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Background: Pseudolymphoma of the liver (reactive lymphoid hyperplasia) (RLH) is a rare condition. It is usually asymptomatic and detected incidentally on radiological imaging. Imaging features are similar to hepatic adenoma, hepatocellular carcinoma, cholangiocarcinoma, and malignant lymphoma and are not specific for pseudolymphoma of the liver. Percutaneous core biopsy is insufficient to distinguish pseudolymphoma of the liver from low-grade malignant lymphoma and extranodal marginal lymphomas. Case Descriptions: In this article, we present a case of hepatic RLH of a patient who was presented with a skin rash on the leg and was detected incidentally on radiological imaging. Conclusion: Preoperative definitive diagnosis of hepatic RLH using various imaging methods, including MRI with hepatocellular agents, is highly difficult.

Background Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare benign illness. Due to atypical clinical and radiographic presentations, diagnosis largely depends on postoperative pathological examination. Thus, preoperative misdiagnosis is often occurred. Case presentation We present a case of asymptomatic PNLH that was seen as ground-glass opacity (GGO) on computed tomography (CT). After 3-year observation, the diagnosis tends to adenocarcinoma owing to increasing density of the node and vessel convergence sign, which were signs of malignancy. Video-assisted segmentectomy (S10) was carried out. Histopathologic examination of postoperative specimen showed follicular lymphoid hyperplasia with interfollicular lymphoplasmacytosis, consistent with PNLH. The follow-up chest CT images showed no recurrence or metastasis. Conclusion Although it is a benign disease, PNLH can exhibit malignant signs in the imaging examinations, which could lead to misdiagnosis. This reminds us of the uncertainty between imaging findings and diagnosis. The diagnosis depends on postoperative pathological examination. Volume doubling time is a potential parameter to differentiate PNLH from lung cancer.

We present the first and rare case report of syndromic multiple odontogenic keratocysts (OKCs) associated with extensive lymphoid proliferation. A 22-year-old male patient presented with radiolucent lesions in bilateral mandible and maxilla. Histopathology of the lesions showed features of multiple odontogenic keratocysts with reactive lymphoid proliferation. Additionally, presence of calcification of falx cerebri, palmar plantar pits and cervical scoliosis in the patient favored the diagnosis of nevoid basal cell carcinoma syndrome or Gorlin Goltz syndrome. Follow up after 2 years did not show any recurrence. Knowledge of this finding is important so that such entities are not confused with associated lymphoid neoplasms. Presence of lymphoid aggregates may be attributed to associated infection or remnants of cystic lining or breakdown products triggering cell mediated immunity leading to lymphoid hyperplasia.

Background: Fine needle aspiration cytology (FNAC) is a quick, sensitive, safe, reliable and cost-effective outdoor procedure that has a lower risk of complications as compared to a surgical biopsy. This study was conducted to analyse the various cytomorphological patterns establishing the diagnosis on FNAC in peripheral lymphadenopathy patients along with their clinical presentation.Methods: This study included 300 patients of peripheral lymphadenopathy in a tertiary care hospital of north-central Haryana. FNAC was done under all aseptic conditions and various cytomorphological patterns were analysed.Result: On stratification of lymph node lesions, 240/300 cases (80%) were reported as non-neoplastic and 60/300 cases (20%) as neoplastic lesions. Among the non-neoplastic lesions, granulomatous pathology was the commonest lesion encountered in 137/240 cases (57.1%), followed by reactive lymphoid hyperplasia and suppurative lymphadenitis. Metastatic involvement of lymph node was the commonest pathological finding diagnosed in 52/60 of malignant neoplastic cases (86.66%). Overall, the cervical lymph nodes were most commonly involved in 68.66% patients, followed by other lymph nodes.Conclusion: Lymphadenopathy can have varied etiologies ranging from non-neoplastic to neoplastic conditions. FNAC as a first line investigative procedure in lymphadenopathy patients obviates the need for surgical excision and guides subsequent patient therapy and management. The cervical group of lymph nodes are most commonly involved in both non neoplastic as well as neoplastic lymph node lesions. In younger age group (

Epstein-Barr virus (EBV) has been associated with a plethora of neurological manifestations including polyneuropathy and polyradiculopathy. A 27-year-old man with a recent upper respiratory system infection presented with difficulty in walking. His neurological examination revealed reduced muscle strength in both proximal and distal lower limb muscles without sensory and autonomic signs. Needle electromyography showed abnormal spontaneous activity and reduced recruitment of motor units in muscles innervated by multiple lumbo-sacral roots. Cerebrospinal examination showed increased protein levels with normal cell counts. While spinal MRI was normal, whole-body CT and PET examination showed disseminated lymph node enlargement. Anti-EBV viral capsid antigen and anti-nuclear antigen IgG but not IgM was positive, whereas EBV PCR was negative in blood. Analysis of inguinal lymph node biopsy showed reactive lymphoid hyperplasia and EBV DNA. Leucine-rich glioma-inactivated protein 1 (LGI1) antibody was found in serum but not in CSF. All clinical, imaging, and electrophysiological findings improved following steroid and intravenous immunoglobulin treatment. These findings suggested the acute involvement of lumbo-sacral spinal roots and/or motor neurons. Purely motor polyradiculopathy has been reported in both EBV-positive and LGI1 antibody-positive patients, and EBV infection is known to precede different autoimmune manifestations. Whether EBV infection may trigger LGI1 autoimmunity and cause involvement of spinal motor roots and/or motor neurons needs to be further studied.

