Green Neutrophilic Inclusion Bodies: a Rare Phenomenon Indicating a More Critical Situation for Patients.

BACKGROUND: Green neutrophil inclusion bodies represents a rare and specific cytoplasmic change in neutrophils, which is often accompanied by acute liver failure and lactic acidosis, making them an indicator of poor prognosis and high mortality risk in patients. METHODS: Here, we report a case with green neutrophil cytoplasmic inclusion bodies from the aspects of clinical manifestation, morphological characteristics, identification of similar inclusion bodies, and scatter diagram distribution, along with a literature review. RESULTS: Green neutrophil cytoplasmic inclusion bodies have a green or blue-green color, variable sizes, and a blocky appearance with ill-defined borders. They are easy to identify and distinguish from similar inclusion bodies and have a characteristic scatter diagram distribution. In addition, their appearance is often accompanied by acute liver failure and lactic acidosis, indicating a very poor prognosis, which is consistent with previous reports. CONCLUSION: Green neutrophilic inclusion bodies are a rare phenomenon indicating a more critical situation for patients. A better understanding of this critical condition is needed to provide insights for clinical prevention and treatment.

[A case of cervical lymph node metastasis after carotid body tumor surgery].

Malignant carotid body tumor is rare, reported this case who had experienced the totally resection of carotid body tumor 16 years ago and presented with cervical tumor now. The patient was a 68 year old male who presented with a low growing left-sided painless neck mass for half a year. Carotid body tumor resection and left carotid artery artificial vascular reconstruction were performed 16 years ago. Physical examination showed that multiple hard and painless masses can be touched behind the left sternocleidomastoid muscle of the neck. Blood routine and biochemical tests were normal. MRI enhancement of the neck showed multiple circular abnormal signals behind the left sternocleidomastoid muscle, with obvious enhancement. The cervical masses of this case were experienced totally resected again, and the postoperative pathology confirmed that it was carotid body tumor and cervical lymph node metastasis. The clinical diagnosis was malignant carotid body tumor with cervical lymph node metastasis. Postoperative PET-CT examination showed multiple lymphadenopathy and abnormal metabolism in hilar, mediastinum and abdominal aorta. Multiple systemic metastasis of malignant carotid body tumor was considered. It was suggested that preoperative whole-body PET-CT examination can be used to evaluate whether the tumor has systemic metastasis.

Interleukin-1ß regulates the expression of glucocorticoid receptor isoforms in nasal polyps in vitro via p38 MAPK and JNK signal transduction pathways.

BACKGROUND: To explore the upstream signal transduction mechanisms responsible for the imbalanced expression of glucocorticoid receptor (GR) isoforms in chronic rhinosinusitis (CRS) mucosa. METHODS: An in vitro model of Glucocorticoid resistance was established by inducing nasal polyp tissue with IL-1ß. Changes in the protein and mRNA expression of GRα, GRß and the key enzymes in the p38 MAPK and JNK signal pathways were measured, respectively, before and after being induced with different doses of IL-1ß and specific inhibitors of p38 MAPK, JNK, ERK, PI3K and PKC. The Glucocorticoid sensitivity was measured using in vitro Glucocorticoid binding assay. Analysis of variance (ANOVA) was used to analyze the data. RESULTS: The mRNA and protein expression levels of GRα, GRß and key enzymes of the p38 MAPK and JNK pathways increased both in time- and concentration-dependent manners in IL-1ß-induced nasal polyp tissue. The expression of GRß increased more significantly than that of GRα, and the GRα/GRß ratio decreased in time- and concentration-dependent manners. Statistically significant differences were found in the GRα/GRß ratio and the mRNA expression of phospho-p38 MAPK and phospho-JNK between the IL-1ß-induced groups and the control groups (P < 0.05). Either a specific inhibitor of the p38 MAPK pathway or a specific inhibitor of the JNK pathway increased the GRα/GRß ratio and the Glucocorticoid affinity. None of the specific inhibitors of ERK, PI3K or PKC had any influence on the expression of GR isoforms. CONCLUSION: Our results demonstrated that the imbalanced expression of GR isoforms in nasal polyp tissue induced by IL-1ß in vitro is mediated through the p38 MAPK and JNK signal pathways.

Endoscopic transoral approach for extracranial hypoglossal schwannoma.

OBJECTIVE: Hypoglossal nerve schwannoma, especially when inside the extracranial region, is extremely rare. This report describes a new endoscopic transoral approach for the removal of extracranial hypoglossal schwannoma. PATIENTS AND METHODS: Three patients (1 male and 2 females, aged 58-63 years) with extracranial hypoglossal schwannoma in the paroccipital condyle and the jugular foramen were treated solely by an endoscopic transoral approach. All patients presented signs of hypoglossal nerve paresis with hemiatrophy of the tongue. In addition, one of them had glossopharyngeal nerve paresis, and vagus nerve paresis was found in another patient. RESULTS: In all patients, tumors underwent successful radical intracapsular removal by the endoscopic transoral approach, as confirmed by the postoperative examinations and MRI. No complications occurred during or after surgery, except that 1 patient had swallowing difficulties and a temporary right vagus palsy during the first day after surgery. All patients were followed up for 6 months, and the lack of any recurrence has been confirmed. Muscle bulk, motor and swallowing functions, and the vagus palsy improved in all patients. CONCLUSION: The endoscopic transoral approach is a safe and useful surgical technique for the removal of intracapsular tumors, including extracranial hypoglossal schwannomas, which involves minimal invasion.

Endoscopic endonasal removal of pituitary adenomas with paraclival internal carotid artery invasion.

OBJECTIVE: To retrospectively evaluate the effectiveness of the endoscopic endonasal removal of pituitary adenomas (PAs) with paraclival internal carotid artery (ICA) invasion. METHODS: Between February 2002 and August 2009, 14 consecutive patients underwent 'pure' extended endonasal transsphenoidal endoscopic surgery for PAs with paraclival ICA invasion. The clinical outcomes of the patients were evaluated, including symptoms, the extent of the tumor, the amount of tumor removed and any complications. RESULTS: Tumor removal, as assessed by intraoperative endoscopic inspection, postoperative magnetic resonance imaging and clinical evaluation, revealed total resection (cured) in 10 out of 14 PA patients, 1 subtotal resection (controlled), and 3 partial resections (improved). Three patients had recurrences and 2 underwent re-resection. A cerebrospinal fluid leak was seen in 1 patient. There were no cases of meningitis. All of the patients who had symptoms were discharged. CONCLUSION: Extended endonasal transsphenoidal endoscopic surgery for PAs with paraclival ICA invasion is a safe and effective alternative procedure after proper training. Moreover, the technique is less invasive and effective and requires less time than traditionally utilized procedures.