Magnetic resonance imaging of cerebellar cysts in a neonate with congenital cytomegalovirus infection.

Congenital cytomegalovirus infection is one of the most common congenital viral infections in the world. Brain magnetic resonance imaging plays a key role in evaluating brain involvement and establishing prognosis; several characteristic features have been described. We present a description of cerebellar cysts in a neonate with polymerase chain reaction-confirmed cytomegalovirus congenital infection, and discuss the differential diagnosis and potential pathophysiological mechanisms.

Surgical Resections of Superinfected Pneumatoceles in a COVID-19 Patient.

Emerging studies on radiologic findings in patients with coronavirus disease 2019 (COVID-19) report a high incidence of bilateral lung involvement, with ground-glass opacities imaging being the most common pattern on computed tomography. Cystic lesions, such as pneumatoceles, are rare, although they may occur in 10% of cases. Cyst formation may be explained by a focal pulmonary trauma caused by mechanical ventilation or infection-related damage to the alveolar walls leading to pneumatoceles. The superinfection of pneumatoceles is a potential life-threatening condition for which no standardized therapeutic algorithm has been accepted. We report a case of a COVID-19 patient successfully treated by lung resections for infected pneumatoceles.

Spontaneous pneumothorax, with or without pulmonary cysts, in patients with COVID-19 pneumonia.

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) affects mainly the lungs causing pneumonia and complications like acute respiratory distress syndrome. Pneumothorax is a rare manifestation of the disease. This report is a description of a series of patients with COVID-19 and spontaneous pneumothorax, some of them with associated pulmonary cysts. METHODOLOGY: Cases were collected retrospectively. We included clinical data from medical records and described radiologic findings. Patients that developed pneumothorax during mechanical ventilation were excluded. RESULTS: Ten cases were included in this report, nine of them were male. The median age of our series was 62 years (IQR = 57-68). The median days since the onset of symptoms until the development of pneumothorax was 27 (IQR = 17-31), most cases developed after the second week of the diagnosis of pneumonia. Two cases required invasive mechanical ventilation, but pneumothorax occurred after ventilator weaning. Three cases showed subpleural pulmonary cysts. CONCLUSIONS: Cysts and pneumothorax are rare manifestations of SARS-CoV-2 pneumonia with mechanisms not completely understood. This report highlights the role of CT scan in diagnosis of COVID-19 complications.

Radiological features of Pneumocystis jirovecii Pneumonia in immunocompromised patients with and without AIDS.

The aim of this study was to compare chest computerized tomography (CT) findings of Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients with and without acquired immune deficiency syndrome (AIDS). Chest CT findings and clinical parameters of 38 consecutive immunocompromised patients, nine with AIDS and 29 with other causes of immunosuppression, were characterized and compared. PCP in patients without AIDS was diagnosed after a significantly shorter time interval from symptom onset: 8 +/- 6 vs. 18 +/- 1.0 days (p = 0.024). From a radiographic point of view, non-AIDS patients had a significantly higher proportion of diffuse ground glass lesions, 86 vs. 44% (p = 0.02), and a lower proportion of cystic lesions, 3 vs. 56% (p = 0.015). The two subgroups did not differ in smoking status and the number of pack-years. On multivariant analysis, only the presence of AIDS was found to be a risk factor for the formation of pulmonary cystic lesions. Different immune reactions to the parasite P. jirovecii in immunocompromised patients with and without AIDS results in a different time lag between symptoms and a correspondingly different radiographic pattern: widespread ground glass opacities in the former and cystic lesions in the latter.

Diagnostic Accuracy of Ultrasonography to Detect False Layers in a Commercial Laying Flock Infected by an Infectious Bronchitis Virus Delmarva Genotype Causing Cystic Oviducts.

