RESUMEN
ABSTRACT: This case emphasizes the value of meticulous observation and regular follow-up of patients receiving rifampicin therapy. The prognosis for complete improvement in renal function in such cases was excellent, with prompt recognition and discontinuation of rifampicin. Teaching patients about these possible adverse effects and encouraging immediate reporting of signs and symptoms are likely to be beneficial because acute kidney injury can manifest itself very quickly after rifampicin is started. Even if renal failure can happen with any dose of rifampicin, primary physicians must have awareness about patients on intermittent or irregular therapy and those who have previously used this medication. It is challenging to determine the prevalence of adverse reactions to common antibiotics where a state- or country-wide reporting system is absent. Along with withdrawal of the causative agent patients were treated with corticosteroids (0.5-1 mg/kg/day) for an average period of 4-12 weeks showing significant recovery of renal function.
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Antituberculosos , Nefritis Intersticial , Rifampin , Humanos , Nefritis Intersticial/inducido químicamente , Rifampin/efectos adversos , Rifampin/uso terapéutico , Antituberculosos/efectos adversos , Antituberculosos/uso terapéutico , Masculino , Granuloma/inducido químicamente , Granuloma/tratamiento farmacológico , Adulto , Femenino , Enfermedad AgudaAsunto(s)
Quiste Epidérmico , Granuloma , Tiña , Humanos , Tiña/microbiología , Tiña/tratamiento farmacológico , Granuloma/microbiología , Granuloma/patología , Quiste Epidérmico/patología , Quiste Epidérmico/microbiología , Masculino , Trichophyton/aislamiento & purificación , Antifúngicos/uso terapéutico , Biopsia , Microscopía Electrónica de Transmisión , Femenino , Resultado del Tratamiento , ArthrodermataceaeRESUMEN
BACKGROUND: Cutaneous infectious granulomas (CIG) are localized and chronic skin infection caused by a variety of pathogens such as protozoans, bacteria, worms, viruses and fungi. The diagnosis of CIG is difficult because microbiological examination shows low sensitivity and the histomorphological findings of CIG caused by different pathogens are commonly difficult to be distinguished. OBJECTIVE: The objective of this study is to explore the application of mNGS in tissue sample testing for CIG cases, and to compare mNGS with traditional microbiological methods by evaluating sensitivity and specificity. METHODS: We conducted a retrospective study at the Department of Dermatology of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 1st, 2020, to May 31st, 2024. Specimens from CIG patients with a clinical presentation of cutaneous infection that was supported by histological examination were retrospectively enrolled. Specimens were delivered to be tested for microbiological examinations and mNGS. RESULTS: Our data show that mNGS detected Non-tuberculosis mycobacteria, Mycobacterium tuberculosis, fungi and bacteria in CIG. Compared to culture, mNGS showed a higher positive rate (80.77% vs. 57.7%) with high sensitivity rate (100%) and negative predictive value (100%). In addition, mNGS can detect more pathogens in one sample and can be used to detect variable samples including the samples of paraffin-embedded tissue with shorter detective time. Of the 21 patients who showed clinical improvement within a 30-day follow-up, eighteen had their treatments adjusted, including fifteen who continued treatment based on the results of mNGS. CONCLUSIONS: mNGS could provide a potentially rapid and effective alternative detection method for diagnosis of cutaneous infectious granulomas and mNGS results may affect the clinical prognosis resulting from enabling the patients to initiate timely treatment.
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Granuloma , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Granuloma/microbiología , Granuloma/diagnóstico , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Bacterias/aislamiento & purificación , Bacterias/genética , Bacterias/clasificación , Anciano , Sensibilidad y Especificidad , Hongos/aislamiento & purificación , Hongos/genética , Hongos/clasificación , Adulto Joven , Metagenómica/métodos , Enfermedades Cutáneas Infecciosas/diagnóstico , Enfermedades Cutáneas Infecciosas/microbiología , Adolescente , Piel/microbiología , Piel/patología , NiñoRESUMEN
Sarcoidosis is a multiorgan granulomatous disease that lacks diagnostic biomarkers and targeted treatments. Using blood and skin from patients with sarcoid and non-sarcoid skin granulomas, we discovered that skin granulomas from different diseases exhibit unique immune cell recruitment and molecular signatures. Sarcoid skin granulomas were specifically enriched for type 1 innate lymphoid cells (ILC1s) and B cells and exhibited molecular programs associated with formation of mature tertiary lymphoid structures (TLSs), including increased CXCL12/CXCR4 signaling. Lung sarcoidosis granulomas also displayed similar immune cell recruitment. Thus, granuloma formation was not a generic molecular response. In addition to tissue-specific effects, patients with sarcoidosis exhibited an 8-fold increase in circulating ILC1s, which correlated with treatment status. Multiple immune cell types induced CXCL12/CXCR4 signaling in sarcoidosis, including Th1 T cells, macrophages, and ILCs. Mechanistically, CXCR4 inhibition reduced sarcoidosis-activated immune cell migration, and targeting CXCR4 or total ILCs attenuated granuloma formation in a noninfectious mouse model. Taken together, our results show that ILC1s are a tissue and circulating biomarker that distinguishes sarcoidosis from other skin granulomatous diseases. Repurposing existing CXCR4 inhibitors may offer a new targeted treatment for this devastating disease.
