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Central and peripheral giant cell granulomas are benign entities mostly seen in mandibular anterior region at female individuals, usually with observed recurrence. Their etiology is still unclear, as is the optimal method for treating them. The aim of this study was to evaluate the incidence, treatment methods, recurrence rates, and initial and definitive correlation of central and peripheral giant cell granulomas. Patients who were referred to our clinic between 2013 and 2023 and who had the lesions' definitive diagnosis as "central giant cell granuloma" (CGCG) or "peripheral giant cell granuloma" (PGCG) were included in the study. Demographic data, recurrence rates, treatment methods, lesion location, clinical behaviors, and sizes were noted on the reports. A total of 30 lesions in 23 patients (14 PGCG and 9 CGCG) were evaluated in this study. The mean follow-up time was 62.6 months; 8 of 23 patients had systemic disease. While only 1 patient was observed to have cortical bone destruction in PCGC, all patients were found to have cortical bone destruction in CGCG (p < 0.05). In both lesions, the correlation of preliminary and definitive diagnosis was evaluated, and it was found to be 50% in PGCG while it was 77.7% in CGCG. The recurrence rates were 21.4% in PGCG and 33.3% in CGCG. Curettage was applied in all patients. Additional treatments (intralesional steroid injections, denasumab applications, resection, and graft application) were performed in 5 patients who were found to have CGCG (p = 0.004). However, there was no significant relation between treatment method and recurrence in CGCG (p > 0.05). Various peripheral lesions could mimic PGCG; thus, curettage therapy could be appropriate in the treatment of PGCG. Nevertheless, in some cases of CGCG, additional treatment methods could be more effective for preventing recurrence and any other complications. [ABSTRACT FROM AUTHOR]

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Nontuberculous mycobacteria (NTM) are emerging opportunistic pathogens causing pulmonary infection to fatal disseminated disease. NTM infections are steadily increasing in children and adults, and immune-compromised individuals are at a greater risk of fatal infections. The NTM disease's adverse pathology and resistance to antibiotics have further worsened the therapeutic measures. Innate immune regulators are potential targets for therapeutics to NTM, especially in a T cell–suppressed population, and many ubiquitin ligases modulate pathogenesis and innate immunity during infections, including mycobacterial infections. Here, we investigated the role of an E3 ubiquitin ligase, Casitas B-lineage lymphoma proto-oncogene B (CBLB), in immunocompromised mouse models of NTM infection. We found that CBLB is essential to prevent bacterial growth and dissemination. Cblb deficiency debilitated natural killer cells, inflammatory monocytes, and macrophages in vivo. However, Cblb deficiency in macrophages did not wane its ability to inhibit bacterial growth or production of reactive oxygen species or interferon γ production by natural killer cells in vitro. CBLB restricted NTM growth and dissemination by promoting early granuloma formation in vivo. Our study shows that CBLB bolsters innate immune responses and helps prevent the dissemination of NTM during compromised T cell immunity. [ABSTRACT FROM AUTHOR]

Individuals with uncontrolled diabetes are highly susceptible to tuberculosis (TB) caused by Mycobacterium tuberculosis (M. tb) infection. Novel treatments for TB are needed to address the increased antibiotic resistance and hepatoxicity. Previous studies showed that the administration of liposomal glutathione (L-GSH) can mitigate oxidative stress, bolster a granulomatous response, and diminish the M. tb burden in the lungs of M. tb-infected mice. Nonetheless, the impact of combining L-GSH with conventional TB treatment (RIF) on the cytokine levels and granuloma formation in the livers of diabetic mice remains unexplored. In this study, we evaluated hepatic cytokine profiles, GSH, and tissue pathologies in untreated and L-GSH, RIF, and L-GSH+RIF treated diabetic (db/db) M. tb-infected mice. Our results indicate that treatment of M. tb-infected db/db mice with L-GSH+RIF caused modulation in the levels of pro-inflammatory cytokines and GSH in the liver and mitigation in the granuloma size in hepatic tissue. Supplementation with L-GSH+RIF led to a decrease in the M. tb burden by mitigating oxidative stress, promoting the production of pro-inflammatory cytokines, and restoring the cytokine balance. These findings highlight the potential of L-GSH+RIF combination therapy for addressing active EPTB, offering valuable insights into innovative treatments for M. tb infections. [ABSTRACT FROM AUTHOR]

