Toxic Shock Syndrome and Other Related Severe Infections
Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy in Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Source control is the biggest factor that will determine the fate of patient lives. In particular, antimicrobial therapy alone is not sufficient to treat necrotizing soft tissue infection [121]. In these cases, early surgical intervention is critical to remove the necrotic infected tissue. For example, in patients with postpartum or postabortal streptococcal TSS, hysterectomy needs to be considered early in patient management [122]. Table 11.6 illustrates the indications for surgical intervention with serious infections in obstetrics and gynecology. In patients with vulvar or incisional necrotizing soft tissue infections, early wide local debridement is critical. All necrotic tissue, including the overlying skin, should be resected until healthy bleeding tissue is encountered. On many occasions, these patients require serial surgical procedures to remove all the necrotic tissue [121].
Volumetric Approach to the Lips
Neil S. Sadick in Illustrated Manual of Injectable Fillers, 2020
Necrosis is a rare but real complication of any dermal filler, including HA fillers. There are two main etiologies of necrosis: first, compression of the vessel either by the product itself or by intradermal bleeding, and second by intra-arterial injection and occlusion of the artery (33). Knowing the signs and symptoms of necrosis is vitally important, as much tissue can be saved if the vascular compromise is caught prior to the death of the cutaneous tissue. Typical signs and symptoms of impending necrosis are a blanching or grey discoloration of the skin, a reticulate or lacy erythema, increasing pain or unusual sensation, or loss of sensation (33). If a patient describes any strange or unusual symptom, it is wise of the physician to insist the patient return to clinic for further evaluation. If impending necrosis is suspected or if necrosis has started, the treatment is with vigorous massage, nitroglycerin ointment, aspirin, warm compresses, and flooding the area of necrosis with two vials of hyaluronidase (33). There are numerous strategies one can employ while injecting to decrease the risk of necrosis; these include refluxing prior to each injection, monitoring the skin’s response with each injection—immediate blanching is a sign of intra-arterial injection, injecting in a retrograde fashion, injecting small amounts with each stroke of the needle, and injecting slowly. Additionally, knowing your vascular anatomy and staying away from danger zones is highly recommended with any facial rejuvenation.
Renal Cell Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Macroscopically clear-cell RCCs have a characteristic appearance with solid areas often interspersed with areas of cystic degeneration. These tumors are richly vascular with numerous vessels throughout the supporting stroma. Microscopically, tumor cells have a clear cytoplasm with a low nuclear to cytoplasmic ratio. The Fuhrman and WHO/ISUP grading systems can aid in the prediction of clinical tumor behavior. Both consist of four grades (I–IV) on the basis of morphologic tumor appearance. Sarcomatoid change may be seen, and represents a poor prognostic feature occurring in approximately 5% of tumors. The presence of tumor necrosis is also of prognostic significance and is associated with a worse survival.6 For the vast majority of patients with clear-cell RCC, the key molecular driver underlying development and progression of both sporadic and hereditary disease is loss of function of the Von Hippel–Lindau (VHL) gene through a process of deletion, mutation, or methylation.7,8 Increasingly evident with the progress in genetic sequencing is that multiple other genes are also responsible for malignant cell proliferation. Located on chromosome 3p in addition to VHL are PBRM1, SETD2, and BAP1 epigenetic/chromatin regulators. Loss of function of these tumor suppressor genes is thought to play a key role in cancer progression. PBRM-1 is mutated in around 40% ccRCC, and subclonal mutations in BAP-1 and SETD2 identified in 10–15% of tumor samples.8,9
A Multicenter Study of Clinicopathology and Immunohistochemical Distinction between Adult and Pediatric Large B-Cell Lymphoma
Published in Fetal and Pediatric Pathology, 2023
Thu Dang Anh Phan, Tu Thanh Duong, Diem Thi Nhu Pham, Minh Hoang Dang, Thien Thanh Ly, Hanh Thi Tuyet Ngo, Dat Quoc Ngo, Nguyen Dinh The Trinh, Uyen Le Ly, Tu Anh Thai, Ha Thi Ngoc Hua, Thao Thi Phuong Doan
The centroblastic morphology was predominant in children (60.0%), while only 12.3% in adults. The anaplastic pattern was 14.8% in adults, and only 2.2% in children (p < 0.001). DLBCL in children also had a frequency of “starry sky” pattern and necrosis higher than in adults (p < 0.001). DLBCL with anaplastic morphology showed low KPS index, advanced disease stage, elevated serum LDH levels, and a higher skin and bone invasion frequency. The frequency of bone marrow invasion was lower than DLBCL with the centroblastic morphology [24]. The “starry sky” pattern had been reported to have MYC gene translocations, an unfavorable prognostic factor for DLBCL. Several studies around the world have reported that negative clinical factors (ECOG index ≥ 2, LDH ratio > 1, advanced clinical stage, …) are more common in tumors with necrosis than others, and this was an independent prognostic factor for progression-free survival and overall survival in DLBCL patients [25]. Although this conclusion is controversial, tumor necrosis is a feature of interest, proposing unfavorable clinical features and poor prognosis. Most studies showed that DLBCL in children had much higher survival rates compared to adults despite the higher rate of centroblastic morphology, “starry sky” pattern, and necrosis [26, 27].