Introduction. At present, lymphadenopathy – as a cause of idiopathic intestinal intussusception in little children - comes to the fore. However, intestinal intussusception in case of destructive mesenteric lymphadenitis in combination with lymphoid hyperplasia of the ileocecal angle ( what does not exclude lymphoma intraoperatively) is extremely rare in clinical practice.Purpose. To present a therapeutic and diagnostic algorithm in intestinal intussusception which was caused by the “volumetric“ abdominal lymphadenopathy.Case Report. A 3-year-old boy was admitted by the ambulance with recurrent abdominal pain, single episode of vomiting and no stool for 4 days. The ultrasound examination revealed intermittent ileocecal intussusception. The risk factor which had triggered the disease was an acute respiratory viral infection complicated with purulent mesenteric lymphadenitis and lymphoid hyperplasia with ulcerative lesions of the mucous membrane in the ileocecal junction. Laparoscopic desinvagination with lymph node removal and colonoscopy with ladder biopsy were performed. A differential diagnostics of nonspecific lymphadenopathy, Burkitt’s lymphoma and Crohn’s disease was made. Immunohistological examination intraoperatively was made; examination of the biopsy material excluded tumor and inflammatory bowel disease (IBD). The inflammatory process regressed under conservative therapy (antibacterial, anti-inflammatory and antispasmolytic) ; there were no any recurrent intussusception episodes within one-year follow-up.Conclusion. Successive ultrasound, laparoscopic and colonoscopic examinations followed by the immunohistological analysis of intraoperative and biopsy material allowed to put a correct diagnosis and, thereby, to minimize surgical aggression in ileocecal intussusception which was accompanied by volumetric lymphadenopathy.

Las hiperplasias cutaneas linfoides, antiguamente llamadas seudolinfomas cutaneos, son proliferaciones benignas de linfocitos, que simulan linfomas tanto clinica como histologicamente y de acuerdo a su componente celular mas predominante pueden ser clasificados como de celulas B o T. La de celulas B se considera una entidad clinicopatologica especifica, mientras que las de celulas T son un grupo heterogeneo de enfermedades, mas que una enfermedad en si. Dado que no son tan frecuentes no se tienen datos precisos de su epidemiologia. Se presenta caso clinico de paciente de sexo femenino de 45 anos con un nodulo eritematoso y violaceo en la region frontal de mas de un ano de evolucion con reporte histopatologico confirmado por estudios de inmunohistoquimica de hiperplasia cutanea linfoide de celulas B. Rev.cienc.biomed.2011; 2(1): 98-105 PALABRAS CLAVES Seudolinfoma cutaneo. Hiperplasia linfoide. Linfomas. Infiltrados cutaneos. SUMMARY The cutaneous pseudolymphoma and cutaneous lymphoids hyperplasias are benign proliferations of lymphocytes that simulate lymphomas clinically and histologically, wich according to its most prominent cellular component may be of B or T cells. The B-cell pseudolymphoma is considered a distinct clincopathologic entity, while the T is a heretogeneous group of diseases rather than a disease itself. Given its low frequency, there is a lack of accurate data about its epidemiology. This review presents a case of a female patient of 45 years old with an erythematous violaceous nodule in frontal region of more than 1 year of evolution with histopathologic report of B cell pseudolymphoma confirmed by inmunohistochemical studies. Rev.cienc.biomed. 2011; 2(1): 98-105 KEYWORDS Cutaneous pseudolymphoma. Lymphoid hyperplasia. Lymphomas. Cutaneous infiltrates.

Chronic follicular cholecystitis (CFC) is a rare pathology characterized by prominent lymphoid follicles in the lamina propria distributed throughout the gallbladder wall. It has also been mentioned in the literature as lymphoid hyperplasia and pseudolymphoma. CFC represents less than 2% of cholecystectomies. Its etiopathology is mostly unknown. Most reports are based on histopathological findings, with little or no imaging analysis. We describe a case involving a 66-year-old man radiologically diagnosed as xanthogranulomatous cholecystitis (XGC) versus malignancy, revealing CFC with surrounding inflammatory changes in the cholecystectomy specimen.

