Severe Manifestation of Peritoneal Tuberculosis: Clinical Case Report

Aim: To describe the clinical manifestation and the diagnostic process of a patient with peritoneal tuberculosis as a clinical challenge in a tertiary referral center in a Latin American country. Case description: A 61-year-old male patient from the urban area of Cali consulted for edema in the lower limbs, ascites, hyporexia, weight loss, cachexia, thrombocytopenia, elevated transaminases, imaging of splenomegaly and pulmonary, hepatic, and peritoneum nodules. Initially, neoplasia was suspected, but the adenosine deaminase report and histopathology were consistent with the diagnosis of peritoneal tuberculosis. Conclusion: Peritoneal tuberculosis represents the sixth cause of extrapulmonary tuberculosis, after lymphatic, pleural, osteoarticular, genitourinary, and meningeal manifestations. Despite having surveillance systems, peritoneal tuberculosis is still considered the most challenging infectious disease to reach a definitive diagnosis. We present a case of disseminated tuberculosis in which invasion of the peritoneum was verified, for which tetraconjugate treatment was started; however, the patient showed an adverse hepatic reaction and died due to multisystem involvement of a pulmonary infectious complication.

Objetivo: describir la presentación clínica y el proceso diagnóstico de un paciente con tuberculosis peritoneal como reto clínico en un centro de alta complejidad de un país latinoamericano. Descripción del caso: un paciente masculino de 61 años procedente del área urbana de Cali consultó por edema en los miembros inferiores, ascitis, hiporexia, pérdida de peso, caquexia, trombocitopenia, elevación de transaminasas, imágenes de esplenomegalia y nódulos pulmonares, hepáticos y en el peritoneo. Inicialmente se sospechó neoplasia, pero el reporte de adenosina desaminasa y la histopatología fueron consistentes con el diagnóstico de tuberculosis peritoneal. Conclusión: la tuberculosis peritoneal representa la sexta causa de tuberculosis extrapulmonar, después de las manifestaciones linfáticas, pleurales, osteoarticulares, genitourinarias y meníngeas. A pesar de contar con sistemas de vigilancia, la tuberculosis peritoneal sigue siendo considerada como la enfermedad infecciosa más desafiante para llegar a un diagnóstico definitivo. Se presenta un caso de tuberculosis diseminada en el que se comprobó invasión del peritoneo, por lo que se inició un tratamiento tetraconjugado; sin embargo, presentó una reacción adversa hepática y falleció producto del compromiso multisistémico de una complicación infecciosa pulmonar.

[Gastric metastases with a choriocarcinoma component from a postpuberal teratoma with mature histology]. / Metástasis gástricas con componente de coriocarcinoma de un teratoma testicular pospuberal con histología madura.

Germ cell tumors are the most frequent neoplasia in young males. The aims of this study is to describe a case in which a postpuberal teratoma suffers a transformation to choriocarcinoma and metastasize to stomach. We have made a systematic review in PubMed and consensus documents to study this mismatch between the tumour, metastasis and the exception of gastric metastatic affectation. We describe three options to explain this discordance: a mixed germ cells tumour, a burned out tumour or a germ cells tumour derived from a malignant germ cell tumour precursor or different clonal strains. After made a thorough investigation we conclude that the most truly option is the last one as we extensive explain below. Once the gastric metastatic lesions are extremely rare and reach to <5%, but there are not conclusive assessments.

Foliculitis pseudolinfomatosa de McNutt (localización nasal) / McNutt's pseudolymphomatous folliculitis (nasal located)

La foliculitis pseudolinfomatosa, descripta por McNutt en 1986, es una afección de etiología desconocida y poco frecuente, que simula un linfoma cutáneo tanto por su clínica como por su histología. Se presenta como una lesión nodular solitaria, eritematosa, de 0,5 hasta 3cm, de crecimiento rápido, sobre todo en la cara, en personas de 40 a 60 años, con una histopatología caracterizada por un infiltrado linfocitario B yT perifocular, y células dendríticas positivas en la inmunohistoquímica para S100yCD1a. Su curso es benigno, muchas veces autolimitado. Se expone el caso de una paciente con una particular forma clínica de pseudolinforma.

