Eosinophils of patients with localized and diffuse cutaneous leishmaniasis: Differential response to Leishmania mexicana, with insights into mechanisms of damage inflicted upon the parasites by eosinophils.

Eosinophils are mainly associated with parasitic infections and allergic manifestations. They produce many biologically active substances that contribute to the destruction of pathogens through the degranulation of microbicidal components and inflammatory tissue effects. In leishmaniasis, eosinophils have been found within inflammatory infiltrate with protective immunity against the parasite. We analyzed the responses of eosinophils from patients with localized (LCL) and diffuse (DCL) cutaneous leishmaniasis, as well as from healthy subjects, when exposed to Leishmania mexicana. All DCL patients exhibited blood eosinophilia, along with elevated eosinophil counts in non-ulcerated nodules. In contrast, only LCL patients with prolonged disease progression showed eosinophils in their blood and cutaneous ulcers. Eosinophils from DCL patients secreted significantly higher levels of IL-6, IL-8, and IL-13, compared to eosinophils from LCL patients. Additionally, DCL patients displayed higher serum levels of anti-Leishmania IgG antibodies. We also demonstrated that eosinophils from both LCL and DCL patients responded to L. mexicana promastigotes with a robust oxidative burst, which was equally intense in both patient groups and significantly higher than in healthy subjects. Coincubation of eosinophils (from donors with eosinophilia) with L. mexicana promastigotes in vitro revealed various mechanisms of parasite damage associated with different patterns of granule exocytosis: 1) localized degranulation on the parasite surface, 2) the release of cytoplasmic membrane-bound "degranulation sacs" containing granules, 3) release of eosinophil extracellular traps containing DNA and granules with major basic protein. In conclusion, eosinophils damage L. mexicana parasites through the release of granules via diverse mechanisms. However, despite DCL patients having abundant eosinophils in their blood and tissues, their apparent inability to provide protection may be linked to the release of cytokines and chemokines that promote a Th2 immune response and disease progression in these patients.

Rosai-Dorfman Disease involving the eye and ocular adnexa. Clinicopathologic series of 17 patients.

PURPOSE: To describe the clinical features and histopathologic findings of Rosai-Dorfman disease (RDD) with ophthalmic involvement diagnosed at a Mexican ophthalmologic referral center in a period of 62 years. RESULTS: A total of 17 cases of RDD with ophthalmologic manifestations in Mexican-mestizo patients were collected. Female predominance was observed in 12 of 17 patients. The mean age was 36 years with a range of 12-76 years. The median age at presentation was 32 years. The orbit was the most affected location with 15 cases. Conjunctival disease was seen in 4 cases: two as isolated lesions, the rest with orbital or uveal involvement . One case suggested choroidal RDD associated to conjunctival and orbital lesion. Three cases presented multifocal disease. A patient with orbital affection developed extranodal disease elsewhere. No concurrent lymphadenopathy was observed in any patient.Histopathological examination revealed classic RDD findings in all cases: A polymorphous cellular infiltrate composed by lymphocytes, plasma cells and large histiocytes with emperipolesis hallmark of the disease. Immunohistochemically, histiocytes were positive for S-100 protein and CD68 in 15 cases. CONCLUSION: RDD of the eye and ocular adnexa in Mexican-mestizo patients is common in middle-aged women frequently as an isolated orbital lesion. Histopathology is necessary for accurate diagnosis. Most patients had a favourable outcome after medical and surgical treatment. To the best of our knowledge this is the largest case series of RDD of the eye and ocular adnexa in Latin-American patients.

Primary conjunctival myxoma: case series and review of the literature.

