Pub Date : 2022-08-25eCollection Date: 2022-01-01DOI: 10.1177/2632010X221118059
Monique Freire, Viviane Carvalho, Renata Spener, Christiane Rodrigues da Silva, João Ricardo da Silva Neto, Luiz Carlos Ferreira, Paulo Afonso Nogueira
Hemophagocytic lymphohistiocytosis (HLH) is a disorder that occurs due to unsuitable monocyte activation in a variety of infections. In human immunodeficiency virus (HIV) infections, patients with advanced immunossupression associated with opportunistic infections are at increased risk of developing HLH. We describe a clinical case of a 33-year-old male student diagnosed with HIV who was hospitalized for investigation of asthenia and dyspnea, accompanied by adynamia, decreased motor force in the left leg, dysphagia, and dysfluency. His general condition was regular, he was pale, feverish, and had normal cardiac and pulmonary auscultation. Physical examination revealed ulcerated lesions in the perianal region and hepatosplenomegaly without palpable lymph node enlargement. Laboratory parameters showed pancytopenia, a slight increase in liver function accompanied by high lactate dehydrogenase, and hiperferritinemia. The initial diagnosis was disseminated histoplasmosis, thus amphotericin B deoxycholate was empirically prescribed while waiting on myeloculture and blood cultures for fungi and mycobacteria. Other clinical procedures were blood transfusion, resumption of antiretroviral therapy (ART) and secondary prophylaxis. Myeloculture blood cultures of fungi and mycobacteria were negative. Patient evolved well in relation to the initial complaints and showed partial clinical and laboratory improvement. However, 23 days after hospitalization, he developed a febrile episode accompanied by chills and a convulsive crisis. The patient was transferred to the intensive unit care and developed septic shock and respiratory failure. He died 25 days after the onset of the condition. After the postmortem examination, histopathology revealed countless rounded fungal structures compatible with Histoplasma sp., which were observed in the peripancreatic lymph node, liver, and spleen, in addition to hemophagocytosis in the splenic parenchyma. We thus conclude that when the patient met criteria for HLH, such as fever, hepatosplenomegaly, hiperferritinemia, and pancytopenia, the evolution was fast due to the aggressive and rapidly fatal nature of HLH, despite anti-fungal and corticoid treatment. Therefore, this case report reinforces the need to consider hemophagocytic syndrome in patients with HIV and disseminated histoplasmosis, especially where histoplasmosis is highly endemic, in order for the treatment be started early when there is high clinical suspicion.
{"title":"Hemophagocytic Syndrome in a Patient with HIV and Histoplasmosis: A not so Rare Correlation.","authors":"Monique Freire, Viviane Carvalho, Renata Spener, Christiane Rodrigues da Silva, João Ricardo da Silva Neto, Luiz Carlos Ferreira, Paulo Afonso Nogueira","doi":"10.1177/2632010X221118059","DOIUrl":"https://doi.org/10.1177/2632010X221118059","url":null,"abstract":"<p><p>Hemophagocytic lymphohistiocytosis (HLH) is a disorder that occurs due to unsuitable monocyte activation in a variety of infections. In human immunodeficiency virus (HIV) infections, patients with advanced immunossupression associated with opportunistic infections are at increased risk of developing HLH. We describe a clinical case of a 33-year-old male student diagnosed with HIV who was hospitalized for investigation of asthenia and dyspnea, accompanied by adynamia, decreased motor force in the left leg, dysphagia, and dysfluency. His general condition was regular, he was pale, feverish, and had normal cardiac and pulmonary auscultation. Physical examination revealed ulcerated lesions in the perianal region and hepatosplenomegaly without palpable lymph node enlargement. Laboratory parameters showed pancytopenia, a slight increase in liver function accompanied by high lactate dehydrogenase, and hiperferritinemia. The initial diagnosis was disseminated histoplasmosis, thus amphotericin B deoxycholate was empirically prescribed while waiting on myeloculture and blood cultures for fungi and mycobacteria. Other clinical procedures were blood transfusion, resumption of antiretroviral therapy (ART) and secondary prophylaxis. Myeloculture blood cultures of fungi and mycobacteria were negative. Patient evolved well in relation to the initial complaints and showed partial clinical and laboratory improvement. However, 23 days after hospitalization, he developed a febrile episode accompanied by chills and a convulsive crisis. The patient was transferred to the intensive unit care and developed septic shock and respiratory failure. He died 25 days after the onset of the condition. After