The luminal gastrointestinal tract can be a site of robust immune response in which reactive lymphoproliferative processes can sometimes be difficult to distinguish from lymphoma. In this article, we review gastrointestinal tract normal resident inflammatory cells and common nonneoplastic lymphoproliferative responses with emphasis on their differential and links to lymphoma. Topics that are covered include lymphocytic esophagitis, gastric chronic inflammation, mucosa-associated lymphoid tissue, and ulceration, small intestinal lymphoid hyperplasia, celiac disease, microscopic colitis, inflammatory bowel disease, primary immunodeficiency, graft-versus-host disease, and anti-programmed cell death protein-1 effect. We additionally present the less common differential of histiocytic processes within the gastrointestinal tract. The aim of this paper is to serve as a reference for practicing pathologists facing lymphoid, lymphoplasmacytic, or histiocytic processes in the luminal gastrointestinal tract. We hope to help the practicing pathologist distinguish benign from malignant entities and identify features requiring further workup.

Common variable immunodeficiency (CVID) is known to cause infectious, inflammatory, and autoimmune manifestations. Pulmonary hypertension (PH) is an unusual complication of CVID with largely unknown characteristics and mechanisms. We report the clinical, functional, hemodynamics, radiologic and histologic characteristics, and outcomes of CVID-associated PH patients from the French PH Network. Ten patients were identified. The median (range) age at CVID diagnosis was 36.5 (4–49) years and the median delay between CVID and PH diagnosis was 12 (0–30) years. CVID-associated PH affected predominantly women (female-to-male ratio 9:1). Most patients were New York Heart Association functional class III with a severe hemodynamic profile and frequent portal hypertension (n = 6). Pulmonary function tests were almost normal in 70% of patients and showed a mild restrictive syndrome in 30% of patients while the diffusing capacity for carbon monoxide was decreased in all but one patient. High-resolution computed tomography found enlarged mediastinal nodes, mild interstitial infiltration with reticulations and nodules. Two patients had a CIVD-interstitial lung disease, and one presented with bronchiectasis. Pathologic assessment of lymph nodes performed in 5 patients revealed the presence of granulomas (n = 5) and follicular lymphoid hyperplasia (n = 3). At last follow-up (median 24.5 months), 9 patients were alive, and one patient died of Hodgkin disease. PH is a possible complication of CVID whose pathophysiological mechanisms, while still unclear, would be due to the inflammatory nature of CVID. CVID-associated PH presents as precapillary PH with multiple possible causes, acting in concert in some patients: a portal hypertension, a pulmonary vascular remodeling, sometimes a pulmonary parenchymal involvement and occasionally an extrinsic compression by mediastinal lymphadenopathies, which would be consistent with its classification in group 5 of the current PH classification.

Background Good’s syndrome (GS) is an immunodeficiency disease, causing thymoma, low or absent B-cells, hypogammaglobulinemia, and defects in cell-mediated immunity. The most common clinical presentation is recurrent infection, followed by refractory diarrhea, due to the immunodeficiency. However, there are only few reports on intestinal endoscopy and pathology. Case summary We report here two typical GS cases with diarrhea as the prominent manifestation. Both cases presented with thymoma combined with immunodeficiency, characterized by hypogammaglobulinemia, low or absent B lymphocytes, and decreased T-cells with inverted CD4+/CD8+ T-cell ratio, while two GS patients were evaluated by endoscopy revealed mucosal edema and fine-granular or nodular appearance changes in the small intestine. Histological examination showed chronic inflammation and villous atrophy. A very interesting finding is that the inflammatory cell infiltration in the two GS cases was different. In one case, predominantly CD138+ plasma cells with only scattered CD3+ T-cells infiltration were revealed, while in another, it showed predominantly T-cells infiltration without plasma cells in the lamina propria. Although GS cases shared various clinical characteristics with common variable immunodeficiency (CVID) cases, they still differed from CVID cases in terms of its late onset, lack of familial clusters, low or absent peripheral blood B lymphocytes, absence of lymphoid hyperplasia, and plasma cells infiltration in the lamina propria in some patients. Although both patients had been diagnosed previously with recurrent diarrhea, respiratory infection, and thymoma, the association between these conditions and the possibility of GS was not recognized. The patients had remained misdiagnosed for 2 and 4 years, respectively, even after receiving the diagnosis of thymoma. The rarity of GS was likely the primary cause for the lack of disease recognition. Reporting of these cases will help to alert clinicians and raise awareness of this disease. Conclusion GS should be considered among the differential diagnoses for patients with unexplained recurrent diarrhea and opportunistic infection. Although it was regarded as a subset of CVID with thymoma, GS had a different clinical-pathological feature from CVID.

