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Striped snakehead fingerlings Channa striata reared in a concrete pond with size 13.5 m3 (3 m ´ 3 m ´ 1.5 m) in a hatchery farm, in Labu, Negeri Sembilan, Malaysia had more than 70% mortality. The pond contained 1500 fingerlings of 5–7 cm in total length (TL). The purpose of this study was to investigate the high mortality event on the farm as part of a veterinary diagnostics service. Clinical signs observed were skin discoloration, lethargy, and anorexia. Necropsy was performed in 10 fish with gross lesions of 1–2 mm and multiple whitish nodules in the abdominal organs and most notably in the liver, and kidney. Following necropsy, bacteriology samples from the kidney and liver were inoculated onto Tryptic Soy Agar (TSA) and Blood Agar (BA). Pure colonies were observed and were Gram-negative with short rod morphology. The full-length 16S rRNA gene was amplified from the pure colonies followed by sequencing using the Nanopore MinION™ (Oxford Nanopore, UK). The isolated strain was identified as Aeromonas schubertii based on the assembled 16S rRNA sequence showing nucleotide identity of 99.73% (top hit) to A. schubertii (GenBank Accession: NR_037014.2) while only a nucleotide identity of 97.55% was observed against Aeromonas hydrophila (GenBank Accession: NR_119190.1-), respectively. Histopathological examination from the liver, kidney, spleen, and intestine revealed granulomatous nephritis, and degeneration of tubular epithelium, with granulomatous hepatitis, splenitis, and enteritis. The prognosis of this case was grave. No treatment was given as the owner had decided to dispose of all current stock. This is the first A. schubertii infection in C. striata described in Malaysia. The findings of the present study may serve as a reference for similar cases in C. striata in the future so rapid diagnosis and treatment can be made if required.

Background The aim of this study is to examine the clinical and pathological attributes of nasopharyngeal tuberculosis.Methods We conducted a retrospective analysis of the clinicopathologic characteristics of nasopharyngeal tuberculosis in 14 patients. The medical records and imaging data obtained between March 2004 and February 2023 were scrutinized. During the pathological review, we classified the types of granulomatous inflammation and graded the extent of caseation.Results Results indicate a 100% female predominance, with chief complaints including hearing loss, postnasal drip, and nasal obstruction. Cervical lymphadenopathy occurred in 21.4% of patients. Chest radiograph abnormalities were found in 58.3%, with three showing active pulmonary tuberculosis. Endoscopic examination revealed three types of lesions, and CT/MRI findings correlated with gross lesions. A statistically significant association was found between lesion characteristics (bulging, ulcerative, necrotic) and pathology patterns (sarcoidosis-like, caseation). Bulging masses exhibited sarcoidosis-like patterns, while ulcerative/necrotic lesions were often associated with caseation. All lesions responded well to over six months of anti-tuberculosis medication, leading to favourable outcomes.Conclusion We studied 14 cases of nasopharyngeal tuberculosis, mostly in females, with common ear and nose symptoms. Lesions were typically visible on nasopharyngeal endoscopy, and endoscopically bulging mass-like lesions had pathologically sarcoidosis-like granulomas. All patients had favourable outcomes.

ABSTRACTExtracellular vesicles (EVs) are membrane-enclosed nanoparticles that transport several biomolecules and are involved in important mechanisms and functions related to the pathophysiology of fungal diseases. EVs from Paracoccidioides brasiliensis, the main causative agent of Paracoccidioidomycosis (PCM), modulate the immune response of macrophages. In this study, we assessed the EVs proteome from a virulent P. brasiliensis isolated from granulomatous lesions and compared their immunomodulatory ability with EVs isolated from the fungus before the animal passage (control EVs) when challenging macrophages and dendritic cells (DCs). Proteome showed that virulent EVs have a higher abundance of virulence factors such as GP43, protein 14-3-3, GAPDH, as well as virulence factors never described in PCM, such as aspartyl aminopeptidase and a SidJ analogue compared with control EVs. Virulent extracellular vesicles induced higher expression of TLR4 and Dectin-1 than control EVs in macrophages and dendritic cells (DCs). In opposition, a lower TLR2 expression was induced by virulent EVs. Additionally, virulent EVs induced lower expression of CD80, CD86 and TNF-α, but promoted a higher expression of IL-6 and IL-10, suggesting that EVs isolated from virulent P. brasiliensis-yeast promote a milder DCs and macrophage maturation. Herein, we showed that EVs from virulent fungi stimulated a higher frequency of Th1/Tc1, Th17, and Treg cells, which gives new insights into fungal extracellular vesicles. Taken together, our results suggest that P. brasiliensis utilizes its EVs as virulence bags that manipulate the immune system in its favour, creating a milder immune response and helping with fungal evasion from the immune system.

Orofacial granulomatosis is a rare disorder that is heterogeneously defined in the published literature. Herein, we describe a patient with orofacial granulomatosis with clinical and histologic evidence, discuss differential diagnoses, and offer clinical pearls for diagnosing and assessing this disorder. Our case provides support that orofacial granulomatosis is a distinct disorder as opposed to a sequela of other systemic granulomatous diseases. This information will aid dermatologists in decision making and diagnosing the disorder.

Generalized perforating granuloma annulare (GPGA) is a very rare form of granuloma annulare, with only 31 reported cases to the best of our knowledge. Furthermore, GPGA is a chronic disease that mimics many diseases, with no known exact etiology, resulting in a lack of specific clinical criteria leading to a lack of guidelines for diagnosis and therapy. In GPGA, papules are the predominant lesions followed by central crusting/scaling or umbilication; pustules, plaques, annular lesions or nodules are less frequent. We report a 66-year-old woman who presented with a 7-month history of mostly asymptomatic generalized infiltrated, flesh-colored to red-brown umbilicated or crusted papules. Histopathological findings were compatible with perforating granuloma annulare. Diagnostic workup revealed latent tuberculosis. To the best of our knowledge, this is the second published case of GPGA associated with latent tuberculosis and the first one that was successfully treated by isoniazid monotherapy. From our case we can speculate and support the theory that GPGA is a phenotypic granulomatous response to multiple etiologies and/or antigenic stimulation and that testing for tuberculosis should be seriously considered in the evaluation of patients with GPGA.

A patient in California, USA, with rare and usually fatal Balamuthia mandrillaris granulomatous amebic encephalitis survived after receiving treatment with a regimen that included the repurposed drug nitroxoline. Nitroxoline, which is a quinolone typically used to treat urinary tract infections, was identified in a screen for drugs with amebicidal activity against Balamuthia.