the postmortem examination, histopathology revealed countless rounded fungal structures compatible with <i>Histoplasma</i> sp., which were observed in the peripancreatic lymph node, liver, and spleen, in addition to hemophagocytosis in the splenic parenchyma. We thus conclude that when the patient met criteria for HLH, such as fever, hepatosplenomegaly, hiperferritinemia, and pancytopenia, the evolution was fast due to the aggressive and rapidly fatal nature of HLH, despite anti-fungal and corticoid treatment. Therefore, this case report reinforces the need to consider hemophagocytic syndrome in patients with HIV and disseminated histoplasmosis, especially where histoplasmosis is highly endemic, in order for the treatment be started early when there is high clinical suspicion.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/65/10.1177_2632010X221118059.PMC9425888.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40342389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meningiomas are tumors arising from leptomeninges. Malignant counterpart of them is known as anaplastic meningioma which are WHO grade III tumors. Intraventricular location of these tumors is rare and is clinic-radiologically challenging. Histopathology and immunohistochemistry are confirmatory. We present case of a 27-year-old girl, who presented with usual symptoms of intraventricular mass in emergency. After shunt surgery, clinical diagnosis of ependymoma was formed with differential of high-grade glioma. Squash tissue was difficult to crush displaying tight clusters of spindle cells with necrosis in background. Definitive histology revealed high grade spindle cell neoplasm disposed in sheets with brisk and atypical mitosis. Only focal whorling pattern was seen. Large cells with eccentric cytoplasm, reminiscent of rhabdoid cells were also seen. Immunohistochemistry was positive for vimentin and EMA, negative for GFAP. Final diagnosis of Anaplastic meningioma was dispatched. The histological pattern of the present case, young age of presentation and presence of Rhabdoid cells make it unusual. Though rare but intraventricular meningiomas must also be kept in clinical radiological differentials apart from the usual ependymoma at this location.
{"title":"Anaplastic Intraventricular Meningioma with Rhabdoid Features: An Unusual Tumor with Usual Clinical Presentation.","authors":"Preeti Agarwal, Nancy Gupta, Alok Srivastava, Madhu Kumar, Suarabh Kumar, Chhitij Srivastava","doi":"10.1177/2632010X221115157","DOIUrl":"https://doi.org/10.1177/2632010X221115157","url":null,"abstract":"<p><p>Meningiomas are tumors arising from leptomeninges. Malignant counterpart of them is known as anaplastic meningioma which are WHO grade III tumors. Intraventricular location of these tumors is rare and is clinic-radiologically challenging. Histopathology and immunohistochemistry are confirmatory. We present case of a 27-year-old girl, who presented with usual symptoms of intraventricular mass in emergency. After shunt surgery, clinical diagnosis of ependymoma was formed with differential of high-grade glioma. Squash tissue was difficult to crush displaying tight clusters of spindle cells with necrosis in background. Definitive histology revealed high grade spindle cell neoplasm disposed in sheets with brisk and atypical mitosis. Only focal whorling pattern was seen. Large cells with eccentric cytoplasm, reminiscent of rhabdoid cells were also seen. Immunohistochemistry was positive for vimentin and EMA, negative for GFAP. Final diagnosis of Anaplastic meningioma was dispatched. The histological pattern of the present case, young age of presentation and presence of Rhabdoid cells make it unusual. Though rare but intraventricular meningiomas must also be kept in clinical radiological differentials apart from the usual ependymoma at this location.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/48/bb/10.1177_2632010X221115157.PMC9340328.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40580121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-23eCollection Date: 2022-01-01DOI: 10.1177/2632010X221114807
Md Ashrafur Rahman, Yeasna Shanjana, Md Shakil Ahmed, Kuldeep Dhama, Mahadi Hasan Fahim, Tarif Mahmud, Arif Anzum Shuvo, Zahid Hossain Milan, Mohammad Saydur Rahman, Arpita Roy, Mohiuddin Ahmed Bhuiyan, Md Rabiul Islam
Background: Abnormalities in hematology and comorbidities might have a role in chronic kidney disease (CKD) patients. However, the exact relationships between hematological parameters and the severity of CKD are not well understood. Also, the underlying mechanisms remain under investigation. The present study aimed to evaluate the association of different blood parameters and comorbidities among hospitalized CKD patients in Bangladesh.
