Presacral teratocarcinoma presenting as anal fistula and rectal adenocarcinoma: a unique case presentation and literature review

Somatic malignancy arising from presacral or retroperitoneal primary teratoma is extremely rare. We report the case of a 37-year-old male patient with adenocarcinoma of respiratory type arising from primary presacral teratoma, but which first presented as anal fistula and rectal adenocarcinoma. The two tumors show the same morphology and immunophenotype (CK7–CK20+CDx2+). Malignant adenocarcinoma transformations from the normal respiratory epithelium are also found. To the best of our knowledge, this is the second case of respiratory type adenocarcinoma arising from primary presacral mature cystic teratoma.

Quadruple rescue therapy for Helicobacter pylori infection after two treatment failures

BACKGROUND

A standard third-line therapy for Helicobacter pylori infection is lacking, and antimicrobial sensitivity data for patients who failed eradication therapy are often unavailable in clinical practice. We therefore designed the prospective study to assess the efficacy of levofloxacin, amoxicillin, bismuth and rabeprazole quadruple therapy as a third-line treatment for H. pylori infection.

PATIENTS AND METHODS

From September 2005 to August 2007, 37 consecutive H. pylori-infected patients who had failed standard first-line and second-line treatments underwent a 10-day quadruple therapy comprising rabeprazole (20 mg b.i.d.), bismuth subcitrate (300 mg q.d.s.), amoxicillin (500 mg q.d.s.) and levofloxacin (500 mg o.d.). Follow-up endoscopy with rapid urease test, histological examination and culture was performed at 6 weeks after the end of treatment to evaluate the response to therapy.

RESULTS

Helicobacter pylori was successfully eradicated in 31 out of 37 patients (84% by both intention-to-treat analysis and per-protocol analysis). All patients complied with the eradication therapies, and only seven patients (19%) complained of mild-to-moderate adverse events. Amoxicillin- and levofloxacin-resistant strains were observed in 17% and 22% of the patients, respectively. There were no significant differences between H. pylori eradication rates and antibiotic resistances.

CONCLUSIONS

The 10-day levofloxacin- and amoxicillin-based quadruple therapy is well tolerated and achieves a high eradication rate as a third-line empirical treatment for H. pylori infection.

Quadruple rescue therapy for Helicobacter pylori infection after two treatment failures

BACKGROUND

A standard third-line therapy for Helicobacter pylori infection is lacking, and antimicrobial sensitivity data for patients who failed eradication therapy are often unavailable in clinical practice. We therefore designed the prospective study to assess the efficacy of levofloxacin, amoxicillin, bismuth and rabeprazole quadruple therapy as a third-line treatment for H. pylori infection.

PATIENTS AND METHODS

From September 2005 to August 2007, 37 consecutive H. pylori-infected patients who had failed standard first-line and second-line treatments underwent a 10-day quadruple therapy comprising rabeprazole (20 mg b.i.d.), bismuth subcitrate (300 mg q.d.s.), amoxicillin (500 mg q.d.s.) and levofloxacin (500 mg o.d.). Follow-up endoscopy with rapid urease test, histological examination and culture was performed at 6 weeks after the end of treatment to evaluate the response to therapy.

RESULTS

Helicobacter pylori was successfully eradicated in 31 out of 37 patients (84% by both intention-to-treat analysis and per-protocol analysis). All patients complied with the eradication therapies, and only seven patients (19%) complained of mild-to-moderate adverse events. Amoxicillin- and levofloxacin-resistant strains were observed in 17% and 22% of the patients, respectively. There were no significant differences between H. pylori eradication rates and antibiotic resistances.

CONCLUSIONS

The 10-day levofloxacin- and amoxicillin-based quadruple therapy is well tolerated and achieves a high eradication rate as a third-line empirical treatment for H. pylori infection.

High-dose versus low-dose esomeprazole-based triple therapy for Helicobacter pylori infection

BACKGROUND

This prospective, randomized, controlled study was conducted to compare the efficacies of high-dose and low-dose esomeprazole-based triple therapies for Helicobacter pylori eradication in Taiwan.

MATERIALS AND METHODS

From January 2004 to June 2006, 240 H. pylori-infected patients were randomly assigned to undergo high-dose (40 mg b.d.) or low-dose (40 mg o.d.) esomeprazole combined with clarithromycin (500 mg b.d.) and amoxicillin (1 g b.d.) for one week. Follow-up endoscopy was performed at eight weeks after the end of treatment to evaluate the response to therapy.

RESULTS

Intention-to-treat analysis demonstrated no differences between eradication rates of high-dose and low-dose groups (92% vs. 90%, respectively, P > 0.05). Per-protocol analysis yielded comparable results (95% vs. 93%). Both groups exhibited similar frequencies of adverse events (13% vs. 11%) and drug compliance (96% vs. 93%). Multivariate analysis indicated that only good compliance (odds ratio: 10.3, 95% CI, 3.0-35.7) was an independent predictor of treatment success.

