Background
Chronic rhinosinusitis (CRS) and eosinophilic esophagitis (EoE) are immune-mediated inflammatory conditions that share common histopathologic features. Once considered two separate ...pathologies, preliminary data has suggested that a higher prevalence of EoE may exist in patients with CRS.
Objectives
We aimed to expand the base of evidence across geographic regions and investigate the association between EoE and CRS, including CRS with nasal polyposis (CRSwNP).
Methods
Quantitative data detailing the prevalence of CRS, CRSwNP, and EoE were pooled from 6 large academic institutions spread across the United States using Epic electronic medical record system. One-way analysis of variance was then used to analyze the data.
Results
The mean prevalence of EoE in our general population sample of over 26 million individual records was 0.058% (range, 0.013%-0.103%). The mean prevalence of EoE in our sub-populations of individual with diagnoses of CRS and CRSwNP was 0.43% (F(1,12) = 8.194, P = .01) and 0.84% (F(1,12) = 23.61, P < .01) respectively.
Conclusion
This study reveals an 8-fold greater prevalence of concurrent EoE in patients with CRS. Importantly, this is the first study to describe the association of EoE and the CRSwNP subtype, and we demonstrate a 14-fold greater prevalence of EoE in patients with CRSwNP.
Abstract
Background
Primitive persistent trigeminal artery (PTA) is an uncommon embryologic vascular communication between the carotid and basilar arteries, which can be intimately involved by skull ...base tumors (SBT). Owing to its rarity, skull base surgeons should familiarize themselves with the anatomical variations of PTA to avoid catastrophic complications.
Objective
To appraise and summarize the available evidence of PTA involved by SBTs while advocating a standardized algorithm for the surgical planning of these patients.
Methods
MEDLINE and PubMed databases were searched using keywords pertaining to PTA and SBTs. Demographics, clinical presentation, radiographic findings, outcomes, and adverse events were extracted and analyzed.
Results
A total of 13 cases between 1973 and 2015 were identified. The mean patient age at presentation was 43 years with predilections toward females and pituitary adenomas. Headaches and endocrine abnormalities were the most common symptoms. The tumors were more frequently associated with Salas medial-type PTA (70%) and Saltzman type-I PTA (31%) than seen in the general population in angiographic studies. We also present a new case of atypical meningioma with Saltzman type-1 PTA.
Conclusion
With endoscopic approaches to SBTs becoming more commonplace, surgeons may encounter this anatomical abnormality more frequently. It is important for both otolaryngologists and neurosurgeons to gain a complete understanding of the anatomical variations and neurointerventional capabilities for the successful endoscopic management of these situations.
Level of Evidence
: 4.
Key points Asian‐American (AA) patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have comparable rates of tissue eosinophilia compared to Caucasians when defined as >10 ...eosinophils/high‐powered field (HPF). AA patients with CRSwNP have significantly higher incidence of mixed inflammation defined as >10 eosinophils/HPF and >10 neutrophils/HPF.
Key points
Hispanic‐American patients with chronic rhinosinusitis with nasal polyps have a comparable level of tissue eosinophilia compared to their Caucasian counterparts in the United States.
Mixed ...inflammation involving both neutrophils and eosinophils is more common in this population compared to Caucasians.
Findings from this study may indicate that Hispanic‐American patients have a unique endotype or endotypes that deserves further investigation.
Plasmablastic lymphoma (PBL) is an uncommon aggressive lymphoma arising most frequently in the oral cavity of HIV-infected patients. Rare cases of PBL have been reported in extraoral sites, ...particularly extranodal sites, as well as in immunocompetent patients. We report an unusual case of PBL in a 69-year-old, HIV-negative non-immunocompromised man presenting with generalized lymphadenopathy. To our knowledge, this is the first case of PBL presented as primarily generalized lymphadenopathy in HIV-negative patients. Histologic examinations of cervical, inguinal and axillary lymph nodes demonstrated a neoplastic proliferation of large cells with extensive necrosis. The neoplastic cells formed sheets with a relatively cohesive growth pattern interspersed by small lymphocytes and plasma cells. The large tumor cells expressed MUM1, OCT-2 and BOB.1, and were negative for CD138, CD38, AE1/AE3, melan A, PLAP, S100, vimentin, CD117, CD30, ALK-1, leukocyte common antigen (CD45), T-cell, B-cell and histolytic markers, CD56, CD10 and BCL-6. The proliferation index by Ki-67 immunohistochemistry was approaching 100%. In situ hybridization for Epstein–Barr Virus-encoded RNA (EBER) was positive in large malignant cells. A diagnosis of PBL was made. These findings indicate that PBL should be included in the differential diagnosis of an HIV-negative, immunocompetent patient with generalized lymphadenopathy. The adjacent plasma cells were positive for CD138 and CD38 and show kappa-light chain restriction, but without EBER expression, raising the possibility of a preexisting or concurrent plasmacytoma and that the PBL may be a high-grade transformation from a preexisting plasma cell neoplasm following Epstein–Barr virus infection. Electron microscopy showed numerous circumferential long slender peripheral cytoplasmic projections in the large tumor cells, suggesting that some of the previously reported large B-cell lymphoma with cytoplasmic projections may actually be PBL.
