Elastic fiber degradation in the development of pediatric granuloma annulare:Report of 39 cases

BACKGROUND Granuloma annulare(GA)has diverse clinical manifestations,multiple subtypes,and unknown etiology and pathogenesis.Existing studies regarding GA in children are scarce.AIM To examine the correlation between clinical manifestation and histopathology of pediatric GA.METHODS A total of 39 patients under 18 years of age with both a clinical and pathological diagnosis of GA at Kunming Children's Hospital from 2017 to 2022 were retrieved.Their medical records were consulted,and clinical data of the children were recorded and summarized,including gender,age,disease site,etc.Existing wax blocks of skin lesion specimens of children and pathological films were retrieved for further study and relevant histology,including hematoxylin-eosin,Alcian blue,elastic fiber(Victoria blue-Lichon red method),and antacid staining.Finally,the children’s clinical manifestations,histopathological results,and special staining characteristics were analyzed.RESULTS The clinical manifestations of granuloma annulare in children were diverse:11 cases presented with a single lesion,25 with multiple lesions,and 3 with generalized lesions.The pathological typing comprised histiocytic infiltration,palisading granuloma,epithelioid nodular,and mixed types in 4,11,9,and 15 cases,respectively.Thirty-nine cases were negative for antacid staining.The positive rate of Alcian blue staining was 92.3%,and that of elastic fiber staining was 100%.The degree of elastic fiber dissolution and granuloma annulare histopathological typing were positively correlated(r=0.432,P<0.05).No correlation was found between clinical presentation and histopathological typing of the granuloma annulare in children.In the pathological diagnosis of granuloma annulare,the positive elastic fiber staining rate was higher than that of Alcian blue staining.A correlation was found between elastic fiber dissolution degree and histopathological staging.However,the differences in pathological staging may have been related to the pathological manifestation of granuloma annulare at different periods.CONCLUSION Elastic fiber degradation may be a critical step in the pathogenesis of pediatric granuloma annulare.This is also one of the first studies focused on granuloma annulare in children.

A Giant Granuloma of the Vocal Process after Double-Lumen Bronchial Catheter Insertion: A Rare Case Report and Literature Review

Background: Double-lumen endotracheal (DLT) is commonly used for one-lung ventilation and lung separation during thoracic surgery. There are case reports of medically induced laryngeal granulomas, mainly in patients after single-lumen endotracheal (SLT) tube intubation and tracheotomy, and giant granulomas of the vocal cords due to double-lumen bronchial tube insertion have rarely been reported. Case presentation: A 49-year-old female patient underwent single-port thoracoscopy after DLT intubation as well as a wedge resection of the lower lobe of the left lung, which caused giant vocal process granulomas (VPGs) postoperatively. Based on a retrospective analysis of the general condition, current medical history, past medical history, and visual laryngoscopic observation of the vocal folds tissue, which ruled out preoperative vocal fold granuloma formation, we hypothesized that double-lumen bronchial catheter intubation may have been the primary cause of her vocal fold granuloma formation. Conclusions: Giant granuloma of the vocal folds after DLT insertion is a rare postoperative complication;therefore, if DLT intubation is to be performed, the anesthesiologist should choose an appropriate intubation plan and deal with it promptly to avoid the risk factors to ensure that the patient’s perioperative period is safe and smooth. In addition, if postoperative complications are encountered, they should be followed up and observed on time.

Suture granuloma of the abdominal wall with intra-abdominal extension 12 years after open appendectomy

Most complications after appendectomy occur within ten days; however, we report the unusual case of a suture granuloma 12 years after open appendectomy. The afebrile 75-year-old woman presented with a slightly painful palpable mass in the right lower abdomen. There was no nausea or vomiting and bowel movements were normal. She lost 10 kg during the 3 mo before presentation. The patient had undergone an appendectomy 12 years previously. Physical examination revealed a tender mass, 10 cm in diameter, under the appendectomy scar. The preoperative laboratory findings, tumor markers and plain abdominal radiographs were normal. Multi-slice computed tomography scanning showed an inhomo-genous abdominal mass with minimal vascularization in the right lower abdomen 8.6cm×8cm×9 cm in size which communicated with the abdominal wall. The abdominal wall was thickened, weak and bulging. The abdominal wall mass did not communicate with the cecum or the ascending colon. Complete excision of the abdominal wall mass was performed via median laparotomy. Histopathological examination revealed a granuloma with a central abscess. This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrants the use of a wide spectrum of diagnostic modalities and consequently different treatment options.

