Inflammation, fibrosis and E1 glycoprotein persistence in joint tissue of patients with post-Chikungunya chronic articular disease.

INTRODUCTION: Chikungunya chronic joint disease causes debilitating arthralgia, significantly impacting the quality of life of affected individuals. METHODS: In this study, patients underwent clinical follow-ups, joint biopsies, and pre-biopsy and 24 months post-biopsy serum dosage of cytokines. RESULTS: All participants were female and had pain in 12 joints on average, with 41.17% exhibiting moderate disease activity. Histopathological analysis revealed collagen deposition. Indirect immunofluorescence detected the CHIKV glycoprotein E1 antigen, and an increase in cytokines. CONCLUSIONS: Persistent inflammation and ineffective antiviral immune responses leading to antigen persistence may contribute to chronic CHIKV arthritis.

Induction chemotherapy response of HPV-related multiphenotypic sinonasal carcinoma: First-ever reported therapeutic outcome and a brief literature review.

A 54-year-old male patient complained of nasal obstruction and epistaxis for 2 years, with worsening of the symptoms in the preceding year. Physical examination revealed a friable, irregular mass, with yellowish secretion, in the left nasal fossa. Magnetic resonance imaging revealed an expansive lesion in the left nasal cavity, extending into the nasopharynx, ethmoid, right nasal cavity, and cortical bone of the hard palate. An incisional biopsy was then performed. Morphologically, a cellular malignant proliferation with a solid basaloid appearance admixed with adenoid cystic-like areas was observed. Immunohistochemistry revealed positivity for AE1/AE3, CK7, p63, and calponin, with focal labeling for CD117 and α-SMA. p16 had diffuse cytoplasmic and nuclear positivity. Ki-67 index was >80%. Given the morphological and immunohistochemical aspects, the diagnosis was conclusive for HPV-related multiphenotypic sinonasal carcinoma. The tumor was considered irresectable, and the patient was submitted to induction chemotherapy with docetaxel, cisplatin, and infusional 5-fluorouracil, with significant regression after therapy, followed by chemoradiotherapy with carboplatin, without limiting toxicities. The patient is currently under regular follow-up, with complete clinical and radiological response. To date, there are no reports in the literature of induction chemotherapy use or its complete therapeutic responsiveness related to this lesion. A brief literature review was included with the main epidemiological, clinical, therapeutic, and prognostic aspects regarding the 85 cases reported in the literature, including ours.

Inflammation, fibrosis and E1 glycoprotein persistence in joint tissue of patients with post-Chikungunya chronic articular disease

ABSTRACT Introduction: Chikungunya chronic joint disease causes debilitating arthralgia, significantly impacting the quality of life of affected individuals. Methods: In this study, patients underwent clinical follow-ups, joint biopsies, and pre-biopsy and 24 months post-biopsy serum dosage of cytokines. Results: All participants were female and had pain in 12 joints on average, with 41.17% exhibiting moderate disease activity. Histopathological analysis revealed collagen deposition. Indirect immunofluorescence detected the CHIKV glycoprotein E1 antigen, and an increase in cytokines. Conclusions: Persistent inflammation and ineffective antiviral immune responses leading to antigen persistence may contribute to chronic CHIKV arthritis.

Complex Fibroadenoma: a Cystic Neoplasia Report Case / Fibroadenoma Complexo: Relato de Caso de uma Neoplasia Cística

