Incidentally found rib hemangioma: Case report and discussion of management

Rib hemangioma is a rare chest wall tumor for which few reports in the literature exist to help guide treatment. The clinical presentation, radiographic findings, and treatment strategies vary in the literature, with the majority of patients undergoing surgical resection to definitively rule out malignancy. Here, we report a 23-year-old woman with an incidentally discovered rib hemangioma, who had a history of migraines, during the workup of a severe headache refractory to medical treatment. Imaging revealed a solitary, expansile tumor arising from the posterior left third rib. Spinal magnetic resonance imaging (MRI) showed a fat-containing lesion with multiple vascular flow voids, non-enhancement, and high signal intensity on the T2-weighted series. It appeared to have a honeycomb core on chest computed tomography (CT). Imaging characteristics of the lesion were consistent with an intraosseous hemangioma. The tumor was managed with upfront surgical resection without a preoperative biopsy. The case was uneventful and no complications were encountered. The patient recovered well, denied any symptoms four weeks after surgery, and a follow-up chest X-ray was unremarkable. Following resection, the pathological diagnosis was concordant with the radiographic diagnosis of a rib hemangioma. Here, we review existing literature on the rare case of a rib hemangioma with a focus on the radiographic characteristics and management. Given that radiographic features of this lesion were consistent with prior reports and surgery did not change the diagnosis, we suggest that non-operative management be considered for similar lesions, as surgical resection does not appear to reveal occult malignancy in the majority of cases

B cells mediate lung ischemia/reperfusion injury by recruiting classical monocytes via synergistic B cell receptor/TLR4 signaling

Ischemia/reperfusion injury-mediated (IRI-mediated) primary graft dysfunction (PGD) adversely affects both short- and long-term outcomes after lung transplantation, a procedure that remains the only treatment option for patients suffering from end-stage respiratory failure. While B cells are known to regulate adaptive immune responses, their role in lung IRI is not well understood. Here, we demonstrated by intravital imaging that B cells are rapidly recruited to injured lungs, where they extravasate into the parenchyma. Using hilar clamping and transplant models, we observed that lung-infiltrating B cells produce the monocyte chemokine CCL7 in a TLR4-TRIF-dependent fashion, a critical step contributing to classical monocyte (CM) recruitment and subsequent neutrophil extravasation, resulting in worse lung function. We found that synergistic BCR-TLR4 activation on B cells is required for the recruitment of CMs to the injured lung. Finally, we corroborated our findings in reperfused human lungs, in which we observed a correlation between B cell infiltration and CM recruitment after transplantation. This study describes a role for B cells as critical orchestrators of lung IRI. As B cells can be depleted with currently available agents, our study provides a rationale for clinical trials investigating B cell-targeting therapies