Background: A central giant cell granuloma (CGCG) is a benign, proliferative, intraosseous, and non-odontogenic lesion occurring primarily in children and young adults. On the histological level, it is characterized by numerous multinucleated giant cells scattered randomly throughout a sea of spindle-shaped mesenchymal stromal cells which are dispersed throughout the fibrovascular connective tissue stroma containing areas of haemorrhage. When it comes to radiographic features, CGCG can have an array of variations, ranging from well-defined expansile lesions to ill-defined and destructive lesions, with or without expansion. Case presentation: This case report reviews an 11-year-old Caucasian patient with a chief complaint of slow-growing swelling involving the right posterior mandibular region. The cone beam computed tomography (CBCT) revealed an ill-defined mixed lesion mimicking both fibro-osseous lesion and hemangioma. However, microscopic examination revealed multinucleated giant cells in a fibrous stroma suggestive of central giant cell granuloma. Conclusion: Our intent in reporting this case is to highlight the importance of thorough clinical, radiographical and histopathological examination for accurate diagnosis and therapeutic interventions as well as to emphasize the importance of taking different possibilities into consideration when examining bony swellings in the head and neck region. [ABSTRACT FROM AUTHOR]

Objective: Granulomatous dermatitis (GD) is a group of diseases grouped under two main headings: infectious and non-infectious, characterized histopathologically by granulomas and may also present with systemic findings. Granulomatous inflammation may be limited to the skin only or may occur as a symptom of a systemic disease. Material and Methods: 105 patients included who were clinically and histopathologically diagnosed with non-infectious GD in our clinic between 2006 and 2023. Results: Of the 105 patients included in our study, 79 were female and 26 were male. The mean age of the patients was 45.72 (age range 2-77). While 12 of the patients were under the age of 18, 12 patients were over the age of 65. The diagnosis of the patients were granuloma annulare (n=43), followed by sarcoidosis (n=24), necrobiosis lipoidica (n=12), interstitial GD (n=6), granulomatous rosacea (n=5), panniculitis (n=5), granuloma fasciale (n=2), Crohn’s disease (n=2), granulomatous vasculitis (n=2), piyoderma gangrenozum (n=1), post herpetic GD (n=1), lupus miliaris disseminatus faciei (n=1), granulomatous mycosis fungoides (n=1) and elastolytic giant cell granuloma (n=1). Conclusion: GDs are a heterogeneous group of diseases with varying clinical and histopathological findings. Histopathological morphology alone is rarely specific and is not sufficient to make a definitive diagnosis of the disease that plays a role in etiology. Conclusion: Differential diagnosis of GDs should be made in the light of histopathological findings, microbiological examination and clinical data. [ABSTRACT FROM AUTHOR]

Background: Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas with predominantly lung manifestations that can cause restrictive or, less commonly, obstructive lung disease. Rarely is pneumothorax a manifestation of sarcoidosis; it has been reported as an early finding in sarcoidosis, but it is typically attributed to ruptured bullae, cysts, or pleural granulomas. Case Presentation: We present a unique case of spontaneous pneumothorax attributed to biopsy-proven sarcoid disease in a patient with no prior history of pulmonary complications. The patient’s rapid development of novel pulmonary sequelae necessitates treatment of sarcoidosis early in the disease course. Conclusion: We recommend a treatment plan of appropriate chest tube placement in the affected lung(s) and prompt steroid therapy for patients with sarcoidosis presenting with a pneumothorax. We also review the literature for the etiology, pathophysiology, and presentation of pneumothorax in sarcoidosis, treatment of this sequela, and pulmonary function test findings in these patients. [ABSTRACT FROM AUTHOR]

The article presents the case of a 10-year-old child with a history of X-linked chronic granulomatous disease (CGD) who is experiencing non-productive cough, dysphonia and weight loss for 12 months to discuss chronic granulomatous disease of the upper airway. Also cited are the use of airway endoscopy to confirm friable, edematous mucosa of the supraglottic larynx and the possible causes of CGD like defects in nicotinamide adenine dinucleotide phosphate (NAPH) oxidase subunits.

Introduction: Sternal pseudotumour is an important but rare entity thought to be an inflammatory, non‐neoplastic lesion that can mimic tumours. The purpose of this paper was to illustrate the imaging features of this lesion to avoid unnecessary investigations. Methods: The clinical notes and imaging features of four patients with a diagnosis of sternal pseudotumour were reviewed over a period from February 2016 to July 2019. Results: All patients were afebrile with no history of trauma. The median age at presentation was 12.5 months. The median length of symptoms prior to presentation was 3.5 days. One patient had a mildly elevated C‐reactive protein. Chest radiographs showed a pre‐sternal soft‐tissue mass, with or without osseous destruction of the subjacent sternum. Ultrasound showed a heterogeneous, hypoechoic pre‐sternal soft‐tissue mass with variable internal vascularity with extension between sternal ossification centres. CT and MRI showed an enhancing dumbbell‐shaped lesion with a pre‐sternal and retro‐sternal soft‐tissue component. The median time to complete resolution was 3 months. One patient had a biopsy that showed chronic inflammation and fibrosis. Discussion: These lesions present in young children typically with a 1‐ to 2‐week history of a focal 2‐ to 4‐cm swelling over the sternum. The aetiology is unknown but may be on the basis of a yet‐to‐be identified pathogen. Inflammatory markers and cultures are normal or mildly elevated. Important differential considerations include sternal osteomyelitis or neoplastic causes such as Ewing sarcoma, rhabdomyosarcoma, Langerhans cell histiocytosis and infantile fibrosarcoma. Conclusion: Sternal pseudotumor is a rare but important entity to be aware of to avoid unnecessary invasive biopsy or further investigations. Our suggestion is that this is a 'Don't touch' lesion that requires close short‐interval follow‐up at a surgical outpatient clinic and with ultrasound until resolution. [ABSTRACT FROM AUTHOR]

Introduction: Metal reaction and pseudotumor formation are very rare complications following ceramic on polyethylene total hip replacement. Pseudotumors have been described in the case of metal on polyethylene as well as in metal on ceramic interfaces. We report the largest pseudotumor formation to be observed after a thorough literature review following ceramic on polyethylene total hip replacement in a case of ankylosing spondylitis and chronic kidney disease. Case report: The patient had reported 7 years following the index surgery with an uncemented total hip arthroplasty and presented with osteolytic changes of the right proximal femur and later was lost to follow-up due to the COVID-19 pandemic. The patient returned again 2 years later presenting with the pseudotumor. Owing to the presence of extensive osteolysis with gross necrotic muscle mass around the proximal one-third of femur and since bone stock was available, reconstruction of the hip joint was not considered and hence a right side hind-quarter amputation was performed. Conclusion: This immune reaction was possibly exacerbated due to the underlying ankylosing spondylitis and chronic kidney disease requires more stringent follow up protocols and early intervention. It is, thereby, necessary to evaluate patients with serial radiography following total hip replacement, especially those with conditions which could accelerate the immune responses to the metal. This could potentially avoid an amputation and allow for reconstruction of the hip with appropriate immunomodulation. [ABSTRACT FROM AUTHOR]