Introducción: la hiperplasia nodular linfoide del colon se define como > 10 nódulos linfoides visibles en colonoscopia. No existen estudios de su validez al compararlo con la histopatología. Objetivos: determinar la validez del hallazgo de nódulos en colonoscopia para el diagnóstico de hiperplasia nodular linfoide. Material y métodos: estudio prospectivo de prueba diagnóstica. Se incluyeron colonoscopias realizadas consecutivamente de 2014 al 2018 con equipos Olympus PCFQ150AI y GIFXP150N con obtención de biopsias. El criterio endoscópico fue la presencia de > 10 nódulos de 2 a 10 mm y el criterio histológico fue hiperplasia de folículos linfoides y mantos de linfocitos en lámina propia o submucosa. Los datos se analizaron en Epidat3.1. Se obtuvo la sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y negativo (VPN), y coeficientes de probabilidad positivo (LR+) y negativo (LR-) con sus intervalos de confianza. Resultados: se incluyeron 327 colonoscopias, la mediana de edad fue de 84 meses. La principal indicación para la colonoscopia fue sangrado digestivo bajo (38,8 %). El hallazgo de nódulos se encontró en el 21 % y el sitio de mayor frecuencia fue el colon total (46 %), mientras que por histopatología se encontró hiperplasia nodular linfoide en el 38 %. El hallazgo de nódulos obtuvo una S de 32 % (intervalo de confianza [IC] del 95 %: 24-140), E de 84 % (IC 95 %: 79-89), VPP de 56 % (IC 95 %: 44-68), VPN de 67 % (IC 95 %: 61-72), LR+ de 2,04 (IC 95 %: 1,4-3) y LR- de 0,8 (IC 95 %: 0,8-0,9). Conclusiones: la validez diagnóstica del hallazgo de nódulos en colonoscopia para hiperplasia nodular linfoide es pobre, por lo que la toma de biopsia debe recomendarse siempre.

Repeat oral administration of aluminum oxide (Al2O3) nanoparticles for 10 days at a total dose of 21 895 mg/kg of body weight causes the death of 50% of individuals in the exposed group. At the same time, the death rate amounts to 25% when exposed to microparticles. Aluminum concentrations after exposure to nanomaterial are increased relative to the control levels by 4.40, 1.23, and 1.48 times in the brain, liver, and blood of exposed animals, respectively. For micromaterial, these indexes are higher by 3.59 and 1.82 times in the brain and blood, respectively. The aluminum concentration under exposure to a nanomaterial is 1.23 times higher in the brain and 1.41 times higher in the liver than under exposure to a micromaterial. When exposed to nanodispersed Al2O3, acute liver congestion, eosinophilic gastroenteritis, lymphoid hyperplasia, and an increase in white pulp up to 70% were observed. When exposed to microparticles, pathomorphological changes were found only in spleen tissues as lymphoid hyperplasia and an increase in white pulp up to 50%. Intratracheal instillation of nano- and microparticles of Al2O3 leads to injuries of alveolar macrophages. When exposed to nanoparticles, the proportion of injuries and their number are 2.50 and 8 times higher, respectively, and the injury diameter is 2.25 times smaller. A high rate of animal death, features of bioaccumulation, pathomorphological changes in organ tissues during oral exposure, and injuries of alveolar macrophages during intratracheal exposure to Al2O3 nanoparticles proves the greater degree of toxicity of the nanomaterial via alimentary intake compared to the microdispersed analog.

Micronodular thymic carcinoma with lymphoid hyperplasia (MNTCLH) is a rare form of thymic carcinoma. We present the experience of RYTHMIC, the French national network devoted to the treatment of thymic epithelial tumors through multidisciplinary tumor boards with a review of all tumors by pathologists for classification and staging. Six cases of MNTCLH were diagnosed during a review of 1007 thymic epithelial tumors. Histologically, epithelial cells with atypia and mitoses formed micronodules that were surrounded by an abundant lymphoid background with follicles. There was neither obvious fibro-inflammatory stroma nor necrosis. Spindle cells areas were common. Initial diagnosis was micronodular thymoma in two cases, cellular atypia being overlooked, eclipsed by the micronodular pattern. Immunohistochemistry with a panel of five antibodies showed that cytokeratins (AE1-AE3) and p63-positive epithelial cells also expressed CD5 and that there was no TdT-positive cells within the tumors. CD20 highlighted the lymphoid hyperplasia. Additionally epithelial cells also expressed CD117 and diffusely Glut 1. Twenty-seven micronodular thymomas with lymphoid stroma diagnosed during the same period did not show the CD5 and CD117 positivities seen in MNTCLH and contained TdT-positive lymphocytes. Three of the 6 patients with MNTCLH had adjuvant radiotherapy. Three patients with follow-up information were alive without recurrence at 38, 51, and 95 months. Our study shows that immunohistochemistry, such as that used in the RYTHMIC network with a small panel of antibodies, may easily help to confirm the correct diagnosis of MNTCLH, a rare and low-aggressive form of thymic carcinoma, and avoid the misdiagnosis of micronodular thymoma.

