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The patch stage of Kaposi's sarcoma (KS) has been recently recognized as histologically distinct from that seen in well-developed violaceous nodules of KS. We report a patient with patch stage KS and its angioendothelioma-like histology. The presence of glomerulus-like vascular structures is a newly described feature.
A 49-year-old man with fever, malaise, weight loss, and pneumonia developed cutaneous nodules and neurologic symptoms. Skin biopsy studies revealed granulomatous inflammation consistent with a sarcoid reaction, and mild granulomatous changes were noted on biopsy specimens of liver and bone marrow. A lymph node biopsy was unremarkable. Neurologic deterioration prompted an extensive workup that revealed an intracranial mass. A brain biopsy study revealed malignant lymphoma, large cell type. Autopsy study confirmed the diagnosis and showed no evidence of granulomatous infiltrates. The cutaneous granulomas represent a nonspecific immune response possibly related to the underlying lymphoma. The relationship between sarcoidosis and sarcoid reactions and lymphoma is discussed.
A case of multicentric reticulohistiocytosis with thyroid involvement is reported. This systemic condition has an unknown cause and is manifested by the development of nodules containing an infiltrate of characteristic histiocytic and multinucleated giant cells in the synovium, skin, subcutaneous tissues, and occasionally bone or other tissues.
We present a case of cutaneous infection due to Cladophialophora bantiana, an agent of phaeohyphomycosis. The patient developed a nodule with pustule formation on the dorsum of the left hand; no trauma was reported. The lesion was successfully treated with itraconazole and surgical excision. Histopathologically, there was a blastomycosis-like tissue reaction pattern. Pigmented organisms were readily identified in tissue sections, and the cultural characteristics were those of Cladophialophora bantiana. This organism, known primarily for intracerebral involvement, can rarely produce cutaneous and subcutaneous infection. Immunosuppression should be suspected but is not always clinically apparent, as was demonstrated by our case.
Nodular fasciitis (NF) is a tumor-like condition composed of fibroblasts and myofibroblasts, usually located in the subcutaneous tissue of the extremities. Histologically, it can mimic a myogenic sarcoma because of its hypercellularity, brisk mitotic rate and the presence of actin. NF of the vulva is rare with only eleven cases reported in the English literature. A 40 year-old woman developed a nodule in labium majus that was surgically excised. Microscopical examination revealed a typical example of NF with occasional multinucleated giant cells. The immunohistochemical study showed positivity for vimentin and muscle-specific actin in the spindle cells. The multinucleated cells stained with CD68. MIB-1 was positive in less than 5% of the cells which indicated a low proliferative activity. The patient has been followed for 5 years and no relapses occurred. The rarity of this lesion in the vulva and the potential difficulties for its diagnosis led us to report the clinical and immunohistochemical study of this case.
Clinical involvement of the palmar and digital skin by Dupuytren's disease occurs frequently. A review of 40 rays in 32 patients who had consecutively undergone dermofasciectomy is presented. The average follow-up period was 38 months, with a minimum of 24 months. Four out of the 40 rays developed recurrent nodule formation limited to the proximal or distal graft insets but there was no recurrent cord formation, suggesting better disease control than by fasciectomy alone. Full thickness graft to resurface the defect has been surprisingly complication-free.
Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare disease that is characterized by the development of nodules of cartilage within the synovial connective tissues of articulating joints. Reports of extracapsular TMJ SC are rare. A case is presented of primary SC of the TMJ with extension to the pterygoid plates, with a suspected traumatic etiology. The differences between primary and secondary SC are discussed.
