Granuloma

A granulomatous interstitial pneumonia is a form of diffuse lung disease in which granulomas are a component of the histologic findings. The differential diagnosis is quite broad, but most cases represent examples of either sarcoidosis, diffuse granulomatous infections, or hypersensitivity pneumonitis. "Hot tub lung" is a recently described form of granulomatous interstitial pneumonia that appears to have some features of diffuse infections and some features of hypersensitivity pneumonitis. The pathologist's approach to these conditions can be facilitated by giving careful attention to the anatomic distribution of the granulomas, the qualitative features of the granulomas, and the histologic changes in the lung tissue around and away from the granulomas. These features, along with the results of cultures and special stains for micro-organisms and clinical and radiologic correlation allow for a diagnosis in the vast majority of cases.

Background: Over 112 million people worldwide are infected with Schistosoma haematobium, one of the most prevalent schistosome species affecting humans. Female genital schistosomiasis (FGS) occurs when S. haematobium eggs are deposited into the female reproductive tract by adult worms, which can lead to pelvic pain, vaginal bleeding, genital disfigurement and infertility. Recent evidence suggests co-infection with S. haematobium increases the risks of contracting sexually transmitted diseases such as HIV. The associated mechanisms remain unclear due to the lack of a tractable animal model. We sought to create a mouse model conducive to the study of immune modulation and genitourinary changes that occur with FGS.

RESUMO A cirurgia parendodôntica constitui uma alternativa na permanência do dente na cavidade bucal exercendo suas funções tendo como finalidade resolver problemas que não puderam ser solucionados pelo tratamento endodôntico convencional ou quando este não é possível. A obturação do canal radicular simultânea ao ato cirúrgico está indicada quando não se consegue conter o exsudato persistente por meio da medicação intracanal, impedindo a obturação dos canais radiculares. O objetivo do estudo foi relatar um caso de caso de apicectomia e obturação simultânea nos dentes 31 e 32, com acompanhamento de 18 meses. Paciente do sexo feminino, 28 anos, fez uso de aparelho ortodôntico por 5 anos, sem histórico de trauma, compareceu ao consultório com sintomatologia dolorosa aguda e constante na região anterior de mandíbula e presença de edema. Clinicamente, foi observado escurecimento da coroa do dente 32 e, radiograficamente, lesão periapical de, aproximadamente, 15 mm, envolvendo o seu ápice, estendendo-se para a região do 31. Ambos os elementos responderam negativamente ao teste de sensibilidade ao frio. Após o diagnóstico clínico de abscesso agudo, foi realizada a abertura coronária, pela qual houve drenagem de exsudato purulento via canal. Após instrumentação dos canais, a medicação de escolha foi o hidróxido de cálcio (Calen PMCC). A cada 30 dias, foi realizada troca da medicação (Calen) durante 4 meses e a drenagem do exsudato no dente 32 persistiu, impedindo a obturação do canal. Assim, o plano de tratamento proposto foi a apicectomia e a obturação simultânea para ambos os canais, após curetagem da lesão periapical. O diagnóstico histopatológico foi de granuloma periapical. Após o procedimento cirúrgico, foi realizado enxerto ósseo. Após 18 meses, verificou-se reparo ósseo e manutenção das estruturas dentais e alveolares. Conclui-se que apicectomia seguida de obturação simultânea ao ato cirúrgico pode solucionar problemas de infecções endodônticas periapicais persistentes e permitir a manutenção das funções dentárias.
Descritores: Apicectomia. Cirurgia bucal. Endodontia. Granuloma. Obturação Retrógrada. Preparo de canal radicular.

Parendodontic surgery is an alternative for functional tooth preservation in oral cavity, it aims to solve situations that could not be solved through regular endodontic treatment or whenever it’s not possible. Root canal filling simultaneously with surgery procedure is indicated when intracanal medication cannot hold resistant exudate or blocking root canal filling. This paper aims to report a simultaneous apicectomy and filling case for teeth 31 and 32, for 18 month monitoring period. Female patient, 28 years old, made use of braces for 5 years, no trauma records, visited the dental office feeling an acute and continuous painful symptomatology in the anterior region of the mandible and swelling. Clinically, a darkening in tooth 32  crown was observed, through x-ray examination it was observed  periapical lesion of approximately 15 mm, enveloping its apex, extending to tooth 31 region. Both elements responded negatively to the cold sensitivity test. After being clinically diagnosed with acute abscess, the coronary opening was undertaken, whereby there was a by canal purulent exudate drainage. After canal instrumentation, calcium hydroxide (Calen PMCC) was the medication choice. Each 30 days, medication (Calen) change was made during 4 months and the exudate drainage from tooth 32 persisted, impairing root canal filling. Thus, the treatment procedure proposed was apicectomy and simultaneous filling for both canals, after a curettage from periapical lesion.  Granuloma periapical was the histopathological diagnose. After surgical procedure, it was performed a bone graft. Upon 18 months, both bone healing or alveolar and teeth structure preservation had been verified. It was thus concluded that apicectomy followed by simultaneous filling during surgical procedure may solve persistent periapical endodontic infections and it allows dental function preservation.

Descriptors: Apicoectomy. Surgery, Oral. Endodontics. Granuloma. Retrograde obturation. Root Canal Preparation

Accepté pour publication le 24 septembre 2014 Disponible sur Internet le 13 novembre 2014 Observation Une femme de 60 ans a bénéficié d'une appendicectomie pour syndrome appendiculaire sans autre renseignement clinique ni anamnestique. À l'examen macroscopique, l'appendice était filiforme d'un diamètre n'excédant pas 10 mm et mesurait 45 mm de long, sans fausse membrane sur le méso. À l'examen histologique (voir lame virtuelle : http://www.goo.gl/fd710), la paroi appendiculaire était amincie avec des secteurs de muqueuse atrophique où les glandes étaient en nombre très diminué et d'architecture conservée, bordées par un revêtement épithélial peu mucosécrétant. Dans d'autres secteurs prédominants, le revêtement épithélial était abrasé au voisinage d'une réaction inflammatoire granulomateuse faite de macrophages épithélioïdes et cellules géantes, bordant la lumière dépourvue de nécrose caséeuse ou suppurée . La musculaire muqueuse était discrètement hyperplasique et la sous-muqueuse épaissie par des remaniements fibro-hyalins . La musculeuse et la séreuse étaient dépourvues de lésion histologique.

Interstitial granulomatous drug reactions are an uncommon entity presenting as asymptomatic, annular, erythematous to violaceous plaques. The incidence of such reactions has been increasing with the use of biologic agents. We report, to the best of our knowledge, the first such reaction to the interleukin (IL)-1 inhibitor anakinra. Our patient presented with pink dermal plaques and nodules in the periaxillary region which resolved with discontinuation of anakinra and recurred upon restarting anakinra. Biopsy revealed a diffuse dermal infiltrate of lymphocytes and histiocytes with interspersed neutrophils and eosinophils. Fragmentation and degeneration of collagen and elastic fibers was also present. Withdrawal of anakinra led to complete resolution of the lesions. Interstitial granulomatous drug reactions are increasing in frequency and we add anakinra to the list of causative agents. ( J Am Acad Dermatol 2008;59:S25-7.)