High-yield areas to grade tumor budding in colorectal cancer: A practical approach for pathologists.

BACKGROUND: Tumor budding (TB) has significant prognostic implication in stage II colorectal cancer (CRC) and is graded based on the International Tumor Budding Consensus Conference (ITBCC) protocol. In the current study, we evaluate tumor budding and its relationship to multiple histologic features in 104 tumors. METHODS: One-hundred four resected CRC cases were retrieved. Tumor bud count and TB grade were compared to the final tumor bud count/TB grade of the tumor per ITBCC protocol. The following high-yield co-features were assessed in each slide: highest T stage, presence of benign mucosa, presence of a precursor lesion, and highest tumor volume. RESULTS: Twenty-nine (28 %) cases had discrepancies between slide TB grade and final TB grade. The least discrepancies were seen in slides with benign mucosa (7 %) and precursor lesions (7 %). Among stage II patients without high-risk features, no discrepancies were observed in slides with benign mucosa. Slides with deepest invasion (rs = 1.000, p = 0.01) and benign mucosa (rs = 0.957, p < 0.001) had the strongest correlation with final tumor bud count in the same stage II subgroup. Similar relationships were observed when comparing final TB grade. Deepest invasion, tumor volume, as well as lymphovascular invasion, when present, also showed strong correlations with final TB grade in the entire cohort (rs = 0.828-0.845, p < 0.001). CONCLUSION: Our study is the first study to evaluate the relationship between TB grade and co-existing histologic features. We highlight the benefit of focusing on slides with high-yield co-features, with the strongest correlation seen in slides with adjacent benign mucosa and precursor lesions.

Predicting severity of periorbital necrotizing fasciitis.

PURPOSE: To determine whether severity of periorbital necrotizing fasciitis can be predicted based on premorbid patient characteristics. METHODS: Records of 10 consecutive patients with periorbital necrotizing fasciitis presenting at a single center, treated by one attending ophthalmic plastic surgeon, were retrospectively reviewed. Demographic information and medical history were used to determine a Charlson Comorbidity Index (CCI) score for each patient. Other variables included presenting visual acuity, number of surgical debridements performed, infectious organism (if known), and visual acuity at last follow-up. Data were compared with Mann-Whitney U test to determine correlation between variables, using p-values as outcome measures. RESULTS: Increased age at presentation correlated with worse presenting and final visual acuity, requiring more surgical debridements to control disease (each p < .0001). Worse initial visual acuity correlated with need for increased number of debridements (p = .002), but increased number of debridements did not correlate with final visual acuity (p = .101). CCI did not correlate with initial vision (p = .30), final vision (p = .72), or number of surgical debridements necessary (p = .99). Presenting visual acuity did not correlate with final visual acuity (p = .268). CONCLUSION: Older patients have more severe cases of periorbital necrotizing fasciitis, as defined by increased number of surgeries required to control disease and worse visual outcomes. CCI did not correlate with severity of disease.

Molecular detection of Toxoplasma gondii and Neospora caninum in neotropical primates.

BACKGROUND: Toxoplasma gondii and Neospora caninum infections in primates are potentially fatal and directly impact the conservation of these animals and public health. MATERIALS AND METHODS: A total of 38 blood/clot samples collected from free-living and captive neotropical primates undergoing clinical care or found dead by environmental authorities in the Mato Grosso State, Brazil, were analyzed by PCR for DNA detection of T. gondii and N. caninum. Furthermore, eight animals were submitted to immunohistochemistry for the detection of T. gondii. RESULTS: DNA of T. gondii and N. caninum was amplified in 11 (28.95%) 10 (26.32%) of samples analyzed, respectively. Coinfection was observed in three individuals. One animal returned a positive result in the immunohistochemistry for the detection of T. gondii. CONCLUSION: These findings reflect a concern for the conservation of these animals, as the pathogen-host interaction is unpredictable and infections by these protozoa can lead to animal mortality, which has a substantial impact on endangered species.

Relapsing Fever Group Borreliae in Human-Biting Soft Ticks, Brazil.

We conducted a molecular survey for Borrelia spp. in Ornithodoros ticks previously reported as biting humans. We collected specimens in natural ecosystems and inside human dwellings in 6 states in Brazil. Phylogenetic analyses unveiled the occurrence of 4 putatively new species of relapsing fever group borreliae.