Infection of the oviduct by an infectious bronchitis virus (IBV) in laying hens has been associated with the false layer syndrome. Because the diagnostic procedure for the detection of cystic oviducts by postmortem examinations in IBV-positive replacement pullet flocks could involve the unnecessary sacrifice of numerous healthy pullets without reproductive tract anomalies, the development of a noninvasive and nonlethal diagnostic procedure would be desirable. The first objective of the study was to evaluate the diagnostic accuracy of a transcutaneous ultrasonography method to predict the presence of cystic oviducts compared to postmortem examinations in a commercial pullet flock positive for an IBV genotype Delmarva (DMV) variant. The second objective was to evaluate the performance of the same ultrasonography method to later detect false layers in the same flock in sexually mature hens by identifying the presence of an egg in the oviduct due to the presence of atretic oviducts undetectable by ultrasonography and the absence of cystic oviducts at that age. In replacement pullets, the sensitivity (Se) and specificity (Sp) of the ultrasonography (index test) compared to the postmortem examination (reference standard test) were 73% and 91%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 67% and 93%. The ultrasonography technique showed a positive likelihood ratio (LR+) of 7.82 and a negative likelihood ratio (LR-) of 0.30. In sexually mature hens, the Se, Sp, PPV, and NPV of the ultrasonography compared to the laying status were 98%. The LR+ was 49.00 and the LR- was 0.02 when compared to the laying status. In conclusion, the ultrasonography could replace postmortem examinations to detect cystic oviducts in commercial flocks of replacement pullets previously infected with an IBV-DMV 1639 variant. Although the test accuracy of ultrasonography was excellent for the hens at production peak to identify laying and nonlaying hens based on the presence of an egg in the reproductive tract, its practicality was limited due to atretic oviducts being not detectable.

Precisión diagnóstica de la ultrasonografía para detectar gallinas falsas ponedoras en una parvada comercial infectada por un virus de la bronquitis infecciosa genotipo Delmarva que causa oviductos quísticos. La infección del oviducto por el virus de bronquitis infecciosa (IBV) en gallinas de postura se ha asociado con el síndrome de la falsa ponedora. Debido a que el procedimiento de diagnóstico para la detección de oviductos quísticos mediante exámenes post mortem en parvadas de pollitas de reemplazo positivas para bronquitis infecciosa podría involucrar el sacrificio innecesario de numerosas pollitas sanas sin anomalías del tracto reproductivo, por lo tanto es deseable el desarrollo de un procedimiento de diagnóstico no invasivo y no letal. El primer objetivo del estudio fue evaluar la precisión diagnóstica de un método de ultrasonografía transcutánea para predecir la presencia de oviductos quísticos en comparación con los exámenes post mortem en un lote comercial de pollitas que resultó positivo para una variante del genotipo Delmarva (DMV) del virus de la bronquitos infecciosa. El segundo objetivo fue evaluar el desempeño del mismo método de ultrasonografía para detectar posteriormente gallinas falsas en la misma parvada en las gallinas sexualmente maduras mediante la identificación de la presencia de un huevo en el oviducto debido a la presencia de oviductos atrésicos indetectables por ultrasonografía y la ausencia de oviductos quísticos a esa edad. En las pollitas de reemplazo, la sensibilidad (Se) y la especificidad (Sp) de la ultrasonografía (prueba de índice) en comparación con el examen post mortem (prueba estándar de referencia) fueron de 73% y 91%, respectivamente. El valor predictivo positivo (VPP) y el valor predictivo negativo (VPN) fueron 67% y 93%. La técnica de ultrasonografía mostró una razón de probabilidad positiva (LR+) de 7.82 y una razón de probabilidad negativa (LR­) de 0.30. En las gallinas sexualmente maduras, la Se, Sp, PPV y NPV de la ultrasonografía en comparación con el estado de postura fueron del 98%. El LR + fue 49.00 y el LR­fue 0.02 en comparación con el estado de la postura. En conclusión, la ultrasonografía podría reemplazar los exámenes post mortem para detectar oviductos quísticos en parvadas comerciales de pollitas de reemplazo previamente infectadas con una variante DMV-1639 del virus de la bronquitis infecciosa. Aunque la precisión de la prueba de la ecografía fue excelente para las gallinas en el pico de producción para identificar gallinas ponedoras y no ponedoras en función de la presencia de un huevo en el tracto reproductivo, su funcionalidad fue limitada debido a que los oviductos atrésicos no fueron detectables.

Cutaneous viral papilloma with local extension and subungual cyst formation in a dog.