AIMS: Myxomas are benign soft tissue tumours resembling primitive mesenchyme. They rarely involve ocular structures, and have been recognized in the conjunctiva, eyelids, cornea, and orbit. The aim of this study was to investigate the clinicopathological features of seven patients with primary conjunctival myxoma seen at Dr Luis Sánchez Bulnes Hospital, an ophthalmological referral centre in Mexico City. METHODS AND RESULTS: We reviewed the clinical, histochemical and immunohistochemical studies of patients with documented myxoma of the conjunctiva diagnosed in our hospital. Seven conjunctival myxomas were retrieved from 5923 conjunctival biopsies (0.1%). The mean age of patients was 40 years, with a range of 27-51 years. Females were more frequently affected, and none of our patients had systemic disease. The left eye was involved in five cases, and most of the lesions were located in the bulbar conjunctiva. Histopathological examination revealed a benign tumour composed of spindle-shaped and stellate-shaped cells immersed within an abundant mucinous matrix with sparse vessels and reticulin fibres. Immunohistochemistry demonstrated positivity for vimentin and negativity for smooth muscle actin, SOX10 and GLUT1 in myxoma cells of all cases. S100 was found to be positive in four cases, and muscle-specific-actin in three cases. CONCLUSIONS: Conjunctival myxomas are uncommon tumours. For accurate diagnosis, histopathological examination is mandatory. The treatment of choice is surgical removal, and the prognosis is excellent.

Periocular myxoma in a child.

Myxomas are locally invasive, benign mesenchymal neoplasms with odontogenic, osteogenic, or soft tissue origin. Facial myxomas probably account for less than 0.5% of all paranasal sinus and nasal tumors. We report a case of a left painless periocular mass in a 11-month-old girl. The lesion was resected with a clinical diagnosis of lacrimal sac tumor. Histopathology and immunohistochemistry proved the tumor to be a myxoma. There has been no recurrence after 4 years of followup. Midfacial myxomas should be differentiated from other benign and malignant tumors such as dermoid, hamartoma, neurofibroma, nasolacrimal duct cyst, and sarcomas in particular embryonal rhabdomyosarcoma. Because of the infiltrative nature of these tumors, a wide surgery is required to achieve clear resection margins and avoid recurrence.

Angiolymphoid hyperplasia with eosinophilia of the lacrimal gland: a case report.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare clinicopathologic entity that has been the subject of considerable confusion and debate. ALHE shares both clinical and histopathologic features with Kimura disease (KD). Because of this overlap, ALHE and KD have been used synonymously in the Western medical literature, as they were thought to represent variations of the same disease. Some pathologic reports have called for distinguishing ALHE and KD as two separate nosological entities, based on their clinical, laboratory, and especially histopathologic findings. ALHE commonly affects women in the third and fourth decades, with head and neck involvement. ALHE has been described rarely in the orbit, eyelids, and lacrimal gland. We report a case of ALHE involving the left lacrimal gland in a 40-year-old Mexican woman. Because ALHE can cause proptosis, lid swelling, ocular dysmotility, or a palpable mass, it should be considered in the differential diagnosis of orbital lesions occurring in adults.

Diagnosis of thymolipoma with fine needle aspiration biopsy. Report of a case initially misdiagnosed as liposarcoma.

BACKGROUND: Thymolipomas are the most outstanding mesenchymal mediastinal tumors although they represent only a small percentage of thymic neoplasms. Their histogenesis remains unsolved, and they are usually benign. Fine needle aspiration biopsy (FNAB) has become the method of choice for the study of mediastinal tumors, including thymolipomas. Making the correct diagnosis depends on the availability of all thymic and lipomatous components as well as on the correct application of a differential diagnosis with other lipomatous tumors. CASE: A 24-year-old woman had a 3-month history of coughing with sputum, fever, asthenia, adynamia, headaches and anemia. Physical examination revealed a bilateral pulmonary condensation syndrome. Imaging studies showed a well-defined, large mass occupying both hemithoraxes and the mediastinum. FNAB revealed an admixture of atypical adipocytes, nonneoplasic lymphoid tissue and capillaries with prominent endothelium. An initial diagnosis of well-differentiated liposarcoma was made. A 2.8-kg, encapsulated, yellowish gray mediastinal tumor was surgically removed. Mature adipose tissue intermingled with abundant thymic tissue containing numerous Hassall's corpuscles were seen histologically. Immunohistochemical markers for thymic epithelium, lymphoid tissue and adipocytes were all positive. Thymolipoma was the final diagnosis. The anemia subsided with resection of the tumor, and the patient was disease free 2.5 years after surgery. CONCLUSION: To the best of our knowledge, this is the second report of a thymolipoma studied with FNAB. The criteria for the differential diagnosis between thymolipomas and other lipomatous tumours should be kept in mind.

A corneal diffuse neurofibroma as a manifestation of von recklinghausen disease.

