Tuberculoma means a tumor-like mass resulting from enlargement of a caseous tubercle which microscopically shows infiltration of epithelioid cells, Langhans giant cells and lymphocytes. In a 57-year-old woman suffering from left renal tuberculosis, we incidentally found a large retroperitoneal tuberculoma (site: retrohepatic, above right adrenal gland, below diaphragm and outside Gerota`s fascia, size: 13X11x9cm). Generally, Mycobacteria tuberculosis invade the lung via airway, and subsequently, they can be disseminated to any organ or tissue. They are apt to establish disease in the organ or tissue of high oxygen tension level. We report a case of retroperitoneal tuberculoma with wonder that it could develop in the retroperitoneum of poor blood supply.
Adrenal Glands ; Diaphragm ; Epithelioid Cells ; Fascia ; Female ; Giant Cells, Langhans ; Humans ; Lung ; Lymphocytes ; Middle Aged ; Oxygen ; Tuberculoma* ; Tuberculosis ; Tuberculosis, Renal

We report herein a case of tuberculosis cutis orificialis in a 50-year-old man. He suffered from well demarcated, 2x5cm sized, slightly tender, pus discharging, perianal ulcer with bluish edges for 3 months. The biopsy specimen from the ulcer revealed tuberculoid structure with Langhans giant cells in the deep dermis and a few acid-fast bacilli. AFB cultures from the sputum, pus, and tissue were successful. Intradermal test with PPD showed positive result. Chest roentgenographic findings disclosed advanced pulmonary tuberculosis. Almost complete healing of the perianal ulcers occurred following 2 months of therapy using antituberculosis drugs.
Biopsy ; Dermis ; Giant Cells, Langhans ; Humans ; Intradermal Tests ; Middle Aged ; Sputum ; Suppuration ; Thorax ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

Scrofuloderrna results from a direct extension of an underlying tuberculous focus such as the lymph nodes, bone or joint to he overlying skin, and is often associated with pulmonary tuberculosis. A 59-year-old male pai ient presented with an asymptomatic, flesh colored, 0.8 x 1.0 cm sized, solitary nodule on the left, middle back area. He had a CT-guided percutaneous lung biopsy 3 weeks before, for the evaluation of a round focal inhomogenous mass in the left lower lung field on radiologic study. An cxcisional biopsy specimen from the skin lesion showed granulomatous infiltration, composed of pithelioid cells, mononuclear cells and Langhans giant cells in the deep dermis and the suhcutaruous fat layer. Caseation necrosis within the tubercles was marked and numerous acid-fast bacilli were identified on AFB staining. Here we report an unusual case of scrofuloderma occurring after a percutaneous lung biopsy.
Biopsy* ; Dermis ; Giant Cells, Langhans ; Humans ; Joints ; Lung* ; Lymph Nodes ; Male ; Middle Aged ; Necrosis ; Skin ; Tuberculosis, Cutaneous* ; Tuberculosis, Pulmonary

This clinical & histopathological study was performed with 48 cases of cutaneous tuberculoeis among 44460 cases of out patient in Dermatologic clinc of St. Mary's hospital, Catholic Medical College, from 1970 to l974. These 48 cases were consistent with skin tuberculosis in histological and clinical findings. The results are follows. I. Clinieal observation. 1) The incidence of skin tuberculosis is 0. 1%, among 44460 cases of out patients. 2) Localized type of skin tuberculosis is l. 4 times more than disseminated type. 3) The ratio between male and female is 2. 4: l. 4) The age of onset is different from type to type, but 70. 8% of all cases occured before the age of 29. 5) Common skin tuberculosis is Erythema induratum (31. 3%),Lupus Vulgaris (20.8%) and Papulonerotic tuberculid (12.5%)II. Histopathological observation. 1) Only 12. 5% of the cases showes typical structure of tubercle in dermis and subcutis. 2) Caseation necrosis showes in 47% and their amounts are different between the types. 3) About 75% of cases showes Langhans giant cells but some of the cases show foreign body giant cells in tubercle or tuberculoid structures. 4) Vessels are involved in all of the cases. Main changes are wall proliferation, degeneration and perivascular infiltration. 5) A.F.B. stain showes negative in all cases.
Age of Onset ; Dermis ; Erythema Induratum ; Female ; Giant Cells, Foreign-Body ; Giant Cells, Langhans ; Humans ; Incidence ; Male ; Necrosis ; Outpatients ; Skin* ; Tuberculosis, Cutaneous*

