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Al-Janabi MH, Hussein BYA, Kahwaji JN, Haidar M, Mortada A, Salloum R. Idiopathic eosinophilic cholecystitis with cholelithiasis: Two rare cases report. Int J Surg Case Rep 2023; 110:108714. [PMID: 37647760 PMCID: PMC10509788 DOI: 10.1016/j.ijscr.2023.108714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Eosinophilic cholecystitis is an unusual condition in which more than 90 % of the inflammatory infiltrate in the gallbladder wall is comprised of eosinophils. The pathogenesis of eosinophilic cholecystitis is still unknown, but in some cases, it is related to hyper-eosinophilic syndrome, parasitosis, infections, and drugs. CASE PRESENTATION We described two cases in which a woman aged 27 years and a man aged 30 years presented with acute and chronic cholecystitis symptoms, respectively. The ultrasound revealed calculous cholecystitis. The cholecystectomy was performed, and the pathological examination of the surgical specimen revealed eosinophilic cholecystitis. CLINICAL DISCUSSION Eosinophilic cholecystitis is a rare disease of the gallbladder. It accounts for 0.25 to 6.4 % of cholecystitis cases. It is characterized by eosinophils infiltration in the lamina propria and the muscle layer. There are no specific symptoms of this disease; it presents as typical cholecystitis. The histopathological investigation is the gold standard for diagnosing eosinophilic cholecystitis, and cholecystectomy is the ultimate treatment for it. CONCLUSION Eosinophilic cholecystitis is a rare condition characterized by acute cholecystitis with eosinophilic infiltration of the gallbladder. In patients with eosinophilic cholecystitis, a comprehensive assessment of the underlying causes is recommended.
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Affiliation(s)
| | | | | | - Maen Haidar
- Department of General Surgery, Tishreen University Hospital, Latakia, Syria
| | - Aiman Mortada
- Department of General Surgery, Tishreen University Hospital, Latakia, Syria
| | - Rabab Salloum
- Department of Pathology, Tishreen University Hospital, Latakia, Syria
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Memis B, Saka B, Roa JC, Bandyopadhyay S, Reid M, Bagci P, Aktas BK, Armutlu A, Basturk O, Adsay NV. Eosinophilic Cholecystitis and Eosinophils in Gallbladder Injuries: A Clinicopathological Analysis of 1050 Cholecystectomies. Diagnostics (Basel) 2023; 13:2559. [PMID: 37568922 PMCID: PMC10417514 DOI: 10.3390/diagnostics13152559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
"Eosinophilic cholecystitis" has been an elusive concept. Around 1050 consecutive cholecystectomies with chronic (CC, n = 895), subacute (SAC, n = 100), and acute cholecystitis (AC, n = 55) were reviewed for eosinophilic infiltration. Eosinophilic hot spots (>40 eosinophils/HPF) were seen in 63% of SAC and 35% of AC (vs. 6% of CC, p < 0.001). Eosinophils were mostly encountered in areas of wall thickening, revealing edema with early collagenization and young tissue-culture-type fibroblasts. However, in ten chronic cholecystitis patients (<1%), prominent eosinophilia with eosinophil-rich foci (>100 eosinophils/HPF) was noted. These ten cases, classified as "eosinophilic cholecystitis", were analyzed further: The patients were relatively young (mean age = 43 years), with a 9:1 female:male ratio. None had blood eosinophilia/eosinophilia syndromes. Although one had ulcerative colitis, others did not have any autoimmune diseases. The mean gallbladder wall thickness was 3.5 mm (vs. 4.2 mm in ordinary CC). In conclusion, eosinophils are a part of especially subacute injuries in the gallbladder. They are typically condensed in the areas of healing and appear to signify a distinctive state of injury in which there are erosions leading to slow/sustained exposure of the mural tissues to the bile contents that induce chemical injury/recruit eosinophils. Eosinophilic cholecystitis is a very uncommon occurrence and appears to be an exaggerated response in allergic patients who are prone to recruit eosinophils in reaction to injury.
