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This article discusses a case of eosinophilic angiocentric fibrosis (EAF) with atypical clinical presentation involving the skin and upper respiratory tract. EAF is a rare fibroinflammatory condition that primarily affects the orbit and upper respiratory tract. The patient in this case initially presented with a firm plaque on her thigh, which later became inflamed and coincided with upper respiratory tract infections. The diagnosis was confirmed through skin and nasal mucosa biopsies, which revealed characteristic histopathological findings, including eosinophils and IgG4+ plasma cells. The patient's symptoms improved with treatment using methotrexate and prednisone. This case highlights the importance of recognizing the diverse and atypical manifestations of EAF for accurate diagnosis and management. [Extracted from the article]

Background: Crohn's disease (CD) is a chronic intestinal inflammatory disorder, the etiology of which remains unknown, and is characterized by symptoms such as chronic abdominal pain, diarrhea, obstruction, and perianal lesions. Histopathology is widely regarded as the preferred method for diagnosing CD, although the histological diagnosis may lack specificity. The identification of granulomas is commonly believed to be the most reliable diagnostic indicator for CD, surpassing all other clinical features in significance. Nevertheless, research indicates that the detection rate of granulomas in CD exhibits considerable variability. Furthermore, granulomas can manifest in various specific infections including tuberculosis and Yersinia, as well as in a range of diseases characterized by macrophage reactions such as sarcoidosis and drug-induced enteritis. Granulomas associated with CD typically do not exhibit necrosis. However, the formation of caseous granulomas may occur as a result of secondary infections related to anti-CD drug treatment or perforation of the intestinal wall. Case presentation: In this study, we present a case of a 28-year-old female patient diagnosed with CD exhibiting histologic granulomas, including both caseating and non-caseating forms, which demonstrated a positive response to medical treatment. Conclusion: In clinical practice, various forms of granulomas may indicate diverse underlying diseases, yet lack specificity. It is suggested that the presence of caseous granulomas should not be considered as a definitive exclusion criterion for the diagnosis when clinical, endoscopic, imaging and other histopathological features are consistent with CD. This study is the first report of caseous granulomas in CD without concomitant tuberculosis infection. [ABSTRACT FROM AUTHOR]

The feline eosinophilic granuloma complex is a well-known dermatological problem that affects domestic cats. It has three characteristic components: eosinophilic plaque, eosinophilic granuloma and indolent ulcer. In this case report, we report a 5-year-old, mixed-breed cat with pruritic plaque formation, which was typical for eosinophilic plaque by dermatological examination. The diagnosis was established by histopathological and clinical findings. As previous literature showed, hair follicle epitheliummucinosis as a histopathological finding could potentially give us fundamental clues about the microscopic diagnosis of this complex. We discuss the presentation, histopathology and treatment response in detail. This case highlights howintricate feline eosinophilic granuloma complex can be, and underscores the significance of hair follicle epithelium mucinosis as a diagnostic tool in histopathology. [ABSTRACT FROM AUTHOR]

Background: Anisakiasis, a zoonotic disease caused by the nematode Anisakis, poses a significant concern for public health, particularly in regions with high consumption of raw or undercooked fish. Case Presentation: We present a case report of a 41-year-old woman who developed severe abdominal symptoms, ultimately diagnosed with intestinal obstruction due to Anisakis infestation, requiring surgery. Despite the absence of prominent eosinophilia or specific radiological findings, the diagnosis was confirmed through histological examination, highlighting the importance of considering anisakiasis in patients with a history of raw seafood consumption. Conclusion: The case underscores the diagnostic challenges associated with anisakiasis, emphasizing the need for increased awareness among healthcare professionals and the public regarding the risks of consuming raw or undercooked seafood. Effective management requires a multidisciplinary approach, including clinical assessment, imaging studies, and histological evaluation, to ensure timely diagnosis and appropriate treatment. [ABSTRACT FROM AUTHOR]

The article discusses the case of a Belgian Malinois dog with colorectal pythiosis with partial obstruction and marked colonic dilatation. Topics discussed include tenesmus, hematochezia, intermittent chronic diarrhea and weight loss presented by the dog, the cytological, histopathological and laboratory findings, and euthanasia performed on the dog due to financial constraints and poor prognosis.

This article presents a case study of an 8-year-old cat with a skull mass diagnosed as osteosarcoma, a type of bone cancer. The mass was found to be located in the right frontoparietal region of the skull and caused a shift in the right cerebral hemisphere. The study discusses the clinical signs, imaging findings, and histopathological examination of the mass. It emphasizes the rarity of skull involvement in osteosarcoma and the importance of advanced imaging techniques in diagnosis. The article also provides information on the prognosis and survival rate associated with different types of osteosarcoma in cats. [Extracted from the article]

Hypereosinophilic syndrome (HES) has substantial clinical heterogeneity and leads to any organ dysfunction and can be fatal without timely treatment. HES is associated with an extremely poor prognosis, with the survival rate at 60 days after intensive care unit (ICU) admission around 20%. A high index of suspicion is needed for timely diagnosis and early initiation of treatment to improve outcomes. Treatment strategies are aimed at symptom control and limiting end-organ damage by lowering blood eosinophils. The combination of immune thrombocytopenic purpura (ITP), deep vein thrombosis (DVT), and cerebral venous sinus thrombosis (CVST) in the setting of eosinophil-related diseases has seldom been reported. Here, we report a case of a young female who developed eosinophilic pneumonia, DVT, CSVT, and ITP managed successfully with steroids, intravenous immunoglobulin, and anticoagulation. [ABSTRACT FROM AUTHOR]