Background: Multiligament knee injuries (MLKI), rare in adolescents, are challenging injuries that require complex surgical reconstruction. Historically, nonanatomic reconstructions have been associated with prolonged immobilization and failure to restore normal knee biomechanics, resulting in arthrofibrosis and high rates of graft failure. Purpose: To describe the clinical and patient-reported outcomes (PROs) for adolescent patients treated with single-stage anatomic multiligament knee reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A single-center retrospective study was performed of patients ≤18 years old who underwent reconstruction of MLKIs by a single surgeon between 2014 and 2019 using a single-stage anatomic technique, with protected weightbearing and early range of motion. Complications were defined as infection, arthrofibrosis, deep vein thrombosis (DVT) or pulmonary embolus, and secondary surgery. PROs, including the pediatric version of the International Knee Documentation Committee (Pedi-IKDC) and the Tegner activity score, were obtained at a minimum of 2 years postoperatively. Results: Included were 30 patients (21 male, 9 female; mean age, 15.4 years). The most common ligamentous reconstruction types were anterior cruciate ligament (ACL) + fibular collateral ligament (12 patients; 40%) and ACL + medial collateral ligament (9 patients; 30%). Three patients (10%) had secondary surgeries, including irrigation and debridement of a granuloma, a staged osteochondral allograft transplantation to a lateral femoral condyle impaction fracture, and repair of a medial meniscal tear and lateral femoral condyle fracture associated with new injuries 2 years after ACL + fibular collateral ligament reconstruction. Two patients (7%) developed arthrofibrosis and 1 patient (3%) developed DVT. PRO scores obtained at a mean of 37 months postoperatively included a mean Pedi-IKDC of 87 (range, 52-92) and a median highest Tegner score at any point postoperatively of 9 (range, 5-10). Of the patients who were athletes before their injury, 70% returned to the same or higher level of sport postoperatively. Conclusion: Reconstruction of MLKI in this series of adolescents with single-stage anatomic techniques and early range of motion resulted in low rates of secondary surgery, few complications, and good knee function as well as PRO scores at mean 3-year follow-up. [ABSTRACT FROM AUTHOR]

Noonan syndrome (NS) is a phenotypically variable inherited multi-system disorder. Maxillofacial findings can be diagnostic, especially in the evaluation of discrete facial dysmorphia. Diagnostic landmark findings of therapeutic relevance for the jaws such as central giant cell granuloma (CGCG) are rare in NS. However, recent molecular genetic studies indicate that these rare, benign lesions are neoplasms and more common in specific syndromes grouped under the umbrella term RASopathies. A specialist surgical diagnosis can be helpful in identifying the underlying disease. This report outlines diagnosis and treatment of a case of CGCG for which jaw diagnosis became the key to identifying a syndromic disease. [ABSTRACT FROM AUTHOR]

Introducción: El fibroma osificante es una neoplasia bien delimitada y ocasionalmente encapsulada, compuesta de tejido fibroso, que contiene cantidades variables de tejido calcificado. Objetivo: Presentar el caso clínico de una paciente con diagnóstico de fibroma osificante de inicio y evolución rara, que solo se definió a través de su histología. Caso Clínico: Paciente femenina de 26 años de edad, con antecedentes de salud aparente y aumento de volumen localizado en la encía interpapilar de los molares superiores derechos, de bordes regulares, que abarcaba paladar duro y blando, no doloroso, de consistencia firme, superficie nodular, hipercoloreado, que parte de un pedículo, pero se asienta y adhiere al paladar, de 4 cm de diámetro, con impresión diagnóstica inicial de granuloma del embarazo, que continuó creciendo de forma lenta hasta afectar la masticación y deglución. Conclusiones: El estudio histopatológico es necesario para el diagnóstico definitivo de esta entidad por su similitud clínica y radiográfica, tanto en su inicio como en su evolución, con otras lesiones hiperplásicas de cavidad bucal.