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Affiliation(s)
- Bahar Memis
- Department of Pathology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul 34396, Turkey
| | - Burcu Saka
- Department of Pathology, Koc University, Istanbul 34450, Turkey
| | - Juan Carlos Roa
- Department of Pathology, Pontificia Universidad Catolica de Chile, Center for Cancer Prevention and Control (CECAN), Millennium Institute on Immunology and Immunotherapy (IMII), Santiago 8331150, Chile
| | | | - Michelle Reid
- Department of Pathology, Emory University, Atlanta, GA 30322, USA
| | - Pelin Bagci
- Department of Pathology, Marmara University, Istanbul 34854, Turkey
| | - Berk Kaan Aktas
- Department of Pathology, Koc University, Istanbul 34450, Turkey
| | - Ayse Armutlu
- Department of Pathology, Koc University, Istanbul 34450, Turkey
| | - Olca Basturk
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - N. Volkan Adsay
- Department of Pathology, Koc University, Istanbul 34450, Turkey
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EGPA Phenotyping: Not Only ANCA, but Also Eosinophils. Biomedicines 2023; 11:biomedicines11030776. [PMID: 36979755 PMCID: PMC10045549 DOI: 10.3390/biomedicines11030776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Background: Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a small-vessel necrotizing vasculitis. The anti-neutrophil cytoplasmic antibodies’ (ANCA) role in defining clinical EGPA phenotypes is well established. Although the role of eosinophils in disease pathogenesis has been clearly demonstrated, the value of blood eosinophil count (BEC) as a biomarker of disease phenotypes is currently uncertain. Methods: We retrospectively analyzed EGPA patients referred to our Immunology Clinic. Demographic, laboratory and clinical features were retrieved from clinical records, and a Logistic Regression was fitted to evaluate the predictive power of all baseline clinical and laboratory features to define EGPA phenotypes. Results: 168 patients were recruited. BEC ≤ 1500 cells/mL was predictive of a clinical involvement characterized by asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and lung opacities (OR 0.18, 95% CI 0.07–0.43; respiratory-limited phenotype); BEC > 3500/mL was predictive of extrapulmonary organ involvement (OR 3.5, 95% CI 1.7–7.1; systemic phenotype). BEC was also predictive of peripheral nervous system (PNS) involvement, with a positive trend with increasing BEC (<1500/mL: OR 0.17, 95%CI, 0.06–0.47; >3500/mL: OR 2.8, 95% CI, 1.5–5.28). ANCA positivity was also predictive of extrapulmonary involvement (OR 4.7, 95% CI 1.9–11.99). Conclusions: according to BEC and irrespective of the ANCA status, two EGPA phenotypes could be identified, named systemic and respiratory-limited phenotypes, with different organ involvement and possibly different prognoses.
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Ito H, Mishima Y, Cho T, Ogiwara N, Shinma Y, Yokota M, Anzai K, Tsuda S, Nagata J, Kojima S, Sasaki N, Wakabayashi T, Watanabe N, Suzuki T. Eosinophilic Cholecystitis Associated with Eosinophilic Granulomatosis with Polyangiitis. Case Rep Gastroenterol 2020; 14:668-674. [PMID: 33442347 PMCID: PMC7772830 DOI: 10.1159/000511863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/18/2020] [Indexed: 11/19/2022] Open
Abstract
We report a case of eosinophilic cholecystitis associated with eosinophilic granulomatosis with polyangiitis (EGPA) complicated by cerebral hemorrhage. A 60-year-old man presented to a local hospital with a diagnosis of acute cholecystitis, with persistent fever and epigastric pain for 2 weeks. His symptoms persisted despite 3-week hospitalization; therefore, he was transferred to our hospital for further evaluation. Laboratory investigations upon admission showed white blood cells 26,300/µL and significant eosinophilia (eosinophils 61%). Abdominal computed tomography revealed no gallbladder enlargement but a circumferentially edematous gallbladder wall. Additional blood test results were negative for antineutrophil cytoplasmic and perinuclear antineutrophil cytoplasmic antibodies; however, immunoglobulin (Ig)G and IgE levels were high at 1,953 mg/dL and 3,040/IU/mL, respectively. He improved following endoscopic transnasal gallbladder drainage for cholecystitis and was diagnosed with EGPA and received corticosteroid and immunosuppressant combination therapy. The eosinophil count decreased immediately after treatment, and abdominal pain and numbness resolved. He returned with left-sided suboccipital hemorrhage likely attributed to EGPA 6 months after discharge. EGPA is characterized by inflammation of small blood vessels and clinically manifests with an allergic presentation of bronchial asthma, as well as renal dysfunction, interstitial pneumonia, enteritis, and cerebral hemorrhage. Few reports have described cholecystitis as a presenting symptom of EGPA. We report a rare case of such a presentation with added considerations.
