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Irqsusi M, Gerlach SV, Rastan AJ, Ghazy T. Invasive Giant B-Cell Lymphoma Mimicking Fulminant Pulmonary Embolism. Thorac Cardiovasc Surg Rep 2023; 12:e21-e23. [PMID: 36987438 PMCID: PMC10040259 DOI: 10.1055/s-0043-1764473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 03/29/2023] Open
Abstract
Background
Cardiac non-Hodgkin's lymphoma is rare and has a poor prognosis. Here we report a rare case mimicking pulmonary embolism.
Case Description
A 38-year-old woman suffered from severe dyspnea after cesarean section. With the clinical picture of fulminant central pulmonary embolism, lysis therapy was initiated. Further deterioration necessitated extracorporeal membrane oxygenation (ECMO) support and cardiosurgical intervention. Intraoperatively, a massive intravascular tumor obstructed the pulmonary bifurcation and was found to be B-cell lymphoma. Aggressive excision and pulmonary tree reconstruction improved the critical condition and initiated convalescence.
Conclusion
High suspicion in central pulmonary embolism and early cardiosurgical therapy after ineffective lysis are essential.
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Affiliation(s)
- Marc Irqsusi
- Department of Heart Surgery, University Hospital, Philipps University of Marburg, Marburg, Germany
- Address for correspondence Marc Irqsusi, MD Department of Heart Surgery, University Hospital, Philipps University MarburgBaldinger Str. 1, 35039 MarburgGermany
| | | | - Ardawan Julian Rastan
- Department of Heart Surgery, University Hospital, Philipps University of Marburg, Marburg, Germany
| | - Tamer Ghazy
- Department of Heart Surgery, University Hospital, Philipps University of Marburg, Marburg, Germany
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2
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Gajawada P, Cetinkaya A, von Gerlach S, Kubin N, Burger H, Näbauer M, Grinninger C, Rolf A, Schönburg M, Choi YH, Kubin T, Richter M. Myocardial Accumulations of Reg3A, Reg3γ and Oncostatin M Are Associated with the Formation of Granulomata in Patients with Cardiac Sarcoidosis. Int J Mol Sci 2021; 22:ijms22084148. [PMID: 33923774 PMCID: PMC8072627 DOI: 10.3390/ijms22084148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/24/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022] Open
Abstract
Cardiac sarcoidosis (CS) is a poorly understood disease and is characterized by the focal accumulation of immune cells, thus leading to the formation of granulomata (GL). To identify the developmental principles of fatal GL, fluorescence microscopy and Western blot analysis of CS and control patients is presented here. CS is visualized macroscopically by positron emission tomography (PET)/ computed tomography (CT). A battery of antibodies is used to determine structural, cell cycle and inflammatory markers. GL consist of CD68+, CD163+ and CD206+ macrophages surrounded by T-cells within fibrotic areas. Cell cycle markers such as phospho-histone H3, phospho-Aurora and Ki67 were moderately present; however, the phosphorylated ERM (ezrin, radixin and moesin) and Erk1/2 proteins, strong expression of the myosin motor protein and the macrophage transcription factor PU.1 indicate highly active GL. Mild apoptosis is consistent with PI3 kinase and Akt activation. Massive amounts of the IL-1R antagonist reflect a mild activation of stress and inflammatory pathways in GL. High levels of oncostatin M and the Reg3A and Reg3γ chemokines are in accordance with macrophage accumulation in areas of remodeling cardiomyocytes. We conclude that the formation of GL occurs mainly through chemoattraction and less by proliferation of macrophages. Furthermore, activation of the oncostatin/Reg3 axis might help at first to wall-off substances but might initiate the chronic development of heart failure.
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Affiliation(s)
- Praveen Gajawada
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
| | - Ayse Cetinkaya
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
| | - Susanne von Gerlach
- Universitätsklinikum Giessen und Marburg GmbH, Standort Marburg, Baldingerstr., 35033 Marburg, Germany;
| | - Natalia Kubin
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany; (M.N.); (C.G.)
| | - Carola Grinninger
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany; (M.N.); (C.G.)
| | - Andreas Rolf
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, 60549 Frankfurt/Main, Germany
- Correspondence: (Y.-H.C.); (T.K.); (M.R.)
| | - Thomas Kubin
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Correspondence: (Y.-H.C.); (T.K.); (M.R.)
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
- Correspondence: (Y.-H.C.); (T.K.); (M.R.)
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Plesker R, Köhler K, von Gerlach S, Boller K, Vogt M, Feder IS. Reactive mesothelial hyperplasia mimicking mesothelioma in an African green monkey ( Chlorocebus aethiops). Primate Biol 2020; 7:5-12. [PMID: 32760782 PMCID: PMC7399384 DOI: 10.5194/pb-7-5-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022] Open
Abstract
A spontaneous reactive mesothelial hyperplasia occurred in a
female, 15.7-year-old African green monkey (grivet; Chlorocebus aethiops). At necropsy, massive
effusions were found in the abdomen, the thorax, and the pericardium.