Introduction: Infection with tuberculosis is a worldwide health concern. Nearly every organ in the body can be affected by Extrapulmonary Tuberculosis (EPTB). A simple diagnosis of Pulmonary Tuberculosis (PTB) can be made using radiography and a positive sputum test. On the other hand, diagnosing EPTB is difficult due to the peculiar presentation of the lesions, which are paucibacillary and exhibit varied sensitivity and specificity in different diagnostic tests across different infected tissues. Aim: To analyse the varied clinical presentations of tuberculosis infection and to assess several diagnostic techniques for detecting pulmonary and extrapulmonary tuberculosis in reference to the Composite Reference Standard (CRS). Materials and Methods: The present cross-sectional study was carried out in the Department of Pathology and Microbiology, PRM Medical College and Hospital (in the tuberculosis endemic zone of Baripada), North Odisha, India, between April 2018 and November 2022. Clinical presentations included lumps, ulcers, inflammation and lesions resembling neoplasia. All age groups of patients suffering from pulmonary and extrapulmonary tuberculosis were included. A total of 400 tuberculosis cases were detected. Fine needle aspiration was performed on the lesions after considering the patient’s age, gender, lesion location and relevant radiological studies. Biopsy samples were handled in a similar manner. To detect mycobacterial nucleic acid, all 400 cytology cases and biopsy samples were processed using the Cartridge-based Nucleic Acid Amplification Test (CBNAAT) and stained with Ziehl-Neelsen (ZN) stain for Acid-fast Bacilli (AFB) identification. A CRS was defined as the presence of bacilli in CBNAAT and/or AFB along with morphologic evidence such as caseating granulomas. To assess sensitivity and diagnostic effectiveness, CRS was used in conjunction with procedures from cytology, histopathology, AFB detection and CBNAAT. The p-value for McNemar’s test was less than 0.05, indicating statistical significance across all analyses. Results: The analysis revealed a male-to-female ratio of 1:1.02, with more females than males over the age of 20 years affected. Pulmonary tuberculosis cases were 39 (9.75%), while extrapulmonary TB cases were 361 (90.25%). The largest percentage of extrapulmonary tuberculosis cases (n=134, 33.5%) involved lymph nodes, with skeletal involvement following closely behind (n=64, 16%). Mycobacterium tuberculosis adversely affected nearly every organ in the body. The most prevalent pattern in histology was necrotising granulomatous inflammation, observed in 85 (69.6%) patients. Similarly, a type II pattern (epithelioid granuloma with caseous necrosis) was seen in 166 (59.7%) cytosmear cases. The sensitivity and diagnostic accuracy of four tests were assessed using the CRS; favourable results were obtained for FNAC (72.2%), histological examination (100%), ZN staining (20.5%), and CBNAAT (85.6%). With a diagnostic accuracy of 92.8%, CBNAAT outperformed FNAC and histology, which both achieved 86% accuracy. Conclusion: The prevalence of pulmonary and extrapulmonary tuberculosis is extremely high among the people of North Odisha. The present study suggests a combined approach of understanding clinical presentation, conducting pathological investigations, and detecting bacilli to recognise atypical presentations of EPTB at an early stage, given the restricted resources and facilities in peripheral hospitals.

Diagnosis of pulmonary sarcoidosis can be difficult and strongly dependent on clinical experience, especially when necrotizing granulomas are present. Here we report an individual who, 3 years after onset of symptoms, was definitively diagnosed with pulmonary sarcoidosis based on percutaneous lung biopsy under the guidance of computed tomography, after he failed to receive a specific diagnosis at other tertiary hospitals based on cervical lymph node biopsy and transbronchial needle aspiration under the guidance of endobronchial ultrasonography. After his definitive diagnosis at our medical center, he was given corticosteroids, which led to remission. Clinicians, especially in areas lacking suitably experienced pathologists, should be aware of how to diagnose sarcoidosis in the presence of abundant necrotizing granulomas in order to ensure timely diagnosis.