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Affiliation(s)
- Hiroyuki Ito
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yusuke Mishima
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tsubomi Cho
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Naoki Ogiwara
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Yoshimasa Shinma
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Masashi Yokota
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Kazuya Anzai
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Shingo Tsuda
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Junko Nagata
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Seiichiro Kojima
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Noriko Sasaki
- Department of Rheumatology, Tokai University Hachioji Hospital, Tokyo, Japan
| | | | - Norihito Watanabe
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Takayoshi Suzuki
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
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Reichman H, Rozenberg P, Munitz A. Mouse Eosinophils: Identification, Isolation, and Functional Analysis. ACTA ACUST UNITED AC 2017; 119:14.43.1-14.43.22. [PMID: 29091265 DOI: 10.1002/cpim.35] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Eosinophils are bone marrow-derived cells that differentiate in the bone marrow and migrate into the peripheral blood primarily under the regulation of interleukin (IL)-5. Eosinophil levels in the blood are relatively low. However, under steady-state conditions and in settings of allergic inflammation, parasite infections, or even cancer, they migrate and mainly reside in mucosal tissues where they have key effector and immune-modulating functions. Functional studies using eosinophils are not simple, since these cells are terminally differentiated and rapidly die in vitro. Thus, establishing simple methods to characterize, obtain, and functionally assess eosinophil activities is important. In this unit, we describe methodology for identifying tissue eosinophils by flow cytometry. In addition, we provide detailed methods for isolating eosinophils and for differentiating them from bone marrow cells for further functional studies. © 2017 by John Wiley & Sons, Inc.
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Affiliation(s)
- Hadar Reichman
- Department of Clinical Microbiology and Immunology, The Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Perri Rozenberg
- Department of Clinical Microbiology and Immunology, The Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Ariel Munitz
- Department of Clinical Microbiology and Immunology, The Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel
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Khan S, Hassan MJ, Jairajpuri ZS, Jetley S, Husain M. Clinicopathological Study of Eosinophilic Cholecystitis: Five Year Single Institution Experience. J Clin Diagn Res 2017; 11:EC20-EC23. [PMID: 28969136 PMCID: PMC5620776 DOI: 10.7860/jcdr/2017/27886.10427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/08/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Gallbladder diseases are very common in Northern India, most common of which is Chronic Cholecystitis. Rarely, histopathological diagnosis of Eosinophilic Cholecystitis (EC) is given when transmural cellular infiltrate consists of more than 90% eosinophils. AIM To determine the prevalence and clinicopathological profile of eosinophilic cholecystitis at a tertiary care hospital of New Delhi. MATERIALS AND METHODS This was a retrospective clinicopathological study done on twenty two cases of eosinophilic cholecystitis over a period of five years from January 2011- December 2015. In cases diagnosed histopathologically as eosinophilic cholecystitis, clinical details were obtained from hospital records and slides were retrieved. Various histologic features, pattern of the inflammatory infiltrate and association of EC with other medical diseases, drugs and allergic states were evaluated. RESULTS Out of a total of 1370 cholecystectomy specimens received during five year period, Eosinophilic cholecystitis was diagnosed in 22 (1.6%) of the specimens. Clinically, seven of these patients had a clinical diagnosis of acute cholecystitis. Patient's age ranged from 25-64 years and male to female ratio was 1:2.7. Most common symptom reported was abdominal pain. Most of the cases showed gallstones radiologically (90%) while only two cases showed peripheral eosinophilia (9%). Histologically, mucosal and muscular eosinophilic infiltrate was seen in 72.6% of the cases. No association with drug therapy, allergies or other pre-existing medical conditions was noted. CONCLUSION EC is a relatively uncommon entity in which histopathology remains the main stay of diagnosis. Although the presentation may be similar to general cholecystitis, if a postoperative histopathological diagnosis of EC is made, then the patient must be investigated thoroughly to rule out other associated disease conditions, which may have a worse prognosis than cholecystitis itself.