CONCLUSIONS

This work demonstrates that low-dose esomeprazole-based triple therapy yields a similar eradication rate as high-dose esomeprazole-based therapy in Taiwan. Since the cost of the low-dose regime is lower than that of the high-dose regime, low-dose esomeprazole-based triple therapy can reasonably be recommended for the first-line eradication of H. pylori for Taiwanese and probably most Asians.

Randomized comparison of two rescue therapies for Helicobacter pylori infection

BACKGROUND

Bismuth salts are not available worldwide. It remains unknown whether clarithromycin can replace bismuth salts as an adjuvant agent in the rescue regimens for Helicobacter pylori infection. We therefore designed the prospective study to compare the efficacies of two rescue therapies for H. pylori infection after standard triple therapies.

PATIENTS AND METHODS

Ninety-three patients who failed H. pylori eradication using proton pump inhibitor plus clarithromycin and amoxicillin were randomly assigned to undergo rescue therapy with esomeprazole, clarithromycin, tetracycline and metronidazole (ECTM group, n = 46) or esomeprazole, bismuth subcitrate, tetracycline and metronidazole (EBTM group, n = 47). Follow-up endoscopy was performed at 8 weeks after the end of treatment to assess the treatment response.

RESULTS

Intention-to-treat analysis demonstrated both groups had similar eradication rates (ECTM 74% vs. EBTM 77%; P = 0.76) and drug compliance (ECTM 94% vs. EBTM 96%; P = 0.68). However, the frequency of adverse events in the ECTM group was higher than that in EBTM group (ECTM 57% vs. EBTM 36%, P = 0.05). In the EBTM group, eradication rate of metronidazole-resistant strains was lower than that of metronidazole-susceptible strains (67%[8/12] vs. 100%[9/9], P = 0.05). However, eradication rates were similar between metronidazole-susceptible and metronidazole-resistant strains in ECTM group (69%[9/13] vs. 70%[7/10], P = 1.00).

CONCLUSIONS

The new ECTM second-line therapy can achieve similar eradication rate as standard EBTM therapy. It may be very useful in countries where bismuth salts are not available.

Experimental testing of spray dryer for control of incineration emissions

The research investigated the absorption/adsorption efficiency of sulfur dioxide (SO2), heavy metals, and polycyclic aromatic hydrocarbons (PAHs) with different Ca-based sorbents in a spray dryer during incineration process. For further improving the adsorption capacity of Ca-based sorbents, different spraying pressure and additives were carried out in this study. Experimental results showed that CaO could be used as an alternative sorbent in the spray dryer at an optimal initial particle size distribution of spraying droplet. In the spray dryer, Ca-based sorbents provided a lot of sites for heavy metals and PAHs condensing and calcium and alkalinity to react with metals to form merged species. As a result, heavy metals and PAHs could be removed from the flue gas simultaneously by condensation and adsorption. The additions of additives NaHCO3, SiO2, and KMnO4 were also found to be effective in improving the removal efficiency of these air pollutants.

Endoscopic 13C-urea breath test for the diagnosis of Helicobacter pylori infection

BACKGROUND

Endoscopic 13C-urea breath test may avoid contamination of oral urease and rapidly discriminate Helicobacter pylori-positive and Helicobacter pylori-negative patients.

AIMS

To compare the accuracy of endoscopic 13C-urea breath test with conventional invasive methods in diagnosis of Helicobacter pylori infection.

PATIENTS

One hundred patients who attended for routine upper gastrointestinal endoscopy were included.

METHODS

13C-urea was applied to the stomach through the working channel of endoscope at the end of endoscopic examination. Breath samples were collected before endoscopy and 2, 4, 6, 8, 10 min after consumption of 100 or 50 mg 13C-urea. Helicobacter pylori infection was defined as those with positive culture or positive results of both histology and CLO test.

RESULTS

The accuracy of 100 mg endoscopic 13C-urea breath test was significantly higher than that of culture and CLO test (100% vs. 88% and 92%, p = 0.02 and 0.03, respectively). The accuracy of 50 mg endoscopic 13C-urea breath test was higher than that of histology and CLO test (98% vs. 90% and 96%, respectively), although the differences were not statistically significant.

CONCLUSIONS

Endoscopic 13C-urea breath test has a higher accuracy compared with biopsy-based modalities. It may be a good choice to diagnose Helicobacter pylori infection if endoscopy is indicated for a dyspeptic patient.

The study of modified calcium hydroxides with surfactants for acid gas removal during incineration

The primary objective of the present work is to use additives to extend the sulfation reaction of the calcium hydroxide (Ca(OH)2) used to control SO2 emission from incineration processes. There are two reasons for adding surfactants (surface-active agent): (1) to provide an appropriate dispersion of the Ca(OH)2', thus preventing particle agglomeration due to humidity; (2) to alter the sulfation reaction environment by adsorbing heterogeneous materials on the surface of the Ca(OH)2 to extend the adsorption equilibrium. A dry scrubber integrated with a fabric filter was employed to study the effect of surfactants on the removal efficiency of acid gas in the flue gas with Ca(OH)2 as the sorbent. The operating parameters evaluated include: (1) the different surfactants (calcium lignosulfonate, sodium lignosulfonate, alkyl naphthalene sodium sulfonate and beta-naphthalene sodium sulfonate condensates) and (2) the composition of acid gas (i.e. sulfur dioxide (SO2), nitrogen oxide (NO) and hydrogen chloride (HCl)). The results show that modified Ca(OH)2 with surfactants could effectively decrease the emission of acid gas during incineration. Different additives had individual absorption efficiencies on different acid gases. On the whole, sodium lignosulfonate and beta-naphthalene sodium sulfonate condensates had better sorption capacity for SO2 and NO, but not for HCl. In addition, when SO2 coexisted with NO and HCl, the concentration of NO and HCl will result in decrease or increase of the removal efficiency of SO2.

