Locally extensive follicular hamartomas with concurrent follicular cysts and dermoid cysts on the head of a dog.

A 5-month-old, male intact Australian shepherd dog was presented with nodular lesions affecting the dorsal head. A locally diffuse form of follicular hamartomas, with concurrent dermoid cysts and follicular cysts, was diagnosed by histopathological examination. Complete surgical excision of the affected skin and closure with a subdermal plexus advancement flap led to long-term resolution.

Un berger australien mâle intact âgé de 5 mois a été présenté avec des lésions nodulaires affectant la face dorsale de la tête. Une forme localement diffuse d'hamartomes folliculaires, avec des kystes dermoïdes et des kystes folliculaires concomitants, a été diagnostiquée par examen histopathologique. L'éxérèse chirurgicale complète de la peau atteinte et la fermeture avec un lambeau d'avancement du plexus sous-cutané ont conduit à une résolution à long terme.

Un perro pastor australiano macho entero de 5 meses de edad se presentó con lesiones nodulares que afectaban el dorso de la cabeza. Mediante examen histopatológico se diagnosticó una forma localmente difusa de hamartomas foliculares, con quistes dermoides y quistes foliculares concurrentes. La escisión quirúrgica completa de la piel afectada y el cierre con una zona avanzada en colgajo del plexo subdérmico condujo a una resolución a largo plazo.

Giant luteinized follicular cyst of pregnancy / Cisto folicular luteinizado gigante da gestação

Functional cysts usually do not cause symptoms or require surgical intervention. We reported a 17-year-old primi-gravida, gestational age of 10 weeks and 2 days, and ultrasound showing anechoic cyst in the right parauterine re-gion without septa, with a larger diameter of 13.5cm, 632ml, and Doppler color without peripheral vascularization. The patient was oligosymptomatic during gestation. At 37 weeks and 6 days, gestation was interrupted, when the cyst had 2600 ml by ultrasonography. Fetal extraction was performed by cesarean delivery, and a large adnexal cyst visualized on the right was removed. The histopathological analysis of the surgical specimen revealed a cystic le-sion coated by luteinized cells with discrete hyperchromatic and slightly pleomorphic nuclei, with underlying fibrous stroma with sparse luteinized cells, characterizing a giant luteinized follicular cyst of pregnancy. The prevalence of ovarian masses in pregnancy is rare, usually not exceeding 5 cm in diameter, and disappearing spontaneously in the second trimester. The patient in the case report had a cyst of 632 ml, increasing in volume to 2600 ml at the time of delivery. Definitive preoperative diagnosis of ovarian masses is still difficult, and predictive criteria for malignancy include the use of tumor markers, ultrasound, and Doppler. The association of these tests should guide the clinician to define the best time for surgical intervention. The association of these tests should guide the clinician to define the best time for surgical intervention (AU)

Os cistos funcionais geralmente não causam sintomas ou requerem intervenção cirúrgica. Relatamos o caso de uma primigesta de 17 anos, idade gestacional de 10 semanas e 2 dias, e ultrassonografia mostrando cisto anecoico em região parauterina direita sem septos, com maior diâmetro de 13,5cm, volume 632ml e Doppler sem vascularização periférica. A paciente permaneceu oligossintomática durante a gestação. Com 37 semanas e 6 dias, a gestação foi interrompida, quando o cisto apresentava 2.600 ml pela ultrassonografia. A extração fetal foi realizada por cesaria-na, e um grande cisto anexial visualizado à direita foi removido. A análise histopatológica da peça cirúrgica revelou lesão cística revestida por células luteinizadas com núcleos discretamente hipercromáticos e levemente pleomór-ficos, com estroma fibroso subjacente com células luteinizadas esparsas, caracterizando cisto folicular luteinizado gigante da gravidez. A prevalência de massas ovarianas na gravidez é rara, geralmente não ultrapassam o diâmetro de 5 cm, e desaparecem espontaneamente no segundo trimestre. A paciente do relato de caso apresentou cisto de 632 ml, aumentando de volume para 2600 ml no momento do parto. O diagnóstico pré-operatório definitivo de massas ovarianas ainda é difícil, e os critérios preditivos de malignidade incluem o uso de marcadores tumorais, ultrassonografia e Doppler. A associação desses testes deve orientar o clínico para definir o melhor momento para a intervenção cirúrgica (AU)

Productive and reproductive performance of crossbred dairy heifers with induced lactation and efficacy of antimicrobial therapy associated with internal teat sealants / Desempenho produtivo e reprodutivo de novilhas com lactação induzida e eficácia da terapia antimicrobiana associada com selante interno de tetos

