Objective:To investigate the pathological characteristics of listeria monocytogenes infection in the placenta during mid-pregnancy. Methods:A retrospective review was conducted on the clinical and placental pathological examination data of a patient admitted to the Affiliated Wuxi People's Hospital of Nanjing Medical University in October 2022, who experienced intrauterine fetal death and maternal sepsis due to listeria monocytogenes infection. Results:(1) Clinical data: The 25-year-old patient had 22 weeks of amenorrhea and was admitted to the hospital for 2 days of fever and 1 day of intrauterine fetal death. The patient had a dietary habit of consuming raw seafood. Upon admission, a large amount of purulent vaginal discharge was observed, and obstetric ultrasound indicated the disappearance of fetal heart sounds. The following day, a cesarean section was performed. A female stillborn fetus weighing 470 g was delivered, which had a distended abdomen with no other malformations. Postoperatively, the patient continued anti-infective treatment for one week and was discharged after correction of infectious shock. She continued to take oral anti-infective drugs for one week after discharge. At 10 months postpartum outpatient follow-up and 18 months postpartum telephone follow-up, the patient recovered satisfactorily, reported no discomfort, and was preparing for pregnancy. (2) Placental examination: The placental surface was covered with grayish-white areas ranging from the size of a needle tip to about 2 cm in diameter. Edema of the umbilical cord was observed. Various-sized abscesses were seen in the placental parenchyma, involving several villi, with many neutrophil infiltrations. There were many acute inflammatory cell infiltrations in the chorionic villous space with abscess formation, acute chorioamnionitis, and infarcts visible in the surrounding chorionic villi. Acute inflammation of the local chorionic interstitial blood vessels with thickening of the blood vessel wall was observed. Many neutrophils were seen in the amniotic membrane-chorioamnionic membrane gap, with a stage 3, level 2 maternal inflammatory response. Cord umbilical venous inflammation was noted, with no inflammatory cell infiltration of arteries. Wharton jelly edema was seen, with neutrophil infiltration in the interstitium. (3) Microbiological examination: Blood, vaginal secretion, uterine secretion, abdominal secretion, and placental bacterial cultures all showed listeria monocytogenes. Mass spectrometer bacterial identification confirmed listeria monocytogenes infection. After silver staining of the placenta, microorganisms were seen in the center of the abscess and in the amniotic epithelial cells. (4) Pathologic diagnosis showed placental acute chorioamnionitis with maternal inflammatory response stage 3 grade 2, accompanied by umbilical cord phlebitis and fetal inflammatory response stage 1 grade 1, acute intervillositis with abscess formation, and acute villositis with abscess formation. Combined with clinical presentation, this is consistent with listeria monocytogenes infection. Conclusion:The pathological characteristics of listeria monocytogenes infection in the placenta include various-sized abscesses in the placenta involving multiple villi and chorionic interstitial spaces, thickening of the interstitial vascular wall of the chorionic villi, and chorioamnionitis with umbilical cord phlebitis.

Objective:To investigate the pathological characteristics of listeria monocytogenes infection in the placenta during mid-pregnancy. Methods:A retrospective review was conducted on the clinical and placental pathological examination data of a patient admitted to the Affiliated Wuxi People's Hospital of Nanjing Medical University in October 2022, who experienced intrauterine fetal death and maternal sepsis due to listeria monocytogenes infection. Results:(1) Clinical data: The 25-year-old patient had 22 weeks of amenorrhea and was admitted to the hospital for 2 days of fever and 1 day of intrauterine fetal death. The patient had a dietary habit of consuming raw seafood. Upon admission, a large amount of purulent vaginal discharge was observed, and obstetric ultrasound indicated the disappearance of fetal heart sounds. The following day, a cesarean section was performed. A female stillborn fetus weighing 470 g was delivered, which had a distended abdomen with no other malformations. Postoperatively, the patient continued anti-infective treatment for one week and was discharged after correction of infectious shock. She continued to take oral anti-infective drugs for one week after discharge. At 10 months postpartum outpatient follow-up and 18 months postpartum telephone follow-up, the patient recovered satisfactorily, reported no discomfort, and was preparing for pregnancy. (2) Placental examination: The placental surface was covered with grayish-white areas ranging from the size of a needle tip to about 2 cm in diameter. Edema of the umbilical cord was observed. Various-sized abscesses were seen in the placental parenchyma, involving several villi, with many neutrophil infiltrations. There were many acute inflammatory cell infiltrations in the chorionic villous space with abscess formation, acute chorioamnionitis, and infarcts visible in the surrounding chorionic villi. Acute inflammation of the local chorionic interstitial blood vessels with thickening of the blood vessel wall was observed. Many neutrophils were seen in the amniotic membrane-chorioamnionic membrane gap, with a stage 3, level 2 maternal inflammatory response. Cord umbilical venous inflammation was noted, with no inflammatory cell infiltration of arteries. Wharton jelly edema was seen, with neutrophil infiltration in the interstitium. (3) Microbiological examination: Blood, vaginal secretion, uterine secretion, abdominal secretion, and placental bacterial cultures all showed listeria monocytogenes. Mass spectrometer bacterial identification confirmed listeria monocytogenes infection. After silver staining of the placenta, microorganisms were seen in the center of the abscess and in the amniotic epithelial cells. (4) Pathologic diagnosis showed placental acute chorioamnionitis with maternal inflammatory response stage 3 grade 2, accompanied by umbilical cord phlebitis and fetal inflammatory response stage 1 grade 1, acute intervillositis with abscess formation, and acute villositis with abscess formation. Combined with clinical presentation, this is consistent with listeria monocytogenes infection. Conclusion:The pathological characteristics of listeria monocytogenes infection in the placenta include various-sized abscesses in the placenta involving multiple villi and chorionic interstitial spaces, thickening of the interstitial vascular wall of the chorionic villi, and chorioamnionitis with umbilical cord phlebitis.