Sequential changes of gastric hyperplastic polyps following endoscopic ligation

BACKGROUND

Endoscopic ligation has been extensively applied in the management of esophageal and gastric varices with or without bleeding. The varices are automatically eradicated through the use of ligation. However, whether avascular necrosis will occur in a gastrointestinal polyp when the base is ligated remains unclear. The aims of this pilot study were to investigate the sequential changes of gastric hyperplastic polyps following endoscopic detachable snare ligation and to determine the possibility of induction of avascular necrosis in these lesions following ligation.

METHODS

Eleven patients with eighteen gastric hyperplastic polyps were treated with endoscopic detachable-snare ligation. The polyps were observed for 5 minutes and biopsies were then conducted. At 14 days after endoscopic ligation, follow-up endoscopies were performed to assess the outcome of the strangulated polyps.

RESULTS

After being strangulated by the detachable snares, a majority of the polyps immediately congested (94%), and then developed cyanotic change (89%) approximately 4 minutes later. Pathological examination revealed severe venous congestion in the lamina propria of the strangulated polyps. On follow-up endoscopy 2 weeks later, all the snares had dropped off, and avascular necrosis occurred in sixteen polyps (89%). All of the polyps with avascular necrosis were detected to have developed cyanotic changes in initial endoscopy. No complications occurred during or following the ligation procedure.

CONCLUSIONS

Most gastric hyperplastic polyps develop avascular necrosis following ligation by detachable snare. Cyanotic change is an important predictor of the outcomes of the lesions following endoscopic ligation. The application of this ligation technique in treatment of bleeding or non-bleeding gastrointestinal polyps deserves further investigation.

Nephrogenic adenoma associated with cytomegalovirus infection of the ureter in a renal transplant patient: presentation as ureteral obstruction

Nephrogenic adenoma (NA), a rare benign lesion of the urinary tract, is widely accepted to be a metaplastic reaction due to urothelial injury. It mainly occurs in the urinary bladder and rarely in the ureter. Renal transplant recipients are prone to the development of NA. However in those patients, NA was diagnosed exclusively in the bladder. Herein, we present the--to our knowledge--first case of NA involving a transplanted ureter. A 42-year-old female kidney transplant recipient suffered hematuria, oliguria, and acute renal failure and presented with ureteral obstruction and hydronephrosis of the renal transplant. To our surprise, evidence of cytomegalovirus (CMV) infection of the NA was demonstrated using special immunohistochemical staining. The findings in this case raise the possibility that CMV infection, as an irritant of the ureteral epithelium, may be an etiological factor of NA.

Clinical significance of oral urease in diagnosis of Helicobacter pylori infection by [13C]urea breath test

This study was performed to evaluate the effect of oral flora on [13C]urea breath test in detecting H. pylori infection and find an optimal method and timing for sample collection. Forty-five volunteers were included in this study. The [13C]urea breath test was performed using mouthwash, endoscopic administration, and conventional methods. According to the receiver-operating characteristic curves, the earliest optimal time for discriminating H. pylori-positive and H. pylori-negative patients was at 25 min with the mouthwash method with 78% sensitivity and 82% specificity, at 2 min with the endoscopic administration method with 100% sensitivity and 100% specificity, and at 6 min with the conventional method with 100% sensitivity and 95% specificity. The study shows a significant effect of oral urease on the results of the [13C]urea breath test. The timing of sampling collection can be shortened to 6 min with the conventional method or to 2 min through endoscopic administration.

Follow-up of Helicobacter pylori status by using 13C-urea breath test in nonulcer dyspeptic patients after eradication therapy

BACKGROUND

The role of eradication therapy is still controversial in H. pylori-related nonulcer dyspepsia (NUD). The aim of this study was to follow up the H. pylori status after eradication therapy in patients with NUD by using l3C-urea breath test (UBT).

METHODS

Patients with a clinical and endoscopic diagnosis of NUD were included. H. pylori infection was established by endoscopic biopsies and 13C-UBT. Patients with H. pylori infection then received a quadruple therapy with colloidal bismuth subcitrate, metronidazole, tetracycline and lansoprazole. Two months after completion of therapy, endoscopic biopsies and 13C-UBT were performed again to confirm eradication. A follow-up 13C-UBT was carried out again in one year to detect recurrence of H. pylori infection.

