ECP 2022 Abstract Book

Virchows Archiv (2022) 481 (Suppl 1):S1–S364 13 examination showed the acellular laminated PAS positive mem- brane with presence in two cases of granulomatous reaction of the adjacent splenic parenchyma. Conclusion: Hydatid cyst of the spleen is uncommon but it should be included in differential diagnosis of other splenic cystic lesions such as epidermoid cysts, pseudocysts, splenic abscesses, hema- tomas and cystic neoplasms of the spleen especially in endemic areas. The standard treatment is total or partial splenectomy com- bined with the perioperative administration of albendazol. E-PS-13-012 Peritoneal tuberculosis: a challenging diagnosis O. Mnif*, R. Ayadi, E. Braham, M. Mlika, A. Rais, O. Ismail, A. Ayadi, F. El Mezni *Abderrahmen Mami Hospital, Tunisia Background & objectives: Peritoneal tuberculosis is a rare entity representing about 2% of all extrapulmonary forms. Those Patients frequently have findings identical to those with underlying malignancy due to non-specific symptoms and imaging. The aim is to present cli- nocopathological characteristics of this entity. Methods: We report a retrospective study of 25 cases of peritoneal tuberculosis diagnosed at our department of pathology between 2005 and 2021. Results: There were 8 male and 17 female patients, aged between 14 and 47 years with a mean of 41. Physical examination was positive for ascites. Computed tomography (CT) abdomen showed large ascites (n=5), peritoneal nodules (n=2) and mesenteric adenopathy (n=2). The diagnosis was made on peritoneal biopsy in all cases. In microscopic examination, granulomatous reaction was composed of epithelioid cells and multinucleated giant cells with variable number of lymphocytes. These granulomatous lesions were centred by caseous necrosis in 19 cases overs 25 (76%), the rest were non caseating (24%). Conclusion: Diagnosis of peritoneal tuberculosis is challenging due to its nonspecific clinical presentation, the limitation of labora- tory testing, and the similarities of radiographic and laparoscopic evaluation to other diseases. Microscopic findings are variable and sometimes uncertain, especially with non caseating necrosis. The histopathological examination must be completed with bacterio- logical studies, mainly when the clinic presentation suggests the diagnosis. E-PS-13-013 Hemophagocytic lymphohistiocytosis in trephine biopsy of a living post-COVID-19 patient M. Ioannou, K. Zacharouli, S.G. Doukas, M. Strataki*, M.D. Diamantidis, V. Tsangari, P.G. Doukas, K. Karakousis, G.K. Koukoulis, D.P. Vageli *Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece Background & objectives: Hemophagocytic lymphohistiocytosis (HLH) constitutes a life-threatening inflammatory syndrome. There are a limited number of sHLH cases in which trephine has been performed in living post-COVID-19 patients. We present an sHLH case diagnosed by trephine biopsy in a living post-COVID-19 patient. Methods: An 81-year-old man with a past medical history of hypertension, diabetes, and ischemic stroke, was referred to the hospital to evaluate leukocytosis, pyuria, and elevation of inflammatory markers four weeks after recovering from COVID-19. Computed tomography of the abdomen and bone marrow (BM) biopsy were performed. The patient received meropenem, two-packed red blood cell units, and was discharged on cefixime. Results: Computed tomography of the abdomen did not reveal focal signs of infection or hepatosplenomegaly. Leukocytes and C-reactive protein were gradually decreased. BM smear revealed severe anaemia, lymphopenia, and dysplastic morphologic findings of erythroblasts, neutrophils, and megakaryocytes. Trephine biopsy revealed hypercellular dyserythropoietic mar row, plasmacytosis, lymphocytosis, histiocytosis, hemophagocytosis, and the absence of granulomas or carcinoma. Immunohistochemistry documented a mixed population of T lymphocytes (CD3+) and B lymphocytes (CD20+). Strong positivity for CD68 confirmed histiocytosis. CD138 κ, λ staining proved polyclonal plasmacytosis. Perl’s staining showed excess hemosiderin deposits. Conclusion: Based on our findings, we document sHLH in tre- phine BM biopsy of a living post-COVID-19 patient and persistent leukocytosis, underscoring the diagnostic value of trephine biopsy in preventing life-threatening conditions such as COVID-19. E-PS-13-014 COVID-19 and small bowel ischemia: immunohistochemical positivity for SARS-CoV-2 in endothelial and inflammatory intestinal cells. A review of two cases G.G. Yange Zambrano*, G. Moreno-De-Juan, P. Martín-Soler, M.d.M. Del-Barrio-Molina, G. Coronado-Vilca, E. Prados-Perez, M.A. Martinez-Ortega *Hospital Mateu Orfila, Spain Background & objectives: COVID-19 is a major pandemic facing the world today caused by SARS-CoV-2, which can cause multisys- tem damage. Although SARS-CoV-2 primarily targets lung epithelium cells, there is growing evidence that the intestinal epithelium is also affected. Methods: First-case. 39-year-old male, admitted for bilateral pneumonia due to COVID-19. On the 13th day-of-hospitalization (DH), he presented paralytic ileus. Abdominal tomography revealed acute jejuno-ileal ischemia. Second-case.65-year-old woman with cough and positive PCR for SARS-CoV-2. One week later she developed abdominal pain and fever; the scan reported small loop intestinal obstruction caused by inguinal hernia. Emergency- surgery was performed in both cases. Results: In the first case a piece of small intestine 164 cm long was resected; in the second case a segment of small intestine and her- nial sac were resected. Both cases had external fibrin plaques and histologically acute intestinal ischemia was observed, with trans- mural necrosis, vasculitis and serositis with perforation; immuno- histochemistry for SARS-CoV-2 (GeneTex) was performed, which was positive in endothelial and inflammatory cells. Both cases presented septic shock secondary to fecaloid peritonitis. The first case developed intestinal failure secondary to short bowel syn- drome, multiorgan failure and finally died 58 days after surgery; the second case presented gradual improvement, was discharged at 43 DH and is currently alive. Conclusion: Although the acute intestinal ischemia of the sec- ond-case was secondary to an inguinal hernia, the presence of SARS-CoV-2 was demonstrated by immunohistochemistry; which is compatible with recent studies (Norsa et al, Megan et al) that describe the replication of this virus in the intestinal mucosa; this may worsen the prognosis and lead in some cases to acute intestinal ischemia and worsening of the clinical status (as in the first-case); S296