Pseudolymphomatous folliculitis, described by McNutt in 1986, is a non-frequent entity of unknown etiology that simulates a cutaneous lymphoma, both clinically and histologically. It shows as a solitary erythematous nodular lesion of 0.5 to 3 cm, with a rapid growth, mainly on the face, in people aged 40 to 60 years, and histopathology characterized by a perifollicular B and T lymphocytic infiltrate, and positive dendritic cells for immunohistochemistry S100 and CD1a. Its course is benign, often self-limited. The case of a patient with a particular clinical form of pseudolymphoma is presented.

Síndrome trófico trigeminal / Trigeminal trophic syndrome

El síndrome trófico trigeminal es una enfermedad infrecuente caracterizada por úlceras faciales autoprovocadas en regiones de anestesia o hipoestesia, secundarias al daño del nervio trigémino. Presentamos tres casos de este síndrome en seguimiento en nuestro centro.

Trigeminal trophic syndrome is an uncommon disease characterized by self-inflicted facial ulcers in anesthetic or hypoesthetic areas, secondary to trigeminal nerve damage. We present three cases in follow up at our hospital.

Late Campanian fossil of a legume fruit supports Mexico as a center of Fabaceae radiation.

Fabaceae is one of the most diverse angiosperm families and is distributed across the globe in a variety of environments. The earliest evidence of the family, previous to this work, was from Paleogene sediments where it was found to be diverse in many fossil assemblages around the world. Here, we describe a fossil legume fruit from the Olmos Formation (upper Campanian) in northern Mexico. We designated the fossil fruit as Leguminocarpum olmensis Centeno-González, Martínez-Cabrera, Porras-Múzquiz et Estrada-Ruiz sp. nov., and related it with the Fabaceae family based on the presence of a dehiscent pod with two valves, an apex bearing stylar base, short stipe, and reticulated veins in the pericarp. We propose a new fossil species of Leguminocarpum for this fossil fruit. This fossil provides critical information on the long geologic history of Leguminosae around the world, significantly extending the record into the Cretaceous of Mexico.

Ectopic liver in a five-week-old embryo.

The first case of a placental tumor composed of benign hepatic tissue was published in 1986 and considered a placental benign hepatocellular adenoma. Since then, this lesion is better known as ectopic liver, and a total of 12 cases have been published. The ectopic liver located in the umbilical cord is an even rarer alteration, with only nine cases described to date. We report another case of ectopic liver, this time in an embryo of only five weeks of gestational age.

Angioleiomioma renal con patrón inmunohistoquímico miogénico y melanocítico como variante del angiomiolipoma / Renal angioleiomyoma with a myogenic and melanocytic immunophenotype, as a variant of angiomyolipoma

Se presenta el caso de un varón de 67 años con tumoración cortical nodular renal izquierda. Fue intervenido quirúrgicamente por crecimiento tumoral progresivo de 16-20mm a lo largo de un año y tras seguimiento por estudio ecográfico y de resonancia magnética. Se practicó tumorectomía del nódulo y en el examen microscópico se observó una formación bien delimitada y no encapsulada, resultante de proliferación tumoral de células fusiformes sin atipias y de apariencia muscular lisa, que adoptaban disposición arremolinada junto a zonas ricamente vascularizadas. En el estudio inmunohistoquímico, en la proliferación fusocelular se demostró positividad para marcadores musculares (actina de músculo liso, desmina y caldesmón) y marcadores melanocíticos (HMB-45 y Melan A). Nuestro caso parece tratarse de una neoplasia renal de patrón angioleiomiomatoso, pero con características inmunohistoquímicas de angiomiolipoma (PEComa) sin componente lipomatoso o lipídico, tipo de tumoración sobre la que no poseemos información previa en la literatura revisada