Influenza A virus (IAV) infections in swine are usually subclinical, but they can reach high morbidity rates. The mortality rate is normally low. In this study, six vaccinated, spontaneously deceased sows revealed IAV infection and enhanced neutrophilic bronchopneumonia with unexpectedly large numbers of infiltrating eosinophils. The purpose of this study was to characterize these lung lesions with special emphasis on the phenotypes of inflammatory cells, the presence of eosinophilic peroxidase (EPO), and neutrophil extracellular traps (NETs). The number of Sirius red-stained eosinophils was significantly higher in the lungs of IAV-infected sows compared to healthy pigs, indicating a migration of eosinophils from blood vessels into the lung tissue stimulated by IAV infection. The detection of intra- and extracellular EPO in the lungs suggests its contribution to pulmonary damage. The presence of CD3+ T lymphocytes, CD20+ B lymphocytes, and Iba-1+ macrophages indicates the involvement of cell-mediated immune responses in disease progression. Furthermore, high numbers of myeloperoxidase-positive cells were detected. However, DNA-histone-1 complexes were reduced in IAV-infected sows, leading to the hypothesis that NETs are not formed in the IAV-infected sows. In conclusion, our findings in the lungs of IAV-infected vaccinated sows suggest the presence of so far unreported field cases of vaccine-associated enhanced respiratory disease. [ABSTRACT FROM AUTHOR]

Background: Diascopy is a point‐of‐care diagnostic test used to differentiate skin erythema due to vascular dilation from haemorrhage. In the veterinary literature, only a handful of diseases have been described to be associated with a negative (nonblanching) diascopy result, and histological investigation of haemorrhage has been inconsistent. Objectives: Retrospective study to undertake a histopathological investigation of canine, nonblanching erythematous dermatoses for the presence or absence of haemorrhage and vascular changes. Materials and Methods: Skin biopsies from dogs presented with moderate‐to‐severe nonblanching erythema were evaluated histologically. Additionally, clinical data about each patient were analysed. Results: Twenty cases were identified with nonblanching erythema. Diagnoses included vasculopathy (n = 6), canine eosinophilic dermatitis (n = 3), cutaneous epitheliotropic T‐cell lymphoma (n = 2), and one case each of sterile granuloma and pyogranuloma syndrome, German shepherd dog pyoderma, multiple mast cell tumours, haemangiosarcoma, exfoliative cutaneous lupus erythematosus, canine leishmaniosis with sebaceous adenitis, sebaceous adenitis with concurrent dermatophytosis, calcinosis cutis and canine atopic dermatitis with insect‐bite reaction. One or more vascular changes were present in all 20 cases and included perivascular oedema, endothelial swelling and neutrophilic infiltration of vessel walls. Haemorrhage was identified in 17 of 20 cases (85%). Three cases without dermal haemorrhage were calcinosis cutis, sebaceous adenitis with dermatophytosis and canine atopic dermatitis with insect‐bite reaction. Conclusions and Clinical Relevance: Negative diascopy was associated with haemorrhage and vascular pathological findings in the majority of cases, yet not all. Haemorrhage was identified histologically in all diseases previously reported as nonblanching as well as in a few additional diseases. [ABSTRACT FROM AUTHOR]

The research letter published in the Journal of Rheumatology in November 2024 discusses the absence of glucocorticoids alongside avacopan treatment and subsequent liver injury in patients with antineutrophil cytoplasmic antibody–associated vasculitis (AAV). The study conducted at multiple hospitals in Japan found that some patients developed liver abnormalities due to avacopan, with improvements seen after discontinuation of the medication. The study suggests a potential link between the lack of glucocorticoid use with avacopan and drug-induced liver injury, highlighting the need for further research in this area. [Extracted from the article]

The document discusses a case of iatrogenic transmission of vascular Aß40 amyloid, highlighting the prion-like transmission of amyloid in amyloidosis pathogenesis. A 42-year-old male developed cerebral amyloid angiopathy 29 years after receiving a cadaveric dural graft, leading to multiple intracranial hemorrhages. The case is unique due to the detailed clinical course and histological findings, suggesting a probable case of vascular Aß40 amyloid transmission. The study emphasizes the need for further research on iatrogenic transmission of amyloid and effective treatments for cerebral amyloid angiopathy. [Extracted from the article]

This article discusses a case report of a 15-year-old female with scalp and skin lesions caused by syphilis. The patient presented with a firm lump on her forehead and violaceous, brown papules on her scalp, trunk, and extremities. Laboratory tests and imaging confirmed the diagnosis of syphilis, and further examination revealed additional lesions consistent with secondary syphilis. The article emphasizes the variable clinical presentations of syphilis and the importance of early detection and treatment. Treatment options for syphilitic osteitis are also discussed. [Extracted from the article]

This article discusses a case report of a patient with eosinophilic granulomatosis with polyangiitis (EGPA), a rare systemic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. The patient presented with a choroidal granuloma near the optic disk, which was highlighted through multimodal imaging. The article describes the patient's medical history, examination findings, and treatment. The authors emphasize the importance of optical coherence tomography (OCT) in diagnosing and imaging retinal pseudo-tumors. This case report provides valuable insights into the ophthalmologic manifestations of EGPA and the utility of multimodal imaging in diagnosing and monitoring the condition. [Extracted from the article]