Methods: The present study enrolled admitted CKD patients at Evercare Hospital Ltd, Dhaka, Bangladesh, from January 1, 2021, to August 1, 2021. For this study, the demographic and clinical information of the patients were collected. Then some routine blood tests for the hematological profile of CKD patients were performed. Finally, several statistical methods were performed and data interpretations were done to evaluate the role of hematological changes on CKD patients.
Results: Among 300 patients, early-stage CKD patients (ESCKDP) and advanced-stage CKD patients (ASCKDP) were 153 and 147, respectively. The decreased levels of hemoglobin (Hb) and red blood cell (RBC) in ASCKDP were observed. However, the present study found increased levels of corpuscular Hb in ASCKDP than ESCKDP. Also, the present study noticed correlations between these changes and the severity of CKD. Also, we observed a significant difference in age and body mass index between ESCKDP and ASCKDP.
Conclusions: Based on our results, lower Hb and RBC levels may use in assessing the severity and the treatment decisions of CKD patients in the hospital setting. Therefore, our findings may assist with developing a treatment protocol for hospitalized CKD patients.
{"title":"Hematological Abnormalities and Comorbidities Are Associated With the Severity of Kidney Disease: A Hospital-Based Cross-Sectional Study in Bangladesh.","authors":"Md Ashrafur Rahman, Yeasna Shanjana, Md Shakil Ahmed, Kuldeep Dhama, Mahadi Hasan Fahim, Tarif Mahmud, Arif Anzum Shuvo, Zahid Hossain Milan, Mohammad Saydur Rahman, Arpita Roy, Mohiuddin Ahmed Bhuiyan, Md Rabiul Islam","doi":"10.1177/2632010X221114807","DOIUrl":"https://doi.org/10.1177/2632010X221114807","url":null,"abstract":"<p><strong>Background: </strong>Abnormalities in hematology and comorbidities might have a role in chronic kidney disease (CKD) patients. However, the exact relationships between hematological parameters and the severity of CKD are not well understood. Also, the underlying mechanisms remain under investigation. The present study aimed to evaluate the association of different blood parameters and comorbidities among hospitalized CKD patients in Bangladesh.</p><p><strong>Methods: </strong>The present study enrolled admitted CKD patients at Evercare Hospital Ltd, Dhaka, Bangladesh, from January 1, 2021, to August 1, 2021. For this study, the demographic and clinical information of the patients were collected. Then some routine blood tests for the hematological profile of CKD patients were performed. Finally, several statistical methods were performed and data interpretations were done to evaluate the role of hematological changes on CKD patients.</p><p><strong>Results: </strong>Among 300 patients, early-stage CKD patients (ESCKDP) and advanced-stage CKD patients (ASCKDP) were 153 and 147, respectively. The decreased levels of hemoglobin (Hb) and red blood cell (RBC) in ASCKDP were observed. However, the present study found increased levels of corpuscular Hb in ASCKDP than ESCKDP. Also, the present study noticed correlations between these changes and the severity of CKD. Also, we observed a significant difference in age and body mass index between ESCKDP and ASCKDP.</p><p><strong>Conclusions: </strong>Based on our results, lower Hb and RBC levels may use in assessing the severity and the treatment decisions of CKD patients in the hospital setting. Therefore, our findings may assist with developing a treatment protocol for hospitalized CKD patients.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/21/db/10.1177_2632010X221114807.PMC9310280.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40639494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-19eCollection Date: 2022-01-01DOI: 10.1177/2632010X221112455
Ritica Chaudhary, Mona Lisa, Payal Kumari, Aman Kumar
Background: The retroperitoneum can host a wide spectrum of soft tissue lesions. These tumours pose a challenge to the pathologist as the morphology is not of much help and immunohistochemistry becomes a necessity.