Objectives The appendix, although considered a vestigial organ, is of considerable clinical importance because acute appendicitis is a common medical problem. There are also other disease processes involving the appendix. The appendix is among the first specimens that the pathologist (and surgeon) cuts one's teeth on. Thus, there may be a tendency to underestimate the clinically and prognostically significant appendiceal pathologies. Methods We provide a vade mecum of the pathologic features of a wide range of nonneoplastic appendiceal pathologies, with an emphasis on developing a practical approach to grossing, microscopy, and reporting—all with clinical and therapeutic implications. Much of this is based on literature on MEDLINE with reference to years 2008 to 2023, as well as on personal experiences and interpretations. Results The appendix can harbor a myriad of nonneoplastic pathologies, including infections, inflammations of varying etiologies (including interval appendectomy), endometriosis, diverticulosis, and so on. Chronic appendicitis, Crohn disease, and clinical audit are recurring themes while COVID-19 is a new entity. Conclusions Most importantly, all pathologists should appreciate that the appendix is not as "routine" a specimen as one would want to believe. [ABSTRACT FROM AUTHOR]

Objectives: There is little knowledge about oxidative stress‐induced senescence involvement in apical periodontitis. Here, we explored its molecular mechanism in periapical lesions. Methods: Ten cases of radicular cysts and five cases of periapical granulomas were randomly selected. Immunohistochemical analysis was performed to detect the expression and correlation between Senescence‐associated factor polymerase I and transcript release factor (PTRF) and Akt/FoxO1 signaling. Human periodontal ligament cells (hPDLCs) pretreated with LY294002 were exposed to H2O2‐induced oxidative stress conditions and then cell proliferation, senescence, apoptosis, and associated signaling were evaluated by EdU labeling, β‐galactosidase assay, RT‐qPCR, and western blot analysis, respectively. Results: Polymerase I and transcript release factor and Akt/FoxO1 signaling were more frequently expressed in the radicular cyst than in periapical granulomas. Notably, cells in radicular cysts showed Akt activation, FoxO1 phosphorylation, and cytoplasmic translocation. In vitro, prominent H2O2‐induced senescence was observed in hPDLCs. LY294002, a PI3K inhibitor, attenuated the expression levels of senescence (Klotho, P16INK4), apoptosis (Bad, Fas), phosphorylated Akt, and phosphorylated FoxO1; however, did not affect cell proliferation. Conclusions: Our data indicated that senescence is present in clinical periapical lesions, and Akt/FoxO1 signaling is involved in the H2O2‐induced cellular senescence, which could serve as a potential therapeutic target. [ABSTRACT FROM AUTHOR]

Aim: This study aims to compare the efficacy and safety of topical application of common salt (CS) in comparison to silver nitrate (SN) for treating infants with umbilical granuloma (UG). Materials and Methods: We conducted an open-label, prospective, single-center, pilot randomized controlled trial. Thirty-seven infants with a clinical UG diagnosis were enrolled between October 2022 and July 2023, excluding those previously treated for UG. Patients were randomly assigned (using the Randomizer® app) to receive either topical CS (applied thrice daily by caregivers at home for 5 days) or SN (applied by pediatric surgeon in clinic and kept under occlusive dressing for 48 h). Patients with partial/no healing received an additional session of the same treatment. Nonresponders transitioned from CS to SN, and vice versa, for two more applications. Healing rates were compared with a significance level of a =0.05. Results: Out of 34 patients (18 CS and 16 SN), 32 successfully completed the trial (17 CS and 15 SN). No significant differences were observed in baseline characteristics. Efficacy rates of CS (19/22; 86.36%) and SN (11/17; 64.71%) did not significantly differ (P = 0.056; 95% confidence interval [CI] -0.4832-0.0502). No major adverse events were reported. CS showed superior healing outcomes in infants below 3 months of age (19/22; 86.36%) compared to SN (11/17; 64.71%) (P = 0.056; 95% CI - 0.4832-0.0502). The timing of umbilical cord detachment did not significantly affect healing rates. Conclusion: Widespread availability, ease of access, suitability for safe home application, and cost-effectiveness make CS a primary treatment option for UG. Larger patient cohorts are needed for conclusive results. [ABSTRACT FROM AUTHOR]

Crohn's disease (CD) is a progressive, multifactorial, immune-mediated disease characterized by chronic inflammation of any part of the gastrointestinal (GI) tract. Pediatric patients present with a more extensive form of the disease, especially in the upper GI tract with various histopathological inflammatory patterns. Our study aims to analyze the clinical, laboratory, endoscopic, and histopathological findings in children with diagnosed CD and compare results on the initial and follow-up tests. We have included 100 children and adolescents with CD, with performed endoscopic and histopathological (HP) procedures. The results of multiple biopsies executed in these 8 years were matched and compared. We found a statistically significant frequency reduction in stool changes (65.52% to 18.18%), weight loss (35.24% to 4%), and abdominal pain (41.86% to 6.67%) as presenting symptoms. There was an improvement in all laboratory values: fecal calprotectin (1000 to 60,8 μg/g), C-reactive protein (12.2 to 1.9 mg/L), and albumin (36 to 41 g/L). On esophagogastroduodenoscopy and ileo-colonoscopy 36.59% and 64.86% patients had specific findings, respectively. A total of 32 patients had evidence of Crohn's disease in the upper GI tract. Non-caseating granulomas were found on 9% of oesophageal, 18% of gastric, and 12% of duodenal biopsies. In the lower GI tract, we have observed a disease progression in the rectum (72.29 to 82.22%) and descending colon (73.49 to 80%). There was no registered disease progression in the upper GI tract. Our study demonstrated a significant decline in the frequency of symptoms and an improvement in laboratory values on the follow-up examinations. More than a third of our patients had specific endoscopic and HP findings in the upper GI tract, and an additional 23% had HP findings highly suggestive of CD. We demonstrated the importance of regular clinical, laboratory, endoscopic, and histopathological assessments of pediatric CD patients. [ABSTRACT FROM AUTHOR]

