Publications by authors named "Pavithra Ayyanar"

34 Publications

Diminution of the Primary Cilia From the Intrahepatic Cholangiocytes in a Pediatric Choledochal Cyst.

Appl Immunohistochem Mol Morphol 2021 Jun 3. Epub 2021 Jun 3.

Departments of Pathology and Lab Medicine Pediatric Surgery Pediatrics, AIIMS, Bhubaneswar, Odisha, India.

Choledochal cyst (CC) is a cystic disease predominantly involving the extrahepatic biliary tree. Biliary atresia (BA), another disorder of the extrahepatic biliary tree, is sometimes considered to be in the same spectrum as pediatric CC. Recently, the absence and/or the structural abnormality of the primary cilia in the intrahepatic cholangiocytes have been implicated in the pathogenesis of BA. We aimed to evaluate the expression of primary ciliary proteins in the intrahepatic cholangiocytes in cases of pediatric CC and compare it with normal control and BA. We performed immunohistochemistry for primary ciliary proteins (acetylated-α-tubulin and double-cortin domain containing 2) on the liver biopsies of control liver (n=5), pediatric CC (n=13), and BA (n=14). We also compared the expression with various clinical, biochemical, histopathologic (portal fibroinflammation and ductal plate malformation), and immunohistochemical (proliferative index) data. There was significant loss of primary cilia from the intrahepatic cholangiocytes in cases of CC and BA as compared with the normal control by both immunostains (CC: P=0.003 and 0.001, respectively; BA: P=0.001 and 0.001, respectively). There was no significant difference between the CC and BA in terms of ciliary protein loss. The loss of the ciliary proteins occurred irrespective of the proliferative (MIB-1 labeling) index, portal fibroinflammation, or ductal plate malformation. The loss of cilia did not correlate with the clinical follow-up in cases of pediatric CC. The loss of primary cilia from the intrahepatic cholangiocytes may be crucial in the etiopathogenesis of pediatric CC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PAI.0000000000000953DOI Listing
June 2021

Dermoscopic features of acute cutaneous lupus erythematosus: A retrospective analysis from a tertiary care centre of East India.

Australas J Dermatol 2021 May 25. Epub 2021 May 25.

Department of Pathology, AIIMS, Bhubaneswar, India.

Background: The cutaneous features of acute cutaneous lupus erythematosus (ACLE) can be confused with other dermatoses. The dermoscopic features of ACLE have rarely been reported.

Aims: We aimed to study the dermoscopic features of ACLE, malar rash, and generalized ACLE.

Materials And Methods: The dermoscopic features of all biopsy and direct immunofluorescence confirmed ACLE cases were analysed retrospectively between May 2019 and May 2020.

Results: A total of 21 patients with skin phototypes III, IV, or V were included in the analysis. A pinkish-white to reddish-white homogenous area (94.1%), brown dots, globules and peppering (76.4%), and keratotic follicular plugging (64.7%) were the common dermoscopic features observed in the case of generalized ACLE. Similarly, in the case of malar rash, a pinkish-white to reddish-white homogenous area (77.8%) was the most common dermoscopic feature, followed by keratotic follicular plugging (66.7%), scales (44.5%), and brown dots, globules, and peppering (44.5%). In both variants, vascular structures were dominated by linear vessels with or without branching.

Conclusions: A multicomponent pattern comprising white scales, homogenous pinkish-white to the reddish-white area, brown dots/globules/peppering, keratotic follicular plugging, and linear vessels with or without branching were the common dermoscopic features observed in our study and may indicate the diagnosis of both localized and generalized ACLE. In addition, a paucity of dotted vessels may serve as an additional clue.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13620DOI Listing
May 2021

The Clinico-histopathological Spectrum of Tumors and Tumor-Like Lesions in Adult Intussusception.

J Gastrointest Cancer 2021 May 20. Epub 2021 May 20.

Dept of Pathology and Lab Medicine, AIIMS, Bhubaneswar, PIN-751019, India.

Background: Intussusception is an uncommon cause of intestinal obstruction in adults. The etiology of this disease differs from the children. Thus, its management depends on the possible etiology and is different from pediatric cases.

Aims: We aimed to study the clinico-histopathological spectrum of the tumors and tumor-like lesions in the intussusception in adults.

Material And Methods: A retrospective review of the adult (> 18 years) intussusception cases was performed. The clinical data and follow-up were obtained. The histopathology was reviewed along with the special stains and immunohistochemistry for ascertaining a histopathological diagnosis.