SPIROCHETES—— THE POSSIBLE ETIOLOGICAL FACTOR OF THE CHEILITIS GRANULOMATOSA

To detect spirochetes in sections and to study the therapeutic effect of penicillin in cheilitis granulomatosa (CG) and Melkersson- Rosenthal syndrome (MRS) and the relationship between the spirochetes infection and CG and MRS. Methods. Routine HE sections and Warthin- Starry special staining were carried out in 20 cases of CG and 6 cases of MRS. Meanwhile there were 9 cases of CG and 2 cases of MRS were treated by penicillin (12 000 000u,IV, per day) for two courses (14 days). Results. A kind of spirochete was discovered in the sections of all cases of the CG and MRS .The CG and MRS could be divided into two types histopathologically, that is granuloma type and interstitial inflammatory type (non- granuloma type), those morphological changes tallied with spirochetosis. After treatment by penicillin, the facial and labial swelling of the 11 cases of CG and MRS were abated. Conclusion. CG and MRS probably are infectious diseases caused by spirochetes.

The anti-inflammatory activity of garden egg(Solanuni aethiopicum) on egg albumin-induced oedema and granuloma tissue formation in rats

Objective:To evaluate the possible anti-inflammatory effect of garden egg[Solatium aethiopieum (S.aethiopieum)]using experimentally induced inflammatory models in rals.Methods:Oedema was induced on the rat hind paw In the injection of 0.1 mL undiluted fresh egg albumin(pbilogistic agent) into the subplantar surface of the rat paw.Tissue granuloma was induced in the rats by the implantation of two autoelaved cotton pellets(30 mg) under the flank o(previously shaved back of anaesthetised rats.Garden egg extract doses were administered to the rats for seven consecutive davs.On dav 8.the animals were killed and the pellets surrounded by granuloma tissue were disseeled out and dried.Results:Extracts of garden egg significanlly(P【0.05) reduced the fresh egg albumin-induced ral paw oedema and also significantly(P【0.05) reduced the granuloma tissue formation in the treated groups when compared to the control.Conclusions:This stud) shows that the fruits of garden egg(S.aethiopieum) have anti-inflammatory activity in the models studied.

Bilateral occurrence of sperm granulomas in the left spermatic cord and on the right epididymis:A case report

BACKGROUND Sperm granuloma is a rare disease in clinical andrology and its incidence is still unclear worldwide.According to the existing literature,sperm granuloma often occurs unilaterally.Clinical and ultrasound features are similar to epididymal tuberculosis,chronic epididymitis and other diseases.Sperm granuloma is usually diagnosed based on postoperative histopathological and immunohistochemical examination.CASE SUMMARY A 46-year-old man was admitted to the hospital due to the presence of a left scrotal mass for 3 mo and aggravation of pain for 1 wk.The lesions at both sites were surgically resected.Postoperative pathological examination showed that the left spermatic cord mass and the right epididymal mass were consistent with sperm granuloma.The sperm granulomas then recurred 3 mo after surgery.There is little change in the local mass so far.CONCLUSION The case report is helpful for our understanding of this disease.In clinical diagnosis,it should be distinguished from epididymal tuberculosis,chronic epididymitis and other diseases.Color Doppler ultrasound can be used as a preferred examination method but postoperative pathological examination is still needed for diagnosis.

Cholesterol granuloma of the right epididymis mimicking an acute scrotum

Dear Sir, I am B. Spajic, the urologist from Clinical Department of Urology, Sestre Milosrdnice University Hospital, Zagreb, Croatia. Recently, we had a rare case of a cholesterol granuloma of the right epididymis at our department, showing clinical signs of acute scrotum. The case described here appears to be the second reporting cholesterol granuloma in the epididymis and the first one presenting with clinical signs of acute scrotum.