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Granuloma , Inmunidad Innata , Receptores CXCR4 , Sarcoidosis , Receptores CXCR4/inmunología , Receptores CXCR4/genética , Receptores CXCR4/metabolismo , Animales , Humanos , Ratones , Sarcoidosis/inmunología , Sarcoidosis/patología , Granuloma/inmunología , Granuloma/patología , Enfermedades de la Piel/inmunología , Enfermedades de la Piel/patología , Femenino , Quimiocina CXCL12/inmunología , Quimiocina CXCL12/genética , Quimiocina CXCL12/metabolismo , Linfocitos/inmunología , Linfocitos/patología , Masculino , Piel/inmunología , Piel/patología , Transducción de Señal/inmunologíaRESUMEN
The control of bacterial growth is key to the prevention and treatment of tuberculosis (TB). Granulomas represent independent foci of the host immune response that present heterogeneous capacity for control of bacterial growth. At the whole tissue level, B cells and CD4 or CD8 T cells have an established role in immune protection against TB. Immune cells interact within each granuloma response, but the impact of granuloma immune composition on bacterial replication remains unknown. Here we investigate the associations between immune cell composition, including B cell, CD4, and CD8 T cells, and the state of replicating Mycobacterium tuberculosis (Mtb) within the granuloma. A measure of ribosomal RNA synthesis, the RS ratio®, represents a proxy measure of Mtb replication at the whole tissue level. We adapted the RS ratio through use of in situ hybridization, to identify replicating and non-replicating Mtb within each designated granuloma. We applied a regression model to characterize the associations between immune cell populations and the state of Mtb replication within each respective granuloma. In the evaluation of nearly 200 granulomas, we identified heterogeneity in both immune cell composition and proportion of replicating bacteria. We found clear evidence of directional associations between immune cell composition and replicating Mtb. Controlling for vaccination status and endpoint post-infection, granulomas with lower CD4 or higher CD8 cell counts are associated with a higher percent of replicating Mtb. Conversely, changes in B cell proportions were associated with little change in Mtb replication. This study establishes heterogeneity across granulomas, demonstrating that certain immune cell types are differentially associated with control of Mtb replication. These data suggest that evaluation at the granuloma level may be imperative to identifying correlates of immune protection.
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Linfocitos T CD8-positivos , Granuloma , Mycobacterium tuberculosis , Mycobacterium tuberculosis/inmunología , Humanos , Granuloma/inmunología , Granuloma/microbiología , Linfocitos T CD8-positivos/inmunología , Femenino , Linfocitos T CD4-Positivos/inmunología , Linfocitos B/inmunología , Masculino , Tuberculosis/inmunología , Tuberculosis/microbiologíaRESUMEN
Granulomatous diseases include a diverse range of chronic inflammatory disorders with a wide variety of pathologies and clinical characteristics. In particular, the orofacial region can be affected by granulomatous conditions-whether as an isolated disease or as part of a systemic disorder. Regardless of the nature of the disease or its mechanism of development, precise diagnosis can be challenging, as etiopathogenesis may be driven by several causes. These include reactions to foreign bodies, infections, immune dysregulation, proliferative disorders,, medications, illicit drugs, and hereditary disorders. Granulomas can be identified using histopathological assessment but are not pathognomonic of a specific disease, and therefore require correlation between clinical, serological, radiographical, and histopathological findings. The purpose of this review is to provide a summary of the etiopathogenesis, clinical and histopathologic characteristics, and treatment of oral granulomatous disorders.