Results: Fifteen cases of adult intussusception were identified from 107 resected specimens of adult intestinal obstruction. The mean age was 44.5 years with a male/female ratio of 1.1:1. A definitive pathology could be ascertained in 80% of the cases (n = 12/15). Eight cases had benign non-neoplastic etiology (53.3%) (33.3% tumor-like lesions) while seven cases (46.7%) had neoplastic etiology (20% benign neoplastic; 26.7% malignant neoplastic). All cases of colonic or enterocolic intussusceptions were associated with neoplasia whereas 90% of the enteric intussusceptions occurred due to benign non-neoplastic causes.  CONCLUSIONS: Non-neoplastic causes are predominant in the enteric intussusceptions while neoplastic causes are more commonly associated with colonic or enterocolic intussusceptions. The post-operative histopathological examination concludes on the adequacy of the index surgery or the provision of further management if required.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12029-021-00647-5DOI Listing
May 2021

Pigmented trichilemmoma: A potential mimicker.

Australas J Dermatol 2021 May 10. Epub 2021 May 10.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13622DOI Listing
May 2021

Dermoscopic features of basal cell carcinoma in skin of color: A retrospective cross-sectional study from Puducherry, South India.

Indian J Dermatol Venereol Leprol 2021 Apr 23:1-7. Epub 2021 Apr 23.

Department of Pathology, AIIMS, Bhubaneswar, Odisha, India.

Background: Dermoscopy is useful in the diagnosis of basal cell carcinoma (BCC). However, most descriptions of the dermoscopic features of BCCs are in Caucasians (skin types I-III) and there is a paucity of data in dark-skinned Indian patients.

Aims: The aim of this study was to describe the various dermoscopic features of BCC in dark-skinned patients from South India and correlate these with the histopathologic subtypes.

Methods: A retrospective observational study of biopsy-proven cases of BCC was conducted at a tertiary care center in South India using nonpolarized contact dermoscopy.

Results: Sixty BCCs in 35 patients predominantly of skin phototypes IV or V were studied. These included 32 nodular, 27 superficial and 1 infiltrative type of BCC. The most common dermoscopic features noted were maple leaf-like areas (61.7%), blue-white veils (53.4%), ulceration (48.4%) and short fine telangiectases (46.7%). Ulceration, blue-white veils and arborizing vessels were significantly associated with nodular BCCs, while maple leaf-like areas, red-white structureless areas, multiple small erosions and spoke wheel areas were noted with superficial BCCs.

Limitations: The limitations of this study include its retrospective nature, the use of only nonpolarized light for examination, the lack of other histopathological variants of BCC as well as the lack of a comparison group.

Conclusion: We report a dermoscopic study of BCC in dark-skinned patients from Puducherry, South India. The blue-white veil was observed in half of the patients and was significantly associated with nodular BCCs. The addition of the blue-white veil to the diagnostic criteria for pigmented BCC could improve the diagnostic accuracy of dermoscopy in Indian patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.25259/IJDVL_420_20DOI Listing
April 2021

Dermoscopy of Bowen's disease: A case series of five patients.

Indian J Dermatol Venereol Leprol 2021 Apr 23:1-5. Epub 2021 Apr 23.

Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.25259/IJDVL_987_20DOI Listing
April 2021

Synchronous colonic adenocarcinoma and well-differentiated neuroendocrine tumor arising in a mature cystic teratoma of ovary - rare presentation in a postmenopausal woman with literature review.

Indian J Pathol Microbiol 2021 Apr-Jun;64(2):385-389

Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India.

Mature cystic teratoma of the ovary (MCT) is rare in pre and postmenopausal age patients. Among various types of malignant transformation in MCT, adenocarcinoma is a rare subtype. Dual type tumors arising from ovarian MCT have been described in the literature very rarely. A 47-year-old postmenopausal female patient presented with abdominal mass for ten years. The radiological opinion was a dermoid cyst. Grossly, a 22 × 20 × 10 cm, unilocular cystic left ovarian mass with intact capsular surface and focal thickened wall measured 3.0 cm. Microscopically, it showed components of all three germ cell layers. In addition, features of colonic type adenocarcinoma and well-differentiated neuroendocrine tumor (carcinoid) were noted and confirmed by immunohistochemistry (IHC). We report this rare case of synchronous malignancy arising from an ovarian MCT with a clinicopathological review.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/IJPM.IJPM_41_20DOI Listing
April 2021

Dermoscopic Appearance of an Annular Subacute Cutaneous Lupus Erythematosus.