The aim of this study was to reproduce severe pneumonic lesions, similar to those during naturally-occurring porcine respiratory disease complex, in pigs dually inoculated with porcine reproductive and respiratory syndrome virus and Mycoplasma hyopneumoniae at 6 weeks of age, followed by inoculation with porcine circovirus type 2 at two weeks after. Time and sequence of infection with three pathogens mirror Asian field conditions. Microscopically, interstitial pneumonia and peribronchiolar lymphoid hyperplasia are considered the most characteristic lung lesions in infected pigs. The results of the present study demonstrate that inoculation of pigs with these three pathogens can lead to severe interstitial pneumonia with peribronchial or peribronchiolar lymphoid hyperplasia and fibrosis.

Primary extranodal non-Hodgkin lymphomas that involve skeletal muscles (PSML) are infrequent with non- specific features or symptoms. Therefore, their diagnosis can be immensely convoluted since they mimic other soft tissue tumors and diseases (34). In this study, the case of a 61-year-old male patient, who presented with a history of a 6-week left thigh oedema and concomitant pain in our Emergency Department, is discussed. The patient was initially reviewed in another institution; the results of imaging studies (ultrasound scan) were consistent with deep vein thrombosis (DVT).Despite treatment, the patient's pain and swelling was exacerbating, which forced him to visit our hospital. Magnetic resonance imaging (MRI) revealed a diffused mass in his right thigh, while fine needle aspiration cytology (FNAC) yielded a diagnosis of B-cell lymphoid hyperplasia. The patient was then referred to a tertiary cancer treatment center for further management.

Introduction: Palatine tonsils are paired masses of lymphoid tissue, which act as an immunologicbarrier against the entry of pathogenic agents into the respiratory and digestive tracts. Tonsillitis is acommon disease, especially among children. Chronic tonsillitis is a disease with repeated attacks ofacute tonsillitis or a sub-clinic form of a resistant or poorly treated infection. Aim: To determine theclinicopathological findings in various lesions of tonsillectomy in the palatine tonsil. Materials andmethods: This is a retrospective study where 105 (Unilateral-20, Bilateral) cases ofhistopathologically identified tonsillectomy specimens as well as 4 tonsillar biopsies were included.The available data for all the patients as regards age, sex, and clinical symptoms were collected.Sections were taken from tonsillectomy specimens from representative areas while tonsillar biopsieswere processed completely. Routine hematoxylin and eosin staining was done along with this specialstain- PAS (periodic acid- Schiff) for actinomycosis and ZN stain for AFB. Results: Amongst thecases, 78 cases showed chronic tonsillitis. 11 cases were chronic tonsillitis with actinomycosis, acutechronic tonsillitis in 07 cases, granulomatous tonsillitis in 03 cases, acute ulcerative tonsillitis withmicroabscesses in 01 case, and reactive lymphoid hyperplasia in 02 cases. Three malignancies wereobserved – Two cases of squamous cell carcinoma and one case of undifferentiatedcarcinoma/lymphoma. Conclusion: Chronic tonsillitis is a common problem facing in all age groups,Histopathology plays a significant role in diagnosing both benign and malignant lesions of the tonsil.

Background This study identifies the incidence of appendiceal Enterobius vermicularis (E.v) infestation in all the patients undergoing appendectomy and evaluates the relationship between E. v infestation of the appendix and the acute appendicitis. Method ology: All the routinely examined appendectomy specimens received in the pathology laboratory of a referral hospital over a three year period of time were reviewed for the existence of E. v. These cases were evaluated for clinico-laboratory characterization. Results Out of 1150 appendectomies for clinical acute appendicitis picture, 31 (2.7%) cases revealed E. v infestation. The age ranged from 6 to 42 years old but more than 80% of the E. v infected cases were children. Twenty four cases (77.4%) did not show any other appendiceal pathology, six cases showed lymphoid hyperplasia and only one case showed concomitant histological acute inflammatory process. Conclusion E. v infestation is an incidental finding during histopathology examination of appendectomy specimens for patients with clinical diagnosis of acute appendicitis, however there is no relation between the existence of E. v and occurrence of acute appendicitis which is the main indication for appendectomy, so further studies are recommended to reach out earlier diagnosis to eliminate the unnecessary surgical intervention. Also surgeons should consider E. v as a differential diagnosis when removing a normal looking appendix to take the necessary precautions for minimizing any chance of contamination and sending all the normal looking appendectomy specimens for histopathology examination., Highlights • E. vermicularis was seen in 2.7% of all the resected appendices. • More than 96% of cases were not associated with any acute inflammatory cells. • Surgical intervention can be avoidable.

BACKGROUND Reactive lymphoid hyperplasia (RLH) of the liver is a rare liver lesion. It is considered difficult to differentiate radiologically from hepatocellular carcinoma, metastatic liver tumor and other pathologies. CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver. The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy. However, histopathological analysis revealed RLH. The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging. On diffusion-weighted imaging (DWI), we encountered linear hyperintensity along the portal tract consecutive to the liver lesion, which is a new characteristic radiologic finding. This finding corresponded to the lymphoid cell infiltration of the portal tract. Furthermore, there was strongly restricted diffusion on the apparent diffusion coefficient map. We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease. CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.