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Affiliation(s)
- Sabina Khan
- Associate Professor, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Mohammad Jaseem Hassan
- Associate Professor, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Zeeba Shamim Jairajpuri
- Associate Professor, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Sujata Jetley
- Professor and Head, Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Musharraf Husain
- Professor, Department of Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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Mucosal Eosinophils. Mucosal Immunol 2015. [DOI: 10.1016/b978-0-12-415847-4.00044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Elliott JA, McCormack O, Tchrakian N, Conlon N, Ryan CE, Lim KT, Ullah N, Mahmud N, Ravi N, McKiernan S, Feighery C, Reynolds JV. Eosinophilic ascites with marked peripheral eosinophilia: a diagnostic challenge. Eur J Gastroenterol Hepatol 2014; 26:478-84. [PMID: 24535594 DOI: 10.1097/meg.0000000000000037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eosinophilic disease of the gastrointestinal tract is rare and is characterized by the presence of gastrointestinal symptoms in association with eosinophilic infiltration of any part of the gastrointestinal tract. Clinical presentation of eosinophilic gastroenteritis (EGE) varies not only by the part of the gastrointestinal tract involved but also with the depth of eosinophilic infiltration of the gut wall. We describe the case of a 41-year-old woman with a history of atopy who presented with severe abdominal pain and diarrhoea. Investigations showed large-volume eosinophil-rich ascites and a markedly elevated peripheral blood eosinophil count and immunoglobulin E level. Bone marrow aspirate, trephine biopsy and T-cell studies showed no evidence of underlying haematological malignancy. Vasculitic disease and parasitic infection were systematically excluded. Colonic and upper gastrointestinal biopsies confirmed a diagnosis of EGE with eosinophilic ascites. The patient was treated with systemic corticosteroids and dietary allergen elimination with dramatic therapeutic response. The diagnostic and therapeutic challenges associated with EGE in its various forms are discussed.
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Affiliation(s)
- Jessie A Elliott
- aDepartment of Surgery, Trinity Centre, St James's Hospital and Trinity College bDepartment of Pathology cDepartment of Immunology dDepartment of Gastroenterology, St James's Hospital, Dublin, Ireland
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Bates AWH. Diagnosing eosinophilic colitis: histopathological pattern or nosological entity? SCIENTIFICA 2013; 2012:682576. [PMID: 24278727 PMCID: PMC3820477 DOI: 10.6064/2012/682576] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 05/06/2012] [Indexed: 06/02/2023]
Abstract
Reports of "eosinophilic colitis"-raised colonic mucosal eosinophil density in patients with lower gastrointestinal symptoms-have increased markedly over the last fifteen years, though it remains a rarity. There is no consensus over its diagnosis and management, and uncertainty is compounded by the use of the same term to describe an idiopathic increase in colonic eosinophils and an eosinophilic inflammatory reaction to known aetiological agents such as parasites or drugs. In patients with histologically proven colonic eosinophilia, it is important to seek out underlying causes and careful clinicopathological correlation is advised. Because of the variability of eosinophil density in the normal colon, it is recommended that histological reports of colonic eosinophilia include a quantitative morphometric assessment of eosinophil density, preferably across several sites. Few reported cases of "eosinophilic colitis" meet these criteria. As no correlation has been shown between colonic eosinophil density and symptoms in older children or adults, it is suggested that treatment should be directed towards alleviation of symptoms and response to treatment assessed clinically rather than by histological estimates of intramucosal eosinophils.
