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Diagnostics Histology, Training and education

Case of the Month

A 71-year-old man presented with a 2x2 cm chest wall mass, which was completely excised. The diagnosis was blastic plasmacytoid dendritic cell neoplasm (BPDCN).

Which of the following immunophenotypic markers is typically negative in BPDCN?

a. CD56
b. CD123
c. CD3
d. CD4
e. CD45RA

Click here to register your guess.

We will reveal the answer next month.

Do you have an interesting case that you would like us to feature? Email it to [email protected].

Courtesy of Case by Gabriel Lerner (Boston University School of Medicine, Boston, Massachusetts, USA), Lija Joseph, Bethany Tierno, Rebecca Shore, and Murat Anamur (Lowell General Hospital, Lowell, Massachusetts, USA); discussion by Genevieve M. Crane, Cleveland Clinic, Cleveland, Ohio, USA.

B. Doxycycline-induced gastric injury

The antibiotic doxycycline has been reported to cause gastric mucosal injury. The histologic findings of doxycycline-induced gastric injury are unique and include characteristic vascular changes. Disruption and degeneration of the superficial capillaries manifest as a ring of deeply eosinophilic granular material that often separates from the surrounding tissue, creating a so-called “halo effect.” Microthrombi are present in some of the capillaries and can be highlighted with a CD61 immunostain. Other typical findings with doxycycline-induced gastric injury include reactive epithelial changes and superficial mucosal necrosis with active inflammation.

Although doxycycline-induced gastric injury is rarely seen, it may be unrecognized and underreported. If these histologic findings are present, they are highly suggestive of doxycycline toxicity and medications should be reviewed for confirmation. In most reported cases, cessation of doxycycline results in resolution of symptoms.

The other options are less likely based on clinical presentation and histology. Disseminated Strongyloides infection can also be associated with abdominal pain and other gastrointestinal symptoms; however, histological examination shows inflammatory infiltrates, prominent eosinophils, and the presence of ova, larval nematodes, and adult nematodes in the mucosal tissue. Like doxycycline-induced gastric injury, gastric antral vascular ectasia (GAVE) can be associated with microthrombi on histological examination. However, vascular ectasia is also present, along with a classical watermelon or honeycomb appearance of the stomach on endoscopy. In contrast with doxycycline-induced gastric injury, mucosal calcinosis is usually asymptomatic and is associated with bluish-purple deposits of aluminum, phosphorus, calcium, and chlorine in the superficial lamina propria. Clinically, it is observed in patients treated with aluminum-containing antacids, citrate-containing blood products, isotretinoin, and sucralfate as well as in patients with hypercalcemia, hyperphosphatemia, renal failure, or organ transplants.

Submitted by Shula A. Schechter, Lecturer, University of Michigan, Ann Arbor, Michigan, USA.

Further reading

  1. AR Shih et al., Am J Surg Pathol, 41, 374 (2017). PMID: 28009607.
  2. SY Xiao et al., Am J Surg Pathol, 37, 259 (2013). PMID: 23060354.
  3. M Gorospe, O Fadare, Adv Anat Pathol, 14, 224 (2007). PMID: 17452819.
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