RESULTS

Eighty-eight of the 148 patients (59.5%) were found to have H. pylori infection by both endoscopic biopsies and 13C-UBT. Anti-H. pylori therapy was given for 55 patients and proved successful in 33 of them two months after the end of therapy. However, recurrence was found one year later in three of these 33 cases, making a recurrence rate of 9.1% (3/33). Three of the 22 cases with unsuccessful eradication were found to have H. pylori eradication at one year by follow-up 13C-UBT. One of the 33 H. pylori-positive patients without anti-H. pylori therapy, who had negative 13C-UBT in one year follow-up, was found taking a high dose and long period of antibiotics.

CONCLUSIONS

The recurrence rate of H. pylori infection in our study was higher than that in the Western population. Delayed eradication of H. pylori may occur after anti-H. pylori therapy. Spontaneous eradication is rare in patients not receiving anti-H. pylori eradication.

Cathepsin E and subtypes of intestinal metaplasia in carcinogenesis of the human stomach

BACKGROUND

Cathepsin E is found mainly over the gastric surface and foveolar epithelial cells, and it also is found in the metaplastic pyloric glands and cancer cells. The exact function of cathepsin E in gastric mucosa remains unclear. The colonic type (type III) of intestinal metaplasia (IM) is strongly associated with intestinal-type gastric carcinoma. IM is considered to be a precancerous lesion. The aim of this study was to find out the role of cathepsin E in IM, dysplasia and cancer of stomach.

METHODS

Sixty nine biopsy specimens with IM and dysplasia and 33 gastrectomy specimens with gastric carcinoma were fixed, sectioned and stained with PAS-alcian blue stain, high iron-diamine alcian blue stain to classify IM and immunohistochemical stain to localize cathepsin E. Those patients with dysplastic gastric lesions received regular endoscopic follow-up.

RESULTS

Fifteen of 69 patients with gastric dysplasia developed cancer in a median 10.5 months follow-up. Severe dysplasia developed carcinoma significantly higher than mild dysplasia (12/20 vs. 1/25, p < 0.001), and type III intestinal metaplasia seemed to have significantly predilection for severe dysplasia and gastric cancer. Cathepsin E was stained in intestinal metaplasia with dysplastic change in 44/69 specimens (63.8%), and carcinoma in 28/48 (58.3%) specimens, there was no significant difference between intestinal type and diffuse type carcinoma in cathepsin E staining. The positive staining for cathepsin E decreased significantly in severe dysplastic gastric mucosa.

CONCLUSIONS

Type III IM is commonly associated with severe dysplasia and cancer; it may be a precancerous lesion. The positive staining of cathepsin E decreased with the severity of gastric dysplasia, representing dedifferentiation of the cells.

Solitary fibrous tumor of the liver

Solitary fibrous tumor of the liver is a rare neoplasm. So far, 21 cases have been described in the English literature. We reported an additional case. Our patient, a 75-year-old man, suffered from abdominal fullness and body weight loss of 6 kg over 6 months, and chills and fever for 2 months. Hypoglycemia was noted at admission. Both abdominal sonography and CT showed a huge mass occupying the right lobe of liver. Liver biopsy showed fibrous tumor. Right lobectomy was performed and the tumor was resected. Pathological examination showed spindle-shaped and fibroblast-like cells within the collagenous stroma. On immunohistochemical stains, these spindle tumor cells showed CD34 positive reactivity. The post-operative course was uneventful and there was no more hypoglycemia. The patient recovered smoothly, regained his body weight, and was alive without evidence of disease recurrence at the last follow-up visit in November, 2000.

Pollutants in incineration flue gas

Previous studies have shown that pollutants from incineration include heavy metals, organic compounds, particulate and acid gas. However, most studies on a single pollutant, it is rare for a study to concentrate on all possible pollutants and the relations between these pollutants under various incineration conditions. The objective of this work was to experimentally study the effect of different operating conditions on the pollutants emitted during incineration and the relations between these pollutants. The operating conditions of the experiments included the temperature of the combustion chamber and the species of organics. The findings indicated that the concentration of hydrogen chloride (HCl) in the presence of polyvinyl chloride (PVC) was higher than that of sodium chloride (NaCl). Regardless of what Cl-containing feedstock was added, the concentration of chromium (Cr) was constant. When organic chloride was added, Cr was the main metallic element which influenced the formation of polycyclic aromatic hydrocarbons (PAHs). On the other hand, when inorganic chloride (NaCl) was added, lead (Pb) was the major element.

Comparison of clinical, serological and histological findings between non-ulcer dyspepsia patients with and without Helicobacter pylori infection

BACKGROUND AND AIMS

The role of Helicobacter pylori (H. pylori) infection in non-ulcer dyspepsia (NUD) remains controversial. This study investigates the clinical, serological and histological differences between patients with H. pylori-positive and -negative NUD.

METHODS

One hundred and eighty consecutive patients with NUD were enrolled from January to December 1998. The severity of symptoms was evaluated by the Tucci's scoring system. The histological changes of gastric mucosa were assessed according to the Updated Sydney System, and a fasting blood sample was obtained to test the serum gastrin and pepsinogen I levels.