Introduction: In dermatology, inflammatory skin conditions impose a substantial burden worldwide, with existing therapies showing limited efficacy and side effects. This report aims to compare a novel immunological activation induced by hyperthermic 20 MHz high intensity focused ultrasound (HIFU) with conventional cryotherapy. The bioeffects from the two methods are initially investigated by numerical models, and subsequently compared to clinical observations after treatment of a patient with the inflammatory disease granuloma annulare (GA). Methods: Clinical responses to moderate energy HIFU and cryotherapy were analysed using numerical models. HIFU-induced pressure and heat transfer were calculated, and a three-layer finite element model simulated temperature distribution and necrotic volume in the skin. Model output was compared to 22 lesions treated with HIFU and 10 with cryotherapy in a patient with GA. Results: Cryotherapy produced a necrotic volume of 138.5 mm3 at − 92.7 °C. HIFU at 0.3–0.6 J/exposure and focal depths of 0.8 or 1.3 mm generated necrotic volumes up to only 15.99 mm3 at temperatures of 68.3–81.2 °C. HIFU achieved full or partial resolution in all treated areas, confirming its hyperthermic immunological activation effect, while cryotherapy also resolved lesions but led to scarring and dyspigmentation. Conclusion: Hyperthermic immunological activation of 20 MHz HIFU shows promise for treating inflammatory skin conditions as exemplified by GA. Numerical models demonstrate minimal skin necrosis compared to cryotherapy. Suggested optimal HIFU parameters are 1.3 mm focal depth, 0.4–0.5 J/exposure, 1 mm spacing, and 1 mm margin. Further studies on GA and other inflammatory diseases are recommended. [ABSTRACT FROM AUTHOR]

We describe a case of congenital syphilis in an adopted infant with a unique dermatologic presentation of scalp granulomas, along with lymphadenopathy, anemia, and elevated liver transaminases. To our knowledge, this cutaneous morphology has not been previously reported in the literature. This case highlights the varied clinical presentation of congenital syphilis and the diagnostic challenge it poses for clinicians, especially in the context of unknown prenatal history/unknown risk factors, or if syphilis is acquired during pregnancy after routine screening is performed. As the incidence of congenital syphilis has more than tripled in recent years, this diagnosis should be considered when a neonate or infant presents with unexplained skin nodules. [ABSTRACT FROM AUTHOR]

Background: Mesotherapy is a popular cosmetic procedure for localized delivery of substances. However, due to the lack of standardized processes, there are potential risks of adverse reactions. Granulomas formation is one of the chronic reactions which impose significant physical and mental burdens on patients. Objectives: The aim of this analysis is to evaluate the safety and feasibility of combining intense pulsed light (IPL) with intralesional corticosteroids for treating noninfectious granulomas after mesotherapy. Methods: This retrospective observational case series included patients who suffer from noninfectious granulomas after mesotherapy and received combination of IPL and intralesional corticosteroids treatment between October 2021 and December 2022 at Peking University Shenzhen Hospital, Shenzhen, China. The process and effect were analyzed and summarized. Results: Among the seven patients, five expressed extreme satisfaction with the efficacy, while two was slightly satisfied. The physicians believed that all patients had shown significant improvement. No adverse reactions or recurrences were observed during follow‐up. Conclusion: Based on this analysis, the application of the combined treatment in patients suffering from noninfectious granuloma due to mesotherapy demonstrates good clinical efficacy and safety, making it worth considering as a treatment option. [ABSTRACT FROM AUTHOR]

Background: Type 1 (Th1) and Type 2 (Th2) immunity have both been implicated in granuloma annulare (GA). To what extent these pathways contribute to clinical/histologic heterogeneity and/or distinct disease endotypes remains unexplored. Methods: We retrospectively analyzed 30 GA biopsies with either palisaded or interstitial histology with and without eosinophils. We performed RNA in situ hybridization to assess how markers of Type 1 (interferon gamma), Type 2 (interleukin [IL]4, IL13, IL5), and Type 3 (IL17A) immunity in GA compared with canonical inflammatory disorders and whether markers correlated with histology. We analyzed another cohort of 14 patients who had multiple biopsies across anatomic space and time for individual conservation of histologic features. Results: Interferon (IFN)G staining is highest in GA relative to other cytokines. Type 2 cytokine staining is less prominent, with IL4 increased in interstitial pattern cases. Eosinophils did not correlate with Type 2 markers. Patients with multiple biopsies display intrapatient variability in histology. Conclusion: Type 1 inflammation predominates over Type 2 inflammation in GA irrespective of histologic pattern. Distinct disease endotypes were not detected. [ABSTRACT FROM AUTHOR]

Aesthetic medicine is a rapidly developing branch of modern medicine. Its main procedures include needle-based procedures such as mesotherapy, botulinum toxin injections and filler injections. Each of them may result in unwanted complications. In the case of mesotherapy, the complications are usually local, while in the case of the usage of botulinum toxin, there have been reports of deaths, whereas filler injections have been reported to cause stroke and loss of vision. It is of the highest importance for the professional to properly prepare for the procedure. In Poland, there is no such thing as a specialization in aesthetic medicine. The lack of precise regulations contributes to an increased number of complications caused by people without appropriate qualifications and offences defined in law as damage to health. It is especially important in cases when the procedure is carried out by people, who are underqualified and do not have appropriate permissions. [ABSTRACT FROM AUTHOR]

Granulomatous rosacea (GR) is a rare and distinct variant of rosacea. We report three cases of recalcitrant GR successfully treated with pulsed‐dye laser (PDL) and provide experimental evidence supporting its potential as a treatment option. PDL treatment demonstrated remarkable efficacy in the three clinical cases, despite their resistance to conventional therapies. Chemokine ligand 9 (CXCL9), a key chemokine involved in inflammation and granuloma formation, was found to be increased in skin sections from all three patients. In vitro experiments using human monocytes and dermal fibroblasts demonstrated that PDL treatment significantly reduced CXCL9 expression in fibroblasts. These findings suggest that PDL may modulate CXCL9 secretion in fibroblasts, potentially limiting the recruitment of immune cells to the lesion. Although further research is needed to fully understand the precise mechanisms underlying the role of CXCL9 in GR, PDL may be a promising therapeutic approach for refractory GR. [ABSTRACT FROM AUTHOR]