Case report: Sixty years old male presented with 2 months history of abdominal lump, pain and dyspepsia. The MRI revealed a heterogeneous mass in the retroperitoneum involving right para spinal muscle, right iliac fossa and right perinephric region with destruction of right transverse process and erosion of adjacent L3 vertebra. Trucut biopsy of the mass was reported as fibroliposarcoma at an outside lab. Patient underwent a wide local excision. Grossly the tumour gave an impression of a liposarcoma but the microscopy showed areas of spindle cells, epitheloid cells, focal areas of ganglion like cells and large areas of myxoid change. IHC panel of S-100, SMA, caldesmon, myogenin, myoglobin and Alk-1 was negative. MDM2, CDK4 and p16 IHC came positive proving it to be a dedifferentiated liposarcoma.
Conclusion: We report a curious case of retroperitoneal soft tissue tumour with complex morphology and IHC features diagnosed as dedifferentiated liposarcoma based on MDM2, CDK and p16 positivity.
{"title":"Dedifferentiated Liposarcoma: A Rare Case Report of Retroperitoneal Myxoid Soft Tissue Tumour with Diagnostic Dilemma.","authors":"Ritica Chaudhary, Mona Lisa, Payal Kumari, Aman Kumar","doi":"10.1177/2632010X221112455","DOIUrl":"https://doi.org/10.1177/2632010X221112455","url":null,"abstract":"<p><strong>Background: </strong>The retroperitoneum can host a wide spectrum of soft tissue lesions. These tumours pose a challenge to the pathologist as the morphology is not of much help and immunohistochemistry becomes a necessity.</p><p><strong>Case report: </strong>Sixty years old male presented with 2 months history of abdominal lump, pain and dyspepsia. The MRI revealed a heterogeneous mass in the retroperitoneum involving right para spinal muscle, right iliac fossa and right perinephric region with destruction of right transverse process and erosion of adjacent L3 vertebra. Trucut biopsy of the mass was reported as fibroliposarcoma at an outside lab. Patient underwent a wide local excision. Grossly the tumour gave an impression of a liposarcoma but the microscopy showed areas of spindle cells, epitheloid cells, focal areas of ganglion like cells and large areas of myxoid change. IHC panel of S-100, SMA, caldesmon, myogenin, myoglobin and Alk-1 was negative. MDM2, CDK4 and p16 IHC came positive proving it to be a dedifferentiated liposarcoma.</p><p><strong>Conclusion: </strong>We report a curious case of retroperitoneal soft tissue tumour with complex morphology and IHC features diagnosed as dedifferentiated liposarcoma based on MDM2, CDK and p16 positivity.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9301116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40645335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: The frequency of breast cancer in young women, corresponding to women under 40 years of age; varies from 5% to 7% in developed countries. The objective of this study was to contribute to the improvement of the management of breast cancer in young women in Togo, by establishing the molecular classification of these cancers.
Methodology: This was a retrospective descriptive and analytical study from January 2010 to December 2020.
Results: About 35 cases of breast cancer were identified in women under 40 years of age. The average age was 35.4 ± 3.5 years. The right breast was affected in 18 cases (51.43%). Histologically, 30 cases (85.72%) were invasive carcinoma of no special type (NST), 2 cases (5.71%) were invasive lobular carcinoma and micro-papillary carcinoma respectively, and 1 case (2.86%) was tubular carcinoma. There were 6 cases (17.1%) of grade I, 25 cases (71.4%) of grade II, and 4 cases (11.4%) of grade III. Molecularly, there were 20 cases (57.1%) of triple-negative subtype, 6 cases (17.1%) of Luminal B subtype, 05 cases (14.3%) of HER2-enriched subtype and 4 cases (11.4%) of Luminal A subtype.
Conclusion: Breast cancers of young Togolese women express very weakly hormone receptors, with a predominance of a triple negative subtype.