IntroductionTuberculosis remains the leading cause of death from infectious diseases among adults worldwide. To date, an overarching review of the immune response to Mtb in humans has not been fully elucidated, with innate immunity remaining poorly understood due to historic focus on adaptive immunity. Specifically, there is a major gap concerning the contribution of the immune system to overall bacterial clearance, particularly residual bacteria. This review aims to describe the time course of interactions between the host immune system and Mtb, from the start of the infection to the development of the adaptive response. Concordantly, we aim to crystallize the pathogenic effects and immunoevasive mechanisms of Mtb. The translational value of animal data is also discussed.MethodsThe literature search was conducted in the PubMed, ScienceDirect, and Google Scholar databases, which included reported research from 1990 until 2024. A total of 190 publications were selected and screened, of which 108 were used for abstraction and 86 were used for data extraction. Graphical summaries were created using the narrative information (i.e., recruitment, recognition, and response) to generate clear visual representations of the immune response at the cellular and molecular levels.ResultsThe key cellular players included airway epithelial cells, alveolar epithelial cells, neutrophils, natural killer cells, macrophages, dendritic cells, T cells, and granulomatous lesions; the prominent molecular players included IFN-γ, TNF-α, and IL-10. The paper also sheds light on the immune response to residual bacteria and applications of the data.DiscussionWe provide a comprehensive characterization of the key immune players that are implicated in pulmonary tuberculosis, in line with the organs or compartments in which mycobacteria reside, offering a broad vignette of the immune response to Mtb and how it responds to residual bacteria. Ultimately, the data presented could provide immunological insights to help establish optimized criteria for identifying efficacious treatment regimens and durations for relapse prevention in the modeling and simulation space and wider fields.

We present the first case of a dupilumab-induced hyperinflammatory state in the setting of underlying eosinophilic esophagitis characterized by multisystem granulomatous inflammation. Although clinical trial data and subsequent real-world experience support dupilumab as a highly effective therapy for eosinophilic esophagitis, close monitoring for development of adverse symptoms following initiation remains paramount.

A patient with GATA2 deficiency developed corticosteroid-responsive sterile granulomatous lung disease despite monocytopenia. The presence of B-lymphopenia, autoimmunity, an elevated level of serum B-cell–activating factor, and pulmonary plasma cell infiltration, which together suggested an underlying mechanism similar to that of combined variable immunodeficiency lung disease.

Objective: To describe the clinical and radio-pathological features of suture granuloma, an inflammatory response to retained suture material that primarily affects non-absorbable sutures. Case report: We report a case of a 26-year-old female presenting with painful swelling at a caesarean section scar, previously excised for similar complaints. Physical examination revealed a solid soft tissue mass on the scar. Magnetic resonance imaging (MRI) identified a 2x2 cm lesion in the right abdominal wall, suggestive of suture granuloma. Surgical excision revealed prolene suture material within the granulomatous tissue. Histopathology confirmed foreign body reaction. Conclusion: Recurrence post-prior excision underscores the importance of complete granuloma removal. Differential diagnoses included scar endometriosis and inflammatory lesions. Suture granulomas, though rare, require consideration in scar-related swelling. Collaboration between specialties ensures accurate diagnosis and management.

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.

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.

Coccidioidomycosis, also known as valley fever, is a fungal infection that can develop after inhalation of arthroconidia from soil. Coccidioidomycosis infections are most common in the southwestern United States and typically involve the lungs. Risk factors for extrapulmonary spread, which can be life-threatening, include older age, diabetes, HIV and AIDS, late-term pregnancy, immunosuppressant drug use and African or Filipino ancestry. This article describes incidental identification of coccidioidomycosis of the peritoneum, an extremely rare site for dissemination, during bariatric surgery in a patient without known risk factors. [ABSTRACT FROM AUTHOR]

One of the most prevalent nematode infections globally is Enterobius vermicularis, commonly known as pinworm. This infection is often seen among children living in poor socioeconomic conditions, in overcrowded households, and in immunocompromised patients with uncontrolled diabetes, hypertension, long-term steroid therapy, and other related issues. With treatment, the cure rate is between 90 to 95%. However, reinfection is frequent, particularly in cases where contacts are not treated concurrently. Hereby, the authors present a case report of two male patients (58 and 40 year-old) with uncontrolled diabetes mellitus who presented with pinworm infections in unconventional sites. Enterobius vermicularis can manifest in uncommon locations such as the caecum, the appendix, and other visceral organs of the abdomen, including the uterine endometrium. These atypical presentations can lead to more serious complications, such as granuloma and abscess formation, which may even result in infertility. Although pinworm infection is typically considered a childhood disease, immunosuppressed adults are also susceptible. [ABSTRACT FROM AUTHOR]

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

Cholesterol Granuloma is a rare lesion which occurs at locations like ear, peritoneum, lungs, breast etc. and formed due to interaction of Cholesterol and living tissue. But Cholesterol Granuloma occurring in the orbit is a very rare entity and so we authors present a case of Cholesterol Granuloma of the orbit. [ABSTRACT FROM AUTHOR]

Ataxia telangiectasia (AT) is a rare autosomal recessive primary immunodeficiency disorder (PID) resulting from a mutation in the ATM gene involved in DNA repair. We describe the case of a young girl with cutaneous granulomas that developed after childhood vaccinations. Immunohistochemistry revealed granulomas induced by the rubella virus vaccine. This finding raises the question of the safety of live rubella vaccine strains in immunocompromised children. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical and radio-pathological features of suture granuloma, an inflammatory response to retained suture material that primarily affects non-absorbable sutures. Case report: We report a case of a 26-year-old female presenting with painful swelling at a caesarean section scar, previously excised for similar complaints. Physical examination revealed a solid soft tissue mass on the scar. Magnetic resonance imaging (MRI) identified a 2x2 cm lesion in the right abdominal wall, suggestive of suture granuloma. Surgical excision revealed prolene suture material within the granulomatous tissue. Histopathology confirmed foreign body reaction. Conclusion: Recurrence post-prior excision underscores the importance of complete granuloma removal. Differential diagnoses included scar endometriosis and inflammatory lesions. Suture granulomas, though rare, require consideration in scar-related swelling. Collaboration between specialties ensures accurate diagnosis and management. [ABSTRACT FROM AUTHOR]

Cholesterol granuloma is the result of foreign body type response to the deposition of cholesterol crystals in the tissues. It is usually associated with chronic middle ear diseases and the middle ear and mastoid antrum are the most common location for this lesion. Histopathological findings are accumulation of cholesterol clefts, ghost cells, chronic inflammatory cells, and giant cells in a fibrous granulation tissue. Cases of cholesterol granuloma have been recently reported in the jaws but still they are few in the literature of dentistry. This article presents a unique case of cholesterol granuloma occurring in the lower lip secondary to a history of trauma. [ABSTRACT FROM AUTHOR]

Coccidioidomycosis is a fungal disease caused by Coccidioides immitis or Coccidioides posadasii. We searched the records of the California Animal Health and Food Safety Laboratory from 1990 through 2020 for cases of coccidioidomycosis in horses. The selection criteria for these cases were: 1) live-born horses submitted for autopsy, and 2) a diagnosis of coccidioidomycosis was established, regardless of cause of death. During that time, 19,054 horses were received, and 26 cases (0.14%) of coccidioidomycosis were diagnosed in horses, of which 19 (73%) cases had pneumonia and/or pleuritis with or without lesions in other organs, and 7 (27%) cases had lesions only in organs other than the lungs (nasal mucosa, spleen, thoracic lymph nodes, heart, pericardial sac, liver, kidney, mediastinum, and/or mesentery). Pneumonia was diagnosed as the cause of death in 1,838 (9.64%) of the horses received; Coccidioides spp. was the cause of pneumonia in 19 (1.0%) of these animals. Horses have been reported to have low susceptibility to coccidioidomycosis, and the severity and chronicity of the disease can be variable. Lesions in our cases consisted of multifocal-to-coalescing pyogranulomas with intralesional fungal spherules. Coccidioidomycosis must be considered a differential diagnosis in cases of persistent cough, chronic weight loss, fever, and cases with a travel history to, or living in, a region considered endemic for coccidioidomycosis. Coccidioides spp. infection should also be considered when pyogranulomatous inflammation is found within lung, spleen, nasal mucosa, and lymph nodes of horses.

A 31-year-old man presented with gingival mass-like lesions. The patient reported occasional bleeding from lesions; otherwise, the lesions were asymptomatic. Intraoral examination revealed multiple interdental red/purple soft, sessile, nodular lesions involving both the maxillary and mandibular buccal and lingual gingivae, with poor oral hygiene. After performing incisional biopsy, the patient was diagnosed with pyogenic granuloma. Subsequently, the patient underwent cleaning of his teeth and within only 3 days of dental cleaning, the patient reported rapid regression of all his lesions. [ABSTRACT FROM AUTHOR]

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]

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]

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]

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]

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]