1/32. Perianeurysmal fibrosis: a relative contra-indication to endovascular repair.OBJECTIVE: Perianeurysmal fibrosis (PAF) with involvement of neighbouring viscera can render open repair of inflammatory aneurysms technically difficult and therefore hazardous. For this reason, endovascular repair (EVAR) has been advocated as the preferred approach for this condition. EVAR is known to induce a systemic inflammatory response in patients but the nature of the local response remains unknown. If significant, such a response could exacerbate rather than ameliorate PAF. The aim of the study was to examine the incidence, course and consequences of perianeurysmal fibrosis detected by computerised tomography (CT) before and after EVAR. MATERIAL AND methods: The clinical records of patients treated by EVAR and followed for at least 6 months were reviewed. Pre and post-operative CT images were independently graded for PAF by three radiologists according to a standard protocol. RESULTS: PAF was documented preoperatively in six out of a total of 61 patients. In two of these PAF worsened after EVAR resulting in ureteric obstruction and hydronephrosis requiring ureteric stents. In the remaining 4 patients PAF did not reduce postoperatively. PAF of low grade developed postoperatively in 10 out of 55 patients (18%) in whom there was no evidence of PAF on preoperative imaging. Median follow-up was 18 months (range 6-36 months). The development of periaortic fibrosis de novopostoperatively was statistically significant (McNemar's test p=0.002). CONCLUSION: EVAR does not seem to reverse PAF if this is present preoperatively and it induces this condition in approximately one sixth of patients without evidence of preoperative PAF. The potential for this adverse inflammatory local response should be taken into account when considering EVAR for treatment of aneurysms with perianeurysmal fibrosis and must be weighed against the perceived benefits of this approach.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/32. Inflammatory involvement of vertebrae in ankylosing spondylitis.Unusual destructive lesions of the cervical and lumbar vertebrae are described in two patients with ankylosing spondylitis. biopsy of a lesion from one of the patients showed it to be inflammatory in nature. Possible mechanisms for vertebral centrum involvement in ankylosing spondylitis, centering on the role of enthesopathies are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/32. Transient granulomatous inflammation of the hand.We present a granulomatous inflammatory tumour of the hand in a fit 26-year-old man. The lesion resolved spontaneously within a month of presentation. Whilst the true nature of this inflammatory lesion remains unknown the case highlights the importance of thorough investigation of all deep-seated soft tissue tumours of the hand prior to committing a patient to surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/32. Xanthogranulomatous choledochitis: a previously undescribed mass lesion of the hepatobiliary and ampullary region.Solid liver and pancreatic masses are commonly neoplastic in nature; however, inflammatory lesions mimicking carcinoma are at times encountered in these sites. We report two cases of previously undescribed inflammatory mass lesions of the liver and pancreas that originated in the biliary tract. Detailed clinical and histologic evaluations were performed in two patients who underwent right partial hepatic lobectomy and Whipple's resection for presumed hepatic and pancreatic neoplasms. In case 1, with a remote history of cholecystectomy and recent extraction of a stone from the common bile duct, a liver mass in segment 6 was discovered incidentally. In case 2, a periampullary pancreatic mass was diagnosed radiographically following papillotomy and stent insertion for stricture and biliary calculous disease. The histologic findings in both cases were similar, localized around a part of the biliary tract, and consisted of inspissated bile, acute and chronic inflammation, abundant lipid-laden macrophages, fibrosis, and giant cell reaction. No neoplasm was identified. On the basis of the close resemblance of these features to those seen in xanthogranulomatous cholecystitis, the lesions seen here were termed xanthogranulomatous choledochitis. In conclusion, xanthogranulomatous choledochitis is a benign inflammatory process involving the biliary tract that can form a mass lesion within the liver or pancreas and thus mimic a neoplasm. Extensive sampling of the lesion is required to rule out an underlying neoplastic process. In our patients a propensity to form lithogenic bile and a prior history of biliary tract operative procedure were present.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/32. 'Eruptive syringoma': a misnomer for a reactive eccrine gland ductal proliferation?BACKGROUND: Syringomas have traditionally been categorized as benign neoplasms of the eccrine gland ductal epithelium. However, the variety of clinical presentations reported in the literature and some cases recently observed by the authors cast doubt upon the neoplastic nature of eruptive syringomas. Our goal is to challenge the traditional notion that eruptive syringomas are neoplastic lesions. RESULTS: We observed two patients who presented with an eczematous process, which resolved leaving residual lesions. Biopsies of the late lesions showed features of eccrine syringoma. Yet a biopsy obtained from an incipient lesion in one of the cases showed a lymphocytic inflammatory reaction of the superficial portion of the eccrine duct resulting in tortuous hyperplastic changes. CONCLUSION: Based on our observations, some of the so-called 'eruptive syringoma' may represent a hyperplastic response of the eccrine duct to an inflammatory reaction rather than a true adnexal neoplasm. We proposed the term 'syringomatous dermatitis' for such cases.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/32. Fusion of ALK to the Ran-binding protein 2 (RANBP2) gene in inflammatory myofibroblastic tumor.Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal proliferation of transformed myofibroblasts, with a prominent inflammatory cell component, that can mimic other spindle cell processes such as nodular fasciitis, desmoid tumor, and gastrointestinal stromal tumor. Genetic analyses have recently demonstrated rearrangements of anaplastic lymphoma kinase (ALK), located at 2p23, in a subset of IMTs. Molecular characterizations have identified ALK fusions involving tropomyosin-3 and -4 (TPM-3 and -4), the clathrin heavy chain (CLTC), and the cysteinyl-tRNA synthetase (CARS) genes as fusion partners. Here we describe two IMTs with a novel ALK fusion that involves the Ran-binding protein 2 (RANBP2) gene at 2q13, which normally encodes a large (358-kDa) nucleopore protein localized at the cytoplasmic side of the nuclear pore complex. The N-terminal 867 residues of RANBP2 are fused to the cytoplasmic segment of ALK in the 1,430-amino acid RANBP2-ALK chimeric protein. myofibroblasts that express RANBP2-ALK exhibit nuclear membrane-associated ALK staining that is unique compared to the subcellular localization observed with other ALK fusions in IMT, presumably attributable to heteroassociation of the fusion with normal RANBP2 at the nuclear pore. These findings expand the spectrum of ALK abnormalities observed in IMT and further confirm the clonal, neoplastic nature of these lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/32. Isolated inflammatory aneurysm of superior mesenteric artery: unexpected pathologic diagnosis.A 78-year-old woman was admitted to our department because of the incidental finding during routine abdominal ultrasound examination of a large aneurysm of the superior mesenteric artery. Presence of the aneurysm was confirmed at computed tomography and digital subtraction angiography, but its inflammatory origin was not recognized. No other aneurysm localization was found. Macroscopic intraoperative findings suggested the inflammatory nature of the lesion, but only histopathologic examination was diagnostic. Aneurismorraphy with prosthetic in-line reconstruction was performed. This report presents the previously undescribed possibility of an isolated inflammatory aneurysm of the superior mesenteric artery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/32. Selective effect of infliximab on the inflammatory component of a colonic stricture in Crohn's disease.Although infliximab has been shown to improve the clinical course of Crohn's disease, its effect on intestinal strictures is controversial. We describe the case of a woman with steroid-resistant colonic Crohn's disease presenting with intermittent obstruction because of a tight stricture in the splenic flexure. Compared with uninvolved areas, biopsies showed intense edema and inflammatory cell infiltration and immunohistochemistry revealed an excess of TNF-alpha. Her symptoms responded promptly (CDAI went from 444 to 168) to an infliximab infusion (10 mg kg(-1) BW), which also had a dramatic effect on the stricture, now presenting radiologically as a moderate residual, apparently fibrotic, narrowing of the lumen. endoscopy and histology confirmed the resolution of inflammation and TNF-alpha virtually disappeared. The patient refused additional infusions and after a few months the disease recurred with features identical to the pre-treatment phase. She then opted for surgery. histology of the resected strictured colon revealed edema, inflammation, and fibrosis, with TNF-alpha back to pre-treatment levels. This case indicates that, in the colon, infliximab specifically relieves the TNF-alpha-mediated inflammatory component of the stricture while having no effect on fibrosis and suggests that the response to infliximab treatment may depend on the nature of the, stricture itself.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/32. Ligneous inflammation of the cervix: a case report.BACKGROUND: Ligneous change of the genital tract is a very rare condition and may result in infertility. CASE: A 27-year-old woman presented with primary infertility and ligneous changes of the genital tract. Cervical and endometrial samples revealed subepithelial deposition of dense, amorphous, eosinophilic material associated with intensive inflammatory cell infiltration. plasminogen functional activity was 16%. CONCLUSION: The clinician must be aware of the systemic nature of this disorder and the multisystem complications.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/32. Inflammatory fibrous histiocytoma. An aggressive and lethal lesion.During an investigation of soft tissue fibrohistiocytic tumors, seven cases were found which we believe represent a new and specific diagnostic subgroup of fibrous histiocytomas. All patients were adults (mean 52.6 years), only one of whom was younger than age 40. There were four females and three males; all were Caucasian. The tumors which occurred in the retroperitoneum, anterior chest wall, anterior abdominal wall, femoral area, and oral cavity, were large, averaging 8.5 cm., and although appearing encapsulated, were microscopically infiltrative. The common histologic feature of all cases was a diffuse and at times intense neutrophilic infiltrate unassociated with tissue necrosis, in combination with bland and anaplastic appearing histiocytes. The presence of this acute exudative reaction is a unique feature of these lesions, and was present not only in the original tumors, but in recurrences and metastatic foci as well. Other cell types including foam cells, lymphocytes, plasma cells, eosinophils, Reed-Sternberg-like and ganglion-like cells were commonly present. A storiform fibrous pattern, a hallmark of the fibrous histiocytomas was seen at some time in all but one case. The treacherous aspect of these lesions was their bland initial histologic appearance. The foci of foam cells associated with the inflammatory elements often led to a diagnosis of a benign inflammatory reaction or xanthogranuloma. However, follow-up has confirmed the aggressive and neoplastic nature of these lesions. The clinical course was usually protracted with multiple recurrences and eventual metastases. All patients died of their tumor, the average survival being 53 months; four patients survived over 5 years. At this time, we propose the term inflammatory fibrous histiocytoma to designate these lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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