This study evaluated (a) the efficacy of an association between injectable antibiotic therapy and sealant (ATBS) on milk yield (MY), somatic cell count (SCC), and prevalence of intramammary infections (IMI); and (b) the efficacy of gonadotropin-releasing hormone (GnRH) on follicular cyst (FCs) resolution (cyclicity at the 45th day in milk; DIM) and cumulative pregnancy rate (CPR) in heifers submitted to a lactation induction protocol (LIP). A total of 114 crossbred (Holstein × Jersey) heifers, with 34.7 ± 4.8 months and 439 ± 56.35 kg were submitted to LIP. On the 5th day of the LIP, the heifers were assigned to (i) ATBS (n = 57) with 7 mg/kg of norfloxacin associated with sealant and (ii) Control 1 (n = 57; CONT1) with no treatments. Lactation began on the 21st day of LIP and the 15th DIM, FCs were diagnosed and 106 heifers were randomized into two treatment groups with 53 heifers each: (i) GnRH (5 mL injectable GnRH) and (ii) Control 2 (CONT2; no treatment). Of the 114 heifers initially induced, 83.33% (n = 95) responded to LIP with an average MY of 15.19 kg/milk/day during 22 weeks of lactation. In the first 14 DIM, the IMI prevalence was 18% and 28% for heifers ATBS and CONT1 treated, respectively. Additionally, coagulase-negative Staphylococcus was the most frequently isolated group of pathogens. Mammary quarters that received ATBS treatment had a lower risk of IMI and SCC than CONT1. The cyclicity at 45 DIM was 68% (ATBS) and 35% (CONT1), and 57% and 46% for animals in the GnRH and CONT2. CPR was 60% in the ATBS group and 89% in CONT1, but GnRH treatment did not affect the CPR. In conclusion, LIP was effective in stimulating MY in heifers, and the IMI prevalence decreased with ATBS treatment. Also, the use of GnRH did not affect the FC regression, cyclicity at 45 DIM, and CPR.(AU)

Este estudo avaliou a (i) eficácia da associação entre antibioticoterapia injetável e selante interno de tetos (ATBS) na produção de leite (PL), contagem de células somáticas (CCS), e prevalência de infecções intramamárias (IIM); e (ii) eficácia do hormônio liberador de gonadotrofina (GnRH) na resolução de cistos foliculares (CFs), ciclicidade ao 45º dia em lactação (DEL) e taxa de prenhez cumulativa (TPC) em novilhas submetidas a um protocolo de indução de lactação (PIL). Um total de 114 novilhas mestiças (Holandês × Jersey), com 34,7 ± 4,8 meses e 439 ± 56,35 kg foram submetidas ao PIL. No 5º dia do PIL, as novilhas receberam: (i) ATBS (n = 57) com 7 mg/kg de norfloxacina associada ao selante interno de tetos e (ii) Controle 1 (n = 57; CONT1) sem tratamento. A lactação teve início no 21º dia do PIL e no 15º DEL, foram diagnosticados CFs e 106 novilhas foram agrupadas em dois grupos de tratamento com 53 novilhas em cada: (i) GnRH (5 mL de GnRH injetável) e (ii) Controle 2 (CONT2; sem tratamento). Das 114 novilhas inicialmente induzidas, 83,33% (n = 95) responderam ao PIL com PL média de 15,19 kg/leite/d durante 22 semanas de lactação. Nos primeiros 14 DEL a prevalência de IIM foi de 18% e 28% para as novilhas tratadas com ATBS e CONT1, respectivamente. Além disso, estafilococos coagulase negativa foram o grupo de patógenos mais frequentemente isolados. Quartos mamários tratados com ATBS tiveram menor risco (0,56) de IIM e menor CCS do que CONT1. A ciclicidade a 45 DEL foi de 68% (ATBS) e 35% (CONT1), e 57% e 46% para os animais no GnRH e CONT2. A TPC foi de 60% no grupo ATBS e 89% no CONT1, porém o tratamento com GnRH não afetou a TPC. Em conclusão, o PIL foi eficaz em estimular a PL em novilhas tardias e a prevalência de IIM diminiuiu com o tratamento ATBS. Além disso, o uso de GnRH não afetou a regressão de CF, ciclicidade em 45 DEL e a TPC.(AU)

Foreign body reaction to ruptured follicular cysts in dogs.