Conjunctival Melanoma: Features and Outcomes Based on the Fitzpatrick Skin Type in 540 Patients at a Single Ocular Oncology Center.

PURPOSE: To determine the association of Fitzpatrick skin type (FST) with conjunctival melanoma. METHODS: Retrospective case series of 540 patients with conjunctival melanoma to assess clinical features and outcomes per FST. RESULTS: The FST was Type I (n = 126, 23%), II (n = 337, 62%), III (n = 56, 10%), IV (n = 8, 2%), V (n = 12, 2%), and VI (n = 1, <1%). A comparison (FST I vs. II vs. III, IV, V, and VI) revealed Types I and II associated with older mean patient age (63.9 vs. 60.7 vs. 51.1 years, p < 0.001), greater percentage of female patients (68% vs. 44% vs. 42%, p < 0.001), lower frequency of complexion associated melanosis (1% vs. 2% vs. 13%, p < 0.001), smaller tumor thickness (2.1 vs. 2.8 vs. 3.6 mm, p = 0.01), and less eyelid involvement (13% vs. 13% vs. 28%, p = 0.02). Kaplan-Meier estimates for 5-year risk showed no difference by Types for visual acuity loss ≥3 lines, local tumor recurrence, exenteration, metastasis, or death. CONCLUSION AND RELEVANCE: Most patients with conjunctival melanoma show FST I or II, and this demonstrated no association with 5-year rate of vision loss, tumor recurrence, exenteration, metastasis, or death.

Ectoparasites of small mammals in a fragmented area of the southern Amazonia: interaction networks and correlations with seasonality and host sex.

The present work aimed to analyze the ectoparasite-host interaction network and possible differences of this interaction related to two seasonal periods and host sex. During November 2016 and July 2017, non-flying small mammals were captured in 17 forest fragments located in the southern portion of the Amazon biome. We captured 96 individuals belonging to 10 host species that were parasitized with a total of 3668 ectoparasites. Overall, we identified 24 ectoparasite taxa belonging to the mite and insect groups Ixodida (ticks), Mesostigmata, Sarcoptiformes, Trombidiformes (mites), Phthiraptera (lice), and Siphonaptera (fleas). The interaction network between all ectoparasites and hosts showed significant deviation from random, with moderately high specialization index (H2' = 0.80). There was seasonal difference in prevalence for Amblyomma cajennense (Fabricius) sensu stricto (s.s), Amblyomma coelebs Neumann and larvae of Amblyomma. This difference was also found in the mean intensity of infestation of Amblyomma larvae and the mite Tur aragaoi (Fonseca). Only mean intensity of infestation differed in relation to host sex for the species Marmosa constantiae Thomas. Our results demonstrate that specificity between ectoparasites and small mammals in this region is moderately high and that the pattern of aggregation of some ectoparasite taxa differed between two seasons, as well as between sexes in M. constantiae.

A new pathogen spillover from domestic to wild animals: Plasmodium juxtanucleare infects free-living passerines in Brazil.

Habitat modification may facilitate the emergence of novel pathogens, and the expansion of agricultural frontiers make domestic animals important sources of pathogen spillover to wild animals. We demonstrate for the first time that Plasmodium juxtanucleare, a widespread parasite from domestic chickens, naturally infects free-living passerines. We sampled 68 wild birds within and at the border of conservation units in central Brazil composed by Cerrado, a highly threatened biome. Seven out of 10 passerines captured in the limits of a protected area with a small farm were infected by P. juxtanucleare as was confirmed by sequencing a fragment of the parasite's cytochrome b. Blood smears from these positive passerines presented trophozoites, meronts and gametocytes compatible with P. juxtanucleare, meaning these birds are competent hosts for this parasite. After these intriguing results, we sampled 30 backyard chickens managed at the area where P. juxtanucleare-infected passerines were captured, revealing one chicken infected by the same parasite lineage. We sequenced the almost complete mitochondrial genome from all positive passerines, revealing that Brazilian and Asian parasites are closely related. P. juxtanucleare can be lethal to non-domestic hosts under captive and rehabilitation conditions, suggesting that this novel spillover may pose a real threat to wild birds.