{"title":"Histo-Molecular Profile of Breast Cancer in Young Women in Togo.","authors":"Toukilnan Djiwa, Baumaney Koui, Panakinao Simgban, Bagassam Mézéwè Sama, Mayi Bombonne, Brahima Doukouré, Tchin Darré","doi":"10.1177/2632010X221112452","DOIUrl":"https://doi.org/10.1177/2632010X221112452","url":null,"abstract":"<p><strong>Introduction: </strong>The frequency of breast cancer in young women, corresponding to women under 40 years of age; varies from 5% to 7% in developed countries. The objective of this study was to contribute to the improvement of the management of breast cancer in young women in Togo, by establishing the molecular classification of these cancers.</p><p><strong>Methodology: </strong>This was a retrospective descriptive and analytical study from January 2010 to December 2020.</p><p><strong>Results: </strong>About 35 cases of breast cancer were identified in women under 40 years of age. The average age was 35.4 ± 3.5 years. The right breast was affected in 18 cases (51.43%). Histologically, 30 cases (85.72%) were invasive carcinoma of no special type (NST), 2 cases (5.71%) were invasive lobular carcinoma and micro-papillary carcinoma respectively, and 1 case (2.86%) was tubular carcinoma. There were 6 cases (17.1%) of grade I, 25 cases (71.4%) of grade II, and 4 cases (11.4%) of grade III. Molecularly, there were 20 cases (57.1%) of triple-negative subtype, 6 cases (17.1%) of Luminal B subtype, 05 cases (14.3%) of HER2-enriched subtype and 4 cases (11.4%) of Luminal A subtype.</p><p><strong>Conclusion: </strong>Breast cancers of young Togolese women express very weakly hormone receptors, with a predominance of a triple negative subtype.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/f0/10.1177_2632010X221112452.PMC9280847.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40602261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a rare case of giant uterine leiomyosarcoma in a postmenopausal woman, whose diagnosis was initially suspected at the evaluation of the abdominal efusion, and confirmed after the pathological examination of the uterus in association with the ancillary tests. The evaluation of the abdominal fluid showed single or clusters of malignant, round or spindle-shaped cells. On microscopic examination of the surgical specimen, a dense cell proliferation of spindle cells, with moderate to severe nuclear pleomorphism and significant mitotic activity was observed. Immunohistochemical evaluation demonstrated the loss of myocytic differentiation by focal, weakly positive expression of smooth muscle actin and desmin. The data presented in this case emphasize the relevance of the cytological examination, although the latter has only indicative value, especially since it is an aggressive tumor, frequently associated with mutant expression of p53. In our case, the first indication of the presence of uterine sarcoma was given by the presence of atypical cells in the peritoneal fluid.
{"title":"Morphological and Ancillary Features of Uterine Leiomyosarcoma: Case Report.","authors":"Mădălina Boșoteanu, Raluca Ioana Vodă, Mariana Așchie, Luana-Andreea Bosoteanu, Gabriela Izabela Bălțătescu","doi":"10.1177/2632010X221105224","DOIUrl":"https://doi.org/10.1177/2632010X221105224","url":null,"abstract":"<p><p>We report a rare case of giant uterine leiomyosarcoma in a postmenopausal woman, whose diagnosis was initially suspected at the evaluation of the abdominal efusion, and confirmed after the pathological examination of the uterus in association with the ancillary tests. The evaluation of the abdominal fluid showed single or clusters of malignant, round or spindle-shaped cells. On microscopic examination of the surgical specimen, a dense cell proliferation of spindle cells, with moderate to severe nuclear pleomorphism and significant mitotic activity was observed. Immunohistochemical evaluation demonstrated the loss of myocytic differentiation by focal, weakly positive expression of smooth muscle actin and desmin. The data presented in this case emphasize the relevance of the cytological examination, although the latter has only indicative value, especially since it is an aggressive tumor, frequently associated with mutant expression of p53. In our case, the first indication of the presence of uterine sarcoma was given by the presence of atypical cells in the peritoneal fluid.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7b/fb/10.1177_2632010X221105224.PMC9240338.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40558901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-24eCollection Date: 2022-01-01DOI: 10.1177/2632010X221106986
Tabitha Block, Jonathann Kuo
Many acute COVID-19 convalescents experience a persistent sequelae of infection, called post-acute COVID-19 syndrome (PACS). With incidence ranging between 31% and 69%, PACS is becoming increasingly acknowledged as a new disease state in the context of SARS-CoV-2 infection. As SARS-CoV-2 infection can affect several organ systems to varying degrees and durations, the cellular and molecular abnormalities contributing to PACS pathogenesis remain unclear. Despite our limited understanding of how SARS-CoV-2 infection promotes this persistent disease state, mitochondrial dysfunction has been increasingly recognized as a contributing factor to acute SARS-CoV-2 infection and, more recently, to PACS pathogenesis. The biological mechanisms contributing to this phenomena have not been well established in previous literature; however, in this review, we summarize the evidence that NAD+ metabolome disruption and subsequent mitochondrial dysfunction following SARS-CoV-2 genome integration may contribute to PACS biological pathogenesis. We also briefly examine the coordinated and complex relationship between increased oxidative stress, inflammation, and mitochondrial dysfunction and speculate as to how SARS-CoV-2-mediated NAD+ depletion may be causing these abnormalities in PACS. As such, we present evidence supporting the therapeutic potential of intravenous administration of NAD+ as a novel treatment intervention for PACS symptom management.
