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Gonzalez RS, Pastrián LG, Pyatibrat S, Arias HDQ, Gil YR, Booth AL, de la Peña Navarro I, Garmendia-Irizar M, Lapointe JR, Mobarki M, Nova-Camacho LM, Parini G, Romio E, Alayza AR, Pritt BS, Ruz-Caracuel I. Submucosal Necrotic Nodule of the Colon: An Enigmatic Entity Potentially Related to Anisakis Infection. Arch Pathol Lab Med 2023; 147:1315-1319. [PMID: 36656170 DOI: 10.5858/arpa.2022-0267-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 01/20/2023]
Abstract
CONTEXT.— Discrete submucosal necrotic nodules may rarely manifest as colon polyps. OBJECTIVE.— To characterize the clinical and pathologic features of this lesion, which has been under-studied in the literature. DESIGN.— We conducted an international search to compile a series. For each potential case, photomicrographs were centrally reviewed to confirm the diagnosis. We gathered clinical and pathologic information on each confirmed case. RESULTS.— The final cohort included 25 patients, with 23 having 1 lesion and 2 having several (31 lesions total). Mean patient age was 62 years; 13 patients (52%) were male. Symptoms were nonspecific, although 4 patients (16%) had blood in stool; 14 patients were asymptomatic. Patient history and medications appeared noncontributory. Most cases were located in the right colon (n = 18; 58%). Mean lesion size was 0.4 cm (range, 0.1-1.7 cm). Histology typically showed a centrally necrotic nodule with peripheral fibrosis, chronic inflammation, and sometimes palisading granulomatous inflammation. Percent necrosis ranged from 5% to 95% (average, 70%), and percent fibrosis ranged from 3% to 70% (average, 25%). In 3 cases, degenerated parasitic structures consistent with Anisakis could be seen on hematoxylin-eosin and trichrome special stain. No patient experienced disease recurrence. CONCLUSIONS.— Submucosal necrotic nodules can present as colon polyps. Most cases are unifocal, and patients do well on follow-up. At least some examples appear to be caused by Anisakis, implicating patient diet. Patients are often asymptomatic, and many cases show no histologic evidence of the causative agent.
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Affiliation(s)
- Raul S Gonzalez
- From the Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia (Gonzalez)
| | - Laura G Pastrián
- The Department of Pathology, La Paz University Hospital, Madrid, Spain (Pastrián)
- The Department of Molecular Pathology and Therapeutic Targets Research Group, La Paz Research Institute (IdiPAZ), Madrid, Spain (Pastrián)
- The CB16/12/00273 Research Group, Net-Biomedical Research Center (CIBERONC), Madrid, Spain (Pastrián)
| | - Sergey Pyatibrat
- The Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, Vancouver, British Columbia, Canada (Pyatibrat)
| | | | - Yolanda Rodriguez Gil
- The Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain (Rodriguez Gil)
| | - Adam L Booth
- The Department of Pathology, Northwestern University, Chicago, Illinois (Booth)
| | - Itziar de la Peña Navarro
- The Department of Pathology, Gregorio Marañón University General Hospital, Madrid, Spain (de la Peña Navarro)
| | - Maddi Garmendia-Irizar
- The Department of Pathology, Donostia University Hospital, San Sebastian, Spain (Garmendia-Irizar, Nova-Camacho)
| | | | - Mousa Mobarki
- The Department of Pathology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia (Mobarki)
- The Pathology Institute of Hospices Civils de Lyon, Lyon, France (Mobarki)
| | - Luiz Miguel Nova-Camacho
- The Department of Pathology, Donostia University Hospital, San Sebastian, Spain (Garmendia-Irizar, Nova-Camacho)
| | - Gina Parini
- The Department of Pathology, Hospital del Mar, Barcelona, Spain (Parini)
| | - Estefania Romio
- The Department of Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain (Romio, Ruz-Caracuel)
| | | | - Bobbi S Pritt
- The Department of Pathology, Mayo Clinic, Rochester, Minnesota (Pritt)
| | - Ignacio Ruz-Caracuel
- The Department of Pathology, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain (Romio, Ruz-Caracuel)
