Adrenal Ganglioneuroma with Multifocal Retroperitoneal Extension: A Challenging Diagnosis

A ganglioneuroma (GN) is the rarest and most benign of the neuroblastic tumors and originates from neural crest cells wherever sympathetic nervous tissue exists, such as in the retroperitoneum and adrenal gland. The diagnosis can be very challenging, given the rarity and asymptomatic presentation of this neoplasia, and can be achieved only by means of histological evaluation. Although benign, a few cases of metastatic GNs have been reported in the literature. The prognosis, however, seems to be excellent after surgical resection. We describe a rare case of multifocal retroperitoneal GN, diagnosed incidentally in a 46-year-old woman, with para-aortic and adrenal localizations. After intraoperative pathological diagnosis was made, complete excision of all the visible masses was performed. The postoperative period was uneventful and she was recurrence free 3 months after surgery. To our knowledge, this is the first case report of a multifocal retroperitoneal GN. Among the broad differential diagnoses of adrenal incidentalomas, an adrenal location of neuroblastic tumors should not be forgotten

Flavouring extra-virgin olive oil with aromatic and medicinal plants essential oils stabilizes oleic acid composition during photo-oxidative stress

Essential oils (EOs) from medicinal and aromatic plants (MAPs) are well-known as natural antioxidants. Their addition to extra-virgin olive oil (EVOO) can contribute to reducing fat oxidation. The main aim of this study was to improve both food shelf-life and aromatic flavour of EVOO, adding different EOs of Sicilian accessions of common sage, oregano, rosemary and thyme. The morphological and production characteristics of 40 accessions of MAPs were preliminarily assessed. EOs from the most promising accessions of MAPs were analysed by gas-chromatography and mass spectrometry. Photo-oxidative studies of the EOs were carried out and the determination of the EVOO fatty acids obtained from 4 Italian olive varieties was also made. EO content was on average 1.45% (v/w) for common sage, 3.97% for oregano, 1.42% for rosemary and 5.90% for thyme accessions. The highest average EO yield was found in thyme (172.70 kg ha1) whilst the lowest (9.30 kg ha1) in rosemary accessions. The chemical composition of EOs was very different in the four MAPs in the study. No significant change of oleic acid percentage was detected in the mixture of EVOO with EO samples. The results seem to highlight the presence of an antioxidant effect of EOs on EVOO

Karpinski Score under Digital Investigation: A Fully Automated Segmentation Algorithm to Identify Vascular and Stromal Injury of Donors’ Kidneys

In kidney transplantations, the evaluation of the vascular structures and stromal areas is crucial for determining kidney acceptance, which is currently based on the pathologist’s visual evaluation. In this context, an accurate assessment of the vascular and stromal injury is fundamental to assessing the nephron status. In the present paper, the authors present a fully automated algorithm, called RENFAST (Rapid EvaluatioN of Fibrosis And vesselS Thickness), for the segmentation of kidney blood vessels and fibrosis in histopathological images. The proposed method employs a novel strategy based on deep learning to accurately segment blood vessels, while interstitial fibrosis is assessed using an adaptive stain separation method. The RENFAST algorithm is developed and tested on 350 periodic acid–Schiff (PAS) images for blood vessel segmentation and on 300 Massone’s trichrome (TRIC) stained images for the detection of renal fibrosis. In the TEST set, the algorithm exhibits excellent segmentation performance in both blood vessels (accuracy: 0.8936) and fibrosis (accuracy: 0.9227) and outperforms all the compared methods. To the best of our knowledge, the RENFAST algorithm is the first fully automated method capable of detecting both blood vessels and fibrosis in digital histological images. Being very fast (average computational time 2.91 s), this algorithm paves the way for automated, quantitative, and real-time kidney graft assessments

Karpinski Score under Digital Investigation: A Fully Automated Segmentation Algorithm to Identify Vascular and Stromal Injury of Donors’ Kidneys

In kidney transplantations, the evaluation of the vascular structures and stromal areas is crucial for determining kidney acceptance, which is currently based on the pathologist's visual evaluation. In this context, an accurate assessment of the vascular and stromal injury is fundamental to assessing the nephron status. In the present paper, the authors present a fully automated algorithm, called RENFAST (Rapid EvaluatioN of Fibrosis And vesselS Thickness), for the segmentation of kidney blood vessels and fibrosis in histopathological images. The proposed method employs a novel strategy based on deep learning to accurately segment blood vessels, while interstitial fibrosis is assessed using an adaptive stain separation method. The RENFAST algorithm is developed and tested on 350 periodic acid-Schiff (PAS) images for blood vessel segmentation and on 300 Massone's trichrome (TRIC) stained images for the detection of renal fibrosis. In the TEST set, the algorithm exhibits excellent segmentation performance in both blood vessels (accuracy: 0.8936) and fibrosis (accuracy: 0.9227) and outperforms all the compared methods. To the best of our knowledge, the RENFAST algorithm is the first fully automated method capable of detecting both blood vessels and fibrosis in digital histological images. Being very fast (average computational time 2.91 s), this algorithm paves the way for automated, quantitative, and real-time kidney graft assessments

Recognizing the new disorder "idiopathic hypocryoglobulinaemia" in patients with previously unidentified clinical conditions

