Corrigendum: Quantification of joint mobility limitation in adult type 1 diabetes.

[This corrects the article DOI: 10.3389/fendo.2023.1238825.].

Quantification of joint mobility limitation in adult type 1 diabetes.

Aims: Diabetic cheiroarthropathies limit hand mobility due to fibrosis and could be markers of a global profibrotic trajectory. Heterogeneity in definitions and lack of a method to measure it complicate studying associations with organ involvement and treatment outcomes. We measured metacarpophalangeal (MCP) joint extension as a metric and describe magnetic resonance (MR) imaging determinants of MCP restriction. Methods: Adults with type 1 diabetes were screened for hand manifestations using a symptom questionnaire, clinical examination, and function [Duruoz hand index (DHI) and grip strength]. Patients were segregated by mean MCP extension (<20°, 20°-40°, 40°-60°, and >60°) for MR imaging (MRI) scanning. Patients in the four groups were compared using ANOVA for clinical features and MRI tissue measurements (tenosynovial, skin, and fascia thickness). We performed multiple linear regression for determinants of MCP extension. Results: Of the 237 patients (90 men), 79 (33.8%) with cheiroarthropathy had MCP extension limitation (39° versus 61°, p < 0.01). Groups with limited MCP extension had higher DHI (1.9 vs. 0.2) but few (7%) had pain. Height, systolic blood pressure, and nephropathy were associated with mean MCP extension. Hand MRI (n = 61) showed flexor tenosynovitis in four patients and median neuritis in one patient. Groups with MCP mobility restriction had the thickest palmar skin; tendon thickness or median nerve area did not differ. Only mean palmar skin thickness was associated with MCP extension angle on multiple linear regression. Conclusion: Joint mobility limitation was quantified by restricted mean MCP extension and had structural correlates on MRI. These can serve as quantitative measures for future associative and interventional studies.

A case-control study addressing the population of epidermal and dermal inflammatory infiltrate including neural milieu in primary prurigo nodularis using S-100 and toluidine blue stain and its therapeutic implications.

BACKGROUND: The pathogenesis of prurigo nodularis (PN) is considered to be multifactorial, with numerous cells and cytokines confabulating to produce an aberrant immune response. METHODS: A cross-sectional observational study was done in cases of untreated primary prurigo nodularis cases with histopathological assessment in 49 cases from lesional and nonlesional skin with assessment of epidermal and dermal changes, dermal infiltrate, S-100 and toluidine blue staining to assess the expression of nerve and mast cells. RESULTS: The most common histological changes seen in lesional skin were hyperkeratosis (98%), irregular hyperplasia (69.4%), hypergranulosis (69.4%), subepidermal clefting (6%), vertical collagen bundles (51.0%), and dermal fibrosis (48.9%). Chronic inflammatory infiltrate was seen in all cases (100%) predominantly of lymphocytes (100%) followed by eosinophils (18.4%), plasma cells (8.2%), and neutrophils (2.0%). There was a marked increase in the expression of S-100 (6.92 ± 3.40 vs. 3.94 ± 2.15, P < 0.001) and toluidine blue (4.99 ± 4.47 vs. 1.22 ± 1.28, P < 0.001) in the lesional skin as compared to the nonlesional skin. CONCLUSION: We can infer that the epidermal and dermal pathology in PN is related to the infiltrate of lymphocytes, mast cells, and neural hyperplasia which perpetuate the pathogenesis by triggering the itch-inflammation cycle. Thus, apart from immunosuppressive agents that target lymphocytes and their cytokines, therapy targeted at mast cells and neural proliferation may be needed to treat prurigo nodularis.

Kimura's disease: A short study of cytomorphologic features with its differential diagnosis and review of literature.

Kimura's disease (KD) is a chronic inflammatory disorder of unknown etiology, endemic in Asia. The typical clinical manifestations include a triad of painless unilateral cervical lymphadenopathy or subcutaneous masses predominantly in the head-and-neck region, blood and tissue eosinophilia, and elevated serum immunoglobulin (Ig) E levels. Many conditions including benign and malignant may mimic KD clinically. This study reports cytologic features of seven cases of KD which were studied and correlated with histology, Ig profile, and peripheral blood examination. KD shows a good response to medical treatment; hence, fine-needle aspiration cytology in conjunction with other laboratory findings lowers the need for additional biopsy procedures for early diagnosis as well as diagnosis of recurrent lesions.