Tuberculous gumma is the result of a hematogenous dissemination of tubercle bacilli from a primary focus during a period of lowered resistance. This unusual disease affects undernourished children of low socioeconomic status or patients who are severely immunodepressed by a disease or therapy. A 68-year-old female patient presented with tender fluctuant erythematous nodules over both upper extremities, shoulder, back and buttock. The biopsy specimen from the fluctuant plaque of right forearm revealed granulomatous infiltration composed of Langhans giant cells, epitheloid cells, plasma cells, lymphocytes and neutrophils in the deep dermis. Numerous acid fast bacilli was identified in AFB staining. Mycobacterium tuberculosis DNA was detected by polymerase chain reaction technique in the specimen from the skin lesion. We here present a very unusual case of tuberculous gumma.
Aged ; Biopsy ; Buttocks ; Child ; Dermis ; DNA ; Female ; Forearm ; Giant Cells, Langhans ; Humans ; Lymphocytes ; Mycobacterium tuberculosis ; Neutrophils ; Plasma Cells ; Polymerase Chain Reaction ; Shoulder ; Skin ; Social Class ; Upper Extremity

Tuberculous gumma is the result of a hematogenous dissemination of tubercle bacilli from a primary focus during a period of lowered resistance. This unusual disease affects undernourished children of low socioeconomic status or patients who are severely immunodepressed by a disease or therapy. A 68-year-old female patient presented with tender fluctuant erythematous nodules over both upper extremities, shoulder, back and buttock. The biopsy specimen from the fluctuant plaque of right forearm revealed granulomatous infiltration composed of Langhans giant cells, epitheloid cells, plasma cells, lymphocytes and neutrophils in the deep dermis. Numerous acid fast bacilli was identified in AFB staining. Mycobacterium tuberculosis DNA was detected by polymerase chain reaction technique in the specimen from the skin lesion. We here present a very unusual case of tuberculous gumma.
Aged ; Biopsy ; Buttocks ; Child ; Dermis ; DNA ; Female ; Forearm ; Giant Cells, Langhans ; Humans ; Lymphocytes ; Mycobacterium tuberculosis ; Neutrophils ; Plasma Cells ; Polymerase Chain Reaction ; Shoulder ; Skin ; Social Class ; Upper Extremity

A 10-month-old male patient was seen with a nodular lesion on his left upper arm which developed several months after BCG vaccination. Physical examination revealed a bean sized, irregular surfaced, erythematous pustular nodule on the left upper arm at a place different from the vaccination site. Histopathologic examination of the nodule on the left upper arm showed tubercles composed of mononuclear cells, epithelioid cells and langhans type giant cells in the dermis. Caseation necrosis within the typical tubercles was noted. Prominent improvement of the lesion was observed 4 months after oral medication with isoniazid and rifampicin.
Arm ; Dermis ; Epithelioid Cells ; Giant Cells, Langhans ; Humans ; Hypogonadism ; Infant ; Isoniazid ; Male ; Mitochondrial Diseases ; Mycobacterium bovis ; Necrosis ; Ophthalmoplegia ; Physical Examination ; Rifampin ; Tuberculosis, Cutaneous ; Vaccination

Tuberculosis cutis orificialis (TCO) is a rare manifestation of cutaneous tuberculosis that is caused by auto-inoculation of mycobacteria in patients with advanced internal tuberculosis. TCO occurs in oral, perianal, or genital mucosa and adjacent skin. The tongue is the most frequently affected site, but the perianal area can also be affected. A 39-year-old male presented with a 4-month history of painful ulcers on the perianal area. The histopathologic findings revealed granulomatous infiltrates composed of epithelioid cells and Langhans-type giant cells in the dermis, and a few acid-fast bacilli noted on Ziehl-Neelsen staining. The polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis and the chest X-ray showed findings consistent with active pulmonary tuberculosis in both upper lung zones. The skin lesion showed complete resolution 2 months after the start of treatment with antituberculosis agents. We report a case of TCO with perianal involvement in a patient with underlying active pulmonary tuberculosis.
Adult ; Dermis ; Epithelioid Cells ; Giant Cells, Langhans ; Humans ; Lung ; Male ; Mucous Membrane ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Skin ; Thorax ; Tongue ; Tuberculosis ; Tuberculosis, Cutaneous ; Tuberculosis, Pulmonary ; Ulcer

