Authors:Liang Ding; MD, PhD, Yujie Zhang, MD, PhD, Lin Lin, MD, PhD* Abstract: Lymph nodes are specialized tissues that play an essential role in the immune system. Nodal hyalinization/sclerosis is often seen in the elderly, involving the mediastinum, pelvis, and other areas. Hyalinization of the lymph node might contribute to impaired filtration function of the node. Nevertheless, the clinical significance is still unclear. Here, we report a 35-year-old Caucasian female with an unremarkable past medical history, presented at the dermatology clinic with a subcutaneous mass in the forearm, and an excisional biopsy was performed. The histological findings are consistent with a lymph node with hyalinization and storiform sclerosis. The patient is doing well after the focal excision. Although deposition of hyaline material can be seen in the pelvic and inguinal lymph nodes of the elder, its histology is drastically different from the one seen in our case. In this case report and brief review, we compare and summarize several benign and malignant conditions associated with nodal hyalinization with or without a storiform pattern [N A J Med Sci. 2022;15(1):001-007. DOI : 10.7156/najms.2022.1501001] Key Words: lymph node, hyalinization, sclerosis, storiform pattern PubDate: Fri, 01 Apr 2022 00:00:00 -070
Authors:Mahmoud Ali; MD, Nell Maloney-Patel, MD, Zhongren Zhou, MD, PhD* Abstract: Foreign bodies used during surgeries and endoscopy procedures may elicit inflammatory reactions and granuloma formation. The resultant lesion may mimic polyps or tumors, which require cautious interpretation. Here we reported that 69-year-old patient with history of treated rectal cancer underwent surveillance colonoscopy where a tubular adenoma was found in the cecum. A follow-up endoscopy found a flat polyp at the ileocecal valve. Right hemicolectomy was performed. On examining the specimen, two lesions were identified in the wall of the ileocecal valve area. Microscopically, there were foreign body giant cell granulomas filled with eosinophilic amorphous material which is consistent with an inflammatory reaction caused by submucosal lifting material injection used during colonoscopy for polypectomy. The granulomas mimicked recurrence of colorectal carcinoma. Therefore, surgeons and pathologists should be aware of the inflammatory reaction elicited by the new lifting agents that may resemble polyps or tumors. [N A J Med Sci. 2021;1(1):001-003. DOI : 10.7156/najms.2021.1401001] PubDate: Thu, 28 Jan 2021 00:00:00 -080
Authors:James Yoonha Paik; Raphael Rakosi-Schmidt, Jun Liu, MD, PhD* Abstract: Coronavirus disease-2019 (COVID-19) is a novel pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). It presents with wide variations in disease severity, and certain populations appear to be more susceptible than others. The mechanisms of such heterogeneity in disease presentation and susceptibility are largely unclear, and this review article aims to examine the existing evidence for the involvement of the human Major Histocompatibility Complex (MHC) system, which is also known as the Human Leukocyte Antigen (HLA) system, as potential effectors of such heterogeneity. We critically examined peer-reviewed case-control, cohort, and in-silico studies, and classified HLA class 1 and 2 alleles into risk and protective alleles based on existing evidence. Furthermore, we summarized the relationship between HLA-DR expression and COVID-19 pathophysiology based on functional studies. We postulate that the identification of HLA alleles that confer risk or protection for COVID19 will not only shed light on understanding disease epidemiology but will also help to guide vaccine development and predict vaccine efficacy across populations. [N A J Med Sci. 2020;1(1):032-038. DOI : 10.7156/najms.2020.1301032] Key Words: SARS-CoV-2, COVID-19, human leukocyte antigen, major histocompatibility complex PubDate: Fri, 16 Oct 2020 00:00:00 -070
Authors:Jing Wang; MD, Oscar A Roncal, MD, Michael M Ittmann, MD, PhD, Ying Ye, MD Abstract: Glypican-3 (GPC-3) is a glycoconjugate protein of heparan sulfate proteoglycan family and is important for embryogenesis but silenced in adult healthy tissue. GPC-3 protein is abnormally expressed in hepatocellular carcinoma (HCC) and has been used as a marker for pathological diagnosis of primary and metastatic HCC. However, GPC-3 expression has also been found in some tumors other than HCC. This study is to investigate the expression of GPC-3 expression immunohistochemically and the staining pattern in poorly differentiated carcinomas of lung primary in order to assess the value of GPC-3 as a marker for diagnosing metastatic HCC in lung. Lung tissue from 44 patients diagnosed with poorly differentiated carcinoma were evaluated, including 23 lung adenocarcinomas, 19 squamous cell carcinomas and 2 adenosquamous carcinomas. Immunohistochemical stains of GPC-3 was performed on tumor tissue samples. The expression pattern of GPC-3 was analyzed. Expression of GPC-3 was found in 45% of primary lung cancers, including 79% of squamous cell carcinomas, 18 % of adenocarcinomas, and 50% of adenosquamous carcinomas. The poorly differentiated carcinomas showed predominantly patchy positivity. The staining pattern ranged from weak granular cytoplasmic positivity to a strong membranous and cytoplasmic positivity, and both cytoplasmic and nuclear positivity. GPC-3 expression was not seen in non-neoplastic lung tissue. GPC-3 is a relatively specific marker for HCC. In this study, we demonstrated the expression of GPC-3 in a significant number of poorly differentiated carcinoma of lung. Therefore, in context of a possible metastatic HCC to the lung, caution should be made by using GPC-3 as a differential marker for HCC, and a panel of stains should be considered. [N A J Med Sci. 2020;1(1):018-023. DOI : 10.7156/najms.2020.1301018] Key Words: glypican-3, lung carcinomas, immunohistochemistry, hepatocellular carcinoma PubDate: Tue, 07 Jul 2020 00:00:00 -070
Authors:Sumant Arora; MD, Zunirah Ahmed, Gurpratap Sidhu, MD, Steven Young, MD, Muhammad Yasir Khan, MD, Deepak Agrawal, MD, Omair Atiq, MD Abstract: Background and Aims:Management of common gastrointestinal diseases by non-gastroenterologists often includes diagnostic tests that do not positively impact patient care but increases cost of care. Our study aimed to determine the prevalence of common inpatient practices by non-gastroenterologist providers. Methods:A validated anonymous survey was designed using ‘Google Forms’ (google.com/forms) and responses were collected on a handheld tablet. The questions included basic demographics, level of training, training specialty and practices related to common gastrointestinal diseases. The practices included fecal occult blood testing (FOBT), recognition of melena, use of lipase in management of acute pancreatitis, placement of nasogastric tube in cirrhosis, duration of nil per oral (NPO) before procedures and international normalized ratio (INR) threshold for paracentesis. Descriptive analysis was performed. Results:We collected 150 responses from 4 different residency training hospitals in the United States. Of the respondents, 84% were resident trainees. Primary specialties of practice were internal medicine (82%), family medicine (11%), and others (7%). Inpatient FOBT was available in 95% of the facilities surveyed. With regards to melena, 77.5% correctly identified it as black tarry stool, but 17% also considered FOBT positive brown stool as melena. 21% correlated high lipase levels with more severe acute pancreatitis.19% considered history of cirrhosis a contraindication for placement of nasogastric tube. Only 35% performed abdominal paracentesis regardless of INR value. Discussion:Low value tests and procedures related to common gastrointestinal diseases are prevalent among non-gastroenterologists. Better communication between primary team and specialist and education is needed to optimize patient care. PubDate: Sat, 29 Feb 2020 00:00:00 -080
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