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Granuloma , Humanos , Granuloma/patología , Granuloma/etiología , Enfermedades de la Boca/patología , Enfermedades de la Boca/etiología , Granulomatosis Orofacial/patología , Granulomatosis Orofacial/etiologíaRESUMEN
Granuloma is a crucial pathological feature of tuberculosis (TB). The relationship between CD4+ T cells in both peripheral blood and granulomatous tissue, and the integrity of granulomas in Human Immunodeficiency Virus (HIV)-MTB co-infection, remains unexplored. This study collected biopsy specimens from 102 TB patients (53 with HIV-MTB co-infection and 49 only with TB). Hematoxylin and eosin (HE) staining and immunohistochemical staining were performed, followed by microscopic examination of the integrity of tuberculous granulomas. Through statistical analysis of peripheral blood CD4+ T cell counts, tissue CD4+ T cell proportion, and the integrity of granulomas, it was observed that HIV infection leads to poor formation of tuberculous granulomas. Peripheral blood CD4+ T cell counts were positively correlated with granuloma integrity, and there was a similar positive correlation between tissue CD4+ T cell proportions and granuloma integrity. Additionally, a positive correlation was found between peripheral blood CD4+ T cell counts and the proportion of CD4+ T cells in granuloma tissues. Therefore, HIV infection could impact the morphology and structure of tuberculous granulomas, with a reduced proportion of both peripheral blood and tissue CD4+ T lymphocytes.
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Linfocitos T CD4-Positivos , Coinfección , Granuloma , Infecciones por VIH , Tuberculosis , Humanos , Infecciones por VIH/inmunología , Infecciones por VIH/complicaciones , Linfocitos T CD4-Positivos/inmunología , Granuloma/inmunología , Granuloma/patología , Masculino , Femenino , Adulto , Coinfección/inmunología , Coinfección/microbiología , Coinfección/virología , Recuento de Linfocito CD4 , Persona de Mediana Edad , Tuberculosis/inmunología , Tuberculosis/patología , Tuberculosis/microbiología , Mycobacterium tuberculosis/inmunologíaRESUMEN
A 10-year-old spayed mixed breed dog presented with severe neurological signs. Computed tomography revealed a cranial mediastinal mass, osteolysis of the right second rib and second thoracic vertebra, tracheobronchial and mesenteric lymph node enlargement, pneumonia and pleural effusion. Magnetic resonance imaging detected lesions in the white matter of the right frontal lobe and left cerebral hemisphere with contrast-enhanced T1-weighted images showing demarcated enhancement. On cut section, the surface of the right cerebral frontal lobe and left cerebral hemisphere corticomedullary junctions were indistinct and the white matter was discoloured. Microscopically, multicentric granulomatous inflammation was seen in the brain, cranial mediastinal mass, masses on the right second rib, tracheobronchial and mesenteric lymph nodes, heart, kidneys, lungs and oesophagus. Necrosis and hyaline fungal structures were frequently observed in the centre of the granulomas. These fungi had septae, Y-shaped branching and were 2-3 µm in width. Sequence analysis of DNA from formalin-fixed paraffin-embedded samples identified the fungi as Schizophyllum commune. Based on these findings, this case was diagnosed as disseminated S. commune infection. This is the first report of granulomatous encephalitis caused by S. commune in a dog.
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Enfermedades de los Perros , Encefalitis , Schizophyllum , Animales , Perros , Enfermedades de los Perros/microbiología , Enfermedades de los Perros/patología , Encefalitis/veterinaria , Granuloma/veterinaria , Femenino , Micosis/veterinariaRESUMEN
OBJECTIVE: Cryptococcus, a genus of fungi, primarily includes Cryptococcus neoformans and Cryptococcus gattii, both known to cause human infections. Skeletal infections are rare, and there have been no reported cases of bone cryptococcal infection in conjunction with differentiated thyroid carcinoma. SUBJECT AND METHODS: A 56-year-old female presented with a one-month history of "cough and throat irritation." Chest CT revealed scattered small nodules in both lungs,suggestive of metastasis.There was minimal inflammation in both lungs, and scattered lymph nodes were observed in the mediastinum and upper pulmonary hilum. RESULTS: The patient was diagnosed with differentiated thyroid carcinoma complicated by cryptococcal infection. Antifungal treatment with itraconazole 200mg/day was initiated, and after 3 months, clinical symptoms disappeared, with a reduction in lung nodules observed in follow-up chest CT. CONCLUSION: When diagnosing distant metastasis in differentiated thyroid carcinoma, a comprehensive analysis combining imaging studies and serum thyroid globulin plays a complementary role, as illustrated in this case of differentiated thyroid carcinoma concurrent with cryptococcal infection.