PURPOSE: To report a case of a primary corneal diffuse neurofibroma in a patient with von Recklinghausen disease (NF-1). METHODS: Case report. A physical examination and histopathology were performed. The immunohistochemical studies were performed using an avidin-biotin-peroxidase complex technique on formalin-fixed and paraffin-embedded tissue. Histologic sections from corneal tissue were incubated with primary antibodies against vimentin and S-100 protein. A complementary ultrastructural study of the same formalin-fixed and paraffin-embedded tissue was made. RESULTS: The ophthalmologic examination revealed a yellowish-white elevated mass that involved the supratemporal cornea but not the limbus. Histologic study showed a tumor of the peripheral nerve sheath, a diffuse neurofibroma in the corneal stroma, and proliferation of spindle cells with markedly elongated nuclei. Cells comprising the tumor reacted with vimentin and S-100 protein, and the ultrastructural studies revealed myelinated nerve fibers confirming the diagnosis. CONCLUSION: The development of a primary diffuse neurofibroma in the cornea of patients with von Recklinghausen disease is possible. The present case supports the statement that neurofibromas arising from the peripheral nerve sheath may involve any part of the body.

Angiosarcoma primario de la órbita: informe de dos casos y revisión de la literatura / Primary orbital angiosarcoma: two cases report and literature

Se informan los casos de un hombre de 53 años y una mujer de 52 años de edad, quienes en el transcurso de 7 y 2 meses respectivamente presentaron dolor retroocular, proptosis y oftalmoplegia. El segundo paciente presentaba además inflamación del párpado superior y lesión subconjuntival ipsilateral. Los estudios de tomografía axial computarizada (TAC) mostraron grandes masas orbitarias de localización superotemporal en ambos casos. El tratamiento de elección fue la escisión local. El diagnóstico del primer caso se modificó con base en los hallazgos histopatológicos por microscopía de luz. En el segundo caso se realizó estudio de inmunohistoquímica para confirmar el diagnóstico original de angiosarcoma (AS). Los hallazgos clínicos, histopatológicos e inmunohistoquímicos son analizados con detalle y se comparan con los casos previamente reportados en la literatura.

Comportamiento biológico atípico del rabdomiosarcoma alveolar en cinco pacientes / Atypical biological behavior of alveolar rhabdomyosarcoma in five patients

Se informan cinco casos de rabdomiosarcoma alveolar con presentación clínica atípica. Tres pacientes presentaron linfadenomegalias como primera manifestación clínica, imitando el comportamiento de un linfoma o de un tumor primario no identificado con metástasis ganglionares. Un sujeto presentó enfermedad tumoral sistémica, y dos presentaron el tumor primario en localizaciones atípicas, como el mediastino y el retroperitoneo. Todos los enfermos fallecieron y cuatro fueron autopsiados. El diagnóstico histopatológico fue confirmado por medio de estudios de inmunohistoquímica en cuatro casos. El rabdomiosarcoma alveolar tiene mal pronóstico y puede presentar un comportamiento clínico y una morfología variable, simulando linfomas, leucemias y enfermedad metastásica sistémica sin tumor primario conocido, como en los casos que aquí se informan

Tercer caso de capilariasis hepática humana en México / Third case of human hepatic capillariasis in Mexico

Se presenta un caso de capilariasis hepática en una mujer de 54 años que estuvo confinada en una institución psiquiátrica. Ingresó al Hospital General de México para recibir cuidados terminales de un cáncer avanzado de mama; murió 12 días después de su ingreso. Clínicamente se detectó hepatomegalia y en la autopsia se encontraron numerosos huevecillos de Capillaria hepática en el hígado. No se observó eosinofilia. Veintiséis casos de capilariasis hepática humana se han registrado en la literatura mundial. Este caso es el tercero que se presenta en la república mexicana, y mientras que los dos primeros ocurrieron en niños éste es el primero en un adulto. Por haber tenido un padecimiento psiquiátrico importante, la paciente pudo haber tenido hábitos alimenticios aberrantes. Por primera vez se describen e ilustran los huevecillos de C. hepática teñidos con metenamina de Jones, lo que permite demostrar una capa multilaminada interna y otra externa dotada de canalículos radiados

Tumor fibroso solitario de la cavidad nasal / Solitary fibrous tumor of the nasal cavity