Rationale: Chronic sarcoidosis is a complex granulomatous disease with limited treatment options that can progress over time. Understanding the molecular pathways contributing to disease would aid in new therapeutic development. Objectives: To understand whether macrophages from patients with nonresolving chronic sarcoidosis are predisposed to macrophage aggregation and granuloma formation and whether modulation of the underlying molecular pathways influence sarcoidosis granuloma formation. Methods: Macrophages were cultivated in vitro from isolated peripheral blood CD14+ monocytes and evaluated for spontaneous aggregation. Transcriptomics analyses and phenotypic and drug inhibitory experiments were performed on these monocyte-derived macrophages. Human skin biopsies from patients with sarcoidosis and a myeloid Tsc2-specific sarcoidosis mouse model were analyzed for validatory experiments. Measurements and Main Results: Monocyte-derived macrophages from patients with chronic sarcoidosis spontaneously formed extensive granulomas in vitro compared with healthy control participants. Transcriptomic analyses separated healthy and sarcoidosis macrophages and identified an enrichment in lipid metabolic processes. In vitro patient granulomas, sarcoidosis mouse model granulomas, and those directly analyzed from lesional patient skin expressed an aberrant lipid metabolism profile and contained increased neutral lipids. Conversely, a combination of statins and cholesterol-reducing agents reduced granuloma formation both in vitro and in vivo in a sarcoidosis mouse model. Conclusions: Together, our findings show that altered lipid metabolism in sarcoidosis macrophages is associated with its predisposition to granuloma formation and suggest cholesterol-reducing therapies as a treatment option in patients. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to present and analyze detailed clinicopathological data of periapical cysts (PCs) and periapical granuloma (PG) in a cohort of 135 cases from the South Indian Population. Methodology: The present study included 135 cases of PC and PG out of 2696 biopsies submitted over 3 years. The clinicodemographic data which included age, gender, location, radiographic appearance, and treatment were collected along with the histopathological examination of the biopsied specimen. Data were entered in a Microsoft Excel spreadsheet, 2021, and analyzed using SPSS software ver. 26. Results: There were 71 cases of PG and 64 cases of PC. The mean age of occurrence in PG was slightly lower than cases in PC. Irrespective of the group, there was a clear male preponderance, and maxillary permanent central incisors were most commonly affected. However, no significant difference was noted. Radiographically, PC significantly showed more well-defined corticated radiolucent lesions compared to PG where most cases were ill-defined (69.01%). Histologically, all cases showed classic features for diagnosis with additional histological characteristics which may aid in diagnosis. Conclusion: PG was more common than PC. There was a predilection for the male gender in both lesions. The actual incidence of these lesions would be actually high, as some cases are lost to private practitioners, and not all the lesions are submitted for histopathological examination. [ABSTRACT FROM AUTHOR]

Background: Granulomatous mycosis fungoides (GMF) is a rare form of cutaneous T-cell lymphoma characterized by a granulomatous inflammatory infiltrate. Objective: The impact of granulomatous inflammation on the prognosis of the disease remains controversial as there have been both favorable and unfavorable outcomes documented. Methods: We performed a systematic review of 116 GMF cases previously described in the literature. Results: In contrast to the classic Alibert-Bazin type of mycosis fungoides (MF), cutaneous lesions in GMF tend to involve distal extremities (lower legs, feet, hands) early in the disease course. In the literature, 30% of GMF patients developed organ metastasis, most frequently to the lung. The median time to stage progression was 25 months. Conclusion: GMF is an aggressive form of MF. Therefore, screening for distant metastases should be considered at presentation and repeated during follow-up. [ABSTRACT FROM AUTHOR]

Objective: To compare the expression of IL‐17 in periapical lesions (cysts and granulomas) among elderly individuals and adults. We selected 20 periapical lesions of the elderly (12 granulomas and eight cysts) and 20 periapical lesions of adults (12 granulomas and eight cysts). Materials and Methods: Immunohistochemistry was performed using a specific antibody for IL‐17. The slides were subdivided into five high magnification fields and then the images were observed through an optical microscope. According to the number of positive markings for the antibody, grades were given, ranging from 0 to 2. Results: The results demonstrate that there was no statistical difference when comparing the expression of IL‐17 between cysts and granulomas of both groups (study group: cysts 0.7 ± 0.21 × granulomas 0.96 ± 0.58, p =.61; control group: cysts 0.37 ± 0.16 × granulomas 0.31 ± 0.23, p =.27). The comparison between adult (control group) and elderly patients (study group) showed a statistical difference both in cysts (study group: 0.7 ± 0.21 × control group: 0.37 ± 0.16, p =.007) and in granulomas (study group: 0.96 ± 0.58 × control group: 0.31 ± 0.23, p =.0009), in which elderly patients had a higher expression of interleukin 17, in relation to adult patients. Conclusion: We concluded that elderly patients have a higher expression of IL‐17 in both cysts and granulomas, when compared to adult patients. [ABSTRACT FROM AUTHOR]

Aim: To discuss the diagnosis and treatment of an exuberant oral pyogenic granuloma (OPG) in the palatal region in a systemically compromised patient. Methods and Results: A 50‐year‐old woman presented with extensive and painless nodular mass that extended throughout the palatal region, with difficulty speaking, swallowing and spontaneous bleeding for 6 months. Her medical history showed poorly controlled type II diabetes mellitus and hypertension. The intraoral physical examination also revealed poor oral hygiene and periodontal disease. After clinical and radiographic evaluation, the presumptive diagnosis of OPG was made and complete excision of the lesion was performed. Local hemostatic measures were employed to control bleeding. Microscopic evaluation showed a lobulated lesion composed of many blood capillaries confirming the diagnostic hypothesis. Conclusions: In summary, individuals with severe periodontal disease and systemic disorders may present exacerbated clinical presentations of OPG. [ABSTRACT FROM AUTHOR]

Objective: Tuberculosis (TB) remains a major health problem, especially in the developing countries. Fine-needle aspiration cytology is the first line of investigation for tubercular lymphadenitis as it is easy to perform, less invasive, quick, and economical. The typical cytopathological features of tuberculosis TB include epithelioid cell granulomas with Langhans giant cells and caseous necrosis. The present study aimed to evaluate the cytomorphological features of newly diagnosed cases of tubercular lymphadenitis confirmed by GeneXpert. Material and Methods: This was a retrospective study in which all fine-needle aspirates from newly diagnosed cases of tubercular lymphadenitis confirmed by GeneXpert over a 1-year period from July 2022 to July 2023 were included in the study. The May–Grunwald–Giemsa stained smears from these aspirates were categorized into three patterns-epithelioid cell granulomas with necrosis, epithelioid granulomas without necrosis, and necrosis only. The granulomas were further categorized into well-formed, ill--formed, and splintered. The background of the aspirate which included a reactive lymphoid background, lymphocytes, eosinophils, and neutrophils was tabulated for all the cases. Results: Out of the three cytomorphological patterns, epithelioid granulomas with necrosis were the most predominant (67.5%), followed by necrosis only (20.8%) and granulomas without necrosis (11.6%). An acid-fast bacilli (AFB) positivity of 53.3% (64 cases) was seen on the Ziehl-Neelsen stain. Well-composed, poorly formed, and splintered granulomas were seen in 55 (57.9%), 42 (44.2%), and 21 (22.1%) cases, respectively. Neutrophils were the most common background population (42, 35%) followed by lymphocytes (36, 30%). Reactive lymphoid cells and eosinophils were seen in 12 (10%) and 3 (2.5%) cases, respectively. Conclusion: Fine-needle aspiration cytology is a rapid inexpensive minimally invasive test for tubercular lymphadenitis as epithelioid cell granulomas along with caseous necrosis are highly suggestive of TB. However, manual acid-fast AFB detection has a low sensitivity as is illustrated in the present study where only AFBwas demonstrated in only 53.3% of cases. [ABSTRACT FROM AUTHOR]