BACKGROUND: Cutaneous cysts are common in dogs, and surgical resection is the recommended treatment. However, additional therapy may be required for ruptured follicular cysts with severe cutaneous complications. CASE PRESENTATION: A 3-year-old neutered male Samoyed was presented with multifocal masses on the forelimbs. A 5-year-old neutered female Maltese was also presented with multiple masses and ruptured lesions, which were ulcerative and painful, around the parotid and submandibular glands. The lesions were examined cytologically. In addition, bacterial and fungal cultures and histopathologic examination were performed. Cutaneous multifocal nodules in the Samoyed could not be diagnosed via cytological examination or bacterial/fungal culture. Histopathology revealed numerous follicular cysts with multiple pyogranulomas of various sizes, some of which contained central keratin debris. In the Maltese, cytologic examination revealed central keratins or enucleated ghost cells in the intact cysts and few keratinized squamous cells mixed with neutrophils, mucus and metachromatic cells in the ruptured cysts. Histopathologic examination revealed severely dilated follicular cysts. Oral steroid and cyclosporine therapy resulted in marked improvement in the aseptic pyogranulomas after 2 weeks in formal case and combined with a surgery for residual cysts in latter case. CONCLUSIONS: We have reported two canine cases of ruptured follicular cysts causing foreign body-like aseptic pyogranulomas around cutaneous tissues and their successful management with pharmacological therapy and surgery.

Hyperreactio Luteinalis (Multiple Luteinized Follicle Cysts): A Report of 10 Cases.

Hyperreactio luteinalis is a rare entity arising in pregnancy and in the setting of gestational trophoblastic diseases (ie choriocarcinoma, molar pregnancy) that presents with, typically, bilateral ovarian enlargement due to numerous follicle cysts. While the phenomenon is benign and spontaneously regresses following delivery or treatment, a specimen may be seen in pathology when oophorectomy or cystectomy is performed to exclude malignancy or to manage acute complications such as torsion. Such resections may exhibit overlapping microscopic features with cystic granulosa cell tumors. We thus reviewed 10 cases of hyperreactio luteinalis in the setting of pregnancy, the largest pathologic cohort to date, to highlight notable features of this disorder. Patients ranged from 22 to 30 yr old. Most patients (n=6) presented at time of cesarean section with incidentally discovered ovarian masses. Three patients presented in the postpartum period, and 1 underwent surgery at 28 wk gestation due to the finding of a unilateral ovarian mass. The ovaries ranged from 8.5 to 29 cm and were multicystic and bilateral in 8 of the cases. Histologic examination demonstrated multiple, variably sized cystic follicles lined by a granulosa cell layer of varying thickness and theca cells with marked eosinophilic cytoplasm. Stromal edema was often prominent, with theca cells occasionally noted in nests, cords, and as single cells in foci of edema. Mitoses were generally seen more often in the granulosa cell layer (mean=2.6 per high power fields) compared with the theca cell layer (mean=1 per 10 high power fields). This series documents the key features of hyperreactio luteinalis that differentiate it from the other benign mass forming lesions encountered in pregnancy, most notably large solitary follicle cyst of pregnancy and puerperium, as well as cystic granulosa cell tumors, especially the juvenile variant, which may also present during pregnancy. Of particular use in differentiating them from juvenile granulosa cell tumor is the absence of pale or vacuolated cytoplasm and solid growth of granulosa cells in cases of hyperreactio luteinalis.

Trichofolliculoma of the Eyelid Margin: A Case Report and Review of Literature.

Trichofolliculoma is a rare benign tumor of the skin, with distinct pilar differentiation and a predilection for the head and neck. To the best of the authors' knowledge, only 10 cases of eyelid trichofolliculoma has been described in the English literature. Moreover, these benign hair follicle lesions have been reported to clinically mimic eyelid malignancy. The authors report a case of a 58-year-old woman with a nodule on the eyelid margin, with typical clinical features and characteristic histopathological findings aiding the diagnosis of trichofolliculoma. Complete resection was performed to prevent recurrence. The authors also reviewed all the cases of eyelid trichofolliculoma reported in literature to highlight the demography, clinical features, and management of this rare eyelid tumor.

Management of Adnexal Torsion: A 13-Year Experience in Single Tertiary Center.

PURPOSE: Adnexal torsion constitutes 2.7% of gynecological emergencies, it is more frequently seen in reproductive age. Delay in diagnosis and treatment may lead to loss of the ovary. In this study, we aimed to assess patients who had adnexal torsion and compare laparoscopy with laparotomy in the treatment of these patients and point the most appropriate surgery according to age groups of the patients and comparison of patient characteristics and management between adnexal torsion in postmenopausal and premenopausal patients. MATERIALS AND METHODS: This study was carried out in Necmettin Erbakan University, Meram Medicine Faculty, Department of Obstetrics and Gynecology. The study retrospectively analyzed 380 patients presented to our clinic with abdominal pain between January 2005 and December 2017 and had surgery for adnexal torsion. RESULTS: The study included 380 patients who had surgery for adnexal torsion. A total of 220 patients had laparoscopy and 160 patients had laparotomy. Laparoscopy group consisted of young patients with low parity, whereas laparotomy group consisted of 160 patients of which 92 (57.5%) were in menopause. Teratomas were the most common pathological finding followed by follicular cysts. Fourteen ovarian malignancies and 11 borderline tumors had been reported. Eleven ovarian malignancies had been reported in postmenopausal patients and three in premenopausal patients. CONCLUSION: Laparoscopic surgery is preferred for young patients who want to preserve their fertility, but postmenopausal ovarian masses presenting with torsion should be analyzed with frozen section whenever possible, if not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.