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Affiliation(s)
- Alan W. H. Bates
- Research Department of Pathology, University College London, London WC1E 6BT, UK
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10
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Yeom SS, Kim HH, Kim JC, Hur YH, Koh YS, Cho CK, Kim HJ, Shin SS, Kim HS. Peripheral eosinophilia - is it a predictable factor associated with eosinophilic cholecystitis? KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:65-9. [PMID: 26388909 PMCID: PMC4574993 DOI: 10.14701/kjhbps.2012.16.2.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUNDS/AIMS The purpose of this study was to evaluate the role of peripheral eosinophilia as a predictable factor associated with Eosinophilic cholecystitis (EC) compared with other forms of cholecystitis in patients who underwent a cholecystectomy. METHODS Between January 2001 and May 2011, the histopathologic features of 3,539 cholecystectomy specimens were reviewed retrospectively. EC was diagnosed in 30 specimens (0.84%). Data from 30 consecutive patients with EC (eosinophilic cholecystitis group [E-group]) were compared with a retrospective control group of 60 patients (other cholecystitis group [O-group]) during the same period. The two groups were matched for age, gender, and the presence of cholelithiasis. RESULTS The median absolute eosinophil count 1 day post-operatively was 144 cells/mm(3) (range: 9-801 cells/mm(3)) in the E-group and 93 cells/mm(3) (range: 0-490 cells/mm(3)) in the O-group (p=0.036). Pre-operative peripheral eosinophilia was more common in the E-group than the O-group (20% vs. 3.3%, p=0.015). Multivariate analysis revealed that pre-operative peripheral eosinophilia was an independent significant predictable factor associated with EC (odds ratio=7.250, 1.365 <95% confidence interval<38.494, p=0.020). CONCLUSIONS In the present study, pre-operative peripheral eosinophilia was shown to be an independent predictable factor associated with EC. Further researches seem to be necessary to confirm this finding.
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Affiliation(s)
- Seung-Seop Yeom
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Hyun Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jung-Chul Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Hoe Hur
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Yang-Seok Koh
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Chol-Kyoon Cho
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Jong Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Soo Shin
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyung-Seok Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
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Aihara Y, Yoshiji H, Yamazaki M, Ikenaka Y, Noguchi R, Morioka C, Kaji K, Tastumi H, Nakanishi K, Nakamura M, Yamao J, Toyohara M, Mitoro A, Sawai M, Yoshida M, Fujimoto M, Uemura M, Fukui H. A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma. World J Gastrointest Oncol 2012; 4:115-8. [PMID: 22645635 PMCID: PMC3360105 DOI: 10.4251/wjgo.v4.i5.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 02/14/2012] [Accepted: 02/20/2012] [Indexed: 02/05/2023] Open
Abstract
Sorafenib, a multikinase inhibitor, is the first and only drug, which improves significantly the overall survival in patients with advanced hepatocellular carcinoma (HCC). However, many patients experience diverse side effects, some of them severe and unexpected. To date, acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib. Here, we report the case of a 43-year-old woman with hepatitis C virus-related advanced HCC. She received sorafenib, and later complained of a sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense. Laboratory examination showed mild elevation of transaminases, biliary enzymes, bilirubin, inflammation markers, and a marked peripheral eosinophilia. Abdominal computed tomography (CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris. Consequently, sorafenib treatment was stopped immediately, and steroid-pulse therapy was performed. Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings, eosinophilia, and liver functions. In summary, we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.