Clear cell-papillary renal cell carcinoma (CC-Pap RCC) is a recently described renal tumor initially reported in the setting of end-stage renal disease (ESRD). It has unique morphologic and ...immunohistochemical features that differentiate it from the more common clear cell RCC and papillary RCC. Recently, these tumors have also been described in a sporadic setting. We studied 64 cases of CC-Pap RCC not associated with ESRD (57 CC-Pap RCCs and 7 cases with features of renal angiomyoadenomatous tumors RAT including 5 initially diagnosed as such). The morphologic features of all cases and the immunohistochemical profile of 59 cases were studied along with the clinical and molecular features of 30 and 12 cases, respectively. All the tumors were well circumscribed with a mean tumor size of 2.6 cm and showed a wide array of architectural patterns, usually mixed, including tubular (77%), papillary (62%), tubulocystic (52%), and compact nested (21%). Seventy-three percent of the cases showed areas in which the tumor nuclei had a distinct orientation away from the basement membrane. Ninety-two percent of the cases had a low Fuhrman nuclear grade (nuclear grade 2%-86%, and nuclear grade 1%-6%); however, 8% cases showed foci of Fuhrman nuclear grade 3. In 4 cases, epithelial tumor comprised <5% of the tumor; >95% of the tumor was cystic or hyalinized. The stroma varied from being minimal to occasionally prominent myxoid to hyalinized and rarely with organized amianthoid fibers or well-defined smooth muscle bundles. Pathologic stage was reliably assigned in 60 cases, of which 93.3% (56 cases) were pT1, 3.3% (2 cases) were pT2, and 3.3% (2 cases) were pT3a with extension into the perinephric fat. One case had coagulative necrosis; sarcomatoid change and vascular invasion was not identified. The tumors showed a fairly typical immunoprofile characterized by positivity for CK7 (100%), HMCK (96%), CAIX (94%), and vimentin (100%) with negativity for AMACR, RCC, and TFE3; CD10 was positive in 24%. None of the cases tested showed recurrent chromosomal imbalances by virtual karyotyping, fluorescence in situ hybridization, or 3p loss of heterozygosity analysis. VHL gene mutations were, however, noted in 3 cases (2 in exon 1 and 1 in exon 3). Clinical follow-up information was available in 47% of the patients, with a mean and median follow-up of 47 and 37 months, respectively (range, 18 to 108 mo). One case occurred in the setting of VHL syndrome and multiple benign cysts. None of the cases showed local recurrence, metastasis, or death due to disease. Morphology, immunophenotype, and molecular studies did not vary between typical cases, those with prominent smooth muscle (so-called RAT), and historically published data on cases occurring in ESRD. Our analysis confirms that CC-Pap RCC is a unique subtype of adult renal epithelial neoplasia in which tumors are frequently small, are of low nuclear grade and pathologic stage, and have extremely favorable short to intermediate range prognosis. Tumors occurring sporadically, with prominent smooth muscle stroma (so-called RAT), and occurring in ESRD are in the spectrum of the same category of tumors.
Introducción: Las mujeres cardiópatas estuvieron "condenadas" durante muchos años a no poder asumir la maternidad debido al riesgo incrementado de mortalidad materna que el embarazo representaba para ...ellas, actualmente el 85 % o más de estas pacientes sobreviven la edad de 18 años, y muchas, dependiendo del tipo específico de la afectación cardiaca y el grado de corrección que se le pueda realizar, pueden tener una expectativa de vida similar a la población general. Objetivo: describir los resultados perinatales obtenidos en las pacientes embarazadas con diagnóstico de cardiopatía congénita, a partir de la aplicación de un protocolo de trabajo realizado por un grupo multidisciplinario de especialistas. Métodos: se realizó un estudio descriptivo prospectivo transversal, en el que se analizaron factores clínicos y perinatológicos asociados a las gestantes con cardiopatías congénitas, atendidas en el Servicio de Cardiopatía y Embarazo del Hospital "Ramón González Coro", en el municipio Plaza, provincia La Habana, en el periodo correspondiente entre el 1ro. de enero de 2000 y el de 31 de diciembre de 2010. Resultados: el 75 % de las pacientes se embarazó antes de los 30 años de edad. El 10,4 % presentó morbilidad de causa obstétrica y entre ellas prevaleció la diabetes gestacional. Hubo agravamiento de la clasificación funcional I al inicio del embarazo a II y III al momento del parto. No hubo recién nacido con diagnóstico de cardiopatía congénita. Conclusión: Con la aplicación del Protocolo de Atención a la Gestante Cardiópata se han logrado resultados perinatales alentadores en la gestante con cardiopatía congénita.
Síndrome de Eisenmenger y embarazo Román Rubio, Pedro A; Pérez Torga, Jesús E; Guerra Chang, Elena ...
Revista cubana de obstetricia y ginecología,
08/2011, Letnik:
37, Številka:
2
Journal Article
Odprti dostop
El síndrome de Eisenmenger se define como una enfermedad vascular pulmonar de tipo obstructivo que se desarrolla a partir de la existencia previa de una comunicación entre la circulación sistémica y ...pulmonar, con desviación de la corriente sanguínea de izquierda a derecha. Durante el embarazo conlleva una mortalidad fetal y materna superior al 50 %. El objetivo de este trabajo es describir un caso clínico de una paciente con síndrome de Eisenmenger asociado al embarazo. Se presenta el caso clínico de una paciente de 16 años de edad, primigesta, con antecedentes de síndrome de Eisenmenger que acude al servicio de Cardiopatía y embarazo con una gestación de 20 sem. Se mantiene hospitalizada con evaluación de la calidad de vida fetal por sospecha de retardo del crecimiento y se utilizan inductores de la madurez pulmonar fetal en las sem 30 y 33 de gestación. A las 34,4 sem se le practica una cesárea electiva y esterilización quirúrgica. Se obtiene un recién nacido masculino, peso 1 958 g, apgar 9/9 sin incidentes anestésicos ni quirúrgicos durante el procedimiento. La evolución del puerperio inmediato y mediato es satisfactoria y egresa a los 36 días. El síndrome de Eisenmenger implica un alto riesgo de morbilidad y mortalidad materno-perinatal y el manejo multidisciplinario optimiza los resultados.
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