Objective: SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a highly malignant neoplasm with an undifferentiated or rhabdoid phenotype, posing a diagnostic challenge. This case report aims to create awareness about this rare neoplasm while dealing with cases presenting with undifferentiated morphology. Case Report: A 55-year-old gentleman with constitutional symptoms and lymphadenopathy. Imaging revealed a mass lesion in the right upper lobe of the lung. A biopsy of the cervical lymph node showed diffusely effaced architecture replaced by sheets of undifferentiated pleomorphic cells with vesicular nuclei, prominent nucleoli, eosinophilic cytoplasm, and multiple necrotic foci. An extensive immunohistochemistry (IHC) panel was applied, which showed positivity for synaptophysin, vimentin, and focal CD34 and EMA expression. Other markers like pan-cytokeratin, p40, TTF1, CD56, INSM1, calretinin, CD45, SOX10, S100, CD30, CD117, SMA, and Desmin were negative, with INI1 retained. The IHC panel excluded the morphological differentials of carcinoma, lymphoma, rhabdomyosarcoma, melanoma, and germ cell tumor. Further literature review led to the possibility of the SMARCA4-UT entity, which had a morphology and IHC profile similar to the present case. Testing for SMARCA4 (BRG-1) by IHC showed a complete loss in the tumor cells, favoring the diagnosis of Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). Conclusion: SMARCA4-UTs are rare, highly aggressive, and poorly differentiated thoracic tumors. Recognizing them is vital as there is potential for therapeutic interventions such as immunotherapy and SMARCA4-targeted therapies, offering promising prospects for the future. [ABSTRACT FROM AUTHOR]

NK/T-cell lymphoma (NKTCL) is a highly aggressive malignant tumour with a very poor prognosis, which often poses diagnostic difficulties due to the non-specificity of its clinical presentation. NK/T-cell lymphoma with eosinophilic hyperplasia syndrome is extremely rare. This article describes a patient with NKTCL misdiagnosed as vasculitis who presented with sinusitis, abdominal pain, anorexia, and lung shadows. Additionally, the patient exhibited extremely high eosinophilia levels, which led to a further misdiagnosis of eosinophilic granuloma. We describe the clinical features, diagnostic methods and differential diagnosis of lymphoma and highlights the importance of a multidisciplinary approach in accurate diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Asthma is a prevalent chronic non-communicable disease, affecting approximately 300 million people worldwide. It is characterized by significant airway inflammation, hyperresponsiveness, obstruction, and remodeling. Eosinophilic asthma, a subtype of asthma, involves the accumulation of eosinophils in the airways. These eosinophils release mediators and cytokines, contributing to severe airway inflammation and tissue damage. Emerging evidence suggests that targeting eosinophils could reduce airway remodeling and slow the progression of asthma. To achieve this, it is essential to understand the immunopathology of asthma, identify specific eosinophil-associated biomarkers, and categorize patients more accurately based on the clinical characteristics (phenotypes) and underlying pathobiological mechanisms (endotypes). This review delves into the role of eosinophils in exacerbating severe asthma, exploring various phenotypes and endotypes, as well as biomarkers. It also examines the current and emerging biological agents that target eosinophils in eosinophilic asthma. By focusing on these aspects, both researchers and clinicians can advance the development of targeted therapies to combat eosinophilic pathology in severe asthma. [ABSTRACT FROM AUTHOR]

This article discusses the lack of detection of aluminum-reactive T-lymphocytes in patients with subcutaneous immunotherapy (SCIT)-induced granulomas. Aluminum contact allergy is commonly seen in children with itching vaccination granulomas, but it can also occur in adults following SCIT. The traditional method of detecting sensitization to aluminum is patch testing, but it has limitations. The study investigates the use of the blood in vitro lymphocyte proliferation test (LPT) as an alternative to patch testing. The results suggest that there may be few or no circulating aluminum-reactive cells in adults with SCIT-induced granulomas, and both patch testing and LPT may have low sensitivity for detecting aluminum contact allergy in adults. [Extracted from the article]

This article discusses a case study of a 72-year-old woman with persistent cutaneous granulomatous lesions on her right arm. Despite numerous treatments, including antibiotics and corticosteroids, the lesions did not improve. The patient was eventually diagnosed with rubella virus (RuV)-associated cutaneous granulomatous disease, which is a rare condition that has been reported in immunocompetent patients. The article highlights the importance of considering RuV infection as a differential diagnosis in cases of cutaneous granulomas of unknown origin, especially when resistant to treatment. Treatment for this condition remains challenging, and further research is needed to develop effective therapies. [Extracted from the article]

Sea urchin injuries are common following accidental contact with sharp sea urchin spines. Immediate manifestations of injury include local erythema, pain, and myalgia. Failure to remove the spines from the skin may result in delayed systemic reactions, secondary infection, granulomas, and—if joint spaces are involved—inflammatory or infectious synovitis and arthritis. The majority of severe complications can be avoided if the spines are fully removed from the skin soon after injury, which can be difficult. This article aims to bring awareness to the myriad complications from sea urchin injuries as well as the mechanisms for successful spine removal. [ABSTRACT FROM AUTHOR]

Abstract Ewing sarcoma is the most common malignant bone tumor of the pelvis in children and young adults. Even with aggressive treatment, its survival rate is amongst the poorest. Classical presentation may not be the rule. It may simulate clinically, imagiologically and histopathologically other nonmalignant entities. Therefore, its suspicion should not be overlooked. We report two cases of pelvic Ewing sarcoma: the first mimicking eosinophilic granuloma, and the second mimicking osteomyelitis. In the latter, we also report an atypical finding of its natural history: an initial response to antibiotic and anti-inflammatory treatment. In both cases, we highlight the possibility of an inconclusive percutaneous bone biopsy and the importance of immunochemistry and cytogenetics for the definitive diagnosis.

Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis (Mtb). When Mtb enters inside the pulmonary alveolus, it is phagocytosed by the alveolar macrophages, followed by a cascade of immune responses. This leads to the recruitment and accumulation of additional macrophages and T cells in the pulmonary tissues. A key outcome of this is the formation of granuloma, the hallmark of TB infection. In this paper, we develop a mathematical model of the evolution of granuloma by a system of partial differential equations that is based on the classical Keller–Segel chemotaxis equation. We investigate the effect of different parameters on the formation of granuloma. We present numerical simulation results that illustrate the impact of different parameters. The implication of our result on the disease progression is also discussed. [ABSTRACT FROM AUTHOR]

Introduction. Recently, an increased risk of celiac disease or eosinophilic esophagitis has been postulated among patients with either of these disorders, prompting some to suggest a common underlying mechanism, whereas others maintain that their co-existence is coincidental. Methods. We compared clinical and pathological features of 29 patients meeting criteria for both celiac disease and eosinophilic esophagitis to 26 celiac disease and 26 eosinophilic esophagitis controls to determine whether any distinguished study patients from controls. Results. Eight (28%) study patients presented with symptoms of both celiac disease and eosinophilic esophagitis, whereas 14 (48%) had celiac disease symptoms only and 5 had (17%) esophageal symptoms only. Study patients had similar autoimmune and atopic conditions seen in both control groups. Histological severity of disease, including Marsh II-III duodenal histology (study specimens: 87%; controls: 89%), mean peak esophageal eosinophil counts (study specimens: 55/400x field; controls: 80/400X field, P =.1), and presence of eosinophil microabscesses, scale crust, and subepithelial fibrosis were also similar to controls. Gluten-free diet resolved celiac disease-related symptoms (19 of 20, 95%) and histology (10 of 12, 83%), but not esophageal symptoms or eosinophilia in most study patients. Conclusion. Patients with concomitant celiac disease and eosinophilic esophagitis lack distinguishing features compared to controls with celiac disease or eosinophilic esophagitis alone. The occurrence of both disorders is likely coincidental in most cases. [ABSTRACT FROM AUTHOR]

Skull lesions in pediatric population are common findings on imaging and sometimes with heterogeneous manifestations, constituting a diagnostic challenge. Some lesions can be misinterpreted for their aggressiveness, as with larger lesions eroding cortical bone, containing soft tissue components, leading to excessive and, in some cases, invasive inappropriate etiological investigation. In this review, we present multiple several conditions that may present as skull lesions or pseudolesions, organized by groups (anatomic variants, congenital and development disorders, traumatic injuries, vascular issues, infectious conditions, and tumoral processes). Anatomic variants are common imaging findings that must be recognized by the neuroradiologist. Congenital malformations are rare conditions, such as aplasia cutis congenita and sinus pericranii, usually seen at earlier ages, the majority of which are benign findings. In case of trauma, cephalohematoma, growing skull fractures, and posttraumatic lytic lesions should be considered. Osteomyelitis tends to be locally aggressive and may mimic malignancy, in which cases, the clinical history can be the key to diagnosis. Vascular (sickle cell disease) and tumoral (aneurismal bone cyst, eosinophilic granuloma, metastases) lesions are relatively rare lesions but should be considered in the differential diagnosis, in the presence of certain imaging findings. The main difficulty is the differentiation between the benign and malignant nature; therefore, the main objective of this pictorial essay is to review the main skull lytic lesions found in pediatric age, describing the main findings in different imaging modalities (CT and MRI), allowing the neuroradiologist greater confidence in establishing the differential diagnosis, through a systematic and simple characterization of the lesions. [ABSTRACT FROM AUTHOR]

Background: Spinal eosinophilic granulomas (EG) are rare tumors, mostly reported in the pediatric age group. They constitute <1% of primary bone neoplasms, and cervical spine involvement is uncommon. Case Description: A 20-year-old male presented with neck pain for a 4-month duration. Six years previously, he had received six cycles of vinblastine for biopsy-proven histiocytosis of an axillary lymph node; this resulted in incomplete remission. Present magnetic resonance/computed tomography (CT) imaging revealed a lytic C2 body lesion with atlantoaxial instability. When the CT-guided biopsy was suggestive of EG, he was managed with definitive surgery and adjuvant radiotherapy. Conclusion: Cervical spine EG is rare in adults. CT-guided biopsy should confirm the diagnosis and should be followed by definitive surgery and adjuvant radiotherapy. [ABSTRACT FROM AUTHOR]