{"title":"Rationale for Nicotinamide Adenine Dinucleotide (NAD+) Metabolome Disruption as a Pathogenic Mechanism of Post-Acute COVID-19 Syndrome.","authors":"Tabitha Block, Jonathann Kuo","doi":"10.1177/2632010X221106986","DOIUrl":"10.1177/2632010X221106986","url":null,"abstract":"<p><p>Many acute COVID-19 convalescents experience a persistent sequelae of infection, called post-acute COVID-19 syndrome (PACS). With incidence ranging between 31% and 69%, PACS is becoming increasingly acknowledged as a new disease state in the context of SARS-CoV-2 infection. As SARS-CoV-2 infection can affect several organ systems to varying degrees and durations, the cellular and molecular abnormalities contributing to PACS pathogenesis remain unclear. Despite our limited understanding of how SARS-CoV-2 infection promotes this persistent disease state, mitochondrial dysfunction has been increasingly recognized as a contributing factor to acute SARS-CoV-2 infection and, more recently, to PACS pathogenesis. The biological mechanisms contributing to this phenomena have not been well established in previous literature; however, in this review, we summarize the evidence that NAD+ metabolome disruption and subsequent mitochondrial dysfunction following SARS-CoV-2 genome integration may contribute to PACS biological pathogenesis. We also briefly examine the coordinated and complex relationship between increased oxidative stress, inflammation, and mitochondrial dysfunction and speculate as to how SARS-CoV-2-mediated NAD+ depletion may be causing these abnormalities in PACS. As such, we present evidence supporting the therapeutic potential of intravenous administration of NAD+ as a novel treatment intervention for PACS symptom management.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/cd/10.1177_2632010X221106986.PMC9234841.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40410143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-18eCollection Date: 2022-01-01DOI: 10.1177/2632010X221099889
Sohel Daria, Md Rabiul Islam
The COVID-19 pandemic has put enormous strain on the global public health and healthcare systems. Here we aimed to assess the prevalence and impact of indiscriminate use of antibiotics for COVID-19 treatment in south Asian countries. We observed the indiscriminate use of antibiotics in south Asian countries and other similar parts of the world. Along with vaccines, people in poor and developing countries have been taking antibiotics and some other medications without proper jurisdiction during the waves of the COVID-19 pandemic. We all know that COVID-19 is a viral disease, and only a few patients might have bacterial co-infections. Therefore, the role of antibiotics is ambiguous in most COVID-19 cases. Consequently, the overuse of antibiotics would cause antimicrobial resistance that has the potential to become a 2-edged sword after the COVID-19 pandemic era. Our findings emphasize the judicious use of antibiotics in COVID-19 therapy, especially in poor and developing countries across the globe.
