Unusual presentation of cactus spines in the flank of an elderly man: a case report

Phyto-intruders in oral tissues: A polarized light microscopic study

OBJECTIVES

Foreign body reactions are common in the oral cavity due to its proximity to the external environment. Rarely, foreign body of plant origin may be encountered in the histopathological sections making the diagnosis problematic. The aim of the present study was to analyze the histological features of various products of plant origin emphasizing on the pathogenesis of tissue reaction occurring in response to their implantation.

METHODS

This observational study included various plant products or phytoproducts commonly consumed in South Indian diet such as rice, curry leaves, coriander leaves, spinach leaves, coconut, green chilli, onion, French beans, urad dal, lentil beans, mustard seed, ginger, and garlic. Formalin-fixed specimens were routinely processed and stained with hematoxylin and eosin. The slides were viewed under light microscope and polarized microscope and evaluated by two oral pathologists.

RESULTS

Each of the phytoproducts had distinctive histological appearance and exhibited positive birefringence. Phytoproducts such as rice, curry leaves, French bean, onion, and green chilli resembled pathological structures such as calcifications, ghost cells, clear cells, atypical adipocytes, and fungal hyphae, respectively.

CONCLUSIONS

Plant products appear as puzzling structures in histological section posing difficulties to the pathologist. Recognition of these structures as foreign body based on their histological appearance is inevitable and their identification may avoid unnecessary delay in treatment planning. The current study serves as an atlas for the histology of extraneous material study and also as a reference for the pathologists whenever mystifying structures are encountered.

Cactus-induced keratoconjunctivitis in Texas: A case series of three dogs and one cat

OBJECTIVE

To describe the historical, clinical, and diagnostic features of small animal patients affected by cactus-induced keratoconjunctivitis and their response to therapy.

ANIMALS STUDIED

Three dogs and one cat.

PROCEDURES

Ophthalmic examination directed subsequent selected diagnostic tests in each case including light microscopy of extracted foreign bodies, in vivo confocal microscopy (IVCM), corneal histopathology, and corneal bacterial culture. Treatments consisted of foreign body surgical extraction with concurrent medical therapy (three cases), or medical therapy alone (one case).

RESULTS

Clinical histories obtained supported acute cactus injury in all cases. Ophthalmic abnormalities were unilateral in each case and included ulcerative keratoconjunctivitis associated with linear, microscopic conjunctival and/or corneal penetrating cactus spines, known as glochids. Light microscopy and IVCM showed glochids to be heavily barbed, consistent with the spine morphology Prickly Pear (Opuntia) cactus species. Bacterial culture yielded Proprionicimonas sp. in one case with keratomalacia. Surgical extraction of spines was challenging, and residual conjunctival and/or corneal glochids were present in all cases. Patient discomfort resolved at a median of 21 days (range 10-51 days). Vision-threatening complications were not observed in any case at the time of last follow-up examination. Epithelial downgrowth, demonstrated by IVCM and histopathology, was present in one case at 108-day follow-up.

CONCLUSIONS

Cactus-induced keratoconjunctivitis should be considered as a differential in regions in which Opuntia cacti are prevalent, and microscopic ocular foreign bodies are observed. Although glochids are difficult to extract, positive clinical outcomes can occur in small animal patients despite the presence of residual organic corneal foreign material.

Granulomatous disorders

Almost all granulomatous skin disorders can cause red lesions on the face. Such disorders may include many bacterial, fungal, or parasitic infections, noninfectious inflammatory disorders, foreign body reactions, and even neoplasms. Clinically, they usually present with papules, plaques, nodules, and/or abscesses, which may ulcerate. It may be helpful in their differential diagnosis to define certain clinical patterns, such as multiple and discrete papules, necrotic or umbilicated papules or nodules, annular plaques, vegetative plaques or tumors, verrucous plaques or tumors, abscesses and/or sinuses, and lymphocutaneous pattern. Some disorders, such as sarcoidosis, can cause a wide variety of lesions. We accept that cutaneous leishmaniasis is also among such great imitators.