Purpose: Retroperitoneal liposarcoma (RLPS) poses a challenging scenario for surgeons due to its unpredictable biological behavior. Surgery remains the primary curative option for RLPS; however, the need for additional information to guide surgical strategies persists. Volume-based 18F-FDG PET/CT may solve this issue. Methods: We analyzed data from 89 RLPS patients, measuring metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) and explored their associations with clinical, prognostic, and pathological factors. Results: MTV, TLG of multifocal and recurrent RLPS were significantly higher than unifocal and primary ones (P < 0.001, P < 0.001, P = 0.003 and P = 0.002, respectively). SUVmax correlated with FNCLCC histological grade, mitotic count and Ki-67 index (P for G1/G2 = 0.005, P for G2/G3 = 0.017, and P for G1/G3 = 0.001, P < 0.001 and P = 0.024, respectively). MTG, TLG and SUVmax of WDLPS were significantly lower than DDLPS and PLPS (P for MTV were 0.009 and 0.022, P for TLG were 0.028 and 0.048, and P for SUVmax were 0.027 and < 0.001, respectively). Multivariable Cox analysis showed that MTV > 457.65 (P = 0.025), pathological subtype (P = 0.049) and FNCLCC histological grade (P = 0.033) were related to overall survival (OS). Conclusions: Our findings indicate that MTV is an independent prognostic factor for RLPS, while MTV, TLG, and SUVmax can preoperatively predict multifocal lesions, histological grade, and pathological subtype. Volume-based 18F-FDG PET/CT offers valuable information to aid in the decision-making process for RLPS surgical strategies. [ABSTRACT FROM AUTHOR]

Background: Giant intracranial 'IgG4-related' lesions are uncommon. They may present as pachymeningitis or localized mass. Here we report, probably, the largest IgG4 skull base mass ever to be reported. Case: A 40-year male presented with headache, diplopia, right-sided sensori-neuronal hearing loss, and left spastic hemiparesis. Magnetic resonance imaging showed a lesion of 8.5 cm extending from the paranasal sinuses to the right petroclival region with uniform contrast enhancement and T2 hypointensity. Endonasal biopsy revealed respiratory epithelium with fibrosis, and lymphoplasmacytic infiltrate having IgG4 positive cells >30/HPF suggestive of 'IgG4-related' disease. Serum IgG4 was within normal levels. With oral prednisolone 60 mg given daily for 6 weeks and then tapered off over 8 weeks, he improved symptomatically. Conclusion: Though rare, 'IgG4-related' disease can also present as a giant skull base mass and should be kept as a differential to fungal granulomas and meningiomas. As they improve dramatically with medical management, extensive skull base resection should not be planned before obtaining a tissue biopsy, especially when there is extension into paranasal sinuses and T2 hypointensity. [ABSTRACT FROM AUTHOR]

Summary: Background: Predictive models for eosinophilic oesophagitis (EoE) may not fully rule in the diagnosis. Aim: To develop a reverse model that predicts against EoE to eliminate the need for oesophageal biopsies. Methods: In this two‐centre study, a predictive model was developed (Mayo Clinic) and validated (University of North Carolina [UNC]). Cross‐sectional data from consecutive adult patients without prior EoE who underwent upper enoscopy with oesophageal biopsies were used. EoE cases had ≥15 eosinophils/high‐power field while controls had no eosinophils. Data were collected on patient clinical and endoscopic features. Multiple variable logistic regression was used to identify predictors of non‐EoE status while maintaining specificity ≥95%. A secondary model was developed to predict against the need for endoscopy in patients suspected of having EoE without alarm symptoms. Results: The Mayo and UNC cohorts consisted of 345 (EoE = 94, non‐EoE = 251) and 297 patients (EoE = 84, non‐EoE = 213), respectively. A primary model based on clinical and endoscopic features predicted against EoE with c‐statistic 0.92 (95% CI: 0.88–0.96), specificity 95%, and sensitivity 65%. This model was validated (UNC) with c‐statistic 0.87 (95% CI: 0.82–0.92). A simplified scoring system was created and a threshold of ≥12 points excluded EoE with 95% specificity and 50% sensitivity. A secondary model based on clinical characteristics alone predicted against EoE with c‐statistic 0.86 (95% CI: 0.82–0.90), specificity 95% and sensitivity 39% and validated (UNC) with c‐statistic 0.78 (95% CI: 0.71–0.85). Conclusion: A simplified scoring system accurately identified a group of patients with a low likelihood of EoE where unnecessary oesophageal biopsies can be avoided, potentially resulting in resource and cost savings. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) is a disease characterized by localized and generalized proliferation of the histiocytes. It is a locally aggressive condition. The clinical presentation is highly variable and can range from isolated, self-healing skin or bone lesions to life-threatening multisystem disease. It can present as a unifocal or multifocal disease. The majority are present in the head and neck region, but the involvement of Paranasal sinuses is rare. Here we describe a 64-years-old female who presented with a slow-growing left nasal mass for 1 year. Evaluation of the patient was suggestive of malignancy, but the biopsy report turned out to be Langerhans cell histiocytosis; subsequently left, total maxillectomy was done. We hereby present a unique case of LCH with isolated nose and paranasal sinus involvement. [ABSTRACT FROM AUTHOR]

A 46-year-old man who had been diagnosed with eosinophilic otitis media (EOM) and eosinophilic chronic rhinosinusitis was referred to our department. He suffered from bilateral earache, clogged ear sensation, and otorrhea associated with EOM. He had been treated with a myringotomy and a ventilation tube (VT) insertion. However, his symptoms did not improve, and the VT repeatedly fell out. We performed canal wall down mastoidectomy via a retro-auricular incision to remove the presumed cholesterol granuloma (CG) and a long-term VT insertion. The VT fell out repeatedly. Therefore, a large VT that Komune devised was inserted. Four months after reinsertion, there was no evidence of recurrent otorrhea or fallout of a large VT. A large VT insertion could be useful in the severe case of EOM with CG. [ABSTRACT FROM AUTHOR]