Metformin induces myeloma cells necrosis and apoptosis and it is considered for therapeutic use
Published in Journal of Chemotherapy, 2023
Zhentian Wu, Lianghua Wu, Liangliang Zou, Muqing Wang, Xin Liu
In our study, cellular and molecular mechanisms responsible for the actions of metformin differed from cell line to cell line. For U266 cells, it induced necrosis. For H929, RPMI8226, and MM.1s cells, it induced apoptosis. Cell cycle analysis showed that the cycle arrest also varied from cell to cell following metformin treatment. We found no change in U266 cells, in H929 and MM.1s cells, it induced at the G0/G1 phase, and in RPMI8226, it induced at the G2/M phase. Cell cycle arrest is controlled by some cyclin-dependent kinases (CDKs), such as cyclin-D1 in the G1/S transition and cyclin-B1 in the G2/M transition. We hypothesize that metformin acts powerfully on the cell cycle via different pathways in different MM cells. For H929 and MM.1s cells, the down-regulation of CyclinD1 leads to G1/G0 arrest and suppresses the cell proliferation. Cyclin-B1 is a key regulator of the cell cycle, it is involved in regulating the events of mitosis. It increased in the early G2 phase, and it is necessary for transition from G2 to M. Here we show that RPMI8226 cells arrested in G2/M with down-regulation of cyclin-B1 while metformin treated. It suggests that this reduction leads to accumulation of MM cells in the G2 phase and inhibits transition to the M phase. Necrosis is an unordered and accidental form of cellular dying, and usually with no changes in cell cycle arrest. For U266, we found necrosis related protein iNOS increasingly expressed and no apoptosis-associated protein was detected. It further confirmed that metformin might induce U266 necrosis.
Hot topics in renal cancer pathology: implications for clinical management
Published in Expert Review of Anticancer Therapy, 2022
Alessia Cimadamore, Anna Caliò, Laura Marandino, Stefano Marletta, Carmine Franzese, Luigi Schips, Daniele Amparore, Riccardo Bertolo, Stijn Muselaers, Selcuk Erdem, Alexandre Ingels, Nicola Pavan, Angela Pecoraro, Önder Kara, Eduard Roussel, Umberto Carbonara, Riccardo Campi, Michele Marchioni
Tumor necrosis is a pathological feature included in several prognostic scores. Presence of necrosis has been correlated to tumor size, grade, presence of distant metastasis and CSS both in univariate and multivariate analysis. However, contradictory reports showed no correlation with OS. These studies have included in their series different subtypes of RCC, tumor with focal microscopic necrosis and tumor with extensive necrosis, features that may have altered their results [44–47]. In the assessment of necrosis, attention should be paid to excluding area of hyalinization, hemorrhage, and fibrosis. Also, a distinction should be made between microscopic coagulative necrosis and extensive necrosis, due in most cases to infarction, secondary to large vessels obstruction. Some authors have proposed the term ‘granular necrosis’ to specifically describe the tumor-associated necrosis characterized by the presence of well-defined necrotic foci being sharply demarcated from the adjacent viable tumor [48]. Compared to other forms of necrosis, granular necrosis shows loss of architecture, granular nuclear with extensive karyorrhexis and cytoplasmic debris, without an associated neutrophilic infiltrate [48].(Figure 6)