A viral-induced digital cutaneous exophytic papilloma was diagnosed in a 2-year-old, spayed, female Siberian husky dog with lameness. Digital pain and lameness persisted after removal of the initial papilloma, and the fifth lateral digit was subsequently amputated. Upon histologic examination of the digit, a de novo digital, cutaneous, inverted, viral papilloma and subungual cyst were diagnosed. The inverted cutaneous papilloma, located at the junction of the digital paw pad and ventral nail, extended focally through the nail into the subungual space, where an expansile cyst was formed. Cellular changes suggestive of papillomavirus infection were present in the epithelium of the original exophytic papilloma, as well as the endophytic mass and subungual cyst. Cytopathic effects included ballooning degeneration of keratinocytes, koilocytosis, irregularity of keratohyalin granules, and margination of nuclear chromatin. Numerous faintly basophilic to eosinophilic intranuclear inclusions measuring 10-15 microm in diameter were present within keratinocytes of the exophytic, endophytic, and subungual cystic lesions. Electron microscopy was performed on tissues from all lesions and revealed numerous 40-45 nm diameter hexagonal virions characteristic of papillomavirus that were arranged in crystalline arrays and dense clusters within affected nuclei.

Nonsurgical management of human immunodeficiency virus-associated parotid cysts: A systematic review and meta-analysis.

BACKGROUND: The purpose of this clinical review was to analyze the effectiveness of nonsurgical management options for human immunodeficiency virus (HIV)-associated parotid cysts. METHODS: We conducted systematic and meta-analysis reviews. Primary outcomes were complete or partial responses. RESULTS: Systematic review identified 12 relevant studies. The average rates of complete response for antiretroviral therapy (ART), sclerotherapy, and fine-needle aspiration (FNA) were 52.8%, 55.5%, and 33.3%, respectively. Three radiotherapy studies, totaling 104 patients, were included in a meta-analysis. Patients receiving high-dose therapy achieved complete and partial response rates of 65.8% (95% confidence interval [CI] 54.3%-76.2%) and 25.2% (95% CI 16.1%-36.3%), respectively. Patients receiving low-dose therapy achieved complete and partial response rates of 23.2% (95% CI 1.2%-60.9%) and 22.3% (95% CI 5.2%-87.8%), respectively. The rate of complete response was significantly greater for high-dose radiotherapy compared to low-dose (P < .001). CONCLUSION: Among nonsurgical treatment modalities for HIV-associated parotid cysts, radiotherapy has the highest number of reported outcomes in the literature and our analysis suggests that higher dose radiotherapy has higher rates of achieving complete response.

Human papillomavirus type 59 identified in a verrucous cyst of the flank.

The verrucous cyst is a non-plantar epidermoid cyst with histopathological features of human papillomavirus (HPV) infection, including papillomatosis and hypergranulosis of the cyst lining. We report the first case of a verrucous cyst demonstrating not only the histopathological and immunohistochemical features of HPV infection, but also homology with HPV type 59 on HPV genotyping. A 28-year-old male developed a palpable mass in his right flank. Histological examination revealed an intradermal cyst lined by an acanthotic and papillomatous squamous epithelium with prominent keratohyaline granules and squamous eddies. The keratinocyte nuclei were positive for papillomavirus antigens on immunohistochemistry and HPV genotyping demonstrated a homology to HPV type 59, a high-risk genital type. Although we only experienced a single case with such a finding, we suggest that it may be necessary to subject patients with verrucous cysts to a closer follow up for better characterization of their clinical behavior.

Pathogenicity for rats of a strain of chicken sarcoma virus.

The RBI rat tumor, induced with cell suspensions from chicken sarcoma B77, is pathogenic for chicks as well as for rats. Cell suspensions from RBI tumors induced sarcomas in 100 percent of inoculated chicks. Cell suspensions of this chicken sarcoma induced early RBA sarcomas in 50 percent of 171 rats. Most of these rats died within 4 weeks after inoculation. The early tumors regressed in 15 of the 85 tumor-bearing rats, and the animals died of cystic hemorrhagic disease. The sarcoma was induced in 9 animals within 50 to 70 days after inoculation, and cystic hemorrhagic disease developed in 117. None of the 171 rats remained free from either tumor or cyst and only 12 survived for 3 months or longer. The tumors induced in rats were transplantable into rats and after transplantation of early-appearing tumors, tumors and cysts developed. Virus strongly infective in chicks was demonstrated by cell-free filtrates and virus preparations from RBI and RBA rat sarcomas induced by chicken sarcoma cells. Cell suspensions from the wall of small cysts induced tumors in chicks and cystic hemorrhagic disease and tumors in rats.