A pathological evaluation is one of the most important methods for the diagnosis of malignant lymphoma. A standardized diagnosis is occasionally difficult to achieve even by experienced hematopathologists. Therefore, established procedures including a computer-aided diagnosis are desired. This study aims to classify histopathological images of malignant lymphomas through deep learning, which is a computer algorithm and type of artificial intelligence (AI) technology. We prepared hematoxylin and eosin (H&E) slides of a lesion area from 388 sections, namely, 259 with diffuse large B-cell lymphoma, 89 with follicular lymphoma, and 40 with reactive lymphoid hyperplasia, and created whole slide images (WSIs) using a whole slide system. WSI was annotated in the lesion area by experienced hematopathologists. Image patches were cropped from the WSI to train and evaluate the classifiers. Image patches at magnifications of ×5, ×20, and ×40 were randomly divided into a test set and a training and evaluation set. The classifier was assessed using the test set through a cross-validation after training. The classifier achieved the highest levels of accuracy of 94.0%, 93.0%, and 92.0% for image patches with magnifications of ×5, ×20, and ×40, respectively, in comparison to diffuse large B-cell lymphoma, follicular lymphoma, and reactive lymphoid hyperplasia. Comparing the diagnostic accuracies between the proposed classifier and seven pathologists, including experienced hematopathologists, using the test set made up of image patches with magnifications of ×5, ×20, and ×40, the best accuracy demonstrated by the classifier was 97.0%, whereas the average accuracy achieved by the pathologists using WSIs was 76.0%, with the highest accuracy reaching 83.3%. In conclusion, the neural classifier can outperform pathologists in a morphological evaluation. These results suggest that the AI system can potentially support the diagnosis of malignant lymphoma.

Historically, high negative appendicectomy rates (NAR) were acceptable to offset the risks of perforation, previously exceeding 20%. With improved imaging and clinical scoring algorithms, there is growing demand for lower negative appendicectomy rates. The objectives were to (1) establish the NAR in our institution and (2) correlate clinical parameters and imaging modalities with histological findings. Patients undergoing an appendicectomy between January 2012 and June 2018 were identified using a prospectively maintained pathology database. Histology findings were cross referenced against our radiology system, and anonymised data was collected for gender, age, WCC, Neutrophil and CRP level. One thousand one hundred fifty-three patients met the inclusion criteria. Fifty-three percent were males (n = 610), with 81% (n = 933) of histology reports classified as appendicitis. Sixty patients had a histologically normal appendix equating to a 5.2% NAR. If lymphoid hyperplasia, fibrosis and atrophy are included, it equates to a NAR of 14.57%. (p < 0.0001). Sixty-six percent of patients had no pre-operative imaging. CT imaging demonstrated a higher sensitivity (93.33%) and positive predictive value (99.60%) compared to ultrasonography. WCC and CRP are statistically significant in predicting appendicitis (p < 0.0001). There is no consensus on defining a negative appendicectomy or for imaging modality utilisation. CT imaging is the most sensitive and should be used in cases of diagnostic uncertainty. A standardised algorithm regarding the workup of patients with RIF pain along with a consensus on the use of imaging will further reduce negative appendicectomy rates.

Summary The gastrointestinal tract (GI) is the primary site of lymphoproliferative lesions, spanning from reactive lymphoid hyperplasia to overt lymphoma. The diagnosis of these diseases is challenging and an integrated approach based on clinical, morphological, immunohistochemical and molecular data is needed. To reach to confident conclusions, a stepwise approach is highly recommended. Histological evaluation should first assess the benign versus neoplastic nature of a given lymphoid infiltrate. Morphological and phenotypic analyses should then be applied to get to a definite diagnosis. This review addresses the key histological features and diagnostic workup of the most common GI non-Hodgkin lymphomas (NHLs). Differential diagnoses and possible pitfalls are discussed by considering distinct groups of lesions (i.e. small to medium B-cell NHLs; medium to large B-cell NHLs; T-cell NHLs; and mimickers of Hodgkin lymphoma). The key clinical and epidemiological features of each entity are also described.

Background Castleman disease (CD) is a lymphoproliferative B-cell disease that is diagnosed from lymphoid hyperplasia with vascular proliferation. Symptoms may include fever, night sweats, and weight loss. Cutaneous manifestations often may go unnoticed since little has been described in the literature regarding them. Materials and methods A search of CD with cutaneous manifestations was performed in PUBMED, ProQuest, Ovid, Scopus, EMBASE, and Medline. All articles included patients over 18 years of age with a diagnosis of CD and cutaneous manifestations. Results A total of 68 articles were included. The most common cutaneous manifestations include paraneoplastic pemphigus and erythematous-brown plaques, papules, or nodules. Patients presenting with these manifestations should always have a thorough physical exam, and clinicians should try to identify any palpable lymph nodes. A complete workup to rule out other neoplasias needs to be performed as well. Conclusions A better understanding of these skin manifestations of CD may help physicians promptly diagnose and reconsider the path of diagnostic tests to identify this entity.

