Acute Dyspnea and Hemoptysis in an 84-Year-Old Man With Multiple Comorbidities.

CASE PRESENTATION: An 84-year-old man with an active smoking habit presented to the ED with dyspnea, hemoptysis, and thick phlegm that was difficult to clear. He reported no weight loss, no fever, and no chest pain or dysphonia. He denied both international travel and previous contact with confirmed cases of TB or SARS-CoV-2. He had no known occupational exposures. The patient's personal history included a resolved complete atrioventricular block that required a permanent pacemaker, moderate-to-severe COPD, rheumatoid arthritis (treated with oral prednisone, 2.5 mg/d) and B-chronic lymphocytic leukemia (treated with methotrexate and prophylactic oral supplements of ferrous sulfate). Moreover, he was in medical follow up because of a peptic ulcer, atrophic gastritis, and colonic diverticulosis. The patient also had a history of thoracic surgery after an episode of acute mediastinitis from an odontogenic infection, which required ICU management and temporal tracheostomy.

Late Cardiac Pathology in Severe Covid-19. A Postmortem Series of 30 Patients.

The role of SARS-CoV-2 as a direct cause in the cardiac lesions in patients with severe COVID-19 remains to be established. Our objective is to report the pathological findings in cardiac samples of 30 patients who died after a prolonged hospital stay due to Sars-Cov-2 infection. We performed macroscopic, histological and immunohistochemical analysis of the hearts of 30 patients; and detected Sars-Cov-2 RNA by RT-PCR in the cardiac tissue samples. The median age of our cohort was 69.5 years and 76.6% were male. The median time between symptoms onset and death was 36.5 days. The main comorbidities were arterial hypertension (13 patients, 43.3%), dyslipidemia (11 patients, 36.7%), cardiovascular conditions (8 patients, 26.7%), and obesity (8 patients, 26.7%). Cardiovascular conditions included ischemic cardiopathy in 4 patients (13.3%), hypertrophic cardiomyopathy in 2 patients (6.7%) and valve replacement and chronic heart failure in one patient each (3.3%). At autopsy, the most frequent histopathological findings were coronary artery atherosclerosis (8 patients, 26.7%), left ventricular hypertrophy (4 patients, 13.3%), chronic epicardial inflammation (3 patients, 10%) and adipose metaplasia (2 patients, 6.7%). Two patients showed focal myocarditis, one due to invasive aspergillosis. One additional patient showed senile amyloidosis. Sars-Cov-2 RNA was detected in the heart of only one out of 30 patients, who had the shortest disease evolution of the series (9 days). However, no relevant cardiac histological alterations were identified. In present series, cardiac pathology was only modest in most patients with severe COVID-19. At present, the contribution of a direct effect of SARS-CoV-2 on cardiac lesions remains to be established.

Nerve Sheath Myxoma Involving the Medial Rectus Muscle: A Case Report.

A 63-year-old man reported a 2-year history of painless OS proptosis. The first MRI, performed in the institution of origin, resulted in a diagnosis of hemangioma versus orbital pseudotumor. Examination revealed proptosis and mild chemosis. Ancillary tests were normal, and oral prednisone was initiated without remarkable changes. Later, an incisional biopsy identified the lesion as an intramuscular myxoma of the left rectus, and a new MRI was ordered. It described a fusiform thickening of the medial rectus with and exophytic growth below the inferior rectus and upward toward the superior oblique. Due to the localization of the lesion, a combined transcaruncular and swinging eyelid approach with a lateral orbitotomy was performed. Histopathological examination revealed a proliferation of stromal origin composed of myxoid matrix with fusocellular and stellate-shaped cells. Cells were S-100, CD34, and CD56 positive and negative for epithelial membrane antigen, CD68, CD10, actin, and desmin. Results were consistent with a left medial rectus nerve sheath myxoma.

[Metaplastic ossification in nasal polyp]. / Metaplasia ósea en pólipo nasal.

Metaplasia is the production by cells of a kind of tissue other than that corresponding to their lineage, ie it represents the conversion of one tissue into another. Bony metaplasia has frequently been described in polyps of the gastrointestinal tract. In nasal polyposis it is an extremely uncommon finding. We describe the case of a 42 year-old female presenting nasal obstruction due to a unilateral nasal tumour. She was operated on by means of endoscopic sinonasal surgery and the definitive diagnosis was nasal polyposis with areas of bony metaplasia.

Metaplasia ósea en pólipo nasal / Metaplastic ossification in nasal polyp

La metaplasia es la producción por parte de las células de un tipo de tejido distinto del de su estirpe; es el cambio de un tejido en otro. La metaplasia ósea ha sido descrita en pólipos del tracto gastrointestinal con cierta frecuencia. En la poliposis nasal es un hecho extremadamente infrecuente. Describimos el caso de una paciente de 42 años con clínica de obstrucción nasal; presentaba una tumoración nasal unilateral y fue intervenida mediante abordaje endoscópico nasosinusal. El diagnóstico definitivo fue poliposis nasal con áreas de metaplasia ósea

Metaplasia is the production by cells of a kind of tissue other than that corresponding to their lineage, ie it represents the conversion of one tissue into another. Bony metaplasia has frequently been described in polyps of the gastrointestinal tract. In nasal polyposis it is an extremely uncommon finding. We describe the case of a 42 year-old female presenting nasal obstruction due to a unilateral nasal tumour. She was operated on by means of endoscopic sinonasal surgery and the definitive diagnosis was nasal polyposis with areas of bony metaplasia