[Lymphoepithelial cysts of the parotid gland: a pathology linked to HIV infection]. / Les kystes lymphoépithéliaux de la glande parotide: une pathologie liée à l'infection VIH.

We review the various lesions encountered in the parotid gland associated with HIV infection and propose guidelines for the management of a chronic parotid swelling in this setting. Lymphoepithelial cysts is the main diagnosis of parotid masses presented by HIV positive patients. This benign condition is diagnosed on cytology and the treatment is usually conservative. Patients with a diagnosis of lymphoepithelial cysts should be tested for HIV.

The benign cystic lymphoepithelial lesion of the parotid gland is a viral reservoir in HIV type 1-infected patients.

The presence of HIV-1 in cystic fluid aspirates from six cases of benign cystic lymphoepithelial lesion (BLL) of the parotid gland, a rare disorder affecting HIV-1-infected patients, has been investigated. HIV-1 p24 protein was present at a concentration ranging from 3 to 15 ng/ml, while it was undetectable in the peripheral blood of the same patients. The number of RNA copies of HIV-1 in the cystic fluids was high, ranging from 0.5 x 10(7) to 7.2 x 10(7) RNA copies/ml. BLL cystic fluid aspirates, despite the high level of HIV-1 RNA, were found to contain only a few infectious virions. The low infectivity correlated with the infrequent detection by electron microscopy of complete HIV-1 particles. The pathogenic mechanism leading to virus accumulation in the cystic fluid was studied by immunohistochemistry of tissue sections. p24 protein was associated with DRC-1+/S-100+ follicular dendritic reticulum cells, which were also present within the cystic cavities. Our findings are consistent with the possibility that the large amounts of virus present in the fluid derive from continuous shedding of HIV-1-infected cells from the surrounding lymphoid tissue.

HIV-related parotid lymphoepithelial cysts. Immunohistochemistry and 3-D reconstruction of surgical and autopsy material with special reference to formal pathogenesis.

Whether lymphoepithelial cysts in the parotid glands in HIV-infected patients develop from pre-existing salivary gland inclusions in intraparotid lymph nodes or from a lymphoepithelial lesion of salivary parenchyma is unclear. To examine their pathogenesis we performed a histological and immunohistochemical study of salivary specimens from 100 AIDS patients in different disease stages. There is a continuous morphological spectrum of changes within the salivary parenchyma, starting with lymphoid stroma infiltration and evolving to characteristic lymphoepithelial duct lesions with a immunohistochemically proven basal cell proliferation and to fully developed ductal cysts. Involvement of myoepithelial cells-postulated in comparable Sjögren-associated duct lesions-is excluded immunohistochemically. Computer-assisted 3-D reconstructions confirm an association of the cysts with the intralobular duct system. Our study disproves the prevailing hypothesis, which suggests that the lymphoid cell compartment of HIV-associated lymphoepithelial cysts stems from pre-existing intraparotid lymph nodes. The results demonstrate that a secondary lymphatic infiltration of salivary parenchyma provokes a lymphoepithelial lesion of striated ducts with basal cell hyperplasia. The frequent progression to a multifocal cystic lymphoepithelial lesion may be supported by ductal compression through a high degree of lymphofollicular hyperplasia in early disease.

Role of cytomegalovirus, Epstein-Barr virus, and human herpes virus-8 in benign lymphoepithelial cysts of the parotid gland.

OBJECTIVE: To provide background and evaluate the role of herpesviruses in benign lymphoepithelial cysts (BLC) of the parotid gland. STUDY DESIGN: Case series derived from review of pathology specimens. METHODS: Radiolabeled polymerase chain reaction (PCR) analysis was used to detect for the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes virus 8 (HHV-8) DNA sequences in 14 paraffin embedded specimens and 1 freshly aspirated BLC specimen. Thirteen normal parotid tissue specimens obtained from paraffin embedded blocks were used as a control group. RESULTS: CMV was detected with nearly equal frequency between the two groups (23% of normal vs. 20% in BLC). HHV-8 was found in 13% of the BLC group and in none of the normal group (P =.4841). There was significant difference in EBV detection between the normal (0%) and the BLC (33%) groups (P =.0437). CONCLUSION: CMV and HHV-8 does not appear to be associated with BLCs. Although EBV is found more frequently in BLC than in normal parotid controls, further studies are needed to elucidate the role of this virus in BLC pathogenesis.