BACKGROUND: Amenorrhea may occur in patients with lupus treated with cyclophosphamide. This is commonly attributed to primary ovarian failure leading to infertility -- a possible complication of cyclophosphamide. Urogenital tuberculosis (TB) can be a rare cause of amenorrhea and infertility in lupus patients.
OBJECTIVE: To present a case of endometrial TB causing amenorrhea and abnormal uterine bleeding in a patient with lupus nephritis treated with cyclophosphamide.
CASE: A 32-year-old Filipino female, who was diagnosed with lupus nephritis, was managed with high dose steroid and intravenous (IV) cyclophosphamide. Lupus nephritis improved with treatment, but she subsequently developed amenorrhea and vaginal spotting for two months. Symptoms were initially attributed to premature ovarian failure due to cyclophosphamide.Gynecologic examination showed thickened endometrium with normal ovaries and uterus on ultrasound. Dilatation and curettage was performed. Histopathology of endometrial curetting revealed chronic granulomatous endometritis with Langhans giant cells. Endometrial TB was diagnosed, and anti-Koch's therapy was started. The patient showed a favourable response, with resumption of normal menstruation after only the first month of treatment.
CONCLUSION: This paper emphasizes the importance of considering a wide range of differential diagnosis for gynecologic symptoms in patients with lupus. Tuberculosis should be considered in areas of high endemicity

Human ; Female ; Adult ; Primary Ovarian Insufficiency ; Lupus Nephritis ; Endometritis ; Amenorrhea ; Giant Cells, Langhans ; Cyclophosphamide ; Menopause, Premature ; Tuberculosis, Urogenital ; Infertility ; Uterine Hemorrhage

OBJECTIVETo explore the role of cytokines and keratinocytes in the survival mechanism of mixed auto and allogeneic skin grafting.

METHODSThirty-six SD rats were employed in the study. The rat model with mixed auto and allogeneic skin grafting and mixed human epithelial and lymphocytic culture (MELC) model were established. The change of IL-10 in the serum and the supernatant of the cultured tissue sample from the local wound was observed after the mixed skin grafting in scalded rats. And the role of epithelium in the induction of immunosuppression in vitro was monitored.

RESULTSThe serum IL-10 content in the rats with mixed skin grafting (25.89 +/- 2.82 ng/L) at 7 postoperative day (POD) was evidently higher than that in normal rats (14.20 +/- 2.43 ng/L) (P < 0.05). The IL-10 content in the culture supernatant of rat tissue samples exhibited evident different during 4-14 PODs (P < 0.05-0.01), while which was no difference to that in normal rat on 21st and 28th POD. The inhibiting effects of autologous epithelia and keratinocytes in MELC system were correlated with their dosage. After the adding of autologous keratinocytes to MELC system the cytokines secreted from Th1 could induce the secretion of cytokines from Th2 by IL-10 mediation. This effect could be corrected by the addition of monoclonal antibody of IL-10.

CONCLUSIONThe keratinocytes inlayed in the autoskin during mixed grafting could increase the local IL-10 level by activating Th2 cells, which might be one of the important reasons of the survival of mixed skin grafting.

Animals ; Burns ; immunology ; surgery ; Cytokines ; metabolism ; Giant Cells, Langhans ; cytology ; Graft Survival ; immunology ; Humans ; Interleukin-10 ; metabolism ; Keratinocytes ; cytology ; Lymphocyte Culture Test, Mixed ; Male ; Rats ; Rats, Sprague-Dawley ; Skin Transplantation ; immunology ; Th2 Cells ; metabolism ; Transplantation, Autologous ; Transplantation, Homologous