Xanthogranulomatous cholecystitis managed by laparotomy may go through troublesome clinical course: Reflection of severe inflammation

To the Editor: Xanthogranulomatous cholecystitis(XGC) is an uncommon inflammatory disease of the gallbladder, and its incidence is reported to be 1.3%-5.2% [1]. XGC is diagnosed by histopathological examination, characterized by severe inflammatory destruction followed by a granulomatous reaction, marked proliferative fibrosis, and infiltration of inflammatory cells [2].

Unusual clinical presentation of oral pyogenic granuloma with severe alveolar bone loss:A case report and review of literature

BACKGROUND Pyogenic granuloma(PG)is a localized,reddish and vascularized hyperplastic lesion of the connective tissue which occurs in the oral cavity.In most cases,the presence of this lesion does not show alveolar bone resorption.The pathology is diagnosed clinically with some caution.However,the diagnosis and treatment are usually corroborated with histopathological evidence.CASE SUMMARY Three clinical cases of PG associated with bone loss were described in this study.The three patients presented tumor-like growth which bled on touch,and were associated with local irritant factors.Radiographs showed bone loss.All cases were treated with conservative surgical excision.The scarring was satisfactory,and there was no case of recurrence.The diagnoses were based on clinical findings,and were confirmed histopathologically.CONCLUSION The occurrence of oral PG with bone loss is unusual.Therefore,clinical and radiographic evaluations are important for the diagnosis.

Primary tuberculosis of the thyroid gland:a case report

Tuberculosis of the thyroid gland is an uncommon disease and primary involvement of Uiyroid is even more rare.It is a rare disease even in countries in which tuberculosis is endemic.The diagnosis is often difficult as the clinical presentation has no distinct characteristics.Clinical course of the disease may resemble toxic goiter or acute thyroiditis or may follow a subacute or chronic growth pattern without specific symptomatology.Histologically presence of necrotizing epithelioid cell granulomas along with langhans type giant cells are the hallmark of thyroid tuberculosis.Demonstration of acid fast bacilli by ZN staining confirms the diagnosis,but this stain is frequently negative in tissue sections.

Pathology of Tuberculosis in Camels ( <i>Camelus dromedaries</i>) in the Sudan

The study was aimed to investigate the pathological changes of condemned lungs of dromedary camels in the Sudan abattoirs using conventional H & E and Zeihl Neelson (ZN) staining procedures. Proliferative granulomatous reaction was demonstrated in one H & E stained lung section which was characterized by focal fibrosis and infiltration of mononuclear cells resembled to tuberculous lesions. While ZN stained sections demonstrated acid fast rod in one pulmonary associated lymph node. These lesions were evidenced presence of tuberculous mycobacteria in camel tissues and recommended further deep investigation of tuberculosis among camels in the Sudan.

Persicaria lanigera (Polygonaceae) leaf extract exhibits antiulcerogenic and antiproliferative activities against acetic acid-induced ulcerative colitis and cotton pellet-induced granuloma tissue in rats

Objective:To assess the effect of leaf extract of Persicaria lanigera on cotton pellet-induced granuloma tissue formation and acetic acid-induced ulcerative colitis.Methods:Rats were randomly divided into six groups:normal control,negative control,positive control(dexamethasone or sulfasalazine)as well as Persicaria lanigera(100-600 mg/kg)-treated groups.The effects of the extracts on body weight,antioxidant,and hematological parameters,as well as mast cell proliferation,were assessed.In addition,a histological evaluation was conducted.Results:Persicaria lanigera extract significantly decreased the mean exudate amount and suppressed granuloma tissue formation in a concentration-dependent manner in rats(P<0.05).Additionally,the extract significantly increased body weight,improved hematological profile,reduced the disease activity index score and malondialdehyde level,as well as enhanced catalase and superoxide dismutase activities(P<0.05).Histological evaluation showed Persicaria lanigera extract alleviated acetic acid-induced colonic damages,as evidenced by decreased cell necrosis,edema,and inflammatory cell infiltration.Conclusions:Persicaria lanigera extract possesses antiproliferative,antioxidative,and anti-colitis activities.However,its underlying mechanisms of action need further investigation.