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Criptococosis , Neoplasias de la Tiroides , Humanos , Femenino , Persona de Mediana Edad , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Criptococosis/diagnóstico por imagen , Criptococosis/complicaciones , Inflamación/diagnóstico por imagen , Inflamación/complicaciones , Granuloma/diagnóstico por imagen , Granuloma/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Identifying new molecular therapies targeted at the severe hepatic fibrosis associated with the granulomatous immune response to Schistosoma mansoni infection is essential to reduce fibrosis-related morbidity/mortality in schistosomiasis. In vitro cell activation studies suggested the lipid molecule prostaglandin D2 (PGD2) as a potential pro-fibrotic candidate in schistosomal context, although corroboratory in vivo evidence is still lacking. Here, to investigate the role of PGD2 and its cognate receptor DP2 in vivo, impairment of PGD2 synthesis by HQL-79 (an inhibitor of the H-PGD synthase) or DP2 receptor inhibition by CAY10471 (a selective DP2 antagonist) were used against the fibrotic response of hepatic eosinophilic granulomas of S. mansoni infection in mice. Although studies have postulated PGD2 as a fibrogenic molecule, HQL-79 and CAY10471 amplified, rather than attenuated, the fibrotic response within schistosome hepatic granulomas. Both pharmacological strategies increased hepatic deposition of collagen fibers - an unexpected outcome accompanied by further elevation of hepatic levels of the pro-fibrotic cytokines TGF-ß and IL-13 in infected animals. In contrast, infection-induced enhanced LTC4 synthesis in the schistosomal liver was reduced after HQL-79 and CAY10471 treatments, and therefore, inversely correlated with collagen production in granulomatous livers. Like PGD2-directed maneuvers, antagonism of cysteinyl leukotriene receptors CysLT1 by MK571 also promoted enhancement of TGF-ß and IL-13, indicating a key down-regulatory role for endogenous LTC4 in schistosomiasis-induced liver fibrosis. An ample body of data supports the role of S. mansoni-driven DP2-mediated activation of eosinophils as the source of LTC4 during infection, including: (i) HQL-79 and CAY10471 impaired systemic eosinophilia, drastically decreasing eosinophils within peritoneum and hepatic granulomas of infected animals in parallel to a reduction in cysteinyl leukotrienes levels; (ii) peritoneal eosinophils were identified as the only cells producing LTC4 in PGD2-mediated S. mansoni-induced infection; (iii) the magnitude of hepatic granulomatous eosinophilia positively correlates with S. mansoni-elicited hepatic content of cysteinyl leukotrienes, and (iv) isolated eosinophils from S. mansoni-induced hepatic granuloma synthesize LTC4 in vitro in a PGD2/DP2 dependent manner. So, our findings uncover that granulomatous stellate cells-derived PGD2 by activating DP2 receptors on eosinophils does stimulate production of anti-fibrogenic cysLTs, which endogenously down-regulates the hepatic fibrogenic process of S. mansoni granulomatous reaction - an in vivo protective function which demands caution in the future therapeutic attempts in targeting PGD2/DP2 in schistosomiasis.
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Granuloma , Cirrosis Hepática , Prostaglandina D2 , Receptores Inmunológicos , Receptores de Prostaglandina , Schistosoma mansoni , Esquistosomiasis mansoni , Animales , Prostaglandina D2/metabolismo , Esquistosomiasis mansoni/metabolismo , Esquistosomiasis mansoni/patología , Esquistosomiasis mansoni/parasitología , Ratones , Receptores de Prostaglandina/metabolismo , Cirrosis Hepática/parasitología , Cirrosis Hepática/metabolismo , Cirrosis Hepática/patología , Granuloma/parasitología , Granuloma/metabolismo , Granuloma/patología , Receptores Inmunológicos/metabolismo , Hígado/parasitología , Hígado/metabolismo , Hígado/patología , Masculino , Femenino , Carbazoles , Piperidinas , SulfonamidasAsunto(s)
Antiinfecciosos Urinarios , Nefritis Intersticial , Nitrofurantoína , Humanos , Nefritis Intersticial/inducido químicamente , Nefritis Intersticial/patología , Nefritis Intersticial/diagnóstico , Nitrofurantoína/efectos adversos , Antiinfecciosos Urinarios/efectos adversos , Granuloma/inducido químicamente , Granuloma/patología , Granuloma/diagnóstico , Masculino , Cristalización , Riñón/patología , Riñón/efectos de los fármacos , Infecciones Urinarias/tratamiento farmacológico , Biopsia , Femenino , Persona de Mediana EdadRESUMEN
In this report, we present the case of a woman with clinical characteristics of hypercalcemia due to ectopic production of 1,25(OH)2D. She reported a history of aesthetic surgery with gluteal fillers. The formation of granulomas after these interventions were previously described. In this case, surgical removal of the foreign formations was attempted with clinical stability during 3 years.