El tumor fibroso solitario (TFS) es una neoplasia mesenquimatosa benigna rara, que generalmente se localiza en la pleura; pero también puede presentarse en las fosas nasales y senos paranasales. Este es el primer caso con esa localización informado en México. Se presento en una mujer de 33 años que tenía 3 años de evolución con obstrucción nasal, ocasionada por un tumor que provenía de la pared lateral nasal, la cual se extirpó mediante un abordaje sublabial ampliado. Microscópicamente mostró diferentes patrones de crecimiento, ultraestructuralmente mostró diferentes patrones de crecimiento, ultraestructuralmente mostró células fusiformes con mitocondrias y retículo endoplásmico rugoso así como escasos filamentos intermedios e inmunohistoquimicamente fue positivo para vimentina y proteína CD34, hallazgos que caracterizan a este tumor

Linfangiomiomatosis pulmonar y Linfangiomiomas: presentación de 8 casos y revisión de la literatura / Lymphangiomyomatosis and lymphangiomyomas: a study of 8 cases and review of the literature

Se presenta un estiduo clinicopatológico de 3 casos de linfangiomiomatosis pulmonar y mediastinal y de 5 linfangiomiomas de mediastino, retroperitoneo, mesenterio (2) y hombro. Seis pacientes fueron del sexo femenino y 2 del masculino, sus edades variaron de 19 meses a 47 años. Todos los pacientes presentaron grandes tumores por períodos que variaron de meses a muchos años, los cuales no afectaron su estado general. Cinco linfangiomiomas y un pulmón con linfangiomiomatosis se extirparon quirúrgicamente, a dos pacientes con linfangiomiomatosis solamente se les pudo biopsiar. Las lesiones midieron entre 12 y 32 cm de eje mayor, frecuentemente eran de aspecto multiquístico con pequeñas áreas sólidas. Microscópicamente, se observaron innumerables espacios quísticos, separados por septos tapizados con revestimiento endotelial y/o epitelial y dotados de músculo liso en haces. Un estudio inmunohistoquímico demostró que los quistes de la linfangiomiomatosis pulmonar tiene su orígen principalmente en conductos aéreos, mientras que los de los linfangiomiomas son exclusivamente de naturaleza vascular. Se informan 3 casos excepcionales en edad pediátrica (1 7/12, 9 y 11 años ) 2 localizaciones no descritas antes (mesenterio y hombro). Se presenta una revisión de las características clinicopatológicas de las dos formas de la enfermedad y su probale asociación con esclerosis tuberosa. Se discuten algunas ideas sobre la histogénesis y la etiopatogenia en estas lesiones de probable naturaleza hamartomatosa o corsistomatosa.

Estudio inmunohistoquímico de antígenos del condiloma y carcino embrionario en el cérvix uterino con infección por virus del papiloma humano y con neoplasia / Immunohistochemical study of condyloma and carcino embryonic antigens in uterine cervix infected with human papilloma virus and with neoplasim

Con la técnica de inmunoperoxidasa PAP se intentó demostrar antígeno carcinoembrionario (ACE) en 37 biopsias de cérvix divididas en 4 grupos: 1) condiloma solo, 2) condiloma con neoplasia intraepitelial cervical (NIC), 3) carcinoma epidermoide invasor solo y 4) cérvix normal y con inflamación crónica. De las 37 biopsias 22 correspondieron a condiloma solo y condiloma asociado a NIC de diversos grados, y en 20 de ellas o sea 90,9% se obtuvieron resultados positivos. En los 7 caos de carcinoma epidermoide in situ e infiltrante la reacción también resultó positiva para ACE. Con la misma técnica se estudiaron 20 biopsias de cérvix de los 4 grupos, para tratar de demostrar antígenos de condiloma: únicamente en las 5 muestras de condiloma solo y en 3 de 4 condiloma, con NIC las reacciones fueron positivas. En cambio, en el carcinoma invasor y en el cérvix y con inflamación crónica, la reacción resultó negativa. Se concluyó que los signos histomorfológicos de infección cervical por virus del papiloma tiene un alto grado de certeza, que aparentemente la infección por virus del papiloma provoca una alteración en la diferenciación celular que se manifiesta por reaparición de ACE, y que el virus del papiloma probablemente juega un papel muy importante en la oncogénesis del carcinoma cervicouterino