Common head and neck manifestations of AIDS.

Head and neck manifestations of acquired immunodeficiency syndrome (AIDS) can involve the skin, ear, upper aerodigestive tract, and neck. Several head and neck manifestations of AIDS may be the only initial sign of this disease process and therefore primary-care physicians and otolaryngologists must be able to recognize and understand the management of these lesions. Cystic enlargement of the parotid gland and Kaposi's sarcoma are increasingly being encountered in the head and neck exam of HIV-infected patients. An example of each of these disease processes is presented with full discussion about the various treatment methods.

Transfusion transmitted virus (TTV) in dental patients.

Transfusion transmitted virus (TTV) is a new DNA virus found in patients with post-transfusion hepatitis. The prevalence of this virus among dental patients has not been reported, therefore, the prevalence of TTV infection in consecutive dental inpatients was evaluated. TTV DNA was assayed by the polymerase chain reaction (PCR) in 441 dental inpatients with oral cancer (n=192) or oral cysts (n=249). The serum HBs antigen and HCV antibody as well as aspartate transaminase (AST), alanine transaminase (ALT), and gamma glutamyl transpeptidase (gamma-GTP) concentrations were also measured. Of 441 subjects, 137 were infected with TTV (31.1%). This prevalence of TTV was much higher than that of HBV or HCV (HBV 1.2%; HCV 6.0%) in these dental patients. There was no gender or age difference in the prevalence of TTV infection. Of the 192 patients with oral cancer, 57 subjects had TTV in their sera, while 80 of 249 with oral cystic disease had TTV. The prevalence of TTV was similar between the two different disease groups. Neither the serum ALT nor serum AST concentrations were different between the subjects positive and negative for TTV DNA. In hospitalized dental patients, 31.1% were infected with TTV. The prevalence of TTV was much higher than that of HBV or HCV. There was no difference in the prevalence of TTV between subjects with cancer and cysts. Dentists should maintain high standards of infection control when treating any dental patient.

HIV-1 (p24)-positive multinucleated giant cells in HIV-associated lymphoepithelial lesion of the parotid gland. A report of two cases.

BACKGROUND: Cystic benign lymphoepithelial lesion (CBLL) is a well-recognized parotid disorder the diagnosis of which can be made on the basis of clinical findings, human immunodeficiency virus (HIV) testing, image studies and fine needle aspiration (FNA). Most aspirations are cystic, and the lesion can be recognized if the triad of foamy macrophages, lymphoid and epithelial (squamous) cells is observed. CASES: The authors recently observed FNA cytologic features of two HIV-associated cases that exhibited numerous multinucleated giant cells (MGCs) but failed to show the epithelial component. A subsequent surgical resection was performed in one patient. Similarly to what has been described for nasopharyngeal (adenoid and tonsil) lymphoid tissue of HIV-positive patients, intense immunoexpression of S-100 and p24 (HIV-1) protein was present in MGC. CONCLUSION: The diagnosis of HIV-associated CBLL should always be considered if a parotid cystic lesion presents with numerous MGCs. Immunocytochemical detection of p24 (HIV-1) protein in MGC becomes a very useful diagnostic aid and extends to parotid CBLL many of those pathogenic features of HIV-1 infection already noted in other HIV-1-infected, lymphoid oropharyngeal lesions.

HIV disease presenting as parotid lymphoepithelial cysts: a presumptive diagnosis of diffuse infiltrative lymphocytic syndrome (DILS).

Diffuse infiltrative lymphocytic syndrome (DILS), is a rare manifestation of human immunodeficiency virus (HIV) disease which is characterized by a diffuse visceral CD8 lymphocytic infiltration, a persistent CD8 lymphocytosis, bilateral parotid swelling and cervical lymphadenopathy. We describe a case of a HIV positive female, who had bilateral parotid swelling and CD8 lymphocytosis, to illustrate this rare clinical entity.