Eruptive vellus hair cysts in identical triplets with dermoscopic findings.

Eruptive vellus hair cysts (EVHCs) are asymptomatic, follicular, flesh-colored to hyperpigmented papules that are typically located on the chest and extremities with an unclear inheritance pattern and pathogenesis. We report a case of EVHCs in 4-year-old identical triplet girls. Our aim is to present another rare case of autosomal-dominant inheritance of EVHCs and to emphasize the utility of dermoscopy as a diagnostic aid for EVHCs that may be misdiagnosed clinically.

Differential diagnostic significance of epithelial and stromal CD10 expression in tumors of trichogenic origin.

BACKGROUND AND OBJECTIVES: The histological differential diagnosis between benign trichogenic skin tumors and basal cell carcinoma may be challenging. We therefore set out to investigate whether expression of CD10, a cell surface protein with neutral endopeptidase activity, might be a suitable marker for the histological differential diagnosis of trichogenic skin tumors. PATIENTS AND METHODS: We immunohistochemically analyzed 119 cases of benign trichogenic skin tumors and basal cell carcinoma. These included 28 nodular and 15 sclerosing basal cell carcinomas, 21 Pinkus tumors, 20 trichoblastomas, nine trichofolliculomas, eleven trichoepitheliomas, five desmoplastic trichoepitheliomas, and ten seborrheic keratoses. RESULTS: The majority of nodular basal cell carcinomas expressed CD10 in tumor cells at the peripheral (22/28 [75 %]). On the other hand, trichoblastomas revealed peripheral CD10 expression in only 10 % (2/20) of cases, whereas 50 % showed central expression (10/20). Peripheral epithelial expression of CD10 was also found in Pinkus tumors (9/21 [42.9 %]) and trichoepithelioma (4/11 [36.4 %]). Desmoplastic trichoepithelioma showed no tumoral CD10 expression at all (0/5 [0 %]), while the majority of sclerosing basal cell carcinomas was positive for CD10 (13/15 [86.7 %]). CONCLUSIONS: Our findings suggest that epithelial expression of CD10 - and not peritumoral stromal CD10 expression, as has been postulated - may well be of differential diagnostic significance. The pattern of distribution of CD10-positive neoplastic cells in particular can be useful in the diagnosis of trichogenic tumors.

Co-occurrence of steatocystoma multiplex, eruptive vellus hair cysts, and trichofolliculomas.

An association between steatocystoma multiplex (SCM) and eruptive vellus hair cysts (EVHCs) has been recognized. Steatocystoma multiplex and EVHC have similar clinical features but distinctive histologic features. Rare cases of co-occurrence of these conditions have been known to occur on the trunk and the forehead. We report a rare case of the simultaneous occurrence of SCM, EVHC, and trichofolliculomas localized to the forehead.

Inflammatory follicular cysts associated to necrotic primary teeth.

BACKGROUND: Cysts are pathological cavities lined by epithelium and supported by connective tissue, containing fluid or semi-fluid substances and presenting developmental or inflammatory origins. CASE REPORT: This study aimed to evaluate a case series of inflammatory follicular cysts in children to clarify their nomenclature, diagnosis, clinical implications and treatment outcomes. Prevalence, aetio-pathogenesis, clinical, radiographic and microscopic findings, treatments and sequelae of this condition were assessed by using the records of patients treated between 2000 and 2015. Data were analysed and presented descriptively. FOLLOW-UP: This was performed periodically for 2 years to monitor lesion regression and complete eruption of impacted permanent teeth. All of the involved permanent teeth erupted naturally. Twelve cases of asymptomatic lesions with volumetric bone expansion were identified through radiographic findings or delayed tooth eruption in patients aged between 8 and 14 years. After establishing the diagnosis of inflammatory follicular cyst, necrotic primary teeth extraction was followed by decompression of the cystic lesions. CONCLUSIONS: The investigated cases were consistent with inflammatory follicular cyst diagnoses. The proposed treatment was considered to be appropriate, that was revealed by the maintenance of the permanent teeth involved during the patients follow-up.