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Delgado-de la Mora J, Martín-Nares E, Quintero-Bustos G, Montante-Montes de Oca D, Martínez Benitez B. Sclerosing Angiomatoid Nodular Transformation of the Spleen in a Patient With Granulomatosis With Polyangiitis. Cureus 2024; 16:e53907. [PMID: 38465190 PMCID: PMC10924643 DOI: 10.7759/cureus.53907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
We present an intriguing case involving a rare occurrence of sclerosing angiomatoid nodular transformation (SANT) in a 57-year-old woman with a history of granulomatosis with polyangiitis (GPA). Despite the extensive literature on SANT, its pathogenesis remains elusive. The patient, diagnosed with serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA)-positive GPA seven years earlier, exhibited a splenic lesion during imaging, leading to laparoscopic splenectomy due to severe abdominal pain. Microscopic analysis unveiled nodular structures with vascular elements surrounded by fibrosclerotic stroma and chronic inflammatory cells. This case raises questions about the interplay between SANT, GPA activity, and vascular damage. Hypotheses regarding SANT's origin, including its potential association with organized hematoma or alterations in splenic blood flow, are discussed. The uniqueness of this case lies in the coexistence of PR3-ANCA-positive GPA and SANT, suggesting a potential link between GPA activity, vascular damage, and SANT development. While causality remains uncertain, this report marks the first documented case of a patient with PR3-ANCA-positive GPA developing SANT. The findings prompt reflection on a potential common pathophysiological mechanism and underscore the importance of considering SANT in cases of splenic lesions associated with conditions causing alterations in splenic blood flow. This contribution serves as a valuable addition to the existing knowledge, urging further research and consideration of SANT in diagnostic scenarios involving splenic abnormalities.
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Affiliation(s)
| | - Eduardo Martín-Nares
- Department of Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
| | | | | | - Braulio Martínez Benitez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MEX
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Quintero-Bustos G, Aguilar-Leon D, Saeb-Lima M. Histopathological and Immunohistochemical Characterization of Skin Biopsies From 41 SARS-CoV-2 (+) Patients: Experience in a Mexican Concentration Institute: A Case Series and Literature Review. Am J Dermatopathol 2022; 44:327-337. [PMID: 35170469 DOI: 10.1097/dad.0000000000002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT The SARS-CoV-2 pandemic brought countless clinical and pathophysiological questions. Although mucocutaneous infections are the most visible, they are among the least studied. This article provides relevant information to characterize morphologically and immunohistochemically the dermatoses from patients with COVID-19, during the first year of the pandemic. Immunohistochemistry reactions against the spike protein were performed in 48 skin biopsies, and the positive cases were classified according to their histomorphology; at the end, 41 biopsies led us to identify 12 morphological patterns that mimic other skin pathologies, among which pityriasiform patterns predominate. For the literature review, we selected cases of SARS-CoV-2 dermatoses that included complete histopathological information and that were published during the same interval of time; after careful evaluation, 205 biopsies were selected and then classified into 8 groups according to previously published proposals. Dermatoses associated with SARS-CoV-2 are as diverse in their clinical expression as in their histopathology, mimicking entities totally unrelated to COVID-19. Furthermore, some of these groups are characteristically associated with an aggressive course of the disease. Undoubtedly, it is necessary to delve into the possibility that these findings are translatable into prognostic and therapeutic factors.
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Affiliation(s)
- Gabriel Quintero-Bustos
- Pathology Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
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Higuera-de-la-Tijera F, Córdova-Gallardo J, Buganza-Torio E, Barranco-Fragoso B, Torre A, Parraguirre-Martínez S, Rojano-Rodríguez ME, Quintero-Bustos G, Castro-Narro G, Moctezuma-Velazquez C. Hepamet Fibrosis Score in Nonalcoholic Fatty Liver Disease Patients in Mexico: Lower than Expected Positive Predictive Value. Dig Dis Sci 2021; 66:4501-4507. [PMID: 33428035 DOI: 10.1007/s10620-020-06821-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) has been associated with different negative outcomes in the presence of advanced fibrosis. The Hepamet Fibrosis Score (HFS), a recently described noninvasive score, has shown excellent performance for the detection of advanced fibrosis. The aim of this study was to assess its performance in a Mexican population with NAFLD. METHODS This was a retrospective cross-sectional study performed in 222 patients with biopsy-proven NAFLD, of whom 33(14%) had advanced fibrosis. We retrieved clinical data from each patient's medical record to compute the HFS, the NAFLD Fibrosis Score (NFS), and the Fibrosis-4 (FIB-4), and assess their performance. RESULTS When considering the models as continuous variables, the area under the receiving operating characteristics curve of the HFS(0.758) was not different from that of the NFS(0.669, p = 0.09) or FIB-4(0.796, p = 0.1). The HFS had a sensitivity, specificity, positive and negative predictive values of 76.7% (95% CI 57.7-90.1), 90.1% (95% CI 85-93.9), 36.7% (95% CI 19.9-56.1), and 94.3% (95% CI 88.5-97.7), respectively. Indeterminate results (i.e., gray area) were more common with FIB-4 and HFS when compared with NFS [139(63%) and 122(55%) vs 80(36%), p < 0.001]. The variables that were associated with misclassification using the HFS were diabetes [OR 3.40 (95% CI 1.42-8.10), p = 0.006] and age [OR 1.06 (95% CI 1.01-1.11), p = 0.01]. CONCLUSION The HFS showed sensitivity and specificity similar to that reported in the original publication; however, the positive predictive value was 36.7% at a pretest probability of 14%. The role of the HFS in prospective studies and in combination with other methods should be further explored.
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Affiliation(s)
- Fátima Higuera-de-la-Tijera
- Department of Gastroenterology, Hospital General de México Dr. Eduardo Liceaga, Dr. Balmis 148, Colonia Doctores, Alcaldía Cuauhtémoc, 06720, Mexico City, Mexico
| | - Jacqueline Córdova-Gallardo
- Hepatology Division, Hospital General "Dr. Manuel GEA González", Calz. de Tlalpan 4800, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico
| | - Elizabeth Buganza-Torio
- Departamento de Gastroenterología, Centro Médico Nacional 20 de Noviembre, Félix Cuevas 540, Colonia del Valle Sur, Alcaldía Benito Juárez, 03229, Mexico City, Mexico
| | - Beatriz Barranco-Fragoso
- Departamento de Gastroenterología, Centro Médico Nacional 20 de Noviembre, Félix Cuevas 540, Colonia del Valle Sur, Alcaldía Benito Juárez, 03229, Mexico City, Mexico
| | - Aldo Torre
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico
| | - Sara Parraguirre-Martínez
- Pathology Division, Hospital General "Dr. Manuel GEA González", Calz. de Tlalpan 4800, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico
| | - Martin Edgardo Rojano-Rodríguez
- Bariatric Surgery Division, Surgery Service, Hospital General "Dr. Manuel GEA González", Calz. de Tlalpan 4800, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico
| | - Gabriel Quintero-Bustos
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Graciela Castro-Narro
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico
| | - Carlos Moctezuma-Velazquez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15, Colonia Belisario Domínguez Secc 16, Alcaldía Tlalpan, 14080, Mexico City, Mexico.
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