Detection of Rickettsia spp. in ticks associated to wild mammals in Northeastern Brazil, with notes on an undetermined Ornithodoros sp. collected from marsupials.

We report tick infestations and rickettsial detection in ticks infesting free-living wild mammals (Monodelphis domestica, Tolypeutes tricinctus, Thrichomys inermis and Kerodon rupestris) captured in the Caatinga ecoregion of Bahia state, northeastern Brazil, during September to December 2016. Overall, 117 ticks (61 larvae, 25 nymphs, 25 males, 6 females) belonging to two genera, and at least three species were collected: Amblyomma auricularium, Amblyomma parvum, Amblyomma sp., Ornithodoros rietcorreai and an unidentified Ornithodoros sp. We provide new host records to the rodent T. inermis parasitized by larva and nymphs of A. auricularium and to the marsupial M. domestica infested by larvae of A. auricularium. Furthermore, we describe new tick-host association for larvae of O. rietcorreai on the rodents K. rupestris and T. inermis. Concerning tick-Rickettsia associations, we detected Rickettsia amblyommatis and an uncharacterized species of Rickettsia belonging to the spotted fever group (SFG) in both A. auricularium and A. parvum. Additionally, 'Candidatus Rickettsia andeanae' was detected in A. parvum as well.

Ticks (Acari: Ixodidae) in the Serra da Canastra National Park in Minas Gerais, Brazil: species, abundance, ecological and seasonal aspects with notes on rickettsial infection.

The Cerrado Biome is the second largest in Brazil covering roughly 2 million km2, with varying features throughout its area. The Biome is endangered but it is also source of animal species for rural, green urban and degraded rainforest areas. Ticks are among Cerrado species that establish at anthropogenic sites and although information about them is steadily increasing, several features are unknown. We herein report tick species, abundance and some ecological relationships within natural areas of the Cerrado at higher altitudes (800-1500 m) within and around Serra da Canastra National Park, in Minas Gerais State Brazil. In total of 1196 ticks were collected in the environment along 10 campaigns held in 3 years (2007-2009). Amblyomma sculptum was the most numerous species followed by Amblyomma dubitatum and Amblyomma brasiliense. Distribution of these species was very uneven and an established population of A. brasiliense in the Cerrado is reported for the first time. Other tick species (Amblyomma ovale, Amblyomma nodosum, Amblyomma parvum, Ixodes schulzei and Haemaphysalis leporispalustris) were found in lesser numbers. Domestic animals displayed tick infestations of both rural and urban origin as well as from natural areas (Rhipicephalus sanguineus sensu lato, Rhipicephalus microplus, Dermacentor nitens, A. sculptum, A. ovale, Amblyomma tigrinum, Argas miniatus). Amblyomma sculptum had the widest domestic host spectrum among all tick species. DNA of only one Rickettsia species, R. bellii, was found in an A. dubitatum tick. Several biological and ecological features of ticks of the studied areas are discussed.

Seroprevalence of Rickettsia spp. in Equids and Molecular Detection of 'Candidatus Rickettsia amblyommii' in Amblyomma cajennense Sensu Lato Ticks From the Pantanal Region of Mato Grosso, Brazil.

The aim of the study was to evaluate exposure of equids to rickettsial agents (Rickettsia rickettsii, Rickettsia parkeri, 'Candidatus Rickettsia amblyommii', Rickettsia rhipicephali, and Rickettsia bellii) and rickettsial infection in ticks of a Pantanal region of Brazil. Sera of 547 equids (500 horses and 47 donkeys) were evaluated by indirect immunofluorescence assay. In total, 665 adults and 106 nymphal pools of Amblyomma cajennense F. sensu lato, 10 Dermacentor nitens Neumann ticks, and 88 larval pools of Amblyomma sp. were tested by polymerase chain reaction (PCR). Overall, 337 (61.6%) equids were reactive (titer ≥64) to at least one antigen of Rickettsia spp. The prevalence values for Rickettsia were 66%, and the highest endpoint titers were observed for 'Ca. R. amblyommii'. By PCR 3 (0.45%) A. cajennense s.l. females were positive for 'Ca. R. amblyommii'. Minimum infection rates of 0.75% for nymphs and 0.34% for larvae were calculated. Positive samples of ticks have had a fragment of the 16S mitochondrial rRNA gene sequenced and sequences showed 99% identity to Amblyomma sculptum Berlese. This study reports a wide exposure of equids to Rickettsia agents, and PCR evidence of infection with 'Ca. R. amblyommii', for the first time, in A. sculptum.