Workers in a print shop are exposed to photocopier toner dust and paper dust over a prolonged period of time. However, there are only rare case reports of toner and paper dust induced lung damage in humans. We reviewed our consultation files for a period of 30 years from 1987 to 2018 to look for cases with a diagnosis of giant cell interstitial pneumonia (GIP), printer toner exposure and paper dust exposure resulting in lung disease. There were two cases which met our inclusion criteria. Slides, clinical histories and imaging were reviewed. Both the patients had worked in print shops, and had no history of exposure to hard metals. Patient 1 presented with shortness of breath and cough over several months, while patient 2 was asymptomatic at presentation. Both the patients underwent surgical lung biopsies. Histopathologic examination from both the cases showed a spectrum of pathology, including features of GIP, desquamative interstitial pneumonia, chronic bronchiolitis with lymphoid hyperplasia, and particulate matter consistent with toner. Energy dispersive spectroscopy was performed on one case, and it revealed no cobalt or tungsten particles. The unusual combination of findings is very suggestive that toner particles with or without paper dust exposure were responsible for the pathologic changes in the lungs of these patients. This possibility should be explored further with additional patients who work in print shops where they are exposed to paper dust and paper toner and have signs or symptoms of diffuse lung disease.

Introduction: Tuberculosis (TB) is an important health problem in the developing countries. Extrapulmonary sites of TB commonly include lymph nodes, pleura, gastrointestinal system, genitourinary system, central nervous system, bones. Most of the EPTB cases present with lymphadenopathy and effusion. The conventional methods to diagnose EPTB includes fine needle aspiration cytology (FNAC) and demonstration of acid fast bacilli (AFB) using Zeihl- Neelson (ZN) staining. Objectives: 1). To assess the efficacy of FNAC positivity in comparison to CB-NAAT in the diagnosis of EPTB. 2). To assess the efficacy of AFB positivity in comparison to CB-NAAT in the diagnosis of EPTB. Materials and Methods: The present retrospective record based study was conducted at the Department of Pathology and CB-NAAT Centre, Mandya Institute of Medical Sciences (MIMS), Mandya, Karnataka. The study was started after obtaining approval from the Institutional Ethics Committee. The records of suspected 100 EPTB patients who had under gone FNAC, ZN stain and CB-NAAT test for EPTB diagnosis during the study period of four months from March to June 2018 were analysed. Results: A total of 100 subjects were included in the final analysis. In our study, youngest patient was 8 months and oldest was 75 years. Of the 100 cases, lymph node involvement accounted for 96 cases and soft tissue swellings accounted for 4 cases. The diagnosis of FNAC of 100 cases were reactive lymphoid hyperplasia, suppurative lesion, epithelioid granuloma without necrosis, epithelioid granuloma with necrosis, caseous necrosis without epithelioid cells and lymphoma and their proportion were 30%, 21%, 22%, 13%, 12% and 2% respectively. Out of 47 cases with FNAC findings favouring EPTB, 30 were CB-NAAT positive and 17 were CB-NAAT negative. Out of 53 cases with negative FNA findings, CB-NAAT was positive in 5 cases (14.2%). Only 13 cases were positive for AFB when compared to 30 CB-NAAT positive cases. Among the 35 CB-NAAT positive

Objective: Acute appendicitis is the most common reason for emergency abdominal surgery in pediatric population. Ultrasonography (US) is a widely used modality to diagnose acute appendicitis. Despite its success in diagnosing acute appendicitis, US have been reported to have a poor diagnostic accuracy to detect perforated appendicitis. We have frequently encountered lymph nodes around transvers colon in pediatric perforated appendicitis cases. We mainly aim to evaluate the accuracy of paracolic lymph node presence as a new diagnostic marker for perforated appendicitis. Materials and Methods: We have evaluated the US reports and/or images of the patients referred to radiology department with a clinical suspicion of acute appendicitis. Paracolic lymph node presence and sonographic findings indicating perforated appendicitis were recorded. Patients were divided into three subgroups according to their final diagnosis: Acute appendicitis, perforated appendicitis, others. Results: Mean age of the population was 14.9±2.3 years. There were 300 acute appendicitis cases, 71 perforated appendicitis cases, and 92 other diagnosis cases (4 lymphoid hyperplasia, 88 normal appendix). Rates of lymph node presence in paracolic area were 41/300 (13.6%) in acute appendicitis subgroup, 58/71 (81.6%) in perforated appendicitis subgroup, and 4/92 (4.34%) in other diagnosis subgroup. A longest diameter of a paracolic lymph node > 8.5 mm seemed to be a good predictor for perforated appendicitis diagnosis (sensitivity 85%, specificity 77%). Conclusion: we showed a statistically significant association between paracolic lymph node presence and perforated appendicitis. This sign can serve to confirm perforated appendicitis diagnosis over simple appendicitis.