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Affiliation(s)
- Yosuke Aihara
- Yosuke Aihara, Hitoshi Yoshiji, Masaharu Yamazaki, Yasuhide Ikenaka, Ryuichi Noguchi, Chie Morioka, Kosuke Kaji, Haruki Tastumi, Keisuke Nakanishi, Maiko Nakamura, Junichi Yamao, Masahisa Toyohara, Akira Mitoro, Masayoshi Sawai, Motoyuki Yoshida, Masao Fujimoto, Masahito Uemura, Hiroshi Fukui, Third Department of Internal Medicine, Nara Medical University, Nara 634-8522, Japan
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12
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Cerdán Santacruz C, Martín Antona E, Martín García-Almenta E, Díez Valladares L, Torres García AJ. [Eosinophilic cholecystitis after elective cholecystectomy for gallbladder stones]. Cir Esp 2012; 91:460-1. [PMID: 22565107 DOI: 10.1016/j.ciresp.2012.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 02/14/2012] [Indexed: 10/28/2022]
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13
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Marked infiltration of eosinophils in necrotizing granulomas in the resected hepatic bed after cholecystectomy resulting from gallbladder cancer and metastatic liver cancer is associated with peculiar peripheral eosinophilia. Med Mol Morphol 2012; 45:53-7. [PMID: 22431184 DOI: 10.1007/s00795-011-0555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/24/2011] [Indexed: 10/28/2022]
Abstract
It is known that after transurethral resection of the prostate (TUR-P) or a bladder tumor (TUR-BT), necrotizing granuloma formation associated with massive eosinophil accumulation can be detected at the site of the scar, revealing marked eosinophilia. This condition is called post-TUR prostatitis or cystitis. In the present study, we noticed a similar phenomenon in five patients who underwent cholecystectomy, of whom four had gallbladder adenocarcinoma and one had metastatic liver cancer originating from the rectum. We detected necrotizing granulomas with massive eosinophil accumulation, associated with marked eosinophilia. To induce these phenomena, the interval between the first operation (i.e., cholecystectomy) and the second operation (i.e., resection of the hepatic bed and extrahepatic bile duct) is very important. If the interval was 1 week, no granuloma formation was detected. On the other hand, if it was more than 2 weeks, the resected hepatic bed contained necrotizing granulomas with substantial eosinophil accumulation combined with an increase in peripheral eosinophilia (up to 34% in one case). Secondary resection was necessary to induce eosinophilia after cholecystectomy. In this sense, malignancies possessed a relationship with delayed eosinophilia. In the granulomas, some foreign body-type multinucleated giant cells were positive for both anti-interleukin (IL)-5 and CD68 antibodies. In sharp contrast, no eosinophilia was detected after cholecystectomy, with or without hepatic resection consequent to severe adhesion. Clinicians as well as pathologists should keep in mind that these peculiar phenomena of eosinophil accumulation surrounding the necrotizing granulomas and peripheral eosinophilia after cholecystectomy could occur.
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Abstract
Eosinophils and gastrointestinal tract interact in an intimate and enigmatic relationship. Under inflammatory conditions, eosinophil infiltration in the gastrointestinal tract is a common feature of numerous eosinophilic gastrointestinal disorders (EGIDs). EGIDs are disorders, for which the diagnosis is relatively difficult. Nevertheless, some common laboratory techniques are currently used for their diagnosis and disease monitoring. Besides eosinophils, mast cells and T cells have also been suggested to play a role in the pathogenesis of these disorders. Here, we review the pathogenesis and common laboratory approaches applied for their diagnosis, in particular eosinophil and mast cell markers.
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Affiliation(s)
- Sébastien Conus
- Department of Pharmacology, University of Bern, Bern, Switzerland.
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15
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Méndez-Sánchez N, Chávez-Tapia NC, Vazquez-Elizondo G, Uribe M. Eosinophilic gastroenteritis: a review. Dig Dis Sci 2007; 52:2904-11. [PMID: 17429740 DOI: 10.1007/s10620-005-9011-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Accepted: 08/11/2005] [Indexed: 01/14/2023]
Abstract
Eosinophilic gastroenteritis is a rare benign disease characterized by tissue eosinophilic infiltration that may involve several digestive tract layers. Also known as allergic, or eosinophilic allergic, gastroenteropathy, it usually involves the stomach and small intestine: rarely the colon. It may or may not be accompanied by higher counts of eosinophils in the peripheral blood. The main clinical manifestations depend on the site affected. It has been classified according to clinical and pathological features, and the symptoms depend on the patient's immunological response to several cytokines released by eosinophils. Because of lack of understanding of the etiology and triggering factors, treatment is based mainly on corticosteroids; although other drugs acting on the immune system have been tested, the results are not always satisfactory. This review focuses on the epidemiology, pathophysiology, clinical features, and treatment of this hitherto under-diagnosed disease.
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Affiliation(s)
- Nahum Méndez-Sánchez
- Department of Internal Medicine, Medica Sur Clinic & Foundation, Mexico City, Mexico.