Biostimulators are the latest trends in cosmetic procedures, substances such as PDLLA are used to induce collagen synthesis by a subclinical inflammatory reaction. We are describing a granuloma-like reaction case presentation 4 months after the application of PDLLA and its complete resolution with injections of triamcinolone. A 45-year-old female with any past medical history of allergies or immune diseases was injected with PDLLA on the mandibular border and cheek area to correct skin laxity. Four months after the application, the patient reported facial edema and granuloma-like reactions according to clinical examination on all the application areas. The ultrasound reports showed the presence of multiple nodules in the injection areas; therefore, we decided to apply triamcinolone to the granulomatous reaction areas 2 times a month and Prednisone 20 mg daily for 3 days followed by 10 mg for 2 days. After 4 applications, the adverse reaction was completely solved. Biostimulators are biocompatible and resorbable substances; however, nodules and/or granulomas have been reported as rare adverse events. Intralesional and oral steroids can allow us to treat this kind of adverse events. [ABSTRACT FROM AUTHOR]

Rubella virus-associated granulomas commonly occur in immunocompromised individuals, exhibiting a diverse range of clinical presentations. These manifestations can vary from predominantly superficial cutaneous plaques or nonulcerative nodules to more severe deep ulcerative lesions, often accompanied by extensive necrosis and significant tissue destruction. TAP1 deficiency, an exceedingly rare primary immune-deficiency disorder, presents with severe chronic sino-pulmonary infection and cutaneous granulomas. This report highlights the occurrence of rubella virus-associated cutaneous granulomas in patients with TAP1 deficiency. Notably, the pathogenic mutation responsible for TAP1 deficiency stems from a novel genetic alteration that has not been previously reported. This novel observation holds potential significance for the field of diagnosis and investigative efforts in the context of immunodeficiency disorders. [ABSTRACT FROM AUTHOR]

Giant cell lesion of the oral cavity in a pediatric population is a very rare entity. Peripheral giant cell granuloma (PGCG) is one such non-neoplastic lesion-causing gingival tumor. Here, a case of successful management of PGCG in a 12-year-old child is presented with a two-year follow-up. Clinical, radiographic, and histological features of PGCG are discussed with the importance of a long-term follow-up of the lesion. [ABSTRACT FROM AUTHOR]

Host-directed therapies (HDTs) represent an emerging approach for bacterial clearance during tuberculosis (TB) infection. While most HDTs are designed and implemented for immuno-modulation, other host targets-such as nonimmune stromal components found in pulmonary granulomas-may prove equally viable. Building on our previous work characterizing and normalizing the aberrant granuloma-associated vasculature, here we demonstrate that FDA-approved therapies (bevacizumab and losartan, respectively) can be repurposed as HDTs to normalize blood vessels and extracellular matrix (ECM), improve drug delivery, and reduce bacterial loads in TB granulomas. Granulomas feature an overabundance of ECM and compressed blood vessels, both of which are effectively reduced by losartan treatment in the rabbit model of TB. Combining both HDTs promotes secretion of proinflammatory cytokines and improves anti-TB drug delivery. Finally, alone and in combination with second-line antitubercular agents (moxifloxacin or bedaquiline), these HDTs significantly reduce bacterial burden. RNA sequencing analysis of HDT-treated lung and granuloma tissues implicates up-regulated antimicrobial peptide and proinflammatory gene expression by ciliated epithelial airway cells as a putative mechanism of the observed antitubercular benefits in the absence of chemotherapy. These findings demonstrate that bevacizumab and losartan are well-tolerated stroma-targeting HDTs, normalize the granuloma microenvironment, and improve TB outcomes, providing the rationale to clinically test this combination in TB patients. [ABSTRACT FROM AUTHOR]

In sarcoidosis, granulomas develop in multiple organs including the liver and lungs. Although mechanistic target of rapamycin complex 1 (mTORC1) activation in macrophages drives granuloma development in sarcoidosis by enhancing macrophage proliferation, little is known about the macrophage subsets that proliferate and mature into granuloma macrophages. Here, we show that aberrantly increased monocytopoiesis gives rise to granulomas in a sarcoidosis model, in which Tsc2, a negative regulator of mTORC1, is conditionally deleted in CSF1R-expressing macrophages (Tsc2 csf1rΔ mice). In Tsc2 csf1rΔ mice, common myeloid progenitors (CMPs), granulocyte-monocyte progenitors (GMPs), common monocyte progenitors / monocyte progenitors (cMoPs / MPs), inducible monocyte progenitors (iMoPs), and Ly6Cint CX3CR1low CD14− immature monocytes (iMOs), but not monocyte-dendritic cell progenitors (MDPs) and common dendritic cell progenitors (CDPs), accumulated and proliferated in the spleen. Consistent with this, monocytes, neutrophils, and neutrophil-like monocytes increased in the spleens of Tsc2 csf1rΔ mice, whereas dendritic cells did not. The adoptive transfer of splenic iMOs into wild-type mice gave rise to granulomas in the liver and lungs. In these target organs, iMOs matured into Ly6Chi classical monocytes/macrophages (cMOs). Giant macrophages (gMAs) also accumulated in the liver and lungs, which were similar to granuloma macrophages in expression of cell surface markers such as MerTK and SLAMF7. Furthermore, the gMA-specific genes were expressed in human macrophages from sarcoidosis skin lesions. These results suggest that mTORC1 drives granuloma development by promoting the proliferation of monocyte/neutrophil progenitors and iMOs predominantly in the spleen, and that proliferating iMOs mature into cMOs and then gMAs to give rise to granuloma after migration into the liver and lungs in sarcoidosis. [ABSTRACT FROM AUTHOR]

Background: Visceral leishmaniasis (VL) is a major public health problem worldwide. In addition to the clinical manifestations, varied hematological abnormalities have also been observed. We aim to study morphology both in peripheral smear and bone marrow aspirates (BMAs) along with clinicohematological correlation in the pediatric age group. Materials and Methods: A retrospective analysis of clinicohematological findings of 47 pediatric patients (0-18 years) diagnosed with leishmaniasis on BMAs from 2006 to 2017 was undertaken. All the results were tabulated and compared for evaluation. Results: From the 47 VL patients, the following abnormalities were noted. Pancytopenia 44.7% (21/47), bicytopenia 42.5% (20/47), anemia 10.6% (5/47), leukopenia 81% (38/47), and thrombocytopenia 53.2% (25/47). On peripheral smear, shift to left (48.3%), nucleated red blood cells (19.4%), toxic granules (6.7%), and Leishmania donovani (LD) bodies (5.7%) were noted. About 5.7% were seen. Bone marrow examination revealed erythroid hyperplasia in 44.6% of cases showing normoblastic (88.8%), megaloblastic (4.4%), and mixed (10.6%) reactions. Dyserythropoiesis (15.5%), drug-induced karyorrhexis (2.1%), dysmyelopoiesis (17%), giant stabs and metamyelocytes (6.3%), coarse granulation (2.1%), intrahistiocytic organisms (100%), increased plasma cells (3.4%), granulomas (25.5%), parasitophorous vacuoles (25.5%), nonhistiocytic intracellular organisms ( 15%), intracellular granule-like organism (8.5%), hemophagocytosis (8.5%), Reed-Sternberg-like cells (2.1%). Conclusion: BMA findings such as increased plasma cells, granulomas, hemophagocytosis, and granule-like organisms are important clues for suspecting leishmaniasis and further searching for LD bodies in patients with fever and splenomegaly. [ABSTRACT FROM AUTHOR]

