Comprehensive bronchoalveolar lavage characterization in COVID-19 associated acute respiratory distress syndrome patients: a prospective cohort study.

COVID-19-related acute respiratory distress syndrome (CARDS) is associated with high mortality rates. We still have limited knowledge of the complex alterations developing in the lung microenvironment. The goal of the present study was to comprehensively analyze the cellular components, inflammatory signature, and respiratory pathogens in bronchoalveolar lavage (BAL) of CARDS patients (16) in comparison to those of other invasively mechanically ventilated patients (24). In CARDS patients, BAL analysis revealed: SARS-CoV-2 infection frequently associated with other respiratory pathogens, significantly higher neutrophil granulocyte percentage, remarkably low interferon-gamma expression, and high levels of interleukins (IL)-1ß and IL-9. The most important predictive variables for worse outcomes were age, IL-18 expression, and BAL neutrophilia. To the best of our knowledge, this is the first study that was able to identify, through a comprehensive analysis of BAL, several aspects relevant to the complex pathophysiology of CARDS.

Prevalence of High-Risk Human Papillomavirus Types and Their Association with Cervical Squamous Cell Carcinoma, and High- and Low-Grade Squamous Intraepithelial Lesions in Turkish Women.

Background: This study aimed to investigate human papillomavirus (HPV) type prevalence in our region and the relationship between uterine cervical HPV types and squamous cell carcinoma (SCC)/intraepithelial lesions. Methods: HPV test results were obtained from patient file archives of the Gynecology and Obstetrics Clinic. Pathology report results were obtained from the digital records of the Pathology Laboratory and the patient file archives of the Gynecology and Obstetrics Clinic in 2018. Results: The most frequently detected was HPV16 (29.2%), followed by HPV51 (13.1%), HPV56 (11%), HPV31 (9.2%), HPV52 (8.4%), and HPV68 (8.2%). HPV16 was positive in 50% of patients diagnosed with SCC, 54.9% of patients with HSIL, 27% of patients with LSIL, and 25% of cases diagnosed as benign (P<0.001). HPV18 was positive in 25% of patients diagnosed with SCC, 11% of patients with HSIL, 4.7% of patients with LSIL, and 5.2% of cases diagnosed as benign (P=0.019). Conclusion: The most frequent hrHPV genotype was HPV16, followed by HPV51, HPV 56, and HPV 31. There is an increase in the frequency of HPV51 and HPV56. HPV51, not included in HPV vaccines and is the second most frequent, should be included in these vaccines. In addition, although the frequency of HPV18 has decreased, HSIL and SCC generation is still high together with HPV16.

Melanocytes as the source of the increased melanisation in pigmented epithelial tumours: a holistic approach.

BACKGROUND: We aimed to elucidate the causes of the increased melanisation in basal cell carcinoma (BCC) and seborrheic keratosis (SK), and the role of melanocytes in this process. METHODS: This study was a retrospective-cohort study conducted in the pathology department of a university hospital between January 2019 and October 2020. Forty-nine SK and 30 pigmented BCC were included in our study. SRY-box transcription factor 10 (SOX10), CD68, and Masson-Fontana staining was used for analysis in all samples. A representative section of each specimen was photographed under ×400 magnification to facilitate the assessments of the morphology of the melanocytes and their following morphometric parameters: density, nuclear diameter, and distribution. The density of pigmented keratinocytes in the lesional epidermis was scored. The nuclear diameters of melanocytes located in the nonlesional epidermis, the density of the melanophages, and the presence or absence of ulceration and solar elastosis were also recorded. RESULTS: The morphometric findings confirmed a statistically significant increase in melanocyte density in the BCC group compared with that in the SK group (p < 0.001). Moreover, the nuclear minor diameters in the melanocytes of the BCC sections were significantly higher than those in the SK specimens (p < 0.001). The epidermal melanocytes were distributed diffusely in almost all BCC specimens (96.7%), whereas they were mainly limited to the basal layer in the majority of the SK sections (59.2%). The number of epidermal melanised keratinocytes with a score of 3 was significantly higher in the SK group (n = 31; 63.2%) than in the BCC group (n = 6; 20%) (p = 0.001), and they were the main cells representing the pigmented appearance of the tumours. No significant difference was found between both tumour groups in terms of their melanophage density scores (p = 0.206). DISCUSSION: This study is the first step towards an objective quantification of the melanocytes in pigmented epithelial tumours and may provide a morphological background for future studies on these skin lesions.

The first case of myxoinflammatory fibroblastic sarcoma affecting the maxillary bone.

Myxoinflammatory fibroblastic sarcoma (MIFS) is rare and malignant soft-tissue neoplasms that typically present in the extremities. In the literature, MIFS has been reported in the groin, back, neck, nose, and temporal regions in addition to the extremities. We report a case of MIFS presenting with the complaints of nasal bleeding, purulent nasal discharge, and swelling on the right side of his face. Polypoid tissues protruded from the middle meatus were observed and initial diagnosis was inverted papilloma. The painless tumor was initially mistaken for low-grade myxofibrosarcoma in biopsy. Maxillectomy was performed and made the rare diagnosis of MIFS. Fibroblastic proliferation with extensive local spread from subcutaneous tissue to the epithelium of the maxillary sinus mucosa, maxillary bone, and especially along the bone marrow was observed. To the best of our knowledge, this is the first reported case of MIFS involving the maxillary bone.