Presentamos el caso de una mujer con características clínicas de hipercalcemia secundaria a la producción ectópica de 1,25(OH)2D. La paciente informó una historia de rellenos glúteos con fines estéticos. La formación de granulomas posterior a este tipo de intervenciones fue previamente descrita por otros autores. En este caso se intentó la extirpación quirúrgica de las formaciones extrañas con estabilidad clínica durante 3 años.
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Granuloma de Cuerpo Extraño , Hipercalcemia , Humanos , Hipercalcemia/etiología , Femenino , Granuloma de Cuerpo Extraño/cirugía , Granuloma de Cuerpo Extraño/etiología , Granuloma/cirugía , Granuloma/etiología , Rellenos Dérmicos/efectos adversos , Persona de Mediana Edad , Técnicas Cosméticas/efectos adversos , Nalgas , Resultado del TratamientoRESUMEN
Granulomatous myositis is a clinical-pathological entity, which has been rarely reported, mostly described in sarcoidosis. Currently, no clear and simple prognostic factor has been identified to predict granulomatous myositis evolution. The clinical, anatomopathological, imaging, and biological characteristics of 26 patients with granulomatous myositis were retrospectively collected to describe clinical presentation and outcomes of this condition. Twenty-six patients with granulomatous myositis were included (14 males) with a median age of symptom onset of 65 years. 54 % of patients presented a severe form of the disease defined as a Rankin score ≥2 at last follow-up visit or a progressive form of the disease (no improvement under treatment). Etiology were sarcoidosis (n = 14), inclusion body myositis (n = 4), autoimmune disease (n = 1), hematological malignancy (n = 1), and idiopathic (n = 6). Distal deficit and amyotrophy were more frequent among those with a severe disease. Corticosteroids led to improvement in 75 % of cases, but 66 % of responders relapsed. Methotrexate appeared as a promising second line therapy with clinical improvement in 50 % of patients, and no relapse in responders. Granulomatous myositis is often a severe and difficult-to-treat disease in which patients frequently progress towards severe disability. The presence of muscle atrophy and distal weakness appears to be frequently associated with a severe form of the disease.
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Miositis , Humanos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Miositis/patología , Adulto , Sarcoidosis/tratamiento farmacológico , Sarcoidosis/patología , Metotrexato/uso terapéutico , Corticoesteroides/uso terapéutico , Resultado del Tratamiento , Granuloma/patología , Anciano de 80 o más AñosRESUMEN
Sarcoid -like reactions (SLRs) can occur in several malignancies adjacent to primary tumour location or the draining lymph nodes. The presence of peritumoural and intratumoural SLR in patients suffering from renal cell carcinoma (RCC) has been reported in few instances. However, the association of RCC with SLR in spleen, liver and other organs in the absence of systemic sarcoidosis is very rare.We present an unusual case of a gentleman in his 30s, who presented with a lesion in the left kidney along with non-specific lesions (likely granulomatous) in liver, spleen and lungs. Partial Nnephrectomy specimen confirmed conventional/clear cell RCC. The histopathology revealed an extensive epithelioid granulomatous reaction affecting both peritumoural and intratumoural areas. Follow-up images demonstrated an almost complete resolution of lesions in the spleen, liver and lungs. Our case supports the hypothesis that non-caseating granulomas of SLR could be a manifestation of an immunologically mediated antitumour response.
