryonic Stem Cells/metabolism , Epinephrine/pharmacology , Neuropeptide Y/genetics , Receptors, Neuropeptide Y/genetics , Adipocytes/cytology , Adipogenesis/genetics , Animals , Cell Differentiation/drug effects , Cell Differentiation/genetics , Cell Line , Embryonic Stem Cells/cytology , Gene Expression Regulation/drug effects , Insulin/pharmacology , Mice , Neuropeptide Y/metabolism , Obesity/genetics , Obesity/metabolism , Receptors, Neuropeptide Y/metabolism , Stress, Physiological , Up-Regulation
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