{"title":"Indiscriminate Use of Antibiotics for COVID-19 Treatment in South Asian Countries is a Threat for Future Pandemics Due to Antibiotic Resistance.","authors":"Sohel Daria, Md Rabiul Islam","doi":"10.1177/2632010X221099889","DOIUrl":"10.1177/2632010X221099889","url":null,"abstract":"<p><p>The COVID-19 pandemic has put enormous strain on the global public health and healthcare systems. Here we aimed to assess the prevalence and impact of indiscriminate use of antibiotics for COVID-19 treatment in south Asian countries. We observed the indiscriminate use of antibiotics in south Asian countries and other similar parts of the world. Along with vaccines, people in poor and developing countries have been taking antibiotics and some other medications without proper jurisdiction during the waves of the COVID-19 pandemic. We all know that COVID-19 is a viral disease, and only a few patients might have bacterial co-infections. Therefore, the role of antibiotics is ambiguous in most COVID-19 cases. Consequently, the overuse of antibiotics would cause antimicrobial resistance that has the potential to become a 2-edged sword after the COVID-19 pandemic era. Our findings emphasize the judicious use of antibiotics in COVID-19 therapy, especially in poor and developing countries across the globe.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9121502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48757009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/2632010X221088966
Jeremy D. Ward, Mahesh S Sharma, M. Pizzuto, V. Moylan, F. Askin, D. Kaufman
Herein we discuss the clinical course and subsequent autopsy of a female infant with trisomy 21 with balanced Rastelli Type “C” complete atrioventricular septal defect (AVSD), tetralogy of Fallot and right aortic arch with mirror image branching pattern who underwent a palliative right modified Blalock-Taussig-Thomas shunt (mBTTS) for hypoxemia from progressive right ventricular outflow tract obstruction. The baby was found to have multiple concomitant pathologic findings not typically seen with this constellation of cardiac anatomy. Autopsy revealed significant abdominal adhesions with near-complete stenosis of the transverse colon. In addition, the infant was found to have significantly elongated villi within the small and large bowel and a relatively large collagenous polyp in the small bowel. The decedent also had an abnormal tracheal bronchus, characterized by an additional superior right-sided bronchus, which is an extremely rare abnormality. Her clinical course was complicated by severe pulmonary hypertensive arteriolar changes out of proportion to what would be typical for her age, trisomy 21 status, and degree of left to right intracardiac shunting. Furthermore, she had refractory anasarca and recurrent chylous pleural effusions without gross lymphatic abnormalities that may have been secondary to systemic capillary leak syndrome (SCLS) versus severe pulmonary hypertension. Due to the aforementioned findings, the family elected for comfort care and the baby expired shortly after extubation. Overall, the infant had multiple, rare coexisting congenital abnormalities that likely represents an extreme phenotype of trisomy 21 that has not been described in the literature to date.
{"title":"Beyond the Syndrome: Extensive Congenital Abnormalities in an Infant With Trisomy 21","authors":"Jeremy D. Ward, Mahesh S Sharma, M. Pizzuto, V. Moylan, F. Askin, D. Kaufman","doi":"10.1177/2632010X221088966","DOIUrl":"https://doi.org/10.1177/2632010X221088966","url":null,"abstract":"Herein we discuss the clinical course and subsequent autopsy of a female infant with trisomy 21 with balanced Rastelli Type “C” complete atrioventricular septal defect (AVSD), tetralogy of Fallot and right aortic arch with mirror image branching pattern who underwent a palliative right modified Blalock-Taussig-Thomas shunt (mBTTS) for hypoxemia from progressive right ventricular outflow tract obstruction. The baby was found to have multiple concomitant pathologic findings not typically seen with this constellation of cardiac anatomy. Autopsy revealed significant abdominal adhesions with near-complete stenosis of the transverse colon. In addition, the infant was found to have significantly elongated villi within the small and large bowel and a relatively large collagenous polyp in the small bowel. The decedent also had an abnormal tracheal bronchus, characterized by an additional superior right-sided bronchus, which is an extremely rare abnormality. Her clinical course was complicated by severe pulmonary hypertensive arteriolar changes out of proportion to what would be typical for her age, trisomy 21 status, and degree of left to right intracardiac shunting. Furthermore, she had refractory anasarca and recurrent chylous pleural effusions without gross lymphatic abnormalities that may have been secondary to systemic capillary leak syndrome (SCLS) versus severe pulmonary hypertension. Due to the aforementioned findings, the family elected for comfort care and the baby expired shortly after extubation. Overall, the infant had multiple, rare coexisting congenital abnormalities that likely represents an extreme phenotype of trisomy 21 that has not been described in the literature to date.","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46683260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-14eCollection Date: 2022-01-01DOI: 10.1177/2632010X221076379
Preeti Agarwal, Fatima Khan, Sameer Gupta, Shalini Bhalla, Ann Thomas, Akshay Anand, Kulranjan Singh, Abhinav Arun Sonkar
Introduction: Invasive Breast carcinoma-No special type (NST) is the most common breast malignancy accounting for 95% of breast cancers. Study of predictive and prognostic immunohistochemical markers estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2neu) expression are crucial for treatment planning.
Materials and methods: In the present study we studied the hormonal profile in 303 sporadic breast cancers and BRCA1 protein expression in these patients along with its clinico-pathological correlation.
Results: In our patient population, Triple negative Breast carcinoma (TNBC) (104/303; 34.3%) was the most common luminal subtype followed by Luminal A 74/303; 24.4%), Her2 enriched (65/303; 21.5%), and Luminal B (60/303; 19.8%) respectively. This contrasts with many western studies which commonly report Luminal A being the largest subgroup. BRCA1 protein loss was more prominently seen in TNBC (64/104;61.5%) highlighting the possibility that high grade tumors are more susceptible to some epigenetic modifications leading to higher likelihood of loss of BRCA1 protein.
Conclusion: Hence, we conclude that like hereditary cases of breast carcinoma with BRCA1 mutation; BRCA1 loss is also more likely in sporadic TNBC cases.
浸润性乳腺癌-无特殊类型(NST)是最常见的乳腺恶性肿瘤,占乳腺癌的95%。研究预测和预后的免疫组织化学标志物雌激素受体(ER)、孕激素受体(PR)和人表皮生长因子受体2 (Her2neu)的表达对治疗计划至关重要。材料与方法:本研究对303例散发性乳腺癌患者的激素谱、BRCA1蛋白表达及其临床病理相关性进行了研究。结果:在我们的患者群体中,三阴性乳腺癌(TNBC) (104/303;34.3%)是最常见的luminal亚型,其次是luminal A 74/303;24.4%), Her2富集(65/303;21.5%), Luminal B (60/303;分别为19.8%)。这与许多西方研究形成对比,这些研究通常报告Luminal A是最大的亚群。BRCA1蛋白丢失在TNBC中更为明显(64/104;61.5%),这表明高级别肿瘤更容易受到一些表观遗传修饰的影响,从而导致BRCA1蛋白丢失的可能性更高。结论:BRCA1基因突变的遗传性乳腺癌病例;BRCA1基因缺失也更可能发生在散发性TNBC病例中。
{"title":"Co-Relation of Hormonal Profile and BRCA1 in Sporadic Breast Carcinoma: A Single Institutional Experience of 303 Patients.","authors":"Preeti Agarwal, Fatima Khan, Sameer Gupta, Shalini Bhalla, Ann Thomas, Akshay Anand, Kulranjan Singh, Abhinav Arun Sonkar","doi":"10.1177/2632010X221076379","DOIUrl":"https://doi.org/10.1177/2632010X221076379","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive Breast carcinoma-No special type (NST) is the most common breast malignancy accounting for 95% of breast cancers. Study of predictive and prognostic immunohistochemical markers estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2neu) expression are crucial for treatment planning.</p><p><strong>Materials and methods: </strong>In the present study we studied the hormonal profile in 303 sporadic breast cancers and BRCA1 protein expression in these patients along with its clinico-pathological correlation.</p><p><strong>Results: </strong>In our patient population, Triple negative Breast carcinoma (TNBC) (104/303; 34.3%) was the most common luminal subtype followed by Luminal A 74/303; 24.4%), Her2 enriched (65/303; 21.5%), and Luminal B (60/303; 19.8%) respectively. This contrasts with many western studies which commonly report Luminal A being the largest subgroup. BRCA1 protein loss was more prominently seen in TNBC (64/104;61.5%) highlighting the possibility that high grade tumors are more susceptible to some epigenetic modifications leading to higher likelihood of loss of BRCA1 protein.</p><p><strong>Conclusion: </strong>Hence, we conclude that like hereditary cases of breast carcinoma with BRCA1 mutation; BRCA1 loss is also more likely in sporadic TNBC cases.</p>","PeriodicalId":53204,"journal":{"name":"Clinical Pathology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2022-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/53/10.1177_2632010X221076379.PMC8851497.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39637362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}