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Carcinoma de Células Renales , Neoplasias Renales , Sarcoidosis , Humanos , Carcinoma de Células Renales/cirugía , Masculino , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Sarcoidosis/complicaciones , Sarcoidosis/tratamiento farmacológico , Adulto , Nefrectomía , GranulomaRESUMEN
Cutaneous granulomatous reactions are diverse, both from the clinical and the pathological perspective. Most underlying pathophysiological aspects remain elusive. Interstitial granulomatous dermatitis and palisaded neutrophilic and granulomatous dermatitis have been claimed to be reactions to systemic disorders, such as infectious, inflammatory, or neoplastic conditions. Recently, the overarching term "reactive granulomatous dermatitis" has been coined to unify both entities. We herein report two cases of reactive granulomatous dermatitis presenting with the widely known, albeit infrequent "rope sign" and provide clinicopathological correlation. The two patients included a 53-year-old woman with enlarging erythematous plaques and underlying palpable cords on both sides of trunk near axillae (rope sign), and a 51-year-old woman with personal history of rheumatoid arthritis and a palpable cord on the left aspect of the trunk. Pathological findings were compatible with reactive granulomatous dermatitis in both cases. In conclusion, the rope sign represents a strikingly infrequent but decisive diagnostic clue of reactive granulomatous dermatitis.
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Granuloma , Humanos , Femenino , Persona de Mediana Edad , Granuloma/patología , Granuloma/diagnóstico , Dermatitis/patología , Dermatitis/diagnósticoAsunto(s)
Granuloma , Trasplante de Células Madre Hematopoyéticas , Virus de la Rubéola , Rubéola (Sarampión Alemán) , Trasplante Homólogo , Humanos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Rubéola (Sarampión Alemán)/diagnóstico , Granuloma/etiología , Virus de la Rubéola/inmunología , Masculino , Femenino , Adulto , Resultado del TratamientoRESUMEN
BACKGROUND: Transthoracic needle biopsy of lung lesions is a well-established procedure for the diagnosis of lung lesions. The literature focuses on the diagnosis of malignant lesions with an often reported accuracy rate of more than 90%. Experience showed that biopsy can identify sometimes incidentally, also benign lesions. There are many reasons why a biopsy is performed for a "benign lesion." First of all, it may be an unexpected diagnosis, as some benign pathologies may have misleading presentations, that are very similar to lung cancer, otherwise the reason is only to make a diagnosis of exclusion, which leads to the benign pathology already being considered in the differential diagnosis. METHODS: This study was designed as a retrospective single-center study. We selected from our database all the lung biopsies performed under CT guidance, from 2015 to 2019 and retrospectively analysed the histological data. We selected only benign lesions describing the imaging feature and differential diagnosis with lung malignancy. RESULTS: In our patient population, among the 969 of them that underwent biopsy, we identified 93 benign lesions (10%). Hamartomas, granulomas, slow-resolving pneumonia and cryptogenic organizing pneumonia are the pathologies that most frequently can misinterpratedas lung cancer. CONCLUSIONS: In this brief report we want to show the percentage and type of benign lesions that are found in our lung trans-thoracic biopsy population. Among these, we identified the three most frequent benign lesions that most frequently enter the differential diagnosis with lung malignant lesions describing the classic and atypical imaging findings.
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Hamartoma , Enfermedades Pulmonares , Neoplasias Pulmonares , Humanos , Estudios Retrospectivos , Diagnóstico Diferencial , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/patología , Enfermedades Pulmonares/diagnóstico , Hamartoma/patología , Hamartoma/diagnóstico , Hamartoma/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Anciano , Granuloma/patología , Granuloma/diagnóstico , Pulmón/patología , Pulmón/diagnóstico por imagen , Neumonía en Organización Criptogénica/patología , Neumonía en Organización Criptogénica/diagnóstico , Neumonía en Organización Criptogénica/diagnóstico por imagen , Biopsia Guiada por Imagen/métodos , AdultoRESUMEN
Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) has recently gained prominence for its ability to provide molecular and spatial information in tissue sections. This technology has the potential to uncover novel insights into proteins and other molecules in biological and immunological pathways activated along diseases with a complex host-pathogen interaction, such as animal tuberculosis. Thus, the present study conducted a data analysis of protein signature in granulomas of cattle and pigs naturally infected with the Mycobacterium tuberculosis complex (MTC), identifying biological and immunological signaling pathways activated throughout the disease. Lymph nodes from four pigs and four cattle, positive for the MTC by bacteriological culture and/or real-time PCR, were processed for histopathological examination and MALDI-MSI. Protein identities were assigned using the MaTisse database, and protein-protein interaction networks were visualized using the STRING database. Gene Ontology (GO) analysis was carried out to determine biological and immunological signaling pathways in which these proteins could participate together with Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. Distinct proteomic profiles between cattle and pig granulomas were displayed. Noteworthy, the GO analysis revealed also common pathways among both species, such as "Complement activation, alternative pathway" and "Tricarboxylic acid cycle", which highlight pathways that are conserved among different species infected by the MTC. In addition, species-specific terms were identified in the current study, such as "Natural killer cell degranulation" in cattle or those related to platelet and neutrophil recruitment and activation in pigs. Overall, this study provides insights into the immunopathogenesis of tuberculosis in cattle and pigs, opening new areas of research and highlighting the importance, among others, of the complement activation pathway and the regulation of natural killer cell- and neutrophil-mediated immunity in this disease.