Dermatol Pract Concept 2021 Mar 8;11(2):e2021013. Epub 2021 Mar 8.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5826/dpc.1102a13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943201PMC
March 2021

Atypical clinical and dermoscopic features of hobnail hemangioma.

Indian J Dermatol Venereol Leprol 2021 Jan-Feb;87(1):93-97

Department of Pathology, AIIMS, Bhubaneswar, Odisha, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.25259/IJDVL_181_20DOI Listing
February 2020

Cecal dermoid masquerading dermoid cyst of ovary: a case report and review of the literature.

J Med Case Rep 2021 Jan 30;15(1):38. Epub 2021 Jan 30.

Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Background: The ovary is the most common site of occurrence of mature cystic teratomas (dermoid cysts). These are the most common ovarian germ cell tumor in the reproductive age group, accounting for 10-20% of all ovarian neoplasms, with a 1-2% risk of malignancy. A cecal dermoid cyst is a rare entity with only ten cases having been reported so far, eight of which could be retrieved as the rest were reported in different languages. None of these cases were managed laparoscopically. Here we present the first case of cecal dermoid managed laparoscopically.

Case Presentation: A 35-year-old nulliparous Indian Hindu woman presented with complaints of on and off abdominal pain for 10 months. The abdominal examination revealed a well-defined mass of about 10 × 5 cm size, palpable in the right iliac fossa. On sonography, it was suggestive of a right-sided ovarian dermoid cyst. The lesion measured 10 × 7 × 5 cm on a contrast-enhanced computed tomogram (CT) scan. It was well defined and hypodense and located in the right lower abdomen. The ovarian tumor markers were normal. On laparoscopy, the uterus, bilateral tubes, and ovaries were found to be healthy. The cyst was seen arising from the right medial wall of the cecum at the ileocecal junction, which was excised laparoscopically. Histopathological study revealed it to be a mature cystic teratoma.

Conclusion: Ovarian mature cystic teratoma commonly has an indolent course and can present with palpable abdominal mass, pain, or vomiting due to complications like torsion, hemorrhage, or infection. Alternatively, these cysts can be asymptomatic and incidentally detected. Clinicians should be aware of the variety of presentations of dermoid cysts of the bowel as well as mesentery. The exact location of the teratoma eluded us till the laparoscopy despite adequate imaging including a contrast-enhanced CT scan having been performed preoperatively. We are reporting this as it is a rare entity, and this knowledge will help gynecologists and surgeons make an appropriate surgical decision.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13256-020-02570-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847138PMC
January 2021

Dermoscopy in the diagnosis of generalized acute cutaneous lupus erythematosus.

Int J Dermatol 2021 Jan 7. Epub 2021 Jan 7.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15413DOI Listing
January 2021

Pigmented infundibulocystic basal cell carcinoma: A diagnostic challenge in dark skin.

Australas J Dermatol 2021 May 3;62(2):e349-e351. Epub 2021 Jan 3.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13540DOI Listing
May 2021

SMARCB1/INI1 Deficient Sino-Nasal Carcinoma: Extending the Histomorphological Features.

Head Neck Pathol 2021 Jun 3;15(2):555-565. Epub 2020 Nov 3.

Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, 751019, India.

SMARCB1/INI1 deficient sinonasal carcinoma is a variant of sinonasal undifferentiated carcinoma (SNUC). There is a paucity of literature describing the histomorphological features of this relatively new entity. Herein we describe the histomorphological features of three such cases and review the literature. We retrospectively reviewed the cases of SNUC diagnosed in our institute in the last 6 years. Immunohistochemistry for INI1, NUT & p16 were performed on these cases. Three cases showed loss of INI1. The histomorphology and clinicopathological features of these cases were studied and compared with non INI1 deficient SNUC. A total of 9 cases of SNUC were identified. Three of these cases showed loss of INI1. These three cases had presented with large sinonasal mass and with intracranial extension. Histopathology of these cases showed a diffuse infiltrative pattern, nest, and islands of predominantly basaloid cells with focal rhabdoid morphology. Additional features like small cell carcinoma like pattern, pseudoalveolar and pseudoglandular patterns, clear vacuoles and pseudopapillary appearance were also noted. We conclude that in presence of a mixed pattern of cells with a predominance of basaloid morphology, the possibility of SMARCB1/INI1 deficient sinonasal carcinoma must be strongly suspected and immunohistochemistry for INI1 must be performed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12105-020-01246-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134582PMC
June 2021

Fibrous hamartoma of infancy with hypertrichosis: the diagnostic challenge of a rare late-onset case.