Inflammatory pseudotumor of the liver: 13 cases of MRI findings

INTRODUCTIONInflammatory pseudotumor of the liver ,a rare benign lesion ,is often confused with the malignant tumors .Until 1998,less than 80 cases had been reported in the world [1,2].The accuracy of the pre-surgical diagnosis was low p[3,4] ,and very few materials on the diagnosis using dynamic MRI were reported [5-7] .We collected thirteen cases of inflammatory pseudotumor of the liver were collected and roved by pathology with MRI studies .Our purpose is to describe and analyze the MRI findings of this lesion and find out the valuable signs suggesting the diagnosis so as to avoid unnecessary operations.

Exophytic inflammatory myofibroblastic tumor of the stomach in an adult woman:A rare cause of hemoperitoneum

Inflammatory myofibroblastic tumor （INT） of the stomach in adults is extremely rare, with unpredictable prognosis. We present a 55-year-old woman with a gastric IMT. She experienced sudden abdominal pain 4 d previously. Physical examination showed mild abdominal tenderness in the hypogastrium, but no palpable abnormal abdominal mass. Abdominal CT showed a mass of approximately 8 cm in the gastrocolic ligament. On laparoscopic exploration, unexpected hemoperitoneum of approximately 1.5 L of blood was found, and an exophytic gastric mass of approximately 10 cm, appeared from the anterior wall of the gastric body along the greater curvature. Laparoscopy further showed that non- clotting blood in the abdominal cavity seemed to be from the gastric tumor. After conversion to open surgery for more precise evaluation of the cause of hemoperitoneum and the large friable tumor, gastric wedge resection, including the tumor, was conducted. The final diagnosis was consistent with IMT that originated from the gastric wall.

Clinical significance of granuloma in Crohn's disease

AIM: Granuloma is considered the hallmark of microscopic diagnosis in Crohn's disease (CD), but granulomas can be detected in only 21-60% of CD patients. The aim of this study was to evaluate the frequency of granulomas by multiple endoscopic biopsies in patients with CD and to examine whether group of patients with or without granuloma exhibit a different clinical course. METHODS: Fifty-six patients with newly diagnosed CD were included in the study. Jejunoscopy, enteroclysis and ileo-colonoscopy were performed in all patients. At least two biopsy specimens from each examined gastrointestinal segment were examined microscopically searching granuloma. The clinical course was followed in all patients, and extraintestinal manifestations as well as details of any immunosuppressive therapy and surgical intervention were noted. RESULTS: Granuloma was found in 44.6% of the cases (25 patients). Patients with granuloma had higher activity parameters at the time of the biopsies. Extraintestinal manifestations were observed and surgical interventions were performed more often in the granuloma group. The need of immunosuppressive therapy was significantly more frequent in the patients with granuloma. Granuloma formation is mote often seen in younger patients, and mainly in the severe, active penetrating disease. CONCLUSION: The significantly higher frequency of surgical interventions and immunosuppressive therapy suggests that granuloma formation is associated with a more severe disease course during the first years of CD.

Perifollicular granulomas with Ig G4 plasmacytosis:A case report and review of literature

Perifollicular granuloma is a unique histologic feature and whether it is associated with immunoglobulin G4(IgG 4)-related disease is controversial. We report a case of a 38-year-old man who presented with worsening left eye pain, proptosis, tearing, gritty sensation, blurred vision and multiple lymphadenopathy. An axillary lymph node resection showed reactive follicular and interfollicular lymph node hyperplasia, and increased eosinophils and plasma cells(at least 80% of Ig G+ plasma cells were positive for IgG 4). A distinct feature was the presence of multifocal, perifollicular histiocytic granulomas, which formed a wreath around the entire follicles. The human herpes virus 8 was not detected by immunohistochemistry. In addition, an extensive panel of special stains, immunohistochemistry, and flow cytometry was negative for lymphoma, fungal, or mycobacterial infection. The findings were suggestive of IgG 4-related sclerosing disease-associated lymphadenopathy. Further laboratory testing showed a significant increase of serum immunoglobulin E(> 23000 IU/mL) and slight increase of total Ig G, but normal serum Ig G4. Even though perifollicular granuloma is a nonspecific histopathologic feature and can be seen in other diseases, such as nodular lymphocyte predominant Hodgkin lymphoma, Ig G4-related lymphadenopathy should be listed in the differential diagnoses of benign reactive lymph nodes, especially when perifollicular granuloma and plasmacytosis coexist.