Diffuse Carbonic Anhydrase 9 and GATA3 Expression in Fumarate Hydratase Deficient Renal Cell Carcinoma - A Case Report and Immunoprofile Review.

Fumarate hydratase deficient renal cell carcinoma (FHRCC) can exhibit a heterogenous immunoprofile. In the present case, a solitary 10.5 cm mixed cystic and solid left kidney tumor showed various growth patterns, involving renal sinus adipose tissue and the renal pelvis. Tumor cells showed prominent nucleoli and perinucleolar halos. Aberrant diffuse (>90%), strong, and membranous carbonic anhydrase 9 and variable GATA3 expression were present. Diagnostic loss of fumarate hydratase expression and 2-succinyl cysteine overexpression (cytoplasmic and nuclear) were identified. Carbonic anhydrase 9 and GATA3 expression in FHRCC is rarely reported in the literature, and may cause misdiagnosis of clear cell RCC and/or urothelial carcinoma.

"Find Your Y": histological differences in early stage (pT) and post-treatment (ypT) oesophageal adenocarcinoma with implications for salvage endoscopic resection.

AIMS: Current guidelines offer limited strategies for managing recurrent/persistent oesophageal adenocarcinoma (EAC). Salvage endoscopic mucosal/submucosal resection (ER) shows promise in oesophageal squamous cell carcinoma, however its success in EAC is limited. We aimed to elucidate histological characteristics influencing salvage ER success in patients with low-stage, pretreated EAC. METHODS: We retrospectively reviewed 272 EAC tumours postoesophagectomy from five US centres and collected clinicopathological data including discontinuous growth (DG), defined as separate tumour foci ≥2 mm from the main tumour. We selected 101 patients with low-stage disease and divided them into treatment-naïve (n=70) and neoadjuvant therapy (n=31) groups. We compared the two groups and differences in clinical, histological and outcome characteristics were identified. RESULTS: In the entire cohort (n=272), DGs were identified in 22% of cases. Multivariate analysis revealed DGs as an independent prognostic factor for recurrence and positive oesophagectomy margins. Lymphovascular invasion (LVI) and background intestinal metaplasia predicted DG presence and absence, respectively. Compared with the treatment-naïve low T-stage subgroup, the pretreated subgroup exhibited higher incidence of poorly differentiated carcinoma (16% vs 46%, p=0.007), larger tumours (14 vs 30 mm, p<0.001), higher tumour, node, metastases stage (7% vs 30%, p=0.004), more nodal disease (7% vs 36%, p<0.001) and frequent DGs (1% vs 13%, p=0.030). CONCLUSIONS: In treated low T-stage EACs, DGs may contribute to suboptimal outcomes following salvage ER. Presence of LVI (as a surrogate for DGs) and poor differentiation in the absence of intestinal metaplasia in biopsy samples may serve as histological poor prognosticators in treated patients with EAC being considered for salvage ER.

Atrophic Kidney-Like Lesion-Case Report and Review of the Literature.

Atrophic kidney-like lesion (AKLL) is a rare kidney lesion, which was recently suggested by the Genitourinary Pathology Society as a provisional entity. As of now, 16 examples of AKLL have been described in the literature. Here we report a new tumor which shows similar clinicopathologic characteristics with those previously reported in AKLL. Immunohistochemical (IHC) studies in the current lesion identified a biphasic staining pattern consisting of a mixture of WT1+/KRT7-/PAX8- large dilated cysts and WT-/KRT7+/PAX8+ small atrophic cysts. Histomorphologic features of AKLL overlap with several neoplastic and non-neoplastic entities which can lead to mischaracterization. Awareness of the differentiating features is likely important when evaluating these lesions.

Clinical Significance and Prognostic Implications of Discontinuous Growth Pattern in Esophageal Adenocarcinoma: A Multi-Institutional Study.