When petroleum hydrocarbons contaminate soil, the carbon:nitrogen (C:N) ratio of the soil is altered. The added carbon stimulates microbial numbers but causes an imbalance in the C:N ratio which may result in immobilization of soil nitrogen by the microbial biomass, leaving none available for plant growth. As members of Leguminosae fix atmospheric nitrogen to produce their own nitrogen for growth, they may prove more successful at growing on petroleum hydrocarbon contaminated sites. During a wider study on phytoremediation of diesel fuel contaminated soil, particular attention was given to the performance of legumes versus other plant species. During harvesting of pot experiments containing leguminous plants, a recurring difference in the number and formation of root nodules present on control and contaminated Common vetch (Vicia sativa L.) plants was observed. The total number of nodules per plant was significant reduced in contaminated plants compared to control plants but nodules on contaminated plants were more developed than corresponding nodules on control plants. Plant performance of Common vetch and Westerwold's ryegrass (Lolium multiflorum L.) was compared to illustrate any difference between the ability of legumes and grasses to grow on diesel fuel contaminated soil. Common vetch was less affected by diesel fuel and performed better in low levels of diesel fuel contaminated soil than Westerwold's ryegrass. The total amount of diesel fuel remaining after 4 months in Common vetch planted soil was slightly less than in Westerwold's ryegrass planted soil.
The anti-inflammatory agent sodium aurothiomalate appears to act upon mononuclear phagocytes, inhibiting their lysosomal enzyme activity. Evidence is presented that gold salts can increase the number of lung tumour nodules that develop following intravenous injection of tumour cells and pretreatment can enhance the take of a subcutaneous tumour inoculum. In contrast, they do not affect the later growth of tumour. Gold salts can also suppress the action of systemically administered C. parvum in inhibiting the growth of subcutaneous tumours. These results are taken as supporting the evidence in favour of a fast acting nonspecific anti-tumour mechanism, probably macrophage mediated, that can be inhibited by gold salts and enhanced by C. parvum. The effect of gold salts upon other biological changes induced by C. parvum is examined, including its adjuvant action, and the results are discussed in the context of the mechanisms underlying the immunotherapeutic action of this organism.
(CIITA) down-modulation on allograft rejection. To inhibit the function of CIITA, we constructed a series of CIITA mutants and found one exhibiting the dominant-negative effect on the regulation of major histocompatibility complex (MHC) class II expression. To test whether the CIITA dominant-negative mutant reduces immunogenicity, CIITA-transfected melanoma cells were injected into allogeneic host and assessed for immune evading activity against host immune cells. We demonstrated that the CIITA dominant-negative mutant allowed tumor nodules to develop earlier in the lung than control by this tumor challenge study. Furthermore, skin grafts deficient for CIITA also survived longer than wild-type in allogeneic hosts. Both the tumor challenge and skin graft studies suggest the inhibition of CIITA molecules in donor tissue would be beneficial to the control of allo-response.
Mice deficient in CuZn superoxide dismutase (CuZnSOD) showed no overt abnormalities during development and early adulthood, but had a reduced lifespan and increased incidence of neoplastic changes in the liver. Greater than 70% of Sod1-/- mice developed liver nodules that were either nodular hyperplasia or hepatocellular carcinoma (HCC). Cross-sectional studies with livers collected from Sod1-/- and age-matched +/+ controls revealed extensive oxidative damage in the cytoplasm and, to a lesser extent, in the nucleus and mitochondria from as early as 3 months of age. A marked reduction in cytosolic aconitase, increased levels of 8-oxo dG and F2-isoprostanes, and a moderate reduction in glutathione peroxidase activities and porin levels were observed in all age groups of Sod1-/- mice examined. There were also age-related reductions in Mn superoxide dismutase activities and carbonic anhydrase III. Parallel to the biochemical changes, there were progressive increases in the DNA repair enzyme APEX1, the cell cycle control proteins cyclin D1 and D3, and the hepatocyte growth factor receptor Met. Increased cell proliferation in the presence of persistent oxidative damage to macromolecules likely contributes to hepatocarcinogenesis later in life.