Fluorescent analysis of bone provides valuable insights into bone structures. However, conventional dyes suffer from low specificity on bone tissue, small stokes shift, short fluorescent lifetime, and aggregation‐caused quenching effect, which result in low efficacy and artifacts. In this work, we design an aggregation‐induced emission (AIE)‐active iridium(III) complex (Ir‐BP2) as a highly selective, convenient, nondestructiveness, and dual‐mode staining agent for bone analysis. Ir‐BP2 containing phosphonate groups selectively binds to hydroxyapatites, the main component of bone matrix, and exhibits turn‐on AIE phosphorescence with prolonged lifetime. Ir‐BP2 exhibits promising biosafety and offers higher accuracy in staining calcium deposits than conventional Alizarin Red S staining assay when it is employed in real‐time monitoring of osteogenesis differentiation process. A ready‐to‐use staining spray of Ir‐BP2 is fabricated. By using fluorescent imaging and lifetime imaging, Ir‐BP2 staining provides valuable insights into bone microstructure analysis, microdamage diagnosis, and bone growth state identification. Further, Ir‐BP2 is successfully applied on a human spine vertebra for diagnosing bone invasiveness of eosinophilic granuloma, validating its clinical practice. This work presents a powerful tool in bone analysis and will lead to new approaches for the diagnosis and treatment of bone‐related diseases. [ABSTRACT FROM AUTHOR]

Eosinophils represent the most active cells in mammals that show protective and assistive activity in the host immune defence against helminth parasites. These cells are also responsible for the reduction of allergic and inflammatory reactions. The eosinophils play a key role in allergic reactions by secretion of different chemical molecules leading to swelling, lesions and granuloma onset. The study was carried out on 30 cats with inflammatory skin lesions. The cats ranged in age from seven months to 13 years, and had an average age of three years. The research methodology included information on the disease, dermatological conclusions, concomitant disorders, medical and laboratory data and the treatment strategy. In total, 30 cats were diagnosed with eosinophilic granuloma complex. The distribution of lesions was 87.1% in the skin and 12.9% at the skin–mucosal junction. The lesions increased and decreased with the seasons of spring and summer, and the onset of the disease usually coincided with exposure to fleas. Eosinophilic granuloma complex in cats is a serious pathology and frequently requires lifelong treatment, so it is important to diagnose it quickly and accurately to ensure optimal treatment of affected animals. [ABSTRACT FROM AUTHOR]

Peripheral giant cell granuloma (PGCG) is an asymptomatic, non-neoplastic, and proliferative lesion of unknown etiology. Possible pre-disposing factors, such as hormonal changes during pregnancy, have been suggested. However, the association between PGCG and pregnancy is controversial. There are few reported clinical cases of pregnancy-associated PGCG in the literature, and they occurred only in the lower jaw. The present report is on a 35-year-old female patient at 36 weeks of gestation who presented with a PGCG in the central and lateral incisors of the upper jaw. Management consisted of complete surgical excision of the lesion along with a margin of healthy tissue under local anesthesia, followed by curettage of the adjacent fibers of the affected bony wall. The patient experienced adequate healing without complications. The diagnosis of PGCG was based on clinical characteristics, imaging examinations, and histopathological confirmation. The patient underwent postoperative follow-up evaluations at 3, 6, and 12 months, and there were no signs of recurrence. [ABSTRACT FROM AUTHOR]

Benign nasal septal tumors are rare and exhibit various histologic features. It is necessary to treat them based on a plan that considers the prognosis, functionality, and esthetics. We report two similar and rare cases of nasal septal tumors with different diagnoses that we treated with nasal septal tumor resection. Eosinophilic angiocentric disease was the most likely diagnosis of one of the two cases, but it was not confirmed by the IgG4:IgG ratio. The other case was diagnosed as extranodal Rosai-Dorfman disease based on its histological features. The histological appearance of nasal septal tumors varies widely; therefore, a careful diagnosis based on both clinical and pathological perspectives is required. [ABSTRACT FROM AUTHOR]

This article discusses a case of ulcerative shell lesions in a diamond-backed terrapin. The terrapin presented with scute sloughing and cystic ulcerative pitting lesions on the carapace and plastron. The lesions were found to be caused by a fungal infection with Emydomyces testavorans, a newly described cause of ulcerative shell lesions in aquatic turtles. The article highlights the importance of thorough examination and testing for fungal hyphae in samples from ulcerative shell lesions in aquatic turtles. [Extracted from the article]

This article discusses the delayed occurrence of foreign body reactions caused by poly-L-lactic acid (PLLA) fillers, which are commonly used for tissue augmentation and cosmetic purposes. The article presents a case study of a 52-year-old woman who developed granuloma formation over 100 months after receiving PLLA injections in the nasolabial fold. The article emphasizes the importance of healthcare providers recognizing the potential adverse effects of PLLA fillers and informing patients about these risks. It also highlights the effectiveness of intralesional steroid therapy in managing complications associated with PLLA injections. [Extracted from the article]