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Rothenberg ME. Eosinophils. Mucosal Immunol 2005. [DOI: 10.1016/b978-012491543-5/50041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Kay AB, Klion AD. Anti-interleukin-5 therapy for asthma and hypereosinophilic syndrome. Immunol Allergy Clin North Am 2004; 24:645-66, vii. [PMID: 15474864 DOI: 10.1016/j.iac.2004.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interleukin 5 (IL-5) is a key cytokine in the regulation of eosinophilia and eosinophil activation in humans. Monoclonal antibodies to anti-IL-5 have become available for use in clinical studies in humans. This article discusses the rationale for the use of anti-IL-5 therapy in asthma and hypereosinophilic syndrome and summarizes the available clinical data on the use of anti-IL-5 to treat these disorders.
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Affiliation(s)
- A Barry Kay
- Department of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Guy Scadding Building, Dovehouse Street, London, SW3 6LY UK.
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Gotlib J, Cools J, Malone JM, Schrier SL, Gilliland DG, Coutré SE. The FIP1L1-PDGFRalpha fusion tyrosine kinase in hypereosinophilic syndrome and chronic eosinophilic leukemia: implications for diagnosis, classification, and management. Blood 2003; 103:2879-91. [PMID: 15070659 DOI: 10.1182/blood-2003-06-1824] [Citation(s) in RCA: 221] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Idiopathic hypereosinophilic syndrome (HES) and chronic eosinophilic leukemia (CEL) comprise a spectrum of indolent to aggressive diseases characterized by unexplained, persistent hypereosinophilia. These disorders have eluded a unique molecular explanation, and therapy has primarily been oriented toward palliation of symptoms related to organ involvement. Recent reports indicate that HES and CEL are imatinib-responsive malignancies, with rapid and complete hematologic remissions observed at lower doses than used in chronic myelogenous leukemia (CML). These BCR-ABL-negative cases lack activating mutations or abnormal fusions involving other known target genes of imatinib, implicating a novel tyrosine kinase in their pathogenesis. A bedside-to-benchtop translational research effort led to the identification of a constitutively activated fusion tyrosine kinase on chromosome 4q12, derived from an interstitial deletion, that fuses the platelet-derived growth factor receptor-alpha gene (PDGFRA) to an uncharacterized human gene FIP1-like-1 (FIP1L1). However, not all HES and CEL patients respond to imatinib, suggesting disease heterogeneity. Furthermore, approximately 40% of responding patients lack the FIP1L1-PDGFRA fusion, suggesting genetic heterogeneity. This review examines the current state of knowledge of HES and CEL and the implications of the FIP1L1-PDGFRA discovery on their diagnosis, classification, and management.
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Affiliation(s)
- Jason Gotlib
- Division of Hematology, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305-5821, USA.
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19
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O'Toole D, Palazzo L, Vullierme MP, Maire F, Lévy P, Ruszniewski P. Bile duct obstruction caused by an eosinophilic papillary pseudotumor. Gastrointest Endosc 2003; 58:445-8. [PMID: 14528227 DOI: 10.1067/s0016-5107(03)00027-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Dermot O'Toole
- Fédération médico-chirurgicale d'hépato-gastroentérologie, Service de Gastroentérologie, Department of Radiology, Hôpital Beaujon, AP-HP, Clichy, France
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Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J, Herrerias-Gutierrez JM. Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. Dig Dis Sci 2003. [PMID: 12757181 DOI: 10.1023/a: 1022521707420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Eosinophilic gastroenteritis (EGE) is a rare inflammatory disease characterized by diffuse or scattered eosinophilic infiltration of the digestive tract and usually by peripheral blood eosinophilia. The most common presenting symptoms of EGE are abdominal pain, vomiting and diarrhea, but clinical features depend on which layers or location of gastrointestinal tract are involved. Treatment with corticosteroids results in clinical and histological remission in most patients and surgery can be avoided if a correct diagnosis is made. Previous history of allergy is a key to diagnosing EGE, but peripheral eosinophilia may be absent in some patients under concomitant treatment with corticosteroids. Radiological and endoscopic findings are also nonspecific and diagnosis must always be histologically confirmed. The gastrointestinal involvement is patchy in distribution, so more than one panendoscopic examination is often necessary to establish the diagnosis, and surgical or CT-guided full-thickness biopsy is needed in patients with muscular or serosal involvement. It emphasises the importance of a high index of clinical suspicion, which mainly depends on knowledge of natural history of the disease. We report here a case of EGE associated with transmural eosinophilic cholecystocholangitis, in a patient who presented with dyspeptic symptoms and recurrent cholestasis responsive to corticoesteroids. To our knowledge, this patient represents the second case, in the English literature, in which corticoid-responsive cholangitis was associated to histologically proven eosinophilic cholecystitis and gastrointestinal involvement, suggesting that EGE must always be considered in the differential diagnosis of biliary tract disease in patients with eosinophilia and/or atopic diseases.