Multiple tuberous xanthomas diagnosed on fine-needle aspiration cytology - Report of a rare case.

Xanthomas are papulonodular skin lesions present in lipoprotein metabolism disorders, which result in cholesterol deposits in subcutaneous tissue, tendons, ligaments, periosteum, etc. A 28-year-old male presented with multiple soft-tissue swellings, prominently over joints. Fine-needle aspiration (FNA) from multiple sites had similar appearance with foamy histocytes and giant cells. We describe an unusual case of tendinous and tuberous xanthoma diagnosed by cytology. Acquaintance with FNA cytology findings in xanthomas can help to avoid the need of surgical biopsy, as xanthomas can regress on medical therapy alone.

Comparison of hematologic abnormalities between hospitalized coronavirus disease 2019 positive and negative patients with correlation to disease severity and outcome.

Peripheral blood smear (PBS) changes in coronavirus disease 2019 (COVID-19) are diverse and have been reported in the literature in the form of case series with relatively smaller sample sizes and with a handful of studies showing the association between PBS and clinical severity. This study aims to highlight the numerical and morphological changes in peripheral blood of COVID-19 patients and to compare the same in intensive care unit (ICU) and non-ICU settings as well as with disease severity and outcome. The study included 80 COVID-19 positive (41 ICU and 39 non-ICU) patients and 32 COVID-19 negative ICU patients. Complete blood counts (CBCs) and PBS findings were studied and scored by two pathologists blindfolded. Absolute lymphocyte count (ALC) and absolute eosinophil count (AEC) were significantly lower in COVID-19 positive cases as compared to the COVID-19 negative group (p = 0.001 and p = 0.001). COVID-19 positive group showed significant left myeloid shift (p = 0.021), Dohle bodies (p = 0.025) with significant prominence of acquired pseudo-Pelger-Huët anomaly, ring-shaped neutrophils, monolobate neutrophils, and plasmacytoid lymphocytes as compared to control group (p = 0.000, p = 0.009, p = 0.046, and p = 0.011, respectively). The overall mean white blood cell (WBC) counts were higher in COVID-19 positive ICU patients as compared to non-ICU COVID patients with significant shift to left, presence of ring-shaped neutrophils, monocyte vacuolation, and large granular lymphocytes (p = 0.017, p = 0.007, p = 0.008, and p = 0.004, respectively). Deceased group showed significantly higher WBC count (p = 0.018) with marked neutrophilia (p = 0.024) and toxic granulation (p = 0.01) with prominence of monocyte vacuolization, ring-shaped neutrophils, large granular lymphocytes, and reactive lymphocytes. Parameters like myeloid left shift, ring-shaped neutrophils, monocyte vacuolation, and large granular lymphocytes emerged as highly sensitive markers of disease severity. Therefore, serial CBC with comprehensive PBS analysis should be done in every newly diagnosed hospitalized COVID-19 patient which potentially predicts the course of the disease.

Aspiration cytology of facial nerve schwannoma of parotid gland: A rare diagnosis.

Schwannoma is a benign nerve sheath tumour rarely found in the head and neck region and much less commonly found in the intraparotid facial nerve. It is a slow-growing encapsulated tumour arising from differentiated Schwann cells or axonal nerve sheath. It can occur anywhere along the course of the facial nerve. Patients most commonly present with an asymptomatic swelling, in the absence of any signs of facial nerve palsy. Accordingly, diagnosis is usually difficult before surgical removal and histopathological examination. Here, we report a rare case of facial nerve schwannoma (FNS), diagnosed on fine needle aspiration cytology, in a 35-year-old male who presented with a painless, gradually increasing swelling in the right infra-auricular region for the last 2 years. His general examination revealed no signs of facial muscle weakness. The cytodiagnosis of intraparotid FNS was further confirmed by immunohistochemistry on cell block.

A prospective study examining the expression of STAT 1, 3, 6 in prurigo nodularis lesions with its immunopathogenic and therapeutic implications.