A rare case of langerhans cell histiocytosis of the gastrointestinal tract

Langerhans cell histiocytosis （LCH） is a group of idiopathic disorders characterized by the proliferation of specialized, bone marrow-derived langerhans cells and mature eosinophils. The clinical spectrum ranges from an acute, fulminant, disseminated disease called Letterer Siwe disease to solitary or few, indolent and chronic lesions of the bone or other organs called eosinophilic granuloma. Involvement of the gastrointestinal tract is very rare in LCH. We present the case of a 53-year-old woman referred by her primary care physician for a screening colonoscopy. A single sessile polyp, measuring 4 mm in size, was found in the rectum. Histopathological examination revealed that the lesion was relatively well circumscribed and comprised mainly a mixture of polygonal cells with moderate-to-abundant pink slightly granular cytoplasm. The nuclei within these cells had frequent grooves and were occasionally folded. Immunohistochemical staining was positive for CD la which confirmed the diagnosis of LCH. On further workup, there was no evidence of involvement of any other organ. On follow up colonoscopy one year later, there was no evidence of disease recurrence. Review of the published literature revealed that LCH presenting as solitary colonic polyp is rare. However, with the increasing rates of screening colonoscopy, more colonic polyps may be identified as LCH on histopathology. This underscores the importance of recognizing this rare condition and ensuring proper follow-up to rule out systemic disease.

Endoscopic findings and pathologic characteristics of gastric eosinophilic granuloma:A report of 18 patients

AIM: To investigate the endoscopic findings and patholo- gic characteristics of gastric eosinophilic granuloma (GEG). METHODS: A retrospective study of 18 cases of gastric eosinophilic granulomas was conducted. Gastroscopy was performed and all specimens of biopsies were stained by H&E and observed under light microscopy. RESULTS: Ulcer was the most frequent endoscopic appearance. The others included deformed pylorus and/or duodenal bulb, esophagitis, mucous hyperemia and/or mucosal erosion. Eosinophilic cell infiltration and generous hyperplasia of arterioles, venules and lymph vessels were found in the lesions of the patients. Interstitium had massive eosinophilic infiltrates and was made up of collagen fibers and fibroblasts. Lymphoid follicles were revealed in some sections of biopsies. CONCLUSION: GEG is lack of specific symptoms and physical signs. It can be misdiagnosed as gastric ulcer in most cases before biopsies. Endoscopy and endoscopic multiple deep biopsies in suspected areas are indispensable for correct diagnosis of GEG.

Expansively Hemorrhagic Foreign Body Granuloma at the Pelvis Caused by Microscopic Materials

A foreign body granuloma is a mass lesion consisting of a foreign body with host reaction. Its diagnosis is not always easy in respect of its similarity to soft tissue sarcoma. The most common foreign body is surgical sponge which can be detectable macroscopically. We present a foreign body granuloma in the left buttock caused by microscopic surgical materials that developed into a large lesion. An 80-year-old man with a history of surgery for dislocation of the left hip 20 years earlier, presented with a slowly growing mass that had expanded rapidly over the preceding 2 months. Histological examination revealed organizing granulation tissue surrounding the scattered foreign materials. One should be aware of foreign body granuloma at previously operated sites even without a retained macroscopic gauze sponge.

Granuloma of graphite foreign body in conjunctiva simulates melanoma: a case report and literature review

Dear Editor,We present a rare case of conjunctival foreign body granuloma simulating melanoma caused by longterm retained pencil core.The pigmented conjunctival mass and eye injury caused by writing instruments are not rare.