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Affiliation(s)
- Manuel Jimenez-Saenz
- Division of Gastroenterology, Department of Pathology, Hospital Virgen Macarena, Seville, Spain
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Jimenez-Saenz M, Villar-Rodriguez JL, Torres Y, Carmona I, Salas-Herrero E, Gonzalez-Vilches J, Herrerias-Gutierrez JM. Biliary tract disease: a rare manifestation of eosinophilic gastroenteritis. Dig Dis Sci 2003; 48:624-7. [PMID: 12757181 DOI: 10.1023/a:1022521707420] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Eosinophilic gastroenteritis (EGE) is a rare inflammatory disease characterized by diffuse or scattered eosinophilic infiltration of the digestive tract and usually by peripheral blood eosinophilia. The most common presenting symptoms of EGE are abdominal pain, vomiting and diarrhea, but clinical features depend on which layers or location of gastrointestinal tract are involved. Treatment with corticosteroids results in clinical and histological remission in most patients and surgery can be avoided if a correct diagnosis is made. Previous history of allergy is a key to diagnosing EGE, but peripheral eosinophilia may be absent in some patients under concomitant treatment with corticosteroids. Radiological and endoscopic findings are also nonspecific and diagnosis must always be histologically confirmed. The gastrointestinal involvement is patchy in distribution, so more than one panendoscopic examination is often necessary to establish the diagnosis, and surgical or CT-guided full-thickness biopsy is needed in patients with muscular or serosal involvement. It emphasises the importance of a high index of clinical suspicion, which mainly depends on knowledge of natural history of the disease. We report here a case of EGE associated with transmural eosinophilic cholecystocholangitis, in a patient who presented with dyspeptic symptoms and recurrent cholestasis responsive to corticoesteroids. To our knowledge, this patient represents the second case, in the English literature, in which corticoid-responsive cholangitis was associated to histologically proven eosinophilic cholecystitis and gastrointestinal involvement, suggesting that EGE must always be considered in the differential diagnosis of biliary tract disease in patients with eosinophilia and/or atopic diseases.
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Affiliation(s)
- Manuel Jimenez-Saenz
- Division of Gastroenterology, Department of Pathology, Hospital Virgen Macarena, Seville, Spain
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23
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Losanoff JE, Jones JW. Eosinophilic colitis. ANZ J Surg 2002; 72:75-6. [PMID: 11906433 DOI: 10.1046/j.1445-2197.2002.2303b.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- M E Rothenberg
- Division of Pulmonary Medicine, Allergy and Clinical Immunology, Department of Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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Affiliation(s)
- M Persić
- Department of Pediatrics, Clinical Hospital Center Rijeka, Croatia
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Abstract
An increase in the blood eosinophil count may occur in a number of disease states including allergies, parasitic infections, vascular disease and as a reaction to the presence of malignant tumours. This article defines those disorders that are not purely reactive, and describes in detail the diagnosis and features of clonal eosinophilic disorders and the hypereosinophilic syndrome. The clonal disorders that are associated with eosinophilia are discussed, in particular the acute and chronic eosinophilic leukaemias and clonal eosinophilias in association with acute myeloid leukaemia, myeloproliferative disorders and myelodysplastic syndromes. Whether eosinophilia is produced by a clonal or reactive disorder, the end result can often be the same, i.e. end organ damage produced by sustained hypereosinophilia in the presence of eosinophil activation. When no cause for the eosinophilia leading to the end organ damage is found, this disease is termed 'idiopathic hypereosinophilic syndrome'. Its pathogenesis, clinical features and management are discussed with particular reference to the possibility of it being a T-cell-associated disorder.
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