BACKGROUND: Prurigo nodularis (PN) is a chronic dermatologic condition manifesting as multiple papulonodular lesions occurring on the background of intense pruritus. PN could be primary or secondary. The exact immune pathogenesis of PN is not yet clear, and multiple pathways are proposed with the JAK-STAT pathway rarely being investigated. AIMS: In this study, our aim was to assess the role of Th cells in PN by comparing the expression of STAT 1, 3, and 6 in involved and normal skin of primary prurigo nodularis. METHODS: A total of 49 clinico-histopathologically proven cases of primary prurigo nodularis were included. Two skin biopsies for each patient from lesional and non-lesional skin were stained with STAT 1, 3, and 6, and the nuclear staining pattern in the epidermis was graded as strong, moderate, weak, or none. RESULTS: Statistically significant expression of STAT 3 and STAT 6 staining was seen in the epidermis of the lesional skin as compared to non-lesional skin. CONCLUSION: Our study showed a marked dominance of STAT 3 and STAT 6 staining in the epidermis which signifies that the keratinocytes play an important role in PN and suggest that Th2, Th17, and Th22 cytokines mediate the tissue response in PN.

Comparative evaluation of squash smear and frozen section in the intraoperative diagnosis of central nervous system tumours.

BACKGROUND: The squash smear technique was introduced into intra-operative neurosurgical diagnosis as early as 1930. It is becoming increasingly popular in the diagnosis of central nervous system (CNS) lesions, and is fairly accurate even with a small sample. The current study assesses the accuracy and utility of the squash smear and frozen section (FS) techniques in intraoperative consultations. Correlations with histopathological diagnoses are presented. AIMS: To compare two intra-operative diagnostic techniques-squash smear cytology and FS examination-in the context of central nervous system tumours. MATERIALS AND METHODS: A total of 53 cases of CNS tumours were included in the study, and all were subjected to squash smear examination. FS examinations were conducted for 39 of these samples. The results of the two techniques were compared and correlated with histopathological diagnoses. The observed results were then analysed using SPSS software. RESULTS: The most common primary CNS tumours were gliomas and meningiomas (28.3% each). The sensitivity, specificity, positive predictive value and negative predictive value for squash cytology were 86.67%, 87.5%, 81.25% and 91.3%, and for FS were 91.67%, 93.10%, 91.67%, 93.10%, respectively, with a corresponding comparative P-value of 0.56 (insignificant). Cytological diagnosis showed complete correlation with histopathological diagnosis in 39 cases (73.58%), partial correlation in eight cases (15.1%) and no correlation in six cases (11.32%). FS diagnosis showed complete correlation in 29 cases (74.35%), partial correlation in eight cases (20.5%) and no correlation in two cases (5.1%). CONCLUSION: Squash smear is a rapid, self-sufficient and cost-effective method for the intraoperative diagnosis of CNS tumours. The squash smear and FS techniques are complementary procedures that assist the pathologist in reaching a diagnosis.

Coronary arteritis as a cause of sudden cardiac death in a young girl.

A case of probable coronary arteritis in a young girl who died suddenly and unexpectedly is presented. The histologic presentation of the disorder is discussed, especially the differential diagnosis of arteritis of the coronary arteries with an emphasis on tuberculosis (TB). TB myocarditis with or without concomitant lung involvement is rare, and tubercular coronary arteritis without underlying pulmonary Koch's disease is all the rarer. We herein describe a case where the cause of death was ascertained on post-mortem examination.

Cytological diagnosis of microfilariae in clinically unsuspected cases: A retrospective review of 12 cases.

BACKGROUND: Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies. AIMS AND OBJECTIVES: This study was undertaken to analyse the prevalence and cytological findings of cases of incidentally found microfilariae in cytology smears (fine needle aspiration cytology [FNAC]/exfoliative cytology) from different parts of the body. MATERIALS AND METHODS: This was a retrospective study over 3 years, in which cases of microfilariae in aspirates from swelling of different locations, body fluids, and pap smears were reviewed, and the clinicopathological data analysed. RESULTS AND ANALYSIS: Out of 11 530 cases of FNAC, 8700 cases of fluid cytology, and 9000 of conventional cervicovaginal smears, 12 cases (0.04%) of incidental findings of microfilariae were documented in cytology smears. The cases were diagnosed from lymph node (one case), hand (one case), scrotal area (one case), axilla (one case), breast (one case), subcutaneous tissue (three cases), urine (three cases), and Pap smear (one case). We found eosinophilia in one case (8.3%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions. CONCLUSION: Cytology smear examination can play an important role in diagnosing occult filariasis in clinically unsuspected cases in association with other pathologies.