Extranodal natural killer T-cell lymphoma, nasal type (ENKTCL), is a rare form of non-Hodgkin lymphoma that is strongly related to Epstein-Barr Virus (EBV) infection and commonly presents as "midline lethal granuloma." Herein, we report a middle-aged lady who presented with a two-week history of fever, sore throat and constitutional symptoms. Intraoral examination revealed a lacerated soft palate with an ulcerated uvula. A diagnosis of ENKTCL was confirmed through deep biopsies under general anaesthesia supplemented with a positive serum EBV genome. Unfortunately, she succumbed due to disease progression with left frontal brain metastasis with concurrent pulmonary tuberculosis before treatment was completed. The recommended treatment is multimodality with L-asparaginase-containing regimes chemotherapy in an advanced stage, relapsed, or refractory ENKTCL for better outcomes. The quantification of circulating plasma EBV deoxyribonucleic acid (DNA) is helpful as the baseline of tumour load and a biomarker for monitoring treatment response and prognostication. We advocate repeated and deeper core tissue biopsies. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a leading cause of non‐infectious uveitis that commonly affects middle‐aged individuals and has a female preponderance. The disease demonstrates age, sex and ethnic differences in clinical manifestations. A diagnosis of sarcoidosis is made based on a compatible clinical presentation, supporting investigations and histologic evidence of non‐caseating granulomas, although biopsy is not always possible. Multimodal imaging with widefield fundus photography, optical coherence tomography and angiography can help in the diagnosis of sarcoid uveitis and in the monitoring of treatment response. Corticosteroid remains the mainstay of treatment; chronic inflammation requires steroid‐sparing immunosuppression. Features on multimodal imaging such as vascular leakage may provide prognostic indicators of outcome. Female gender, prolonged and severe uveitis, and posterior involving uveitis are associated with poorer visual outcomes. [ABSTRACT FROM AUTHOR]

Background: Chronic granulomatous disease (CGD) is a rare disorder normally diagnosed in infancy. Case presentation: A 27-year-old man admitted with non-specific symptoms of CGD first underwent endoscopy, and colonoscopy procedures as primary evaluation of clinical presentation. Eighteen months after the first admission, he was referred to the emergency department for hematemesis, and critical situations, such as a severe anemic with Hgb= 2.6 mg/dl. As a result of this specific clinical presentation, urgent emergency treatment was performed, and endoscopic examination revealed ulcers and abnormalities in the duodenal bulb and jejunum. Other imaging procedures, such as sonography, and abdominal CT scans, showed splenomegaly. He underwent splenectomy, and after that, endoscopic treatment with balloon TTS dilation was scheduled, but this procedure failed. So, we decided to do a gastro-jujenostomy that alleviated the clinical symptoms. After nine months, he was referred to GOO, and endoscopic evaluation showed giant ulceration with severe stricture in the duodenum, and a polyp in the jejunostomy. Finally, Based on clinical presentation and pathologic evidence of biopsies, the patient approached CGD as the final diagnosis. Conclusion: Step-by-step, rule out of different highly suspicious diseases may result in a definite CGD diagnosis, and rapid management of these patients may increase the chance of survival. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to delineate the clinical characteristics, surgical details, and treatment outcomes of patients diagnosed with ocular toxocariasis (OT) who underwent pars plana vitrectomy (PPV). Materials and Methods: A retrospective review of medical records was conducted for patients with OT who underwent PPV at a tertiary uveitis clinic between September 2021 and November 2023. Clinical evaluations, laboratory investigations, treatment modalities, and surgical details were analyzed. A 23-gauge PPV was performed due to persistent vitreous opacity despite medical treatment in all patients. Results: Three pediatric patients with OT were included in this study. All patients presented with vitreous opacity and granuloma at the peripheral retina. Diagnosis relied on characteristic ophthalmologic manifestations and detection of serum or ocular anti-Toxocara antibodies. PPV facilitated the removal of vitreous opacities, traction bands, and inflammatory debris. Silicone oil was used as intraocular tamponade. Postoperatively, visual acuity improved in all cases, with no recurrent inflammation during follow-up. Conclusion: PPV showed promising outcomes in managing OT, leading to significant improvements in visual acuity, resolution of traction bands, and disease stabilization. Further research is required to comprehend the long-term effectiveness and safety of PPV for OT, as well as factors that can predict treatment outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To assess and compare the effectiveness of various treatment approaches for laryngeal contact granulomas (LCG). Methods: A retrospective analysis was conducted on a cohort of 45 patients diagnosed with LCG at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to May 2023. Based on the treatment modalities administered, patients were categorized into three groups: acid suppression alone, hormone injection combined with acid suppression, and surgery combined with acid suppression. Subsequently, the study compared differences in treatment efficacy and average healing time among these three groups, using various indicators. Results: The findings indicate that the granuloma size in LCG patients with hoarseness (0.126, 95% CI 0.087–0.288) was significantly greater compared to LCG patients without hoarseness (0.047, 95% CI 0.014–0.083) (P = 0.001). However, there were no significant variations in age, morphology (unlobulated/lobulated), laterality ratio (left/right), sex ratio (male/female), history of tracheal intubation (non-intubation/intubation), and RFS score (RFS > 7/RFS ≤ 7) (P > 0.05), regardless of the presence of hoarseness symptoms. At the treatment observation endpoint of 3 months, the curative ratio in the group receiving hormone injection combined with acid suppression was found to be significantly higher compared to the group receiving acid suppression alone (P = 0.018). In addition, the average healing time of patients in the hormone injection combined with acid suppression group was notably shorter than that of the acid suppression alone group (P = 0.007). Conclusions: The combination of hormonal injections and acid suppression may enhance the curative ratio and expedite the healing time of LCG. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate immunophenotypic profiles of infiltrating cells in surgically excised tissues of chalazion and pyogenic granuloma associated with chalazion. Methods: Eighty-two surgical specimens from 74 consecutive patients newly diagnosed with chalazion or chalazion-associated pyogenic granuloma at Tokyo Medical University Hospital between 2016 and 2022 were studied. Sixty specimens were chalazion lesions and 22 specimens were pyogenic granuloma lesions (from 15 men and 7 women, mean age 36.6 ± 14.4 years). All patients were immunocompetent Asian Japanese adults. Specimens were analyzed by immunohistochemistry and flow cytometry. Flow cytometry was performed using the following antibodies: CD3, CD4, CD8, CD11b, CD11c, CD16, CD19, CD20, CD23, CD25, CD34, CD44, CD56, CD69, and CD138. Results: In flow cytometric analysis, the proportion of cells expressing the T cell marker CD3 was significantly higher compared with other immune cells expressing specific markers (p < 0.0001), and the proportion of CD4-positive T cells was significantly higher than that of CD8-positive T cells (p < 0.0001), in both chalazion and pyogenic granuloma specimens. The chalazion and pyogenic granuloma lesions shared similar immunophenotypic profile characterized by predominant T cell infiltration, and CD4 T cells dominating over CD8 cells. The pattern of expression of CD4 and CD8 in the specimens was confirmed by immunohistochemistry. Conclusion: The present study demonstrates immunophenotypic features of chalazion and chalazion-associated pyogenic granuloma. Although various inflammatory cells are involved in the pathology of chalazion and pyogenic granuloma, a significantly higher proportion of CD4-positive T cells may be closely related to the pathological mechanisms of both lesions. [ABSTRACT FROM AUTHOR]