RESULTS

The H. pylori-positive NUD patients were notably older than H. pylori-negative NUD patients (48.2 +/- 15.9 vs 39.8 +/- 15.7 years, P= 0.001). There were no differences in other clinical factors between the two NUD groups. The serum pepsinogen I levels were considerably higher in H. pylori-positive NUD patients than in H. pylori-negative NUD patients (78.9 +/- 42.2 vs 61.5 +/- 43.3 ng/mL, P<0.01). However, no significant differences in serum gastrin levels were discovered between the two groups. The antrum histological scores for chronic inflammation, acute inflammation, gland atrophy and lymphoid follicles were higher in H. pylori-positive NUD patients than in H. pylori-negative NUD patients (2.09 vs 1.01, P<0.001; 1.22 vs 0.36, P<0.001; 0.76 vs 0.36, P<0.01; 0.33 vs 0.13, P<0.01, respectively).

CONCLUSIONS

The present study discovered marked differences in age, serum pepsinogen I levels, histological grades of acute inflammation, chronic inflammation, gland atrophy and lymphoid tissue formation between H. pylori-positive and H. pylori-negative NUD patients. Further investigation of the clinical prognosis of the two groups of patients is necessary.

Eradication of Helicobacter pylori prevents ulcer development in patients with ulcer-like functional dyspepsia

BACKGROUND

Although the eradication of Helicobacter pylori infection benefits patients with gastric or duodenal ulcers, the value of eradicating the infection in the patients with functional dyspepsia (FD) remains controversial.

AIMS

To determine whether eradicating H. pylori can prevent the subsequent development of ulcers or relieve the symptoms of functional dyspepsia patients.

METHODS

In a double-blind, placebo-controlled trial, 161 patients infected with H. pylori who had functional dyspepsia were randomly assigned to 7 days of treatment with a lansoprazole-based triple therapy or placebo and then followed for 1 year. The main outcome measures were the development of peptic ulcers and the resolution of symptoms.

RESULTS

H. pylori was eradicated in 63 out of 81 patients (78%) in the treatment group and none of the 80 patients (0%) in the placebo group. During the follow-up period, two patients in the treatment group and six patients in the placebo group developed peptic ulcers at repeat endoscopy (2.5% vs. 7.5%; 95% CI: -12 to 2). The reduction in ulcer rates was statistically significant in the 'ulcer-like' sub-group (0% vs. 16.7%; 95% CI: -32 to -2), but not in the 'dysmotility-like' and 'unclassifiable' sub-groups. Regarding symptom response, the resolution rates of symptoms were similar between the treatment and placebo groups (58.0% vs. 55.0%, 95% CI: -12 to 18). Additionally, no significant differences existed in the symptom responses between the treatment and control arms in each of the dyspepsia sub-groups.

CONCLUSIONS

Eradicating H. pylori can prevent the subsequent development of peptic ulcers in the patients with 'ulcer-like' functional dyspepsia. However, this approach does not significantly reduce the symptoms of functional dyspepsia patients.

Sauropus androgynus-constrictive obliterative bronchitis/bronchiolitis--histopathological study of pneumonectomy and biopsy specimens with emphasis on the inflammatory process and disease progression

AIMS

The histopathology of the Sauropus androgynus (SA)-constrictive bronchiolitis obliterans (BO) is still controversial. A recent report using pneumonectomy specimens showed that the major histopathology was obliterative arteriopathy with segmental necrosis of small bronchi instead of constrictive BO as previously described.

METHODS AND RESULTS

We analysed semiquantitatively and immunohistochemically the histopathology of one pneumonectomy and four biopsies specimens of SA-associated lung disease. We found a significant number of constrictive and obliterative bronchioles 1 mm or less in diameter and segmental inflammatory destruction with complete luminal obliteration of the bronchi less than 3 mm in diameter in the pneumonectomy specimen (37% and 25%, respectively). Fibromuscular intimal sclerosis of the bronchial arteries was identified in 15% of the bronchi 4 mm or less in diameter. The inflammation in these airways was composed predominantly of T-lymphocytes, macrophages, mast cells and eosinophils. They were present throughout the evolutionary stages of the bronchiolitis ranging from early oedematous to the late fibrotic obliterative stage. Double immunohistochemical stains revealed negative proliferative cell nuclear antigen for most of the T-lymphocytes and macrophages but positive for fibroblasts.

CONCLUSIONS

A more accurate histopathological designation of the SA-associated lung disease should be constrictive obliterative bronchitis/bronchiolitis, with the participation of T-lymphocytes, macrophages, mast cells, eosinophils and fibroblasts in its morphogenesis. The persistent accumulation of inflammatory cells was mediated predominantly by continued recruitment to the site of injury from the bloodstream, resulting eventually in the irreversible fibrosis of the bronchioles and the bronchi less than 3 mm in diameter. Obliterative arteriopathy is suspected of being only an indirect contributing factor.

Papulonecrotic tuberculid--a rare skin manifestation in a patient with pulmonary tuberculosis

Papulonecrotic tuberculid (PNT), a cutaneous manifestation of tuberculosis, is rare even in areas endemic for tuberculosis such as Taiwan. Concomitant pulmonary tuberculosis is uncommon in patients with PNT. We describe a patient with rare skin manifestations and simultaneous pulmonary tuberculosis. This 48-year-old woman had suffered from productive cough for 4 months, and pea-sized papules with central umbilication were noted over the extensor surface of her four extremities and lower abdomen 1 month prior to admission to our hospital. Chest roentgenography showed reticulonodular lesions with small cavitation over the lower right lung field, and sputum culture yielded Mycobacterium tuberculosis complex. PNT was diagnosed using the skin biopsy results and the papules healed with scar formation after antituberculous therapy.