We present a case of a 67 year old male with a cortical nodular tumour of the left kidney. During a year's follow-up with ultrasound and MRI, the tumour was seen to increase in size by 16-20 mm. The nodule was surgically removed. Microscopically it was well defined and unencapsulated, with a proliferation of typical fusiform cells of smooth muscle cell appearance, clumped around well vascularized areas. Immunohistochemically, the neoplasm was positive for muscle markers (smooth muscle actin, desmin and caldesmon) and melanocyte markers (HMB-45 and Melan A). Our case would appear to be a renal neoplasm with an angioleiomyomatous pattern, but with immunohistochemical characteristics of angiomyolipoma (PEComa), however, without either a lipomatous or lipid cell component. We found no previous reports of this type of tumour in the literature

[Renal angioleiomyoma with a myogenic and melanocytic immunophenotype, as a variant of angiomyolipoma]. / Angioleiomioma renal con patrón inmunohistoquímico miogénico y melanocítico como variante del angiomiolipoma.

We present a case of a 67 year old male with a cortical nodular tumour of the left kidney. During a year's follow-up with ultrasound and MRI, the tumour was seen to increase in size by 16-20 mm. The nodule was surgically removed. Microscopically it was well defined and unencapsulated, with a proliferation of typical fusiform cells of smooth muscle cell appearance, clumped around well vascularized areas. Immunohistochemically, the neoplasm was positive for muscle markers (smooth muscle actin, desmin and caldesmon) and melanocyte markers (HMB-45 and Melan A). Our case would appear to be a renal neoplasm with an angioleiomyomatous pattern, but with immunohistochemical characteristics of angiomyolipoma (PEComa), however, without either a lipomatous or lipid cell component. We found no previous reports of this type of tumour in the literature.

Nasal embryonal rhabdomyosarcoma with bone marrow metastasis simulating acute leukemia: A case report and review of the literature / Metástasis en médula ósea de rabdomiosarcoma embrionario simulando una leucemia aguda: reporte de un caso y revisión de la literatura

We present a case of a nasal rhabdomyosarcoma (RMS) in a 27-year-old male with epistaxis and nasal obstruction due to a mass, which was subjected to prophylactic tumor embolization. However, histopathological study on the nasal biopsy was impossible due to necrotic changes. As blast cells were present in peripheral blood samples, a bone marrow biopsy was recommended in order to reach a definitive diagnosis. The possibility of an RMS in cases of bone marrow infiltration by a diffuse tumor constituted by small, round, blast-like cells mimicking acute leukemia should be assessed. Immunohistochemical staining in bone marrow biopsy and flow cytometry in aspirate samples may help to establish the diagnosis (CD45 negativity and CD56 positivity) and cytogenetic studies can be useful in identifying a RMS subtype. When clinically possible, it is desirable to await the results of the tumor immunophenotype and those of the primary mass or bone marrow biopsy to avoid possible errors of diagnosis and treatment

Se presenta el caso de un rabdomiosarcoma (RMS) en un varón de 27 años de edad con cuadro de epistaxis y obstrucción por masa nasal, que fue sometido a embolización tumoral profiláctica. El estudio en sangre periférica, fundamentalmente por la detección de células de apariencia blástica, recomendó biopsia de médula ósea que fue determinante para el diagnóstico, debido a que la embolización tumoral en la biopsia nasal, invalidó por cambios necróticos su estudio histopatológico. Se debe evaluar la posibilidad diagnóstica de un RMS, en casos de infiltración de médula ósea por un tumor difuso constituido por células pequeñas, redondas y similares a blastos que imitan una leucemia aguda. La tinción inmunohistoquímica en la biopsia de médula ósea y la citometría de flujo en muestras de aspirado, pueden ayudar a establecer el diagnóstico (negatividad CD45 y positividad CD56) y los estudios citogenéticos pueden ayudar a diferenciar el subtipo de RMS. Cuando sea clínicamente posible, se debe esperar a los resultados del inmunofenotipo celular del tumor y los de la masa primaria o la biopsia de la médula ósea, para así evitar posibles errores de diagnóstico y tratamiento

Nasal embryonal rhabdomyosarcoma with bone marrow metastasis simulating acute leukemia: A case report and review of the literature.