Abstract Fluorescent analysis of bone provides valuable insights into bone structures. However, conventional dyes suffer from low specificity on bone tissue, small stokes shift, short fluorescent lifetime, and aggregation‐caused quenching effect, which result in low efficacy and artifacts. In this work, we design an aggregation‐induced emission (AIE)‐active iridium(III) complex (Ir‐BP2) as a highly selective, convenient, nondestructiveness, and dual‐mode staining agent for bone analysis. Ir‐BP2 containing phosphonate groups selectively binds to hydroxyapatites, the main component of bone matrix, and exhibits turn‐on AIE phosphorescence with prolonged lifetime. Ir‐BP2 exhibits promising biosafety and offers higher accuracy in staining calcium deposits than conventional Alizarin Red S staining assay when it is employed in real‐time monitoring of osteogenesis differentiation process. A ready‐to‐use staining spray of Ir‐BP2 is fabricated. By using fluorescent imaging and lifetime imaging, Ir‐BP2 staining provides valuable insights into bone microstructure analysis, microdamage diagnosis, and bone growth state identification. Further, Ir‐BP2 is successfully applied on a human spine vertebra for diagnosing bone invasiveness of eosinophilic granuloma, validating its clinical practice. This work presents a powerful tool in bone analysis and will lead to new approaches for the diagnosis and treatment of bone‐related diseases.

Langerhans cell histiocytosis is a rare disease with diverse clinical presentations. We report a 4-year-old boy with progressive weakness in lower extremities, a large head lump, and inability to walk. On physical examination, bulged scalp, ulcerative skin lesions, engorged veins over the abdomen and chest, and decreased muscle strength were evident. The computed tomography and magnetic resonance imaging revealed lytic lesions on vertebral bodies (T5-T8), resulting in the destruction of T7 vertebra and compression of the spinal cord, along with abnormal meningeal enhancement and multiple enhanced cerebral lesions, mainly at the junction of white and gray matter. Biopsy of T7 vertebra revealed Langerhans cell histiocytosis, confirmed by S-100 and CD1a expression in immunohistochemistry. The clinical team should be vigilant for the insidious development of central nervous system (CNS) symptoms and seek the required neurosurgical interventions to have a timely and definitive diagnosis and tackle the CNS lesions before resulting in permanent deficits.

Bone defects have recently surfaced as an important topic to discuss in orthopedic clinics, and as a result, they have captured the attention of the biomedical community as well as the general public. Because of their unique characteristics, such as high water content, softness, flexibility, and biocompatibility, hydrogels are gaining more and more traction in the field of tissue regeneration research within the medical industry. Intelligent biomaterials, like hydrogels, are much better than their predecessors because they can respond to new stimuli on multiple levels, such as the physical, chemical, and biological. Because they are sensitive to different outside cues, like shape in three dimensions and conditions between solid and liquid phases, they show certain traits. This indicates that they have the capability of developing into a more efficient material in the future, which would make them better suited to facilitate the localized repair of bone lesions. This article takes a look at hydrogels that alter their shape in response to the environment they are in. Some of the topics covered in this article include the classification of these materials, the concepts that underlie their synthesis, and the current state of research in this potentially fruitful field. This research was conducted with the intention of finding novel ways to treat severe bone defects. [ABSTRACT FROM AUTHOR]

Patients with inborn errors of immunity (IEI) may develop granulomas in multiple organ systems including the skin. Vaccine strain rubella virus (RuV), part of the live attenuated measles, mumps, and rubella (MMR) vaccine, has been identified within these granulomas. RuV is typically found in macrophages; however, recently neutrophils have been identified as a novel cell type infected. Here, we present a case of RuV‐associated cutaneous granuloma with RuV localized to neutrophils. A 46‐year‐old female with common variable immunodeficiency presented with verrucous papules and crusted plaques from the right knee to the distal shin of 20 years duration, associated with prior physical trauma. Biopsy specimen showed palisaded granulomas surrounding central necrosis with scattered aggregates of neutrophils. Vaccine‐derived RuV was detected by molecular sequencing in lesional skin. Fluorescent immunohistochemistry with CD206, myeloperoxidase (MPO), and RV capsid (RVC) antibodies demonstrated that RuV localized to neutrophils but not macrophages. The clinical presentation, cutaneous findings, and likely presence of RVC‐positive granulocytes in bone marrow provide potential support to the evolving hypothesis of persistent RuV within neutrophils contributing to chronic granulomatous inflammation in a milieu of immune dysregulation. [ABSTRACT FROM AUTHOR]

Bovine tuberculosis still represents a universal threat that creates a wider range of public and animal health impacts. One of the most important steps in the pathogenesis of this disease and granuloma formation is the phagocytosis of tuberculous bacilli by macrophages. Mycobacteria replicate in macrophages, which are crucial to the pathophysiology of mycobacterial infections; however, scarce information is available about the dynamics of the granuloma-stage immunological response. Therefore, immunohistochemistry was used in this work to evaluate the expression of CD68, iNOS, and HLA-DR in different stages of TB granulomas from naturally infected cattle with tuberculosis. Two thousand, one hundred and fifty slaughtered beef cattle were examined during the period from September 2020 to March 2022. Sixty of them showed gross tuberculous pulmonary lesions and samples were collected from all of them for histopathological examination, Ziehl-Neelsen (ZN) staining, and bacteriological culturing. Selected samples that yielded a positive result for ZN and mycobacterial culturing were subjected to an immunohistochemical study of CD68, iNOS, and HLA-DR expression by macrophages according to granuloma stages. Immunohistochemical analysis revealed that the immunolabeling of CD68+, iNOS+, and HLA-DR+ macrophages significantly reduced as the stage of granuloma increased from stage I to stage IV (P < 0.003, P < 0.002, and P < 0.002, respectively). The distribution of immunolabeled macrophages was similar for the three markers, with immunolabeled macrophages distributed throughout early-stage granulomas (I, II), and surrounding the necrotic core in late-stage granulomas (III, IV). Our results suggest a polarization to the pro-inflammatory environment and increased expression of CD68+, iNOS+, and HLA-DR+ macrophages in the early stages of granulomas (I, II), which may play a protective role in the immune response of naturally infected beef cattle with tuberculosis. [ABSTRACT FROM AUTHOR]