Allergic eosinophilic gastroenteritis in a boy with congenital duodenal obstruction

Eosinophilic gastroenteritis (EG) is a rare allergy-related disease, especially in early childhood. We present the case of a 1 year 4 month old boy with congenital duodenal obstruction who developed EG. That diagnosis of EG was made by a series of imaging studies and was confirmed by upper gastrointestinal (UGI) endoscopic biopsy studies which showed significant tissue eosinophilia in both mucosal and submucosal layers. No evidence of parasite segment or ova was found in the stool and biopsy specimen. Specific IgE antibodies to milk were estimated to be 2 + (CAP system). Cow's milk allergy was highly suspected but not confirmed by consecutive elimination and challenge tests since the child was too much suffered to be tested. There was partial response to the 2-week treatment with Alfare (semi-elemental formula) and oral prednisolone 1 mg/kg/day. One month after initial examination, perforation of the stomach occurred and exploratory laparotomy disclosed stenosis of the duodenum. Congenital duodenal obstruction was diagnosed based on operative findings and previous sonographic findings. There has been only one report of EG in an infant with congenital duodenal obstruction. The nature of the relationships among cow's milk allergy as a possible etiologic factor, congenital duodenal obstruction as an predisposing factor and EG involvement at both mucosal and submucosal layers remains unclear.

Risk factors for presentation with bleeding in patients with Helicobacter pylori-related peptic ulcer diseases

At present, there is no study that simultaneously addresses the apparent differences between bacterial and host factors in patients with bleeding and nonbleeding Helicobacter pylori-related ulcer diseases. Therefore, we designed this prospective study to evaluate whether there are identifiable differences between the two groups of patients whose H. pylori-related peptic ulcer diseases present with bleeding or dyspepsia. From July 1996 to November 1996, consecutive patients presenting with upper gastrointestinal bleeding or dyspepsia were enrolled if H. pylori-related ulcer diseases were confirmed. Fifteen clinical, endoscopic, histologic, and serologic factors were tested for association with ulcer bleeding by a logistic regression analysis. In the study period, bleeding occurred in 39 out of 119 patients with H. pylori-related peptic ulcer diseases. Multivariate analysis showed that ingestion of nonsteroidal antiinflammatory drugs (NSAIDs; p = 0.0156; odds ratio = 5:4), ulcer size > or = 1 cm (p = 0.0033; odds ratio = 4:2), and low bacterial density (p = 0.0030; odds ratio = 4:1) were independent factors associated with the risk of bleeding. There were no associations between ulcer bleeding and age, sex, smoking, alcohol consumption, the histologic grade of gastritis, location and number of ulcers, and the cytotoxin-associated gene (CagA) status of H. pylori strain. Therefore, we concluded that H. pylori-related ulcer patients who use NSAIDs or have large ulcers are more likely to present with upper gastrointestinal bleeding; that the CagA-bearing strains are not associated with the development of bleeding complication in patients with peptic ulcer diseases; and that the exact reason concerning the association between low bacterial density and ulcer bleeding merits further investigation.

Gastrointestinal metastasis in hepatocellular carcinoma: radiological and endoscopic studies of 11 cases

BACKGROUND

From October 1990 to January 1999, 11 of 2237 hepatoma patients at our hospital had gastrointestinal tract metastasis. We describe the radiological and endoscopic features, clinical course and prognoses of those patients.

METHODS

All patients were male. Six patients were hepatitis B carriers, and cirrhosis was noted in eight patients on admission. We reviewed all available radiological, endoscopic and pathological features.

RESULTS

The commonest clinical presentation was frank gastrointestinal bleeding. Histological proof of gastrointestinal involvement was seen in six patients. Endoscopic features included ulcerative tumours mimicking advanced gastric carcinoma (43%) and submucosal tumours (29%). The sites of organ involvement were stomach (five), duodenum (two), colon (three) and duodenum and colon (one). Direct invasion by a contiguous neoplasm was the major route of gastrointestinal tract metastasis. Portal vein thrombosis may be the key point of haematogenous spread to other sites.

CONCLUSIONS

The prognosis in these patients was extremely poor. Almost all patients died within 5 months if no further aggressive management was performed. Surgical intervention may be the optimal choice for palliative treatment of HCC with gastrointestinal tract involvement.

Impact of Helicobacter pylori eradication on the development of MALT, gland atrophy and intestinal metaplasia of the antrum

BACKGROUND

Chronic Helicobacter pylori infection leads to the development of mucosa-associated lymphoid tissue (MALT), gland atrophy, intestinal metaplasia, and in certain individuals, gastric lymphoma and adenocarcinoma. We conducted a prospective study to determine the effect of H pylori eradication on the development of MALT, gland atrophy and intestinal metaplasia.