We present a case of a nasal rhabdomyosarcoma (RMS) in a 27-year-old male with epistaxis and nasal obstruction due to a mass, which was subjected to prophylactic tumor embolization. However, histopathological study on the nasal biopsy was impossible due to necrotic changes. As blast cells were present in peripheral blood samples, a bone marrow biopsy was recommended in order to reach a definitive diagnosis. The possibility of an RMS in cases of bone marrow infiltration by a diffuse tumor constituted by small, round, blast-like cells mimicking acute leukemia should be assessed. Immunohistochemical staining in bone marrow biopsy and flow cytometry in aspirate samples may help to establish the diagnosis (CD45 negativity and CD56 positivity) and cytogenetic studies can be useful in identifying a RMS subtype. When clinically possible, it is desirable to await the results of the tumor immunophenotype and those of the primary mass or bone marrow biopsy to avoid possible errors of diagnosis and treatment.

Extraparenchymal ovarian and testicular Leydig cells: ectopic/heterotopic or orthotopic?

PURPOSE: We are conducting a prospective study trying to determine, in both sexes, the frequency of appearance of ectopic Leydig cells, their preferred location, their relationship with nerve structures and the possible causes of their appearance. METHODS: We have studied 86 cases that were removed according to different clinical indications for pathological study: uterine leyomiomas (n = 12), ovarian cystadenoma (n = 4), endometrial hyperplasia (n = 8), endometrial carcinoma (n = 12), cervical carcinoma (n = 4), seminoma (n = 4), fallopian tube ligatures (n = 24), vasectomies (n = 8), nonspecific orchiepididymitis (n = 2), and unknown (n = 8). RESULTS: We have observed ectopic Leydig cells in 13/86 cases (15.11%), 9/72 in the female samples (12.50%) and 4/14 in male samples (28.57%). The most frequent location was the mesosalpinx (4 of 13: 30.76%). CONCLUSIONS: These high figures lead us to believe that the ectopia of Leydig cells is not really a pathologic entity, but a finding related to specific functions yet to be determined.

Multi-Institution Case Series of Pediatric Patients with Laparoscopic Repair of Morgagni Hernia.

INTRODUCTION: Morgagni Larray hernia (MLH) is a very rare disease, which accounts for less than 5% of all congenital diaphragmatic hernias. Laparoscopic repair has been widely used and accepted as a treatment option for patients with this disease. The purpose of our study is to analyze the outcomes of patients with MLH who underwent laparoscopic repair, and to evaluate their postoperative course for outcome, morbidity, and mortality. MATERIALS AND METHODS: A retrospective chart review was performed of patients who were diagnosed with MLH and treated laparoscopically by 10 board-certified pediatric surgeons. RESULTS: Fourteen patients were included in the study. One patient died 1 month postoperatively due to respiratory complications unrelated to the surgery. Thirteen patients were followed for a median of 1.75 years (interquartile 0.3-6.95). There was a single recurrence, which resulted in a partial resection of the hernia sac and repaired without a mesh. We had a success rate of 92.86%. CONCLUSION: MLH is a rare congenital diaphragmatic hernia that is usually diagnosed incidentally. Laparoscopic repair has high success rates and is a viable option for patients with this pathology.

Vessel diameter is related to amount and spatial arrangement of axial parenchyma in woody angiosperms.

Parenchyma represents a critically important living tissue in the sapwood of the secondary xylem of woody angiosperms. Considering various interactions between parenchyma and water transporting vessels, we hypothesize a structure-function relationship between both cell types. Through a generalized additive mixed model approach based on 2,332 woody angiosperm species derived from the literature, we explored the relationship between the proportion and spatial distribution of ray and axial parenchyma and vessel size, while controlling for maximum plant height and a range of climatic factors. When factoring in maximum plant height, we found that with increasing mean annual temperatures, mean vessel diameter showed a positive correlation with axial parenchyma proportion and arrangement, but not for ray parenchyma. Species with a high axial parenchyma tissue fraction tend to have wide vessels, with most of the parenchyma packed around vessels, whereas species with small diameter vessels show a reduced amount of axial parenchyma that is not directly connected to vessels. This finding provides evidence for independent functions of axial parenchyma and ray parenchyma in large vesselled species and further supports a strong role for axial parenchyma in long-distance xylem water transport.

Tattoos: Very Popular, Not So Innocent.

Tattooing is a popular practice worldwide. Its origin dates back to the year 5000 BCE with a frozen mummy and travels across time through diverse cultures and places until it reaches the modern occidental world. Inks and materials used for tattooing are poorly controlled and carry potential risks of skin reactions. The procedure itself is also not innocuous. In this review, different types of tattoos are mentioned and associated dermatologic conditions are discussed. Unfortunately, treatment and removal procedures are often poor in effectiveness and lead to unwanted results. Combining different lasers may be a suitable option that requires further investigation.

A global analysis of parenchyma tissue fractions in secondary xylem of seed plants.

Parenchyma is an important tissue in secondary xylem of seed plants, with functions ranging from storage to defence and with effects on the physical and mechanical properties of wood. Currently, we lack a large-scale quantitative analysis of ray parenchyma (RP) and axial parenchyma (AP) tissue fractions. Here, we use data from the literature on AP and RP fractions to investigate the potential relationships of climate and growth form with total ray and axial parenchyma fractions (RAP). We found a 29-fold variation in RAP fraction, which was more strongly related to temperature than with precipitation. Stem succulents had the highest RAP values (mean ± SD: 70.2 ± 22.0%), followed by lianas (50.1 ± 16.3%), angiosperm trees and shrubs (26.3 ± 12.4%), and conifers (7.6 ± 2.6%). Differences in RAP fraction between temperate and tropical angiosperm trees (21.1 ± 7.9% vs 36.2 ± 13.4%, respectively) are due to differences in the AP fraction, which is typically three times higher in tropical than in temperate trees, but not in RP fraction. Our results illustrate that both temperature and growth form are important drivers of RAP fractions. These findings should help pave the way to better understand the various functions of RAP in plants.

Verrugosis generalizada con linfedema, inmunodeficiencia y displasia genital: síndrome WILD / Generalized verrucosis with limphoedema, immunodeficiency and genital dysplasia: WILD syndrome

La verrugosis generalizada es un rasgo común a diferentes síndromes de inmunodeficiencia, cuyo prototipo es la epidermodisplasia verruciforme (EV). Se presenta una paciente con síndrome WILD (Warts, Immunodeficiency, Lymphoedema, anogenital Dysplasia), que consultó por verrugas profusas, con displasia genital y linfedema. La presencia de DNA para los papilomavirus de los grupos I y II se reveló con hibridización molecular por captura híbrida en microplaca para detección del DNA de HPV de lesiones de cuello uterino. La inmunofenotipificación en sangre periférica demostró población linfoide con moderado aumento de poblaciones NK y TNK, sin evidencia inmunofenotípica de población B clonal. Las verrugas planas mejoraron con retinoides sistémicos e imiquimod tópico. La displasia genital desapareció luego de la vacunación para HPV con vacuna cuadrivalente (AU)

Generalized verrucosis is a common characteristic of several immunodeficiency disorders whose prototype is the epidermodysplasia verruciformis. We report a patient with WILD SYNDROME (Warts, Immunodeficiency, Lymphoedema and anogenital Dysplasia) who consulted for profuse warts, genital dysplasia and limphoedema. The presence of DNA from papillomavirus groups I and II was revealed by molecular hybridization with hybrid capture in microplate for HPV DNA detection of uterine cervical lesions. Immunophenotyping in peripheral blood showed lymphoid population with moderate increase in NK and TNK populations without immunophenotypic evidence of clonal B population. Flat warts improved with systemic retinoids and topical imiquimod. The genital dysplasia disappeared after vaccination with quadrivalent HPV vaccine (AU)

Functional Traits in Parallel Evolutionary Radiations and Trait-Environment Associations in the Cape Floristic Region of South Africa.