Objective:To investigate the clinicpathological characteristics of post-transplant lymphoproliferative disorders (PTLD) in transplanted lung, and to improve its diagnosis and treatment.Methods:The clinicopathological characteristics of PTLD in three transplanted lungs were evaluated at Wuxi People′s Hospital Affiliated to Nanjing Medical University from 2014 to 2019. HE, immunohistochemical staining and in situ hybridization were performed. The relevant literature of PTLD was reviewed.Results:All three patients had chronic obstructive pulmonary disease (COPD) before lung transplantation. After receiving both lung transplants, they were all treated with anti-rejection drugs tacrolimus or mycophenolate mofetil, and combined with antiviral and/or rituximab. The time from transplantation to diagnosis of PTLD was four years, seven months, and five months, respectively. Two patients died one month and five months after initial diagnosis, and one patient was alive with no disease after one year. Histologically, all cases were monomorphic B-cell PTLD (diffuse large B-cell lymphoma, unspecified), and the tumor cells were positive for Epstein-Barr virus by in situ hybridization; one of the late-onset patients had herpes simplex virus infection.Conclusions:PTLD in the post-transplant lung tissue shows unique morphology and clinical characteristics, and is closely related to Epstein-Barr virus infection. Patients who receive lung transplantation due to COPD are more susceptible to develop PTLD, while late-onset ones occur more commonly in the hilum of lungs, and the prognosis is relatively poor.

Objective: To investigate the correlation between the expression of programmed death-1(PD-1), PD ligand-1(PD-L1), indoleamine 2, 3-dioxygenase 1(IDO-1) and clinical parameters in sinonasal malignant mucosal melanoma (SNM). Methods: Samples from 86 SNM patients who did not receive immune-targeted therapy and radio-chemotherapy were analyzed for PD-1, PD-L1, and IDO-1 expression by immunohistochemistry. Results: High clinical/pathologic staging, brain metastases and advanced age were independent risk factors of poor prognosis. The overall survival rate of SNM without pigment was lower than that with pigment. PD-1, PD-L1 and IDO-1 expression was not correlated with tumor pigmentation, but correlated with different primary site.PD-1, PD-L1 and IDO-1 were expressed in 47.6% (41/86), 53.5% (46/86) and 58.1% (50/86)of SNM samples respectively. PD-1 was associated with brain metastasis. Negative expression of PD-1(P=0.031) and IDO-1(P=0.017 9) correlated with worse disease-free survival. No significant association was found between PD-L1 and prognosis. For stages Ⅲ, ⅣA and ⅣB patients, PD-1 expression was associated with better outcome (P=0.025), but PD-L1 negative and IDO-1 positive patients hadworse outcome (P>0.05). PD-1 positive and IDO-1 negative stage ⅣC patients had poorer overall survival. Conclusions In SNM patients, clinical/pathologic staging, brain metastases, age and pigmentation were prognostic indicator. IDO-1 and PD-1 can also be used as reference to evaluate prognosis. Anti-IDO-1 targeted therapy may be suitable for middle to late stage patients, while advanced stage patients might benefit from anti-PD-1 targeted therapy. PD-1/PD-L1 and IDO-1 may be considered as joint targeted therapy.The predictive value of PD-L1 requires further study.

Carcinoma, Squamous Cell ; diagnosis ; virology ; Head and Neck Neoplasms ; diagnosis ; virology ; Humans ; Laryngeal Neoplasms ; diagnosis ; virology ; Papillomaviridae

Objective To study the expression and predictive value of MTDH, Bcl-2 and E-cadherin in sinonasal malignant mucosal melanoma (SNM).Methods Seventv-four fonnalin-fixed paraffin-embedded SNM specimens were subjected to immunohistochemical staining of MTDH, Bcl-2 and E-cadherin.Correlation between staining results and disease outcome was analvzed.SPSS 19.0 software was used to analyze the data.Results Positive staining of MTDH, Bcl-2 and E-cadherin was observed in 56/74 (75.7％), 18/74 (24.3％) and 21/74 (28.4％) cases, respectively.MTDH positive patients had higher metastatic rate than MTDH negative patients (67.9％ vs.33.3％ , P =0.009, OR =2.037, 95％ CI: 1.034-4.016).Negative Bcl-2 was correlated with worse overall survival time (HR =2.023, P =0.025).Expression of E-cadherin was adversely associated with expression of MTDH (r =-0.315, P =0.006).Conclusion High MTDH expression and low Bcl-2 expression suggest poor prognosis of SNM, while the predictive value of E-cadherin needs further study.