The significance of discontinuous growth (DG) of the tumor to include tumor deposits and intramural metastasis in esophageal adenocarcinoma (EAC) is unclear. Esophagectomy specimens from 151 treatment-naïve and 121 treated patients with EAC were reviewed. DG was defined as discrete (≥2 mm away) tumor foci identified at the periphery of the main tumor in the submucosa, muscularis propria, and/or periadventitial tissue. Patients' demographics, clinicopathologic parameters, and oncologic outcomes were compared between tumors with DG versus without DG. DGs were identified in 16% of treatment-naïve and 29% of treated cases ( P =0.01). Age, gender, and tumor location were comparable in DG+ and DG- groups. For the treatment-naïve group, DG+ tumors were larger with higher tumor grade and stage and more frequent extranodal extension, lymphovascular/perineural invasion, and positive margin. Patients with treated tumors presented at higher disease stages with higher rates of recurrence and metastasis compared with treatment-naïve patients. In this group, DG was also associated with TNM stage and more frequent lymphovascular/perineural spread and positive margin, but not with tumor size, grade, or extranodal extension. In multivariate analysis, in all patients adjusted for tumor size, lymphovascular involvement, margin, T and N stage, metastasis, neoadjuvant therapy status, treatment year, and DG, DG was found to be an independent adverse predictor of survival outcomes in EAC. DG in EAC is associated with adverse clinicopathologic features and worse patient outcomes. DG should be considered throughout the entire clinicopathologic evaluation of treatment-naïve and treated tumors as well as in future staging systems.

Prevalence and seasonal aspects of parasitism by Oestrus ovis (Diptera: Oestridae) in sheep from Mato Grosso State, Brazil.

Oestrus ovis larvae are obligate parasites of vertebrates and cause cavitary myiasis (oestrosis) in sheep and goats. It is also reported as a zoonosis causing ophthalmomyiasis and nasopharyngeal myiasis. Despite being relatively common in Brazil, epidemiological studies on O. ovis are scarce. Considering that the infestation is influenced by the climate and biomes of the studied region, we aimed to investigate the seasonal prevalence of O. ovis among slaughtered sheep in the northern region of the state of Mato Grosso, Brazil. The heads of sheep (n=697) slaughtered at a slaughterhouse in the municipality of Terra Nova do Norte (November 2011 to November 2013) were collected to count, catalog, and identify the larvae found in the upper respiratory tract. Overall, 45.77% (319/697) of the animals were infested with 2,412 recovered larvae, 96.89% (2,337/2,412) of which were identified at the species level as O. ovis. Seasonal variations in prevalence ranged from 41% (spring) to 56% (summer); however, no correlation was observed between prevalence and season, mean humidity, or temperature. In conclusion, parasitism by O. ovis in sheep in the studied area, occurs year-round, considering the occurrence of larvae (L1, L2, and L3) throughout the year, probably because of the area's environmental conditions.

Detection of parasitic forms in feces of Chelonoidis carbonarius (Linnaeus, 1766) from Brazilian Cerrado.

Chelonoidis carbonarius is host to a great diversity of endoparasites. This research aimed to identify and taxonomically classify the parasitic forms of endoparasites found in the feces of C. carbonarius using coproparasitological methods. In total, 38 fecal samples were collected from animals captured in the municipalities of Cuiabá (n = 23) and Jataí (n = 15) in the Brazilian Ceraado. Fecal samples were submitted to at least one of the following techniques: Willis-Mollay flotation technique, zinc sulfate centrifugal flotation technique, and spontaneous sedimentation of Hoffman, and Pons, and Janer. Overall, 86.85% (33/38) of animals were positive in at least one of the diagnostic techniques. Of the 38 samples used, 50% of the animals were captive and 50% of the animals were free-living. Cysts, oocysts, and parasitic eggs were identified, as follows: Chapiniella spp. (65.78%; n = 24), Sauricola spp. (31.57%; n = 12), Ascaroidea (15.78%; n = 6), Oxyuridae (2.63%; n = 1), Trematoda (2.63%; n = 1), Acanthocephala (2.63%; n = 1), Balantidium spp. (39.47%; n = 15), Eimeria spp. (21.05%; n = 8), and Nyctotherus spp. (2.63%; n = 1). The study showed that both captive and free-living C. carbonarius are often parasitized by different endoparasite species, with nematode eggs being the most common.

Molecular detection and characterization of Bartonella spp. in small mammals in the Amazonia and Cerrado biomes, midwestern Brazil.