Comparison of the healing effects of mesazaline and Ganoderma lucidum in acetic acid-induced colitis in rats.

PURPOSE: The etiology and pathogenesis of distal colitis (DC) are poorly understood. Activation of intestinal inflammatory response may lead to intestinal tissue necrosis. Antioxidant and anti-inflammatory agents are among the treatment options. Our study aimed to compare the protective effects of mesalazine and Ganoderma lucidum in acetic acid (AA)-induced colitis in rats. METHODS: Twenty-four rats were randomly grouped as colitis, mesalazine, G. lucidum, and combined (G. lucidum + mesalazine) groups. DC was induced by intrarectal administration of AA. Statistical comparisons were done by using parameters including colonic tissue IL-1, IL-6, TNF-α, and CRP levels. Histopathologic changes of the samples of colonic tissue were scored as mucosal damage score and inflammatory score. A P-value of <0.05 was considered significant. RESULTS: Intrarectal administration of AA leads to increased interleukin and CRP levels. High mucosal damage and inflammatory scores were noted in colitis group animals. Single mesalazine or G. lucidum treatment produced considerably decreased tissue interleukin and CRP levels. The lowest tissue interleukin and CRP levels were noted in the combined treatment group of animals. Mucosal damage and inflammatory scores were found to be significantly low in this group of animals. CONCLUSION: The intrarectal administration of AA results in an activation of intestinal inflammation and severe mucosal damage in colonic tissue. Single use of mesalazine and G. lucidum treatment decreases the severity of intestinal inflammatory response and mucosal damage. The healing effects of the combined treatment of mesalazine and G. lucidum seem to be more effective than that of separate use in the treatment of DC.

A Case of Primary Undifferentiated Pleomorphic Sarcoma of the Lung.

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Dermoscopic diagnosis of notalgia paresthetica.

Dermoscopic examination is a very effective and practical method that significantly reduces the need for invasive diagnostic procedures in many skin diseases. Dermoscopic features of many cutaneous conditions have been well described, however, only one single case report has defined dermoscopic features of notalgia paresthetica so far. The clinical presentation of this entity can mimic many dermatological conditions including lichen simplex chronicus, cutaneous amyloidosis, and tinea versicolor. We tried to identify dermoscopic findings of the notalgia paresthetica, aiming to facilitate the diagnosis.

Comparison of the histopathological differences between the spinal material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis.

BACKGROUND: Lumbar disc herniation (LDH) occurs owing to the inability of the posterior longitudinal ligament (PLL) to preserve the disc material within the intervertebral space. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH. OBJECTIVE: Investigate and compare the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH. DESIGN: Descriptive, cross-sectional. SETTING: Pathology and neurosurgery departments of a tertiary health care institution PATIENTS AND METHODS: The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material were removed together, and had disc degeneration findings that were radiologically and histologically concordant. MAIN OUTCOME MEASURES: PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histo-pathological findings. SAMPLE SIZE: 50. RESULTS: MRI and histological examinations showed fully degenerated black discs (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades (P=.002). CONCLUSION: Longitudinal ligament degeneration can play a significant role in the pathogenesis of LDH. To the best of our knowledge, this study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH. LIMITATIONS: Small sample, retrospective CONFLICT OF INTEREST: None.

Dermoscopic rainbow pattern: A strong clue to malignancy or just a light show?

OBJECTIVE: Rainbow pattern is a dermoscopic finding composed of multiple colors simulating a rainbow. It is known as a characteristic feature of Kaposi's sarcoma. Here, we reported different non-Kaposi's sarcoma conditions with a rainbow pattern aiming to discuss the diagnostic significance of the finding. METHODS: In this multicenter study, dermoscopic images of the non-Kaposi's sarcoma lesions having a histopathological diagnosis were reviewed for the presence of a rainbow pattern. Dermoscopic examination was performed by a polarized handheld dermoscope with x10 magnification. RESULTS: A total of 840 lesions were reviewed and 21 (2%) non-Kaposi sarcoma lesions having dermoscopic rainbow pattern were detected. These lesions were as follows; pyogenic granuloma (n=4, 19%), hypertrophic scar (n=4, 19%), basal cell carcinoma (n=2, 10%), dermatofibroma (n=2, 10%), angiokeratoma (n=2, 10%), blue nevus (n=1, 5%), granuloma annulare (n=1, 5%), strawberry angioma (n=1, 5%), epidermal cyst (n=1, 5%), malignant melanoma (n=1, 5%), dissecting cellulitis (n=1, 5%) and subungual hematoma (n=1, 5%). The most common localization was limb (n=14, 67%) followed by face (n=3, 14%). CONCLUSION: We suggest that the rainbow pattern is a complex and quite unspecific optic phenomenon which can be seen both in vascular and non-vascular lesions. Its diagnostic significance should be considered in the context of the other structural dermoscopic finding. To the best of our knowledge, to our knowledge, this is the most comprehensive study focusing on rainbow pattern in non-Kaposi's sarcoma lesions. Here, we also reported rainbow pattern in dissecting cellulitis, granuloma annulare and subungual hematoma which has not been shown to have rainbow pattern previously.