Additionally, multiple small, beige-gray nodules were detected on the
serosal surfaces of the abdominal organs. Histopathologically, the
mesothelial cells resembled the epithelioid subtype of a mesothelioma, but
no infiltrative or invasive growth could be demonstrated. The mesothelial
cells on the thoracis, liver, and intestinal serosa were accompanied by
chronic serositis. Mesothelial cells expressed cytokeratin, vimentin,
calretinin, desmin, Wilms Tumor 1 (WT-1) protein, and epithelial membrane
antigen (EMA). Cells were negative for carcinoembryonic antigen (CEA),
cluster of differentiation 15 (CD15), and podoplanin. Ultrastructurally,
cells revealed a moderate amount of microvilli of medium length, perinuclear
tonofilament bundles, and long desmosomes. In fluorescence in situ
hybridization (FISH) for the detection of characteristic gene loss (p16;
CDKN2A), NF2, and MTAP, no deletions were detected. No asbestos fibers and no
presence of Simian virus 40 antigen (SV40) could be demonstrated.
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Affiliation(s)
- Roland Plesker
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
| | - Kernt Köhler
- Institut für Veterinär-Pathologie, Justus-Liebig-Universität Gießen, Gießen, Germany
| | - Susanne von Gerlach
- ÜGP MVZ, Institut für Pathologie, Zytologie und Molekularpathologie GbR, Wettenberg, Germany
| | - Klaus Boller
- Paul-Ehrlich-Institut, Paul-Ehrlich-Str. 51-59, 63225 Langen, Germany
| | - Markus Vogt
- Institut für Pathologie, Ruhr-Universität Bochum, Bochum, Germany
| | - Inke S Feder
- Institut für Pathologie, Ruhr-Universität Bochum, Bochum, Germany
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Hahn A, Lauriol J, Thul J, Behnke-Hall K, Logeswaran T, Schänzer A, Böğürcü N, Garvalov BK, Zenker M, Gelb BD, von Gerlach S, Kandolf R, Kontaridis MI, Schranz D. Rapidly progressive hypertrophic cardiomyopathy in an infant with Noonan syndrome with multiple lentigines: palliative treatment with a rapamycin analog. Am J Med Genet A 2015; 167A:744-51. [PMID: 25708222 DOI: 10.1002/ajmg.a.36982] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 01/02/2015] [Indexed: 12/16/2022]
Abstract
Noonan syndrome with multiple lentigines (NSML) frequently manifests with hypertrophic cardiomyopathy (HCM). Recently, it was demonstrated that mTOR inhibition reverses HCM in NSML mice. We report for the first time on the effects of treatment with a rapamycin analog in an infant with LS and malignant HCM. In the boy, progressive HCM was diagnosed during the first week of life and a diagnosis of NSML was established at age 20 weeks by showing a heterozygous Q510E mutation in PTPN11. Immunoblotting with antibodies against pERK, pAkt, and pS6RP in fibroblasts demonstrated enhanced Akt/mTOR pathway activity. Because of the patient's critical condition, everolimus therapy was started at age 24 weeks and continued until heart transplantation at age 36 weeks. Prior to surgery, heart failure improved from NYHA stage IV to II and brain natriuretic peptide values decreased from 9,600 to <1,000 pg/ml, but no reversal of cardiac hypertrophy was observed. Examination of the explanted heart revealed severe hypertrophy and myofiber disarray with extensive perivascular fibrosis. These findings provide evidence that Akt/mTOR activity is enhanced in NSML with HCM and suggest that rapamycin treatment could principally be feasible for infantile NSML. The preliminary experiences made in this single patient indicate that therapy should start early to prevent irreversible cardiac remodelling.