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Andres AM, Encinas JL, Sánchez-Galán A, Rodríguez JS, Estefania K, Sacristan RG, Alcolea A, Serrano P, Estébanez B, Leon IV, Burgos P, Rocafort AG, Ramchandani B, Calderón B, Verdú C, Jimenez E, Talayero P, Stringa P, Navarro IDLP, Ramos E, Oliveros FH. First case report of multivisceral transplant from a deceased cardiac death donor. Am J Transplant 2023; 23:577-581. [PMID: 36725427 DOI: 10.1016/j.ajt.2022.12.021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/27/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023]
Abstract
The current shortage of pediatric multivisceral donors accounts for the long time and mortality on the waiting list of pediatric patients. The use of donors after cardiac death, especially after the outbreak of normothermic regional perfusion, has increased in recent years for all solid organs except the intestine, mainly because of its higher susceptibility to ischemia-reperfusion injury. We present the first literature case of multivisceral donors after cardiac death transplantation in a 13-month-old recipient from a 2.5-month-old donor. Once exitus was certified, an extracorporeal membrane oxygenation circuit was established, cannulating the aorta and infrarenal vena cava, while the supra-aortic branches were clamped. The abdominal organs completely recovered from ischemia through normothermic regional perfusion (extracorporeal membrane oxygenation initially and beating heart later). After perfusion with the preservation solution, the multivisceral graft was uneventfully implanted. Two months later, the patient was discharged without any complications. This case demonstrates the possibility of reducing the time spent on the waiting list for these patients.
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Affiliation(s)
- Ane M Andres
- Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (Idipaz), La Paz University Hospital, Madrid, Spain; European Reference Network on Transplantation in Children (TransplantChild ERN), Madrid, Spain; Anatomy, Histology and Neuroscience Department, University Autonoma of Madrid, Madrid, Spain.
| | - Jose Luis Encinas
- Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | | | - Javier Serradilla Rodríguez
- Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (Idipaz), La Paz University Hospital, Madrid, Spain
| | - Karla Estefania
- Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Rocio Gonzalez Sacristan
- Pediatric Gastroenterology Department, Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain
| | - Alida Alcolea
- Pediatric Gastroenterology Department, Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain
| | - Pilar Serrano
- Pediatric Gastroenterology Department, Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain
| | - Belén Estébanez
- Intensive Care Unit and Transplant Coordination Unit, La Paz University Hospital, Madrid, Spain
| | - Iñigo Velasco Leon
- Pediatric Perfusion Department, La Paz University Hospital, Madrid, Spain; Pediatric Cardiovascular Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Paula Burgos
- Pediatric Perfusion Department, La Paz University Hospital, Madrid, Spain; Pediatric Cardiovascular Surgery Department, La Paz University Hospital, Madrid, Spain
| | | | - Bunty Ramchandani
- Pediatric Cardiovascular Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Belén Calderón
- Pediatric Intensive Care Unit Department, La Paz University Hospital, Madrid, Spain
| | - Cristina Verdú
- Pediatric Intensive Care Unit Department, La Paz University Hospital, Madrid, Spain
| | - Esperanza Jimenez
- Pediatric Anesthesiology Department, La Paz University Hospital, Madrid, Spain
| | - Paloma Talayero
- Immunology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pablo Stringa
- Institute for Immunological and Physiopathological Studies (IIFP-CONICET-UNLP), National University of La Plata, Buenos Aires, Argentina
| | | | - Esther Ramos
- Pediatric Gastroenterology Department, Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain
| | - Francisco Hernandez Oliveros
- Pediatric Surgery Department, La Paz University Hospital, Madrid, Spain; La Paz Research Institute (Idipaz), La Paz University Hospital, Madrid, Spain; European Reference Network on Transplantation in Children (TransplantChild ERN), Madrid, Spain
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