Cytomorphological spectrum of cysticercosis: A study of 26 cases.

BACKGROUND: Cysticercosis is a systemic parasitic disease caused by the larval stage of Taenia solium. It is the most common parasitic disease worldwide. Fine needle aspiration cytology can play an important role in prompt recognition of this disease. OBJECTIVE: To study the role of FNAC in the diagnosis of cysticercosis. MATERIALS AND METHODS: This study included 26 patients with parasitic infestation who presented with palpable subcutaneous and intramuscular nodules at different sites. Their clinical presentations and fine needle aspiration cytomorphological features are reported. RESULTS: The age range of these patients was 7-60 years. The majority were males. The most commonly affected site was head and neck followed by upper extremity. Most of the cases were clinically misdiagnosed as lipomas, neurofibromas, lymphadenitis, epidermal inclusion cyst, sialadenitis, and soft tissue tumours. The aspirate was clear fluid in the majority of cases. All of the cases revealed fragments of bladder wall with associated granulomas in seven cases and giant cells in four cases. However, none of the case revealed hooklets. CONCLUSION: Fine needle aspiration cytology can provide a simple, minimally invasive, low-cost, outpatient diagnostic technique for the diagnosis of cysticercosis, as cytological diagnosis is quite clear when the actual parasitic structures are identified in the smear.

A Rare Case of Epithelioid Myofibroblastoma of Breast Mimicking Lobular Carcinoma on Trucut Biopsy: a Diagnostic Pitfall and Literature Review.

Epithelioid myofibroblastoma of the breast is a rare benign stromal tumor occurring in the postmenopausal females and elderly males. We report one such case in a 65-year-old female who underwent trucut biopsy from a well-defined right breast lump, which was misinterpreted as invasive lobular carcinoma on histology. Tumor showed mild to moderately pleomorphic tumor cells arranged in single file pattern, loosely dispersed and focally in sheets with inconspicuous nucleoli embedded in a fibrotic and hyalinized stroma. Immunohistochemistry for E-cadherin was negative further substantiating the morphological diagnosis. However, mastectomy specimen revealed it to be a case of epithelioid myofibroblastoma with the help of a large panel of immunohistochemical stains. In this report, we emphasize on the challenges of establishing this rare diagnosis mimicking lobular carcinoma, a diagnostic pitfall on trucut biopsy.

A Prospective Study Examining the Effect of Selected Topical and Systemic Drugs on Pruritus Grading System Score and STAT 6 Expression in Patients of Prurigo Nodularis.

Background: Prurigo nodularis (PN) is a chronic dermatologic condition presenting as multiple papulonodular lesions occurring with intense pruritus. Though numerous agents (topical, systemic, phototherapy and biological drugs) have been tried, the outcomes are variable. Objectives: The aim of this study was to assess the role of topical and systemic therapies in primary PN by comparing the Pruritus Grading System (PGS) score at baseline and 1 month post-therapy. Materials and Methods: Of 86 diagnosed cases of PN, 49 cases of primary PN were clinically graded by Pruritus Grading System Score (PGSS), and assessed histopathologically by IHC staining (STAT-1, 3, and 6). Apart from topical agents, oral nortriptyline (mild grade), methotrexate (moderate grade) and thalidomide (severe grade) were administered, whereas doxepin was administered for itching. The PGSS was assessed after 1 month of therapy. Results: Among 49 patients of PN, the majority of patients showed a significant decrease in PGSS (P = <0.001) in 1 mont, which correlated with STAT-6 expression. The combination of different topical and oral agents resulted in a statistically significant change in severity, though individual drugs did not achieve statistically significant results. Conclusion: A combination of selected oral and topical agents can effectively control the severity of PN within one month, and this was found to correlate with STAT 6 expression.

Coronary arteritis as a cause of sudden cardiac death in a young girl

A case of probable coronary arteritis in a young girl who died suddenly and unexpectedly is presented. The histologic presentation of the disorder is discussed, especially the differential diagnosis of arteritis of the coronary arteries with an emphasis on tuberculosis (TB). TB myocarditis with or without concomitant lung involvement is rare, and tubercular coronary arteritis without underlying pulmonary Koch's disease is all the rarer. We herein describe a case where the cause of death was ascertained on post-mortem examination.