Severe generalized nodular and bullous mastocytosis of the xanthelasmoid type is described in a 7-month-old boy. Reddish to yellowish-brown xanthelasmoid papules and nodules first developed in the inguinal region a few weeks after birth and then progressively spread to cover nearly the entire body surface. There was severe pruritus and recurrent episodes of blistering. The diagnosis of cutaneous mastocytosis of the xanthelasmoid type with subepidermal bullae was confirmed by skin biopsies showing solid and deeply penetrating infiltrates of metachromatic mast cells under light and electron microscopy. Systemic involvement of other organs, however, was excluded by bone scintigraphy, abdominal ultrasound, bone marrow aspiration and echocardiography. The extensive skin involvement was reflected in highly elevated urinary levels of histamine (263.4 microg L(-1)) and its metabolite N-methylimidazole acetic acid (20.8 mg L(-1)). The patient was systematically well and received only symptomatic treatment. Over a period of 1 year, the condition gradually improved, and the skin lesions began to flatten and regress.
OBJECTIVE: An association between acromegaly and goitre is well recognized. We have studied the incidence and morphology of goitre in acromegaly, and examined the role of IGF-I and TSH in goitre pathogenesis. DESIGN AND SUBJECTS: Thirty-seven subjects with acromegaly, active or in remission, were assessed by ultrasound to determine thyroid volume (TV) and morphology, and compared with normal controls. Nine subjects with acromegaly were also studied again following treatment with octreotide for 1 year. RESULTS: Compared with controls, TV was greater (28.7 +/- 18.3 ml vs 5.4 +/- 2.6 ml, P < 0.001) and IGF-I levels were higher (62.0 +/- 34.8 nM vs 28.9 +/- 10.9 nM, P < 0.001) in subjects with acromegaly. Those with active disease tended to have larger glands (30.0 +/- 17.2 ml vs 22.2 +/- 16.7 ml, P = 0.18). The overall incidence of goitre was 92%. Twenty-seven subjects (73%) had nodules or heterogeneous thyroid echotexture. Subjects with nodular goitre had a longer duration of acromegaly than those with homogeneous glands (12.1 +/- 5.7 vs 7.6 +/- 4.0 years, P = 0.032). Those with nodular glands also had larger goitres than those with homogeneous glands (35.2 +/- 18.8 ml vs 19.5 +/- 11.9 ml, P = 0.032). Thyroid volume correlated with IGF-I levels (r2 = 0.38, P = 0.002) and body mass index (r2 = 0.24, P < 0.001), and there was an inverse relationship with TSH levels (r2 = 0.46, P = 0.032). Patients studied again after treatment with octreotide for 1 year had a reduction in TV from 32.6 +/- 16.1 to 27.6 +/- 17.0 ml (P = 0.041). CONCLUSIONS: This study confirms that goitre is a common finding in acromegaly. Our findings suggest that early in the course of the disease, diffuse goitre occurs. Subsequently, thyroid autonomy and nodule formation develop, and further growth may occur independent of TSH. With control of GH hypersecretion, a reduction in thyroid size occurs, but this may be limited by the extent of thyroid nodularity.
AIMS: We present the clinical and histopathological findings of an unusual pulmonary cystic lymphoepithelial lesion in an HIV sero-positive patient. METHODS AND RESULTS: The 32-year-old female patient developed two nodules in the vicinity of the right and left hila. Left upper lobectomy showed a 40-mm wide cystic lesion. The cyst wall was lined by a squamous epithelium and lymphoid tissue with a marked follicular hyperplasia and a prominent follicular cell dendritic network expressing HIV major core protein p24. CONCLUSIONS: The absence of an Epstein-Barr virus infected lymphoid population and monoclonal immunoglobulin gene rearrangement supported the benign nature of the lesion.