Int J Dermatol 2021 Feb 20;60(2):e59-e60. Epub 2020 Oct 20.

Department of Pathology, AIIMS, Bhubaneswar, Odisha, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.15259DOI Listing
February 2021

Linear comedonal Darier disease: A rare variant.

Australas J Dermatol 2021 May 9;62(2):e318-e319. Epub 2020 Oct 9.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13468DOI Listing
May 2021

Dermoscopic examination of a case of pigmented intraepithelial carcinoma on the palm.

Australas J Dermatol 2021 Feb 27;62(1):e153-e155. Epub 2020 Sep 27.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13465DOI Listing
February 2021

Dermoscopic features in a case of chondroid syringoma.

Indian J Dermatol Venereol Leprol 2021 Jan-Feb;87(1):89-92

Departments of Dermatology and Venereology, AIIMS, Bhubaneswar, Odisha, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijdvl.IJDVL_167_20DOI Listing
February 2020

Clinical and Histopathological Spectrum of Adult Gastrointestinal Inflammatory Neuropathy.

Int J Surg Pathol 2021 May 23;29(3):246-256. Epub 2020 Sep 23.

410775All India Institute of Medical Sciences, Bhubaneswar, India.

Gastrointestinal inflammatory neuropathy, namely, eosinophilic myenteric ganglioneuronitis (EMG) and lymphocytic ganglioneuronitis (LG), is a form of chronic intestinal pseudo-obstruction and results from the infiltration of the myenteric plexus by eosinophils and lymphocytes, respectively. The literature related to the clinicopathological features of adult inflammatory neuropathy is scarce. We aim to elucidate the clinical and histological details of 7 cases of inflammatory neuropathy (EMG, n = 4, and LG, n = 3) and compare the features of EMG and LG retrospectively. There was no difference between these two entities in terms of clinical, hematological, or biochemical parameters. Histologically, almost all cases (n = 6/7) showed accompanying elements of ganglion cell vacuolization, mesenchymopathy, and partial/complete desmosis in addition to the disease-defining pathology. Besides, all cases of EMG showed infiltration of the inner circular muscle of muscularis propria by eosinophils. Two cases of LG showed additional muscular pathology pertaining to the muscularis propria. Inflammatory infiltration of the myenteric plexus is pathognomonic for the diagnosis of gastrointestinal inflammatory neuropathy although additional features in the form of ganglion cell vacuolization, reduction in the number of ganglia, desmosis, mesenchymopathy, and inflammation of the muscularis propria (eosinophils in EMG) can be seen. The pathologists need proper awareness along with judicious use of special and immunostains for clinching the diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1066896920960515DOI Listing
May 2021

Diagnosis of idiopathic T-cell pseudolymphoma: A continuous challenge.

Australas J Dermatol 2021 Feb 20;62(1):e142-e144. Epub 2020 Aug 20.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13445DOI Listing
February 2021

GATA3 expression in the solid cell nest of thyroid.

Indian J Pathol Microbiol 2020 Jul-Sep;63(3):493-494

Department of Pathology and Lab Medicine, AIIMS, Bhubaneswar, Odisha, India.

Solid cell nest (SCN) of thyroid is a benign histomorphological mimicker of papillary microcarcinoma. Previous studies have elucidated a few immunohistochemical markers of SCN that aid in its distinction from papillary microcarcinoma. The positivity of GATA3 in SCN has been demonstrated only recently. We also document GATA3 positivity in three cases of SCN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/IJPM.IJPM_651_19DOI Listing
June 2021

Macro-follicular variant of papillary carcinoma of thyroid with mediastinal lymphadenopathy - A rare histology and surgical challenge.

Oral Oncol 2020 12 4;111:104887. Epub 2020 Aug 4.

Department of Surgical Oncology, Institution- All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oraloncology.2020.104887DOI Listing
December 2020

An unusual dermoscopic presentation of eruptive lichen planus dominated by rosettes and blink sign.

Australas J Dermatol 2021 Feb 5;62(1):72-75. Epub 2020 Aug 5.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13398DOI Listing
February 2021

Expression of CD56 is Not Limited to Biliary Atresia and Correlates with the Degree of Fibrosis in Pediatric Cholestatic Diseases.

Fetal Pediatr Pathol 2020 Jun 8:1-11. Epub 2020 Jun 8.

Pathology and Lab Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India.

