Sarcoidosis with prevalent and severe joint localization: A case report

BACKGROUND: Sarcoidosis is a systemic granulomatous disease of unknown origin, characterized by the formation of granulomas without central necrosis. Each organ and tissue can be affected by the disease, but in most cases mainly the lungs and mediastinal lymph nodes but also skin, heart, eyes and joints are involved, the latter are mainly the metacarpophalangeal joints and bone lesions are often associated with involvement of the overlying skin. The diagnosis is often of exclusion, based on clinical and radiological suspicion, and should be confirmed by biopsy, although in each case it is necessary to exclude other possible causes of granulomatosis, including infections by mycobacteria. Here it is reported a case of particularly aggressive sarcoidosis with primitive involvement of the small joints of the hands and feet, and mediastinal lymph nodes. CASE PRESENTATION: The subject, a man, 60 years old, born in Morocco but living in Italy for many years, presented important involvement of bone structures and soft periarticular tissue, and was affected by the formation of granulomas without “caseum necrosis”. The painful symptoms and the skin ulceration had led to surgical amputation of the distal phalanges of most fingers of his hands and feet, but with subsequent resurgence of lesions in acral locations after surgery. The PET/CT scan showed an amount of radiotracer in mediastinal lymph nodes, while the lymph nodes sampled by TBNA were normal and the CD4/CD8 ratio was less than 3 in the bronchoalveolar lavage. We ruled out any possible infectious cause, including mycobacterial infection (both tubercular and atypical), so the patient was treated with systemic corticosteroids, with an excellent clinical and radiological response. CONCLUSIONS: Such a case shows how the disease can have variable expressions, without primitive lung involvement; therefore, it should be necessary to consider any possible, unpredictable localization of the disease

KPNA2/ERG Coexpression is Associated With Early Recurrence in Advanced Prostate Cancers

Most prostate cancers (PC) overexpress the ERG oncogene and karyopherin α 2 (KPNA2). These genes play a role in prostatic carcinogenesis, but their prognostic significance is still debated. The aim of this study was to determine the prognostic significance of ERG and KPNA2 expression, and their association to early prostate-specific antigen (PSA) biochemical recurrence in advanced PC with lymph node metastases. A series of 65 consecutive pN1 M0 R0 PC samples obtained by radical prostatectomy with lymphadenectomy has been analyzed for ERG and KPNA2 expression by immunohistochemistry. For each case, the following clinical data were collected: age, preoperative serum PSA levels, Gleason grade group, TNM stage, and follow-up. PC recurrence was investigated by serum PSA assay and defined by a PSA concentration >0.2 ng/mL after a nadir of <0.1 ng/mL following radical prostatectomy. ERG-positive staining was found in 25/65 cases (38%), and KPNA2 in 56/65 cases (86%); neither was detected in normal prostatic tissue. Immunohistochemical concordance was found between primary tumor and lymph node metastases in 24/25 (96%) of ERG and 53/56 (95%) of KPNA2-positive cases. The follow-up was known in all cases, and early PSA recurrence occurred in 25/65 cases (38%). ERG positivity, both alone and in conjunction with KPNA2 positivity, was strongly associated with early PSA recurrence [both ERG+ and KPNA+, odds ratio: 22.2 (95% confidence interval, 6.0-82.3); ERG+ alone odds ratio: 17.9 (95% confidence interval, 5.1-63.5); P<0.0001 for both]. KPNA2 expression was significantly associated with the tumor stage (P<0.00001). The results suggest that the ERG+ phenotype might be selected in metastasis-initiating clones. ERG and KPNA2 may have a prognostic value, and their positivity in PC might warrant more aggressive treatments

Mesocosm Experiments at a Tunnelling Construction Site for Assessing Re-Use of Spoil Material as a By-Product

Mechanized excavation of tunnels with Earth Pressure Balance-Tunnel Boring Machines requires the use of foaming agents. The latter contain the anionic surfactant sodium lauryl ether sulphate (SLES) as the main compound. The re-use as a by-product of excavated soil containing foaming agents (spoil material) can pose a risk for soil and particularly for aquatic ecosystems if they are close to the spoil material final destination site. This work reports the chemical results (SLES residual concentrations) and ecotoxicological effects (battery of five tests) of 28 day-mesocosm studies performed at a tunnelling construction site. The soil mesocosms were set up with two different lithologies, which contained four different foaming agent products at the highest amounts used for excavation. The decrease in SLES concentrations and the ecotoxicological tests were performed in soil and its water extract (elutriate) at different times (0, 7, 14, 28 d). Elutriates were prepared in order to simulate a possible SLES leaching from soil to water. The results showed a decrease in SLES over time and different ecotoxicological responses depending not only on the initial amount of each product, but also on the soil lithology and organism tested (aquatic or terrestrial). This study showed how only site-specific ecotoxicological evaluations can ensure a safe management of the spoil material, making possible the re-use of soil and avoiding production of waste

Mesocosm Experiments at a Tunnelling Construction Site for Assessing Re-Use of Spoil Material as a By-Product

Mechanized excavation of tunnels with Earth Pressure Balance-Tunnel Boring Machines requires the use of foaming agents. The latter contain the anionic surfactant sodium lauryl ether sulphate (SLES) as the main compound. The re-use as a by-product of excavated soil containing foaming agents (spoil material) can pose a risk for soil and particularly for aquatic ecosystems if they are close to the spoil material final destination site. This work reports the chemical results (SLES residual concentrations) and ecotoxicological effects (battery of five tests) of 28 day-mesocosm studies performed at a tunnelling construction site. The soil mesocosms were set up with two different lithologies, which contained four different foaming agent products at the highest amounts used for excavation. The decrease in SLES concentrations and the ecotoxicological tests were performed in soil and its water extract (elutriate) at different times (0, 7, 14, 28 d). Elutriates were prepared in order to simulate a possible SLES leaching from soil to water. The results showed a decrease in SLES over time and different ecotoxicological responses depending not only on the initial amount of each product, but also on the soil lithology and organism tested (aquatic or terrestrial). This study showed how only site-specific ecotoxicological evaluations can ensure a safe management of the spoil material, making possible the re-use of soil and avoiding production of waste