We report a case of an Epstein-Barr virus (EBV)-associated nasal-type natural killer cell lymphoma (NKCL) preceded by benign panniculitis, which arose in a 48-year-old woman with an asymptomatic human T-cell leukemia/lymphoma virus type-1 (HTLV-1) infection. A biopsy of the initial panniculitis lesion demonstrated lobular panniculitis with a germinal center composed of benign mononuclear cells with a phenotype of CD4+CD45RO+CD5sCD3+ cCD3 epsilon + T-cell intracellular antigen-1 (TIA-1)- and granzyme B-. One year after oral prednisolone therapy, the patient developed subcutaneous nodules composed of atypical lymphoid cells with a phenotype of CD4-CD45RO+CD56+sCD3-cCD3 epsilon + (TIA-1)+ and granzyme B+. In the initial panniculitis lesion, neither EBV-encoded RNA (EBER-1) nor clonal proliferation of EBV-infected cells was identified. In later lesions, however, a large number of atypical cells were positive for EBER-1, and a clonal expansion of EBV-infected cells was detected. No clonal rearrangement of T-cell receptor-alpha, -beta, or -gamma genes was found in either specimen. This patient was an asymptomatic carrier of human T-cell leukemia/lymphoma virus type-1 (HTLV-1) without clonal integration of proviral HTLV-1 in neither the peripheral blood nor the skin lesions. These observations suggest that EBV-associated NKCL occurred subsequently in the clinical course of benign panniculitis under the influence of immunosuppression caused by prednisolone treatment and HTLV-1 infection.
The present experiment was performed to test the pathogenicity of Actinomyces-like bacteria in experimental animals and swine. Two rough (R) strains of Actinomyces-like bacteria isolated from a site of arthritis and from the tonsil in pigs were used as inocula. To investigate their susceptibility to Actinomyces-like bacteria, BALB/c, SS and ddY mice and guinea-pigs were inoculated intraperitoneally with the strains of Actinomyces-like bacteria. The ddY mice were used for the long-term observation of Actinomyces-like bacteria lesions and the mammary tissue of a sow was inoculated with Actinomyces-like bacteria isolated from swine tonsil. Macroscopic observation revealed many abscesses on the surfaces of the abdominal and/or thoracic organs in the mice, but not on those of the guinea-pigs. The sow developed firm nodules at the inoculation site in the mammary glands. Histopathologically, the lesions in the mice were characterized as actinomycotic abscesses in the early stage and as pus-forming granuloma (PFG) in the advanced stage; the lesions were accompanied by crystalloid particles. Actinomyces-like bacteria induced granulomatous mastitis in the sow, and the lesion was characterized as PFG. The characteristic actinomycotic lesions in swine mammary glands were reproduced by experimental infection.
Rhodococcus equi is an opportunistic pathogen that usually causes infection in immunocompromised hosts. A heart transplant recipient who had been treated with amphotericin B for pulmonary aspergillosis showed newly developed multiple nodules with a central necrotic area in the right lower lobes. Cultures of several blood samples and an aspirate of the lung nodule yielded a Gram-positive coccobacillary bacterium, which was initially reported as a Corynebacterium species, but was later identified as R. equi by API CORYNE (bioMerieux SA, Marcy l'Etoile, France) and by demonstrating the production of 'equi factor'. The identification was subsequently confirmed by an R. equi-specific polymerase chain reaction (PCR). The patient was successfully treated with ciprofloxacin and azithromycin for 14 weeks. This is the first documented case of R. equi infection in Korea. There is a possibility of underestimation of R. equi infections due to the misidentification of the organism as a contaminating diphtheroid. Because R. equi will not respond to the conventional empirical therapy, the microbiology laboratory should identify R. equi in a timely manner. R. equi-specific PCR will be a useful confirmatory test in human infection.
A comparison was made of disease development in two lines of transgenic mice in which the granulocyte-macrophage colony-stimulating factor (GM-CSF) transgene was inserted in different chromosomal locations. Female-line mice (X chromosome insertion) had equivalent elevations of serum GM-CSF levels to those in male-line mice (autosomal insertion) but a shorter survival (median survival, 95 versus 145 days) and a significantly higher incidence of large inflammatory foci in skeletal muscle and gut congestion. Male-line transgenic mice had higher levels of cells in the peritoneal cavity and a higher frequency of spleen enlargement with excess erythropoiesis than female-line mice and uniquely developed fibrotic nodules in the abdominal and pleural cavities. The various diseases in GM-CSF transgenic mice are likely to have been induced by GM-CSF-stimulated products of macrophages, and in the two transgenic lines the macrophages exhibit characteristic differences in morphology and possibly functional activity.