1/41. Inflammatory metastatic melanoma.An 87-year-old woman developed erythema, induration and tenderness of the skin overlying each breast. One year before, she had undergone an axillary lymph node dissection because of metastases from melanoma. The primary site was unknown. A skin biopsy showed pigmented tumor nests within the dermal lymphatic vessels, and immunohistochemistry confirmed the melanocytic origin. The diagnosis of inflammatory metastatic melanoma was made.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/41. Lesion development in Marburg's type of acute multiple sclerosis: from inflammation to demyelination.We report a patient who suffered from acute inflammatory CNS demyelination and underwent two consecutive diagnostic stereotactic brain biopsies during the early disease course. The first lesion was drawn 33 days after the onset of disseminated neurological symptoms. macrophages and T lymphocytes diffusely infiltrated small vessel walls and the white matter. mRNA for tumor necrosis factor alpha (TNFalpha) and inducible nitric oxide synthase (iNOS) was abundantly expressed. Myelin sheaths were entirely preserved. The second biopsy 76 days later showed confluent demyelinating lesions with a diffuse infiltration of macrophages that were positive for myelin debris, activation markers and TNFalpha and iNOS mRNA. IgG and C9neo deposits were found along myelin sheaths. The patient had received intravenous immunoglobulins (IVIG) prior to biopsy. Findings from this single patient affirm that demyelination follows the migration of inflammatory cells from the circulation into the white matter with subsequent inflammation and demyelination. inflammation alone may be sufficient to cause significant clinical deficits without demyelination. Inflammatory mediators such as TNFalpha and NO are involved at very early stages in the pathogenetic process. IVIG treatment may lead to the deposition of immunoglobulins and to the activation of the complement cascade, but the clinical relevance of this particular finding remains uncertain.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/41. A case of lymphocytic infundibuloneurohypophysitis: histophathological studies.A 57-year-old woman presented with 2-year history of polyuria and polydipsia. Hormonal studies revealed almost normal anterior pituitary function and central diabetes insipidus. magnetic resonance imaging showed thickening of the pituitary stalk and enlargement of the neurohypophysis without high intensity of the posterior lobe on T1-weighted images, which were compatible with lymphocytic infundibuloneurohypophysitis. Transsphenoidal biopsy was done and histological examination disclosed moderate fibrosis and lymphocytic infiltration not only in the posterior pituitary, but also in the adjacent anterior pituitary part of the gland. The lymphocytes both in the anterior and posterior pituitary were mainly T cells that were positive for UCHL 1, CD 3, and CD 8. Immunofluorescence of frozen tissue detected immunecomplex deposition in small vessels and the interstitium. These findings suggested that allergic reactions may play an important role in the pathogenesis of lymphocytic infundibuloneurohypophysitis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/41. Atrophoderma of moulin with preceding inflammation.A 16-year-old Vietnamese man presented to the dermatology Clinic with a 10-year history of bizarre brown patches, which initially started as red asymptomatic "bumps" on the trunk, upper and lower extremities, and face. His past medical history was significant for hypothyroidism and idiopathic urticaria. He was on Eltroxin for hypothyroidism. The family history was noncontributory. physical examination revealed two types of lesion: erythematous, well-circumscribed papules in a linear configuration along with linear hyperpigmented atrophic patches following Blaschko's lines were noted on the lower extremities (Fig. 1), right upper extremity, right flank (Fig. 2), and right jawline. Initial biopsies taken from the papular lesions on the right thigh and right elbow revealed the following changes. The first biopsy showed a slightly thinned epidermis with prominent dilated blood vessels in the superficial dermis. There also appeared to be a slight increase in the amount of collagen in the deep dermis. The findings were reported as in keeping with "epithelial atrophy." The second biopsy from the lesion on the right elbow revealed an acanthotic epidermis. The granular layer was absent in several areas and there was marked overlying parakeratosis. In the dermis, there was a heavy perivascular lymphocytic infiltrate. The appearances were consistent with a psoriasiform dermatitis (Fig. 3). A biopsy taken from the left thigh approximately 18 months later showed slight irregular acanthosis with dermal edema, dilated blood vessels, and a patchy lymphocytic infiltrate. The appearances were compatible with mild inflammation.- - - - - - - - - - ranking = 25.262834622827keywords = blood vessel, vessel (Clic here for more details about this article) |
5/41. Inflammatory cutaneous metastasis from laryngeal carcinoma.The authors report the case of a 64-year-old man who presented with erythematous infiltrating plaques sited on his right supraclavicular and infraclavicular regions. Five years before a laryngeal epidermoid carcinoma had been surgically removed. After two years the patient underwent lymphadenectomy and radiotherapy for the presence of metastasis in his right cervical lymph nodes. He was disease free until two months before our examination when small red spots appeared on his right supraclavicular region, slightly enlarging. A skin biopsy was performed and histological examination showed the presence of metastatic cells inside dilated lymphatic vessels. Immunohistochemical markers showed only positive staining of atypical cells with monoclonal anti-cytokeratin antibodies (cytokeratin B-ORTHO=34betaE12) confirming the epithelial origin of metastastic cells. A diagnosis of inflammatory cutaneous metastasis from laryngeal epidermoid carcinoma was given. This type of metastasis has been frequently observed in patients with breast carcinoma and it has also been described during the course of other malignant tumours. Malignant tumour of the larynx generally spreads to regional lymph nodes or, through blood, to the lungs. skin metastasis have rarely been described, and always as multiple or solitary nodules. According to our knowledge this is the first case of inflammatory cutaneous metastasis from laryngeal epidermoid carcinoma reported in the literature.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/41. Exudative retinal detachment and scleritis in polyarteritis.A 64-year-old white man, treated with systemic corticosteroids for five years, developed polyarteritis. He then developed a severe scleritis with an exudative retinal detachment in the right eye, which became blind and painful and was enucleated 23 months after onset of the scleritis. Histopathologic examination of the enucleated eye revealed granulomatous scleritis, chronic nongranulomatous uveitis, exudative retinal detachment, and perivasculitis of intrascleral, iris, ciliary body, and retinal blood vessels. Systemic findings were minimal and limited to elevated sedimentation rate, weight loss, mild anemia, and microscopic hematuria. Respiratory disease, severe kidney disease, hypertension, and arthritis were notably absent. A muscle biopsy established the diagnosis.- - - - - - - - - - ranking = 12.631417311414keywords = blood vessel, vessel (Clic here for more details about this article) |