A male patient in his early sixties with recurrent diarrhea was transferred to our hospital. The patient did not have any pulmonary or upper respiratory symptoms. He was noted to have peripheral eosinophilia. Further workup revealed a negative antineutrophilic cytoplasmic antibody titer but a positive myeloperoxidase antibody and positive proteinase 3 antibodies. A colon biopsy also revealed eosinophilic-rich granulomas in the mucosa, confirming a diagnosis of eosinophilic granulomatosis with polyangiitis. On cardiac imaging, eosinophilic myocarditis was also discovered. To treat active severe EGPA, the patient received high-dose corticosteroids and intravenous cyclophosphamide. The occurrence of gastrointestinal involvement as an initial manifestation of eosinophilic granulomatosis with polyangiitis is infrequent, emphasizing the significance of its recognition. This case underscores the importance of identifying and diagnosing such atypical presentations to facilitate timely and appropriate management. [ABSTRACT FROM AUTHOR]

Only a small number of infected people are highly susceptible to schistosomiasis, showing high levels of infection or severe liver fibrosis. The susceptibility to schistosome infection is influenced by genetic background. To assess the genetic basis of susceptibility and identify the chromosomal regions involved, a backcross strategy was employed to generate high variation in schistosomiasis susceptibility. This strategy involved crossing the resistant C57BL/6J mouse strain with the susceptible CBA/2J strain. The resulting F1 females (C57BL/6J × CBA/2J) were then backcrossed with CBA/2J males to generate the backcross (BX) cohort. The BX mice exhibited a range of phenotypes, with disease severity varying from mild to severe disease, lacking a fully resistant group. We observed four levels of infection intensity using cluster and principal component analyses and K-means based on parasitological, pathological, and immunological trait measurements. The mice were genotyped with 961 informative SNPs, leading to the identification of 19 new quantitative trait loci (QTL) associated with parasite burden, liver lesions, white blood cell populations, and antibody responses. Two QTLs located on chromosomes 15 and 18 were linked to the number of granulomas, liver lesions, and IgM levels. The corresponding syntenic human regions are located in chromosomes 8 and 18. None of the significant QTLs had been reported previously. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We report on a 2‐year‐old boy whose initially inconspicuous skin lesions later on evolved into a typical clinical presentation of benign cephalic histiocytosis (BCH). The diagnosis of BCH can often be made on clinical grounds without the need for an extensive diagnostic work‐up. Given the benign and self‐limited course of the disease treatment is not required and the clinical management can be limited to a watchful waiting approach. [ABSTRACT FROM AUTHOR]

Aneurysmal bone cyst (ABC) is a benign osteolytic, expansile, sometimes destructive but self-limited bone lesion, composed of blood-filled channels and cystic spaces that are separated by stromal fibrous septae. We present the case of a 29-yearold female patient who discovered a deformity of the left forearm after trauma. The imaging data (simple radiography and whole-body scintigraphy) suggested the following diagnosis: low-grade central osteosarcoma, eosinophilic granuloma, Ewing sarcoma or osteoblastoma. The histologic examination of the bone biopsy showed a benign vascular lesion with overlapping features of ABC and osteoblastoma with ABC-like changes. The immunohistochemical tests (CD31, CD56, SATB2, MDM2, CD45 and Ki-67) were in favor of aneurysmal bone cyst, but they could not definitively exclude an osteoblastoma with ABC-like changes. We discuss each of the aforementioned differential diagnoses from the histopathological point of view, and we found arguments favoring both ABC and osteoblastoma with ABC-like changes. We conclude on the importance of correlations between the imaging data and the histopathological diagnostic. [ABSTRACT FROM AUTHOR]

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Periapical odontogenic granulomas are among the most encountered pathology that involve the alveolar bone, with severe consequences such as bone resorption, the presence of inflammatory infiltrate and the formation of abnormal vascularization. The present study aimed to quantify the existence of the microvessel density (MVD), mast cell density (MCD) and heterogeneity of the encountered blood vessels. A total of 37 patients diagnosed with odontogenic periapical granulomas were included, and the gender distribution, age and localization of the pathological lesions was assessed. After the surgical removal of the periapical odontogenic granuloma, the collected tissue was fixed in 10% buffered formalin. Primary processing, morphological analysis and immunohistochemical staining was performed in order to characterize the altered tissue. The results outlined the presence of a high number of mast cells, especially in the area of the inflamed tissue; the high heterogeneity of the blood vessels; and increased MVD with positive CD34. The conclusions of the study focus on the key role of the mast cells and their implication in the initiation and development of the angiogenesis process, triggering the inflammatory response of the host. Nevertheless, periapical odontogenic granulomas develop as an inflammatory response to the interaction between the host's immune system and microbial invasion. [ABSTRACT FROM AUTHOR]