Evolutionary radiations with extreme levels of diversity present a unique opportunity to study the role of the environment in plant evolution. If environmental adaptation played an important role in such radiations, we expect to find associations between functional traits and key climatic variables. Similar trait-environment associations across clades may reflect common responses, while contradictory associations may suggest lineage-specific adaptations. Here, we explore trait-environment relationships in two evolutionary radiations in the fynbos biome of the highly biodiverse Cape Floristic Region (CFR) of South Africa. Protea and Pelargonium are morphologically and evolutionarily diverse genera that typify the CFR yet are substantially different in growth form and morphology. Our analytical approach employs a Bayesian multiple-response generalized linear mixed-effects model, taking into account covariation among traits and controlling for phylogenetic relationships. Of the pairwise trait-environment associations tested, 6 out of 24 were in the same direction and 2 out of 24 were in opposite directions, with the latter apparently reflecting alternative life-history strategies. These findings demonstrate that trait diversity within two plant lineages may reflect both parallel and idiosyncratic responses to the environment, rather than all taxa conforming to a global-scale pattern. Such insights are essential for understanding how trait-environment associations arise and how they influence species diversification.

Poroqueratosis genitoglútea: una rara enfermedad habitualmente mal diagnosticada / Genitogluteal porokeratosis: a rare disease often misdiagnosed

Las poroqueratosis constituyen un grupo hererogéneo de trastornos de la queratinización caracterizados por placas anulares de borde elevado queratósico con histopatología que muestra lamelas cornoides. La poroqueratosis genitoglútea (PPG) es una rara variedad, con lesiones inflamatorias, eritematosas, con variable descamación, que suelen confurndirse con enfermedades venéreas, especialmente las provocadas por HPV. Se presenta un paciente con más de 20 años de evolución de la enfermedad, sin diagnóstico previo de la misma, tratado como enfermedad infecciosa...

Wood anatomy reveals high theoretical hydraulic conductivity and low resistance to vessel implosion in a Cretaceous fossil forest from northern Mexico.

The Olmos Formation (upper Campanian), with over 60 angiosperm leaf morphotypes, is Mexico's richest Cretaceous flora. Paleoclimate leaf physiognomy estimates indicate that the Olmos paleoforest grew under wet and warm conditions, similar to those present in modern tropical rainforests. Leaf surface area, tree size and climate reconstructions suggest that this was a highly productive system. Efficient carbon fixation requires hydraulic efficiency to meet the evaporative demands of the photosynthetic surface, but it comes at the expense of increased risk of drought-induced cavitation. Here we tested the hypothesis that the Olmos paleoforest had high hydraulic efficiency, but was prone to cavitation. We characterized the hydraulic properties of the Olmos paleoforest using theoretical conductivity (Ks), vessel composition (S) and vessel fraction (F), and measured drought resistance using vessel implosion resistance (t/b)h(2) and the water potential at which there is 50% loss of hydraulic conductivity (P50). We found that the Olmos paleoforest had high hydraulic efficiency, similar to that present in several extant tropical-wet or semi-deciduous forest communities. Remarkably, the fossil flora had the lowest (t/b)h(2), which, together with low median P50 (-1.9 MPa), indicate that the Olmos paleoforest species were extremely vulnerable to drought-induced cavitation. Our findings support paleoclimate inferences from leaf physiognomy and paleoclimatic models suggesting it represented a highly productive wet tropical rainforest. Our results also indicate that the Olmos Formation plants had a large range of water conduction strategies, but more restricted variation in cavitation resistance. These straightforward methods for measuring hydraulic properties, used herein for the first time, can provide useful information on the ecological strategies of paleofloras and on temporal shifts in ecological function of fossil forests chronosequences.