Epidermolysis bullosa acquisita and bullous systemic lupus erythematosus are blistering skin diseases characterized by IgG autoantibodies that predominantly target the noncollagenous domain 1 of type VII collagen, a skin basement membrane component. The basic immunologic events leading to the blistering processes in these diseases remains unclear. We defined the subclass and light chain compositions of the IgG autoantibodies in 15 patients, in order to gain insight into the blistering mechanism. Immunofluorescence correlated the patients' in vivo-bound and circulating antibasement membrane autoantibodies. Four eukaryotic recombinant proteins, including one full-length and three truncated noncollagenous domain 1 proteins generated by sequential deletion of C-terminal amino acids, were used to perform enzyme-linked immunosorbent assay to detect the patients' anti-type VII collagen autoantibodies. The majority of patients' autoantibodies contained both complement-activating and non-complement-activating IgG subclasses. The presence or absence of complement-activating IgG autoantibody subclasses did not correlate with the inflammatory or noninflammatory clinical phenotype. The majority of tested sera contained both kappa and lambda light chain autoantibodies. All sera that reacted to the full-length noncollagenous domain 1 also reacted to the smallest truncated protein containing the cartilage matrix protein and the first three fibronectinlike repeats. The patients' anti-type VII collagen autoantibodies, likely to be polyclonal in nature, may contribute to the pathogenesis of the blistering process by both complement-dependent inflammatory injury and complement-independent mechanical disruption of the anchoring function of type VII collagen. The N-terminal region of the noncollagenous domain 1 may contain an important antigenic epitope targeted by the IgG autoantibodies.
BACKGROUND Abnormal Uterine Bleeding (AUB) is one of the most common menstrual complaints and a frequent indication for hysterectomy. It can be a manifestation of any number of pathological entities. Causes of AUB ranges from organic pathologies like leiomyoma, polyps, adenomyosis and malignancy to conditions like coagulopathy and drug-induced AUB and aetiologies vary in different age groups. Histopathological evaluation of endometrium is very vital to identify the cause of AUB. The objectives of this study are to, 1. To evaluate the endometrial histopathology in AUB, and 2. To estimate the incidence of endometrial polyp in AUB. MATERIALS AND METHODS This is a prospective study carried out on 120 women who presented with AUB. Endometrial samples collected were analysed for their histopathological pattern. RESULTS Out of 120 endometrial samples analysed among women of 30-39 years, proliferative endometrium was seen in 43.3% and secretory endometrium in 33.3% and endometrial polyp in 13.3%. In women of 40-49 years, proliferative endometrium in 36.8%, secretory endometrium in 30.9% and disordered proliferative endometrium was seen in 19% of women. The incidence of endometrial polyp was found to be 8.3% in our study. CONCLUSION There is an age-specific relation of abnormal endometrial histopathology. Among abnormal endometrial pathology, disordered proliferative endometrium was more common in perimenopausal age group and endometrial polyps in reproductive age group. The results of this study indicate that benign endometrial histopathology is common in AUB suggesting a role for more conservative therapeutic strategies.
CaseA 22-year-old male consulting Emergency department for voice changes, cough for 1 week, neck swelling extending to the both ears lasting for 4 weeks, peri -orbital swelling, and swelling in both groins ( Figure 1). On arrival, he was in respiratory distress, oxygen saturation: 87%, unable to pronounce some letters; as emergency management, he was given oxygen 5L/ min with non retreater mask and saturation: 92-95%. Physical examinationThe patient had multiple huge adenopathies localized on cervical region, subclavical region, both axillar, and on both groins. Bed site Ultrasound findings: multiple lymph nodes of neck and para-auricular, cervical, axillar, and inguinal regions. The biggest measuring 3-5 cm. He also had huge ascitis, bilateral pleural effusion, and small pericardial effusion. Initial laboratory results were showing mild elevated white blood cell (24.15), with normal differentiation Hemoglobin of 8.3g/dl; renal, liver function test, and electrolytes were normal. The following are bed site ultrasound images (Figures 2-7). Based on history, physical exam and Ultrasound images, we can conclude that swelling is lymph nodes and not anything else. Our differential diagnoses were Hodgikin lymphoma. To rule out TB adenitis, the internal medicine consultant requested a fine needle aspiration (FNA), which was none conclusive, and the pathologist suggested doing an open biopsy. The results of open biopsy showed: HL Hodgkin lymphoma (Nodular sclerosis type). Nodular sclerosis Hodgkin's disease accounts for 80% of all Hodgkin's disease. AbstractPeripheral lymphadenopathy is a condition found frequently in tropical regions, which is sometimes due to a local or systemic, benign, infectious, or underlying malignancy. According to research, 75% are localized with 50% seen on head and neck.
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