This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-β, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. IFN-γ and TGF-β were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P <.05), and IL-2 and TGF-β (P <.05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P <.05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P <.05). IFN-γ and TGF-β were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment. [ABSTRACT FROM AUTHOR]

Tuberculosis is caused by Mycobacterium tuberculosis. If the treatment is inadequate or if host defenses are impaired, the apical lesion in primary tuberculosis expands into adjacent lung tissues and may spread via airways, lymphatic channels, or the vascular system. It may also circulate back to the lung and cause miliary pulmonary disease. Systemic miliary tuberculosis occurs when bacteria disseminate through the systemic arterial system to involve any organ. In the present study, we discuss five such cases of systemic miliary tuberculosis wherein the deceased succumbed to the illness. [ABSTRACT FROM AUTHOR]

Hybrid tumours encompass lesions containing two or more pathologic entities. The pathogenesis of these lesions is barely understood and described. Juvenile trabecular ossifying fibroma (JTOF) is a benign but locally aggressive fibro-osseous neoplasm commonly affecting the maxilla of the adolescent age group. Hybrid lesions of JTOF have been reported along with central giant cell granuloma (CGCG), aneurysmal bone cyst (ABC) and traumatic bone cyst, respectively. However, the co-occurrence of JTOF with CGCG and ABC in a single patient has not yet been reported in the literature, hence, making ours the first case report of this kind. Theories describing the pathogenesis of this rare phenomenon have also been proposed and elaborated. [ABSTRACT FROM AUTHOR]

Objectives: Granulomatous mastitis is a rare benign inflammatory disease of the breast commonly seen in women at childbearing age. The aim of this study is to describe clinical and paraclinical characteristics of GM patients, to demonstrate the management and follow-up experience of our center, and review the literature on the topic. Methods: 30 GM cases were identified among the 3248 patients who applied to the breast health center of the Liv Bona Dea hospital between January 2018 and August 2023. Cases were identified as granulomatous mastitis histopathologically from the biopsy specimens. Patient data was evaluated from the database, and missing information was retrieved by calling the patients. Results: Among the 3248 patients who were admitted to our breast health center, 30 patients (0.9%) had a diagnosis of GM and were identified as applicable to our study. All the patients were female, with a median age of 33, ranging from 27 to 66. Of the 30 patients, 11 were overweight and 7 were obese at the time of diagnosis (mean BMI: 26.7). While the majority (n=23, 76%) of the patients presented with a breast lump, only 1 (3%) of the patient’s only symptom was breast lump. 8 (27%) of the cases had comorbidities, including Hashimoto Thyroiditis (n=1), Hypertension (n=6), Diabetes Mellitus type 1 (=1), Diabetes Mellitus type 2 (n=4), Major Depression (n=1). Of the lesions, 16 (53%) showed high suspicion with a Bi-Rads score ≥ 4, and 14 (47%) showed low suspicion with a Bi-Rads score ≤ 4. 18 (60%) of patients received only medical treatment, 11 (37%) patients received both surgery (excision) and medical treatment, and only 1 (3%) received surgery (excision) alone. Conclusion: Even though idiopathic GM is the most common GM type, results from the paper of Ercan Kokrut et al. suggest that Tuberculosis should not be skipped, especially in developing countries, with reported 20% as a cause of GM. A multidisciplinary team is crucial in the diagnosis and treatment of GM to be able to distinguish it from breast cancer To conclude, Granulomatous mastitis is a tricky condition that can cause high anxiety in physicians as high as in patients. Idiopathic GM is the most common type, but evaluation of other reasons, such as tuberculosis mastitis, must be on the checklist. More research regarding the outcome of different treatment modalities will give a straightforward approach for physicians. [ABSTRACT FROM AUTHOR]

Striped snakehead fingerlings Channa striata reared in a concrete pond with size 13.5 m3 (3 m x 3 m x 1.5 m) in a hatchery farm, in Labu, Negeri Sembilan, Malaysia had more than 70% mortality. The pond contained 1500 fingerlings of 5–7 cm in total length (TL). The purpose of this study was to investigate the high mortality event on the farm as part of a veterinary diagnostics service. Clinical signs observed were skin discoloration, lethargy, and anorexia. Necropsy was performed in 10 fish with gross lesions of 1–2 mm and multiple whitish nodules in the abdominal organs and most notably in the liver, and kidney. Following necropsy, bacteriology samples from the kidney and liver were inoculated onto Tryptic Soy Agar (TSA) and Blood Agar (BA). Pure colonies were observed and were Gram-negative with short rod morphology. The fulllength 16S rRNA gene was amplified from the pure colonies followed by sequencing using the Nanopore MinION™ (Oxford Nanopore, UK). The isolated strain was identified as Aeromonas schubertii based on the assembled 16S rRNA sequence showing nucleotide identity of 99.73% (top hit) to A. schubertii (GenBank Accession: NR_037014.2) while only a nucleotide identity of 97.55% was observed against Aeromonas hydrophila (GenBank Accession: NR_119190.1-), respectively. Histopathological examination from the liver, kidney, spleen, and intestine revealed granulomatous nephritis, and degeneration of tubular epithelium, with granulomatous hepatitis, splenitis, and enteritis. The prognosis of this case was grave. No treatment was given as the owner had decided to dispose of all current stock. This is the first A. schubertii infection in C. striata described in Malaysia. The findings of the present study may serve as a reference for similar cases in C. striata in the future so rapid diagnosis and treatment can be made if required. [ABSTRACT FROM AUTHOR]