: CD56 immunostain is used as an adjunct to aid in the preoperative diagnosis of biliary atresia (BA) by liver biopsy. We aimed to study the expression of CD56 in different pediatric cholestatic diseases thereby evaluating its utility in the diagnosis of BA.: We performed immunohistochemistry for CD56 on 35 cases of pediatric cholestatic diseases and five age-matched controls. CD56 expression was assessed by a multiplication score (percentage positivity x intensity) in the biliary epithelium.: The multiplication score between BA and choledochal cyst was not significantly different. High scores were also encountered in other cholestatic disorders. The score showed a significant negative association with serum albumin and a significant positive correlation with the serum ALT level. Very significant positive correlation between the score and portal fibrosis was obtained.: CD56 expression is an infidel marker for the histological diagnosis of BA and rather provides a clue to the disease status in pediatric cholestatic diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15513815.2020.1765917DOI Listing
June 2020

Laparoscopic excision of a large Adrenal Ganglioneuroma masquerading as Pheochromocytoma- A case report & review of literature.

Urol Case Rep 2020 Nov 22;33:101276. Epub 2020 May 22.

Department of Urology, All India Institute of Medical Sciences, Bhubaneswar, India.

Adrenal Ganglioneuromas are rare. Evaluation for hormone secretion followed by complete excision is the treatment of choice for such masses. We present our experience of a symptomatic large Adrenal Ganglioneuroma, which was removed with laparoscopic procedure. A 44-year gentleman presented with a symptomatic adrenal tumor. Under the impression of Adrenal Pheochromocytoma, tumor was excised laparoscopically without any untoward event. And to our surprise Adrenal Ganglioneuroma was detected in biopsy. Hence, Ganglioneuromas should be considered as a differential for a functional or symptomatic adrenal mass. And by following proper technique even such large functional adrenal masses can be removedlaparoscopically.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eucr.2020.101276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262088PMC
November 2020

Dermoscopic features of solitary neurofibroma: A retrospective analysis of 32 cases.

Australas J Dermatol 2020 Nov 29;61(4):e406-e409. Epub 2020 May 29.

Department of Pathology, AIIMS, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13338DOI Listing
November 2020

Multicoloured rainbow pattern in a case of aneurysmal dermatofibroma.

Australas J Dermatol 2020 Nov 28;61(4):e432-e434. Epub 2020 Apr 28.

Department, Pathology, All India Institute of Medical Sciences, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ajd.13302DOI Listing
November 2020

Granulosis rubra nasi seen through the dermatoscope.

JAAD Case Rep 2020 Mar 26;6(3):234-236. Epub 2020 Feb 26.

Department of Dermatology and Venereology, All India Institute of Medical Sciences, Bhubaneswar, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jdcr.2020.01.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044648PMC
March 2020

Histopathologic Spectrum of Neuromuscular and Vascular Hamartoma With Special Reference to the Vasculopathic Phenomenon.

Int J Surg Pathol 2020 Jun 24;28(4):382-392. Epub 2019 Nov 24.

All India Institute of Medical Sciences, Bhubaneswar, India.

Neuromuscular and vascular hamartoma (NMVH) is an unusual lesion presenting as intestinal obstruction by stricture formation. It is characterized by a hamartomatous mass comprising haphazardly arranged mesenchymal tissue native to the intestinal mucosa and submucosa. We aimed to characterize the clinicohistopathological spectrum of NMVH in adult subjects with a search for an etiological clue. We reviewed 84 resected specimens (adult cases) of intestinal obstruction in our institute and diagnosed 4 cases with NMVH. A panel of special stains (Masson trichrome, Verhoeff-van-Gieson, and periodic acid-Schiff) and immunohistochemistry (smooth muscle actin, S100, Bcl, CD34, vimentin, desmin, CD117, and CD3) were performed in all cases. All cases of NMVH showed characteristic hamartomatous mounds comprising haphazardly arranged smooth muscle, nerves, ganglia, vessels, and collagen with overlying mucosal ulceration. Adjacent bowel showed submucosal fibrosis, muscularis mucosae thickening, and duplication along with vasculopathy. A typical vasculopathy ("vessel-in-vessel" appearance) was seen in the submucosal and/or subserosal veins. Besides, different other forms of vasculopathic changes like obliterative venopathy and concentric myohypertrophy were also seen. One case had vasculitis and the patient died despite successful surgery. One other case was associated with lymphocytic ganglioneuronitis and granulomatous etiology. We conclude that NMVH can be multifactorial in origin although ischemia resulting from vasculopathy appears to be directly causative. The characteristic vasculopathy in the submucosal location may aid in the diagnosis of NMVH in small biopsy samples.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1066896919890129DOI Listing
June 2020