Context: Fine needle aspiration cytology (FNAC) is widely used in the investigation of lymphadenopathy. A combination of FNAC and Flow cytometric immunophenotyping (FCI) can help to establish an accurate diagnosis and classification in most cases of NHL (Non-Hodgkin lymphoma). Aims: We evaluated the effectiveness of FNAC along with flow cytometry (FCM) with histopathology in the diagnosis and classification of NHL by applying FCI on a sample obtained from the FNAC of lymphoid tissue. Settings and Design: A cross-sectional study was conducted in the Department of Pathology. Patients of all ages presenting peripheral lymphadenopathy were screened on FNAC. All Cases suggested as NHL were taken up for FCM as well as for excision biopsy. Methods and Material: FCI of lymph node aspirate was performed by using four-color FCM (FACScalibur; Becton Dickinson). The sections were processed in Shandon Citadel 2000 tissue processor for histopathology. Statistical analysis used: Descriptive statistics were used to describe the study sample. Data were analyzed using SPSS. Results: A total of 30 patients, 27 (90%) male, and 3(10%) female were included in the study. Generalized lymphadenopathy (46.7%) was prominent followed by cervical lymphadenopathy(40%). Out of the 30 cases, eight cases were not analyzed due to the paucity of events. Out of 22 cases, a total of 18 cases were diagnosed as B-cell lymphoma, two cases as T-cell lymphoma, and two cases as reactive lymphoid hyperplasia. Conclusions: FNAC in conjunction with FCI is a reliable method that can be used as a first-line investigation to give rapid results, which can guide further investigation and facilitate cost-effective patient management. Key Messages: Excision biopsy and histopathological examination remain the gold standard for the classification of NHL. However, the need for anesthesia and possible complications of excision biopsy limits its role. FNAC in conjunction with FCI is a reliable method that can be used as a

Objective This study aims to study the expression and role of IgG and IgG4 in orbital MALT lymphoma and to compare the characteristics of IgG4-related diseases. Patients and methods Patients with orbital MALT lymphoma, treated in the West China Hospital of Sichuan University from 2012 to 2017, were enrolled in the current study. The immunological examination of the wax blocks of orbital masses was performed again and the expression level of IgG and IgG4 in pathological tissue was analyzed. Results The results presented that the positive rates of IgG and IgG4 in the cases of orbital MALT lymphoma were 90.91% and 61.98% respectively, of which IgG4/IgG >40% accounted for 49.33%. The positive rates of IgG and IgG4 in relapse cases were 94.60% and 70.27% respectively, and IgG4/IgG >40% accounted for 42.31%. There was no significant change in the expression of IgG and IgG4 in cases of lymphoproliferation converting to MALT lymphoma whereas, in cases of MALT lymphoma postoperatively converting to lymphoproliferation, there was an increase in IgG and IgG4 expression, with the change of IgG4 being significant. Conclusion IgG and IgG4 have a high correlation in the pathogenesis of MALT lymphoma and may even play an important role in the transformation of MALT lymphoma into orbital lymphoid hyperplasia. Given the association of IgG4 with inflammation and tumors and as an important diagnostic indicator for IgG4-RD and IgG4-related ophthalmic diseases, IgG4 may play an important role in these diseases.

Introduction: Palatine tonsils are paired masses of lymphoid tissue which act as immunologic barrier against the entry of pathogenic agents into the respiratory and digestive tracts. Despite their protective function, tonsils are prone to infection. Tonsillitis is a common disease especially among the children. Chronic tonsillitis is a disease with repeated attacks of acute tonsillitis or a sub-clinic form of a resistant or poorly treated infection. Aim: To study the histomorphological findings of various lesions of tonsils. Materials and Methods: A cross sectional study was carried out at a department of pathology in a tertiary care hospital for a period of two years. A total 160 cases of the histomorphologically identified tonsillectomy specimens were included and stained by Hematoxylin & Eosin . Results: We studied histopathology of 160 cases, out of which 156 were tonsillectomy specimens, 4 were tonsillar biopsies. The age of patients ranged from 1 to 60 years. In our study the histomorphological diagnosis showed 45(28.1%) cases showed chronic tonsillitis, 62(38.7%) cases of follicular tonsillitis, 5(3.2%) cases of chronic tonsillitis showed actinomycotic colonies, with no tissue reaction, 2(1.2%) cases of acute on chronic tonsillitis, and 40(25%) cases of reactive lymphoid hyperplasia and 5(3.2%) cases of Acute suppurative tonsillitis 1(0.6%) cases and 1(0.6%) case of moderately differentiated squamous cell carcinoma were seen. Conclusion: Routine histomorphogical study of tonsillectomy specimens has a low cost-benefit rate, and most diagnostic tool for early screening and follow-up of malignancy. Keywords: Chronic tonsillitis, Tonsillectomy, Histopathology.