7/41. A clinicopathological study of a patient with anti-Hu-associated paraneoplastic sensory neuronopathy with multiple cranial nerve palsies.Only a few cases of paraneoplastic neurologic syndrome with multiple cranial palsies have been reported. This is the case report of a patient with small-cell lung cancer and a high titer of anti-Hu antibodies who developed a tonic left pupil and multiple cranial nerve palsies, including palsies of the left fifth through tenth nerves and both twelfth nerves, as in Garcin syndrome showing at least more than seven ipsilateral cranial nerve palsies, in the course of paraneoplastic sensory neuronopathy (PSN). Pathologic examination revealed no metastasis or direct invasion of malignancy with gliosis and perivascular inflammation throughout the brainstem, indicating paraneoplastic encephalomyelitis (PEM). The numbers of EBM11 cells (probably reactive microglia), CD8 cells, and CD4 cells increased. Intracellular adhesion molecule-1 and lymphocyte function associated molecule-1 were expressed intensely on the endothelia of microvessels and were found to have infiltrated mononuclear cells around microvessels in the brainstem. Multiple cranial nerve palsies and their effects including the tonic pupil are likely due to the paraneoplastic effect of the primary systemic malignancy.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/41. Splenic involvement in Wegener's granulomatosis.OBJECTIVE: A clinicopathologic review of splenic involvement in Wegener's granulomatosis. DESIGN: A retrospective case review, spanning a 10-year period, identified five patients with Wegener's granulomatosis and splenic involvement. SETTING: A large teaching hospital and outpatient clinics. INTERVENTIONS: Cytotoxic therapy (cyclophosphamide and corticosteroids), mechanical ventilation in respiratory failure, renal hemodialysis in renal failure, and general supportive care. RESULTS: Necrotizing granulomatous inflammation and vasculitis with fibrinoid necrosis were found in the spleen in one antemortem case. At autopsy, two cases demonstrated extensive infarction; microscopic examination revealed parenchymal coagulative necrosis, microcalcification, and vascular thrombosis, but no evidence of vasculitis. Two other cases showed nonspecific changes of diffuse hyalinization of blood vessels, vascular congestion, and hemosiderin deposition. CONCLUSIONS: Splenic involvement in Wegener's granulomatosis is rarely diagnosed during life, occurs more frequently than once thought, and can occasionally lead to considerable morbidity.- - - - - - - - - - ranking = 12.631417311414keywords = blood vessel, vessel (Clic here for more details about this article) |
9/41. Pathological and virological assessment of acute HTLV-I-associated myelopathy complicated with encephalopathy and systemic inflammation.HTLV-I-associated myelopathy, also known as tropical spastic paraparesis (HAM/TSP), is a chronic inflammatory disease of the spinal cord. Acute cases are uncommon. We report the case of a 41-year-old woman with acute HAM/TSP complicated with encephalitis, an intense inflammatory reaction of the nervous system and lymphocytic infiltration of skeletal muscles, liver, salivary, adrenal and pituitary glands. The immunohistochemical studies of the lymphocytes surrounding blood vessels showed both B- and t-lymphocytes, in similar proportion, with both CD4- and CD8-positive cells. In addition, many perivascular and scattered macrophages were observed. adult T-cell leukemia/lymphoma (ATL) was ruled out. The marrow aspirate was normal. Serial cerebrospinal fluid (CSF) analysis showed presence of htlv-i antibodies, but without intrathecal synthesis of specific antibodies. Determination of HTLV-I viral loads demonstrated increased levels in the CSF relative to the peripheral blood and may be associated with widespread inflammation. The pathological and immunological findings may help understand the role of immune-reactive cells in the pathogenesis of HTLV-I-associated myelopathy.- - - - - - - - - - ranking = 12.631417311414keywords = blood vessel, vessel (Clic here for more details about this article) |
10/41. Inflammatory fibroid polyp of the ileum causing intussusception: report of two cases with emphasis on cytologic diagnosis.Inflammatory fibroid polyp (IFP) of the gastrointestinal tract is a type of inflammatory pseudotumor or inflammatory myofibroblastic tumor that occurs most commonly in the stomach but also in the small and large bowel. Small-bowel IFP usually presents with intussusception. The purpose of the current study is to describe cytological features of this lesion with differential diagnoses since pathologists may be called on to render a diagnosis on fine-needle aspiration. Two cases of IFP are described with diagnostic features on imprint smears. Both were middle-aged obese women with a history of prior intra-abdominal surgical procedures who presented with signs of intestinal obstruction and were found to have a tumor causing intussusception. At intraoperative consult, scrape cytology specimens showed cellular smears with a heterogeneous population of myofibroblasts, inflammatory cells and vessels. The features together with clinical history are sufficient to suggest the diagnosis. IFP is a lesion with a characteristic morphology. The differential diagnosis includes several other lesions, hence triage of cytological specimen for culture, electron microscopy, and immunohistochemistry is important in facilitating a correct diagnosis. Although a surgical procedure may still be necessary once a diagnosis of IFP is made, treatment may be tailored for a less aggressive process.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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