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Granuloma , Mycobacterium tuberculosis , Proteómica , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Tuberculosis , Animales , Porcinos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/veterinaria , Bovinos , Proteómica/métodos , Mycobacterium tuberculosis/inmunología , Tuberculosis/inmunología , Tuberculosis/veterinaria , Tuberculosis/microbiología , Tuberculosis/metabolismo , Granuloma/inmunología , Granuloma/microbiología , Granuloma/metabolismo , Granuloma/veterinaria , Enfermedades de los Porcinos/inmunología , Enfermedades de los Porcinos/microbiología , Mapas de Interacción de Proteínas , Interacciones Huésped-Patógeno/inmunología , Proteoma , Transducción de SeñalRESUMEN
When a mass occurs at the staple line following lung resection, it can be difficult to distinguish between local cancer recurrence and granuloma. We present a case of a staple-line granuloma with 18F-fluorodeoxyglucose-positron emission tomography uptake and elevated serum carbohydrate antigen 19-9 (CA19-9) in a patient with ovarian cancer lung metastasis. After granuloma resection, serum CA19-9 levels normalized, and CA19-9 positive cells were identified in the resected tumor. Therefore, serum CA19-9 elevation does not rule out a staple-line granuloma. Whereas granulomas on computed tomography (CT) scans tend to show smooth shadows along the staple line unilaterally, detailed CT evaluation may help diagnostic differentiation. Differentiation based on imaging and tumor markers has limitations. However, core needle biopsy has the risk of misdiagnosis and tumor cell dissemination, therefore surgical resection should be considered when comprehensive findings indicate a potential recurrence.
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Neoplasias Pulmonares , Neoplasias Ováricas , Humanos , Femenino , Neoplasias Ováricas/cirugía , Neoplasias Ováricas/patología , Neoplasias Pulmonares/cirugía , Neoplasias Pulmonares/patología , Granuloma/patología , Granuloma/cirugía , Granuloma/etiología , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The diagnosis of solitary pulmonary nodules has always been a difficult and important point in clinical research, especially granulomatous nodules (GNs) with lobulation and spiculation signs, which are easily misdiagnosed as malignant tumors. Therefore, in this study, we utilised a CT deep learning (DL) model to distinguish GNs with lobulation and spiculation signs from solid lung adenocarcinomas (LADCs), to improve the diagnostic accuracy of preoperative diagnosis. METHODS: 420 patients with pathologically confirmed GNs and LADCs from three medical institutions were retrospectively enrolled. The regions of interest in non-enhanced CT (NECT) and venous contrast-enhanced CT (VECT) were identified and labeled, and self-supervised labels were constructed. Cases from institution 1 were randomly divided into a training set (TS) and an internal validation set (IVS), and cases from institutions 2 and 3 were treated as an external validation set (EVS). Training and validation were performed using self-supervised transfer learning, and the results were compared with the radiologists' diagnoses. RESULTS: The DL model achieved good performance in distinguishing GNs and LADCs, with area under curve (AUC) values of 0.917, 0.876, and 0.896 in the IVS and 0.889, 0.879, and 0.881 in the EVS for NECT, VECT, and non-enhanced with venous contrast-enhanced CT (NEVECT) images, respectively. The AUCs of radiologists 1, 2, 3, and 4 were, respectively, 0.739, 0.783, 0.883, and 0.901 in the (IVS) and 0.760, 0.760, 0.841, and 0.844 in the EVS. CONCLUSIONS: A CT DL model showed great value for preoperative differentiation of GNs with lobulation and spiculation signs from solid LADCs, and its predictive performance was higher than that of radiologists.