A considerable number of patients with high clinical suspicion for cryoglobulinaemic vasculitis either show negative results for the detection of cryoglobulins or show only trace amounts which cannot be characterized for composition. We aimed at establishing whether the failure to detect or the detection of trace amounts of cryoglobulin with conventional methods either identifies a peculiar subset of low level cryoglobulinaemia (from now on hypocryoglobulinaemia) or represents a separate entity. Using a modified precipitation technique in hypo-ionic medium, we prospectively identified between 2008 and 2021 237 patients (median age 60.8 years [22–97], 137 females) having < 0.5% cryocrit and clinical suspicion of autoimmune disorder. Of these 237 patients, only 54 (22.7%) had a history of HCV infection. One hundred and sixty-nine out of 237 patients (71%) had an established underlying disease, while 68 patients (28.6%) (median age 62.9 years [29–93], 35 females) did not show either laboratory markers or clinical symptoms consonant with an underlying aetiology. These 68 cases with only trace amounts of cryoglobulins were defined as having a putatively idiopathic hypocryoglobulinaemia. Nineteen of these 68 patients (27.9%) had a history of HCV infection. Twenty-four patients out of 68 (35.3%) were positive for rheumatoid factor (RF), while 25 (36.7%) patients had signs of complement consumption (i.e., C4 < 15 mg/dl and/or C3 < 80 mg/dl ), and 36 (52.9%) had increased inflammatory indexes. Seven patients only had arthralgia and constitutional symptoms while 61 out of 68 (89.7%) presented with at least one of the three cardinal signs of cryoglobulinaemic vasculitis including skin lesions, peripheral nerve involvement, and glomerulonephritis. Seventy-five percent of the subjects had type III hypocryoglobulins. In patients with hypocryoglobulinaemia the histologic features of glomerulonephritis (also examined by electron microscopy) resembled those of mixed cryoglobulinaemia-associated glomerulonephritis. In conclusion, hypocryoglobulins are often polyclonal and are mainly unrelated to HCV infection. Patients who present high clinical suspicion for vasculitis, especially glomerulonephritis and yet test negative for cryoglobulinaemia detected by standard techniques, could require deeper investigation even in the absence of HCV infection, RF activity or signs of complement consumption

Feijoa Fruit Peel: Micro-morphological Features, Evaluation of Phytochemical Profile, and Biological Properties of Its Essential Oil

Acca sellowiana (O. Berg) Burret (Feijoa) is an evergreen shrub, belonging to the Mirtaceae family. The aim of this study was to investigate the micromorphological features of the feijoa fruit peel and to evaluate the phytochemical profile, as well as the antioxidant, cytoprotective, and antimicrobial properties of its essential oil (EO), by several in vitro cell-free and cell-based assays. The micromorphological analysis showed several schizogenic secretory cavities, immediately below the epidermal layer. Forty compounds were identified and quantified by GC-FID and GC-MS analyses. Sesquiterpenes were the most abundant ones (76.89%), followed by monoterpene hydrocarbons (3.26%), and oxygenated monoterpenes (0.34%). The main compounds were \u3b3-Selinene (17.39%), \u3b1-Cariophyllene (16.74%), \u3b2-Cariophyllene (10.37%), and Germacene D (5.32%). The EO showed a strong and dose-dependent antioxidant, and free-radical scavenging activity. Furthermore, it showed cytoprotective activity on the lymphocytes, that have been pre-treated with 100 \u3bcM tert-butyl-hydroperoxide (t-BOOH), as well as a decrease in intracellular reactive oxygen species (ROS), induced by t-BOOH on erythrocytes. A preliminary antimicrobial screening against GRAM+ and GRAM- bacteria, as well as on fungi highlighted that EO showed the best activity against S. aureus and C. albicans (MIC 2.7 mg/mL). In light of these results, feijoa fruit EO could find various applications, especially in the food, nutraceutical, and pharmaceutical fields

DNAJB9 Is a Reliable Immunohistochemical Marker of Fibrillary Glomerulonephritis: Evaluation of Diagnostic Efficacy in a Large Series of Kidney Biopsies

Fibrillary glomerulonephritis (FGN) is a rare glomerular disease characterized by a challenging diagnostic workup requiring ultrastructural identification of 20 nm-thick randomly oriented fibrillar deposits. However, the recent introduction of DNAJB9 as a putative diagnostic marker of FGN could thoroughly improve this diagnostic scenario. This study aims to assess the DNAJB9 immunohistochemical expression in a large series of FGN cases and to eventually confirm its role as a diagnostic marker of FGN. We evaluated the immunohistochemical expression of DNAJB9 (Rabbit Polyclonal, ThermoFisher) in a series of 77 FGN and 128 non-FGN cases diagnosed between January 1992 and June 2022 at the Pathology Unit of the AOU Città della Salute e della Scienza Hospital. DNAJB9 was expressed in 73 of the 74 evaluable FGN cases, mostly showing a strong glomerular positivity (68 cases). Additionally, DNAJB9 resulted positive in all challenging scenarios [early-stage (6), congophilic (4), combined (4), and uncertain (4) cases of FGN)]. DNAJB9 was negative in all non-FGN cases, eventually resulting in a specificity of 100% and sensitivity of 99%. In conclusion, we confirmed the role of DNAJB9 as a diagnostic marker of FGN. Its adoption in the clinical routine will allow a faster, more feasible, and more accurate FGN diagnosis