Although Bartonella spp. have been worldwide described in rodents and bats, few studies have reported these agents in marsupials. The present work aimed to investigate the occurrence and genetic diversity of Bartonella in small mammals (rodents, marsupials, and bats) and associated ectoparasites in two ecoregions (Amazonia and Cerrado biomes) in midwestern Brazil. For this purpose, DNA samples from 378 specimens of small mammals (128 rodents, 111 marsupials, and 139 bats) and 41 fleas (Siphonaptera) were screened for the Bartonella genus employing a quantitative real-time PCR assay (qPCR) based on the nuoG (nicotinamide adenine dinucleotide dehydrogenase gamma subunit) gene. Then, positive samples in qPCR were submitted to conventional PCR (cPCR) assays targeting the gltA, ftsZ, and rpoB genes. One (0.78 %) rodent, 23 (16.54 %) bats, and 3 (7.31 %) fleas showed positive results in the qPCR for Bartonella sp. After cPCR amplification and sequencing, 13 partial Bartonella DNA sequences of the following genes were obtained only from bats´ blood samples: 9 gltA (citrate synthase), 3 ftsZ (cell division protein), and 1 rpoB (RNA polymerase beta subunit). The maximum likelihood inference based on the gltA gene positioned the obtained sequences in three different clades, closely related to Bartonella genotypes previously detected in other bat species and bat flies sampled in Brazil and other countries from Latin America. Similarly, the ftsZ sequences clustered in two different clades with sequences described in bats from Brazil, other countries from Latin America, and Georgia (eastern Europe). Finally, the Bartonella rpoB from a specimen of Lophostoma silvicolum clustered with a Bartonella sp. sequence obtained from a Noctilio albiventris (KP715475) from French Guiana. The present study provided valuable insights into the diversity of Bartonella genotypes infecting bats from two ecoregions (Amazonia and Cerrado) in midwestern Brazil and emphasized that further studies should be conducted regarding the description and evaluation of different lineages of Bartonella in wild small mammals and their ectoparasites in different Brazilian biomes.

Localized cystic disease of the kidney: study of 14 cases and review of the literature.

Localized cystic disease of the kidney (LCDK) is rare without hereditary background and does not progress. It can mimic neoplastic process, leading to unnecessary surgical intervention. We present 14 patients [male-to-female 9:5; mean age 50.3 years (range: 3-79)] with LCDK in a multinational cohort. Flank pain (n=5) and incidental lesions (n=4) were common. All cases were unilateral (9 right, 5 left), and contralateral kidneys were mostly normal (n=11). No family history was present, and none had extrarenal solid organ cysts. Radical and partial nephrectomies were performed in 9 and 5 cases, respectively. All lesions were multilocular, ranging from 1.8 - 20cm. 2 cases had diffuse renal involvement. Cystic septa contained nonneoplastic elements including renal tubules and glomeruli without primitive epithelial cellular elements, blastema, or immature stromal cells. In addition, we also comprehensively reviewed 75 previously reported cases. Conclusions. LCDK should be considered in the differential of cystic kidney lesions.

Gastrointestinal Helminths in Wild Felids in the Cerrado and Pantanal: Zoonotic Bioindicators in Important Brazilian Biomes.

Environmental changes in the Brazilian Pantanal and Cerrado facilitate the spread of parasitic diseases in wildlife, with significant implications for public health owing to their zoonotic potential. This study aimed to examine the occurrence and diversity of gastrointestinal parasites in wild felids within these regions to assess their ecological and health impacts. We collected and analyzed helminth-positive samples from 27 wild felids using specific taxonomic keys. Diverse parasitic taxa were detected, including zoonotic helminths, such as Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma pluridentatum, Toxocara cati, Toxocara canis, Dipylidium caninum, Taenia spp., Echinococcus spp., and Spirometra spp. Other nematodes, such as Physaloptera praeputialis and Physaloptera anomala, were identified, along with acanthocephalans from the genus Oncicola and a trematode, Neodiplostomum spp. (potentially the first record of this parasite in wild felids in the Americas). Human encroachment into natural habitats has profound effects on wild populations, influencing parasitic infection rates and patterns. This study underscores the importance of continuous monitoring and research on parasitic infections as a means of safeguarding both wildlife and human populations and highlights the role of wild felids as bioindicators of environmental health.