Abstract Fibroadenoma is the most common breast tumor in young woman. It is considered a non-malignant tumor, showing hyaline component and a biphasic stroma and epithelial process, thus, it is similar to phyllode tumor revealing intralobular stroma. The cystic changes in a complex fibroadenoma may mimic a carcinoma, therefore it may represent some problems in images interpretation, and it may enlarge the risk of cancer development. This is a description of a case report with literature review. A 21-year-old female patientwith no history of breast cancer in family, presented a palpable lump in her right breast and clinical examination revealed a mobile, firm, circumscribed lesion in the right inner quadrant, measuring around 8 x 7 cm. An excision had been done under a stereotactic surgery and the structure revealed a nodular surface, measuring 8 x 6.5x 5.5cm. Cut section revealed heterogeneous aspect: cysts with colloid content and white-gray compact fibroblastic areas. Histopathological examination shows hypocellular stroma and few hypercellular areas, without atypia. Epithelial components presenting proliferation of intracanalicular and pericanalicular pattern ducts. Cystic proliferation with epithelial lining and apocrine characteristics without atypia. Because of the variation may be present inside the lesion it is difficult to establish the diagnosis without a biopsy, and a histopathological analysis. Moreover, it is necessary to know the microscope difference between fibroadenoma and the other sort of lesions; furthermore, that heterogeneity represent why that tumor is considered complex. (AU)

Resumo Fibroadenoma é o tumor de mama mais comum em mulheres jovens. É considerado um tumor não-maligno, apresentando um componente hialino e um estroma bifásico, e processo epitelial, por isso, é similar ao tumor filoide, revelando estroma intralobular. As alterações císticas no fibroadenoma complexo pode mimetizar um carcinoma, isso acarreta alguns problemas na interpretação das imagens, e pode aumentar o risco de desenvolvimento de câncer. Trata-se de um relato de caso de paciente de 21 anos de idade, sem histórico de câncer de mama na família, apresenta uma massa palpável em seio direito. Exame clinico revelou lesão móvel, firme, circunscrita no quadrante interno do seio. Excisão por cirurgia estereotáctica e a estrutura se mostra com superfície multinodular, medindo 8 x 6,5 x 5,5 cm. com aspecto heterogêneo, cistos com conteúdo coloide, e áreas fibrobásticas branco-acinzentada. Exame histológico demonstra-se estroma hipercelular, com áreas hipocelularizadas, sem atipia. Componentes epiteliais apresentando proliferação intercanalicular e intracanicular dos ductos. Proliferação cística com revestimento epitelial e características apócrinas sem atipia. Por conta da variação presente na lesão, pode ser difícil a estabelecimento de um diagnóstico se biópsia e análise histopatológica. Além disso, é fundamental o conhecimento das diferenças microscópicas entre o fibroadenoma e outros tipos de lesões; além disso, a heterogeneidade representa o motivo do tumor ser considerado complexo. (AU)

Ferritin, Erythrocyte Sedimentation Rate, and C-Reactive Protein Level in Patients with Chikungunya-Induced Chronic Polyarthritis.

Chikungunya virus (CHIKV) is a global emergent arthritogenic alphavirus transmitted by anthropophilic Stegomyia mosquitoes. Chikungunya fever may evolve to chronic arthralgia in 57-80% of infected patients. This study was developed to identify possibly fast, simple low-cost biomarkers to monitor chronic CHIKV-induced articular disease. Between 2017 and 2018, we analyzed clinical data of patients meeting the criteria established by standard protocols to define chronic chikungunya articular disease. Patients were classified according to the disease activity scores, inflammatory biomarkers (erythrocyte sedimentation rate [ESR], ferritin, and C-reactive protein [CRP] serum), positive rheumatoid factor, comorbidities, smoking, and previous use of corticosteroids determined before beginning therapy. Of 106 patients, 98 (92.5%) were women with mean age of 52 ± 13 years, 6.8 ± 4.4 months of illness duration at the first medical appointment, and 6.7 ± 4.5 affected joints. Mean ESR (26 ± 19), CRP (2.6 ± 3.6), and stratified ferritin (144 ± 115) levels were normal according to reference values. There was no significance in comparing the levels of inflammatory biomarkers and the additional variables analyzed in the presence of moderate chronic joint disease in the study population. However, we identified a negative correlation between disease activity measures and duration of disease at the first medical evaluation after initial infection (P < 0.001), corroborating data observed in the literature.