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Affiliation(s)
- Andreas Hahn
- Department of Child Neurology, University Hospital Giessen, Justus-Liebig University, Giessen, Germany
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Wygrecka M, Dahal BK, Kosanovic D, Petersen F, Taborski B, von Gerlach S, Didiasova M, Zakrzewicz D, Preissner KT, Schermuly RT, Markart P. Mast Cells and Fibroblasts Work in Concert to Aggravate Pulmonary Fibrosis. The American Journal of Pathology 2013; 182:2094-108. [DOI: 10.1016/j.ajpath.2013.02.013] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 01/10/2013] [Accepted: 02/04/2013] [Indexed: 02/07/2023]
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Wygrecka M, Kwapiszewska G, Jablonska E, von Gerlach S, Henneke I, Zakrzewicz D, Guenther A, Preissner KT, Markart P. The Role of Proteinase-activated Receptor-2 in Idiopathic Pulmonary Fibrosis: Is There Really Novel Therapeutic Potential Here? Am J Respir Crit Care Med 2012. [DOI: 10.1164/ajrccm.185.4.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wygrecka M, Kwapiszewska G, Jablonska E, Gerlach SV, Henneke I, Zakrzewicz D, Guenther A, Preissner KT, Markart P. Role of Protease-activated Receptor-2 in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2011; 183:1703-14. [DOI: 10.1164/rccm.201009-1479oc] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Langheinrich AC, Yeniguen M, Ostendorf A, Marhoffer S, Dierkes C, von Gerlach S, Nedelmann M, Kampschulte M, Bachmann G, Stolz E, Gerriets T. In vitro evaluation of the sinus sagittalis superior thrombosis model in the rat using 3D micro- and nanocomputed tomography. Neuroradiology 2009; 52:815-21. [PMID: 19921163 DOI: 10.1007/s00234-009-0617-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/09/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Thrombosis of the cerebral veins and sinus are common causes of stroke. Animal models help us to understand the underlying pathophysiology of this condition. Therefore, the purpose of our study was to evaluate a well-established model for sinus sagittalis (SSS) thrombosis using micro- and nanocomputed tomography (CT) imaging. METHODS SSS thrombosis was performed in four rats. After contrast perfusion, brains were isolated and scanned using micro-CT at (8 microm)(3) voxel size to generate 3D images of the cerebral vasculature. For more detailed information on vascular perfusion territories, nano-CT imaging was performed to investigate the boundary layer of contrast-enhanced vessels and the occluded veins. The venous and arterial vascular volume fraction and gray scale measurements were obtained in the SSS thrombosis group and compared to controls. The significance of differences in vascular volume fraction and gray scale measurements was tested with analysis of variance. Results were complemented with histology. RESULTS Micro-CT proved to accurately visualize and differentiate vascular occlusion territories performed in the SSS thrombosis model. Moreover, 3D micro-CT provided quantitative information on arterial and venous vascular volume fraction. Micro-CT imaging enables a total 3D visualization of complications (ventricle rupture) in the SSS thrombosis model. We established gray scale measurements by which focal cerebral ischemia could be radiographically categorized (p < 0.001). CONCLUSIONS Using nano-CT, the interface of contrast-perfused and occluded veins can be visualized. Micro-CT is feasible for analysis and differentiation of perfusion territories in an animal model of focal cerebral ischemia.
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Kraft M, Glanz H, von Gerlach S, Wisweh H, Lubatschowski H, Arens C. Clinical value of optical coherence tomography in laryngology. Head Neck 2008; 30:1628-35. [DOI: 10.1002/hed.20914] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Brueck M, Bandorski D, Kramer W, Schoenburg M, von Gerlach S, Tillmanns H. Aortic valve stenosis due to alkaptonuria. J Heart Valve Dis 2008; 17:127-129. [PMID: 18365580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cardiovascular disease is a less-well appreciated aspect of alkaptonuria. A 69-year-old man presented with shortness of breath and exertional chest pain. He had a previous diagnosis of alkaptonuria (endogenous ochronosis), confirmed on the basis of urine coloration, skin pigmentation and ochronotic arthropathy in the knees. Echocardiography and coronary angiography revealed severe aortic valve stenosis and concomitant coronary artery disease. The patient underwent biological aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). Operative findings included ochronosis of a severely calcified aortic valve and the aortic intima, and bioprosthetic AVR and CABG were successfully performed.
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Affiliation(s)
- Martin Brueck
- Department of Cardiology, Hospital of Wetzlar, Wetzlar, Geramny.
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Langheinrich AC, Bohle RM, Greschus S, Hackstein N, Walker G, von Gerlach S, Rau WS, Hölschermann H. Atherosclerotic lesions at micro CT: feasibility for analysis of coronary artery wall in autopsy specimens. Radiology 2004; 231:675-81. [PMID: 15105456 DOI: 10.1148/radiol.2313021718] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility of micro computed tomography (CT) for analysis of the coronary artery wall. MATERIALS AND METHODS With micro CT, two-dimensional transverse images were generated from 10 human autopsy specimens of coronary arteries (2.5-3.5 cm long), with section thickness of 6 microm. Vessel wall perimeter, plaque area, calcified lesion area, media area, and lumen area were determined by three experienced radiologists. Results were compared with those obtained from a detailed conventional histomorphometric analysis of corresponding cross sections. Hotelling T(2) test (a multivariate generalization of the univariate Student t test) and Pearson correlation coefficient were used to assess the correlation between micro CT findings and conventional histologic measurements. The significance of differences in gray-scale measurements was tested with analysis of variance. RESULTS Micro CT provided quantitative information about plaque morphology equivalent to that provided with histomorphometric analysis. Hotelling T(2) test revealed significantly smaller values for vessel wall perimeter and lumen area with histologic sections (P <.001). Gray-scale measurements were established with which lesions could be categorized after histologic classification. CONCLUSION Micro CT is feasible for analysis of the coronary artery wall.
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