METHODS

From July 1995 to October 1996, 63 consecutive patients with H pylori-associated peptic ulcer disease were enrolled in a bacterial eradication trial. The grade of MALT and the degree of gastritis of the antrum were assessed using Wotherspoon's scale and the Sydney system before treatment, and at eight weeks and one year after H pylori eradication therapy.

RESULTS

During the study period, 43 patients received complete follow-up. In the patient group with eradication failure (n = 22), MALT score was significantly decreased at the end of the eighth week (p < 0.05) but returned to the initial level by one year of follow-up. There were no changes in the scores for inflammation, neutrophil activity, gland atrophy or intestinal metaplasia at the end of the eighth week and at one year following H pylori eradication therapy. In contrast, there was a marked reduction in the MALT, inflammation, and activity scores at eight weeks (p < 0.01, < 0.05 and < 0.05, respectively) and one year after treatment (p < 0.05, < 0.001 and < 0.001, respectively) in the patient group with successful eradication (n = 21). However, no significant changes in gland atrophy and intestinal metaplasia were observed during the follow-up period.

CONCLUSIONS

Eradication of H pylori leads to regression of MALT in the stomach, but the degrees of gland atrophy and intestinal metaplasia remain unchanged, even after one-year of follow-up.

A 15-minute [13C]-urea breath test for the diagnosis of Helicobacter pylori infection in patients with non-ulcer dyspepsia

BACKGROUND

Non-ulcer dyspepsia (NUD) accounts for the majority of dyspeptic patients and studies on the epidemiology of Helicobacter pylori infection in NUD depend on a non-invasive and rapid diagnostic test. This study was performed to determine the sensitivity and specificity of a 15-min simplified protocol of the [13C]-urea breath test ([13C]-UBT) for the diagnosis of H. pylori infection in patients with NUD.

METHODS

One hundred and thirty-six patients with a clinical and endoscopic diagnosis of NUD were included. The [13C]-UBT was modified from the European standard protocol. The baseline breath sample was collected 5 min after the patient took a test meal and the 13CO2 was collected 15 min after the patient drank 100 mg [13C]-urea. The gold standard used for comparison was either a positive culture or positive histology + positive rapid urease test sampled on upper gastrointestinal endoscopy.

RESULTS

The prevalence of H. pylori infection in NUD by the gold standard was 59.6%, whereas that calculated by the [13C]-UBT was 60.3%. The sensitivity and specificity of [13C]-UBT was 93.8 and 89.1% compared with the gold standard. The shortened collection time and simplification of the procedure may have led to a decline in specificity.

CONCLUSION

The 15-min [13C]-UBT is a rapid but less specific protocol for detecting the presence of H. pylori infection in patients with NUD.

Impact of bacterial eradication on the cell proliferation and p53 protein accumulation in Helicobacter pylori-associated gastritis

BACKGROUND

This study investigates the cell proliferation and the expression of p53 protein in Helicobacter pylori (H. pylori)-associated gastritis and assesses the effect of bacterial eradication on these epithelial factors.

MATERIAL AND METHODS

Seventy-nine patients with H. pylori-associated gastritis were randomized into the control group (n = 38) and anti-H. pylori group (n = 41). Each patient received endoscopic examinations with gastric biopsy before and 8 weeks after the treatment. The specimens from gastric antrum were immunostained for monoclonal antibodies against the proliferating cell nuclear antigen (PCNA) and p53 protein.

RESULTS

In the control group, the total labeling index (L.I.) of PCNA and the positive index (P.I.) of p53 in the whole foveolar epithelium were unchanged after treatment. In the anti-H. pylori group, 35 of 41 cases (85.3%) achieved eradication of H. pylori. Amongst the H. pylori-eradicated cases, the total L.I. of PCNA in the whole foveolar epithelium did not meaningfully alter after H. pylori elimination (p > 0.05). However, a significant reduction of L.I. was observed in the middle compartments of the gastric pits (before vs. after treatment: 14.0 vs. 7.3, p < 0.05). With regard to the p53 expression, the P.I.s were significantly decreased in the whole foveolar epithelium (before vs. after treatment: 0.57 vs. 0.17, p < 0.05) and in each compartment of the gastric pits (before vs. after treatment: [upper compartment]: 0.34 vs. 0.15, p < 0.05; [middle compartment]: 0.67 vs. 0.23, p < 0.05; [lower compartment]: 0.71 vs. 0.20, p < 0.05) after eradication of H. pylori.

CONCLUSIONS

Bacterial eradication reverses the hyperproliferating status of the foveolar epithelium in patients with H. pylori gastritis and leads to a decrease in p53 accumulation in the epithelial cells.

Analysis of FHIT transcripts in cervical and endometrial cancers

Carcinoma of the uterine cervix is a common malignancy, and many affected women, have been found to exhibit loss of heterozygosity (LOH) in the chromosome 3p region. Recent studies have localized the FHIT (fragile histidine triad) gene in this region and also demonstrated a high frequency of abnormalities of this gene in various cancers. To determine the role of the FHIT gene in cervical and uterine carcinomas, 16 cases of cervical carcinoma and 7 cases of endometrial carcinoma, as well as nearby non-cancerous tissues in these patients, were analyzed by reverse transcription of the FHIT mRNA followed by polymerase chain reaction amplification and sequencing of the products. In this study, 13 of 16 cervical cancers and 4 of 7 endometrial cancers displayed abnormal FHIT transcripts, including a lack of 2 or more exons of the FHIT gene, the insertion of several bases in the deletion junctions, and a 282 bp deletion from cDNA 171 to 452, resulting in a frameshift. Moreover, 5 of 16 matched non-cancerous tissues from the cervical cancer patients and 4 of 7 non-cancerous tissues from endometrial cancer patients also showed the presence of abnormal transcripts lacking 3 or more exons of the FHIT gene. Only 1 of 23 paired samples exhibited LOH. Our results suggest that the abnormal transcript of the FHIT gene is common in both normal and tumor tissues of the uterus and cervix. We also checked for HPV infection in these samples and found no definite relationship between the abnormal transcript and human papillomavirus infection.

Expression of inducible nitric oxide synthase and apoptosis in human lupus nephritis

To understand the expression of inducible nitric oxide synthase (iNOS) and its possible association with apoptosis in human lupus nephritis, 48 renal tissue samples from patients with lupus nephritis were investigated immunohistochemically and by the terminal-deoxynucleotidyl-transferase-mediated dUTP nick end labeling method for the detection of iNOS and apoptosis, respectively. Modulation of apoptosis by p53 and Bcl-2 was also evaluated. This study showed immunohistochemical evidence of iNOS expression, predominantly in the glomerular and tubulointerstitial cells of class-IV lupus nephritis. The frequency of iNOS+ glomeruli was significantly correlated with that of apoptosis+ glomeruli, and the frequency of the latter was also significantly correlated with that of the glomeruli showing p53 overexpression. Bcl-2 was predominantly expressed in the cellular and fibrocellular crescents. This study suggests that induction of iNOS, and thus nitric oxide production, plays a role in the occurrence of apoptosis in the glomeruli of lupus nephritis; and the occurrence of apoptosis might in part be modulated by p53 and Bcl-2-related pathways. The expression of Bcl-2 in predominantly cellular and fibrocellular crescents suggests that Bcl-2 may participate in persistent proliferation of the crescentic cells.

Correlation of serum immunoglobulin G Helicobacter pylori antibody titers with histologic and endoscopic findings in patients with dyspepsia

Serum immunoglobulin G (IgG) antibody tests are used extensively. We attempted to find out whether the titers of anti-Helicobacter pylori IgG antibody correlated with the degree of macroscopic gastrointestinal damage, the severity of antral gastritis, and the density of antral H. pylori colonization in symptomatic patients. Peripyloric antral biopsy specimens were obtained from 50 consecutive patients with dyspepsia undergoing upper gastrointestinal endoscopy. The macroscopic gastrointestinal damage and the histologic grades of antral gastritis were scored by a modified Lanza scale and Sydney system, respectively. In addition, the densities of antral H. pylori colonization were graded semiquantitatively. Serum IgG antibodies to H. pylori were measured by enzyme-linked immunosorbent assay. Thirty-six (M/F = 29/7) of the 50 patients had H. pylori infection documented by histologic examination or rapid urease test or both. Among the subjects, the IgG antibody titers to H. pylori correlated significantly with the grades of antral polymorphonuclear cell infiltration (p = 0.002) and antral bacterial density (p = 0.01) but not with endoscopic scores, the grades of mononuclear cell infiltration, mucosal atrophy, or intestinal metaplasia (p > 0.05). In addition, endoscopic scores also were found to be significantly correlated with antral bacterial density (p = 0.049) and the grade of polymorphonuclear cell infiltration (p = 0.012). We therefore conclude that high titers of IgG antibody to H. pylori in patients with dyspepsia indicate dense H. pylori colonization and severe antral polymorphonuclear cell infiltration. However, it cannot replace endoscopic examination to evaluate the degree of macroscopic gastrointestinal damage.

Retroperitoneal bronchogenic cyst: a case report

Only a few subdiaphragmatic bronchogenic cysts are described, and their occurrence in the retroperitoneum is extremely rare. So far, only a few cases have been reported in the English-language literature. The pathogenesis is caused by the pinching off of irregular lung budding of the primitive ventral foregut, with aberrant migration into the abdomen before fusion of the diaphragm during embryonal development. A unique case with clinical, radiographic, surgical finding is presented. Final pathological findings confirmed the diagnosis of retroperitoneal bronchogenic cyst without other associated congenital anomalies. Retroperitoneal bronchogenic cyst, although rare, should be considered in the differential diagnosis in the retroperitoneal mass. This rare case is described and the relevant literature, reviewed.

Cutaneous Rosai-Dorfman disease manifestating as recurrent breast tumor: a case report

A case of cutaneous Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) manifestating as a recurrent breast tumor is reported. The tumor occurred on the left breast of a 35-year-old woman. Before arriving at the correct diagnosis, four biopsies had been performed with various diagnoses of chronic inflammation, plasma cell mastitis and inflammatory pseudotumor. Numerous typical histiocytes with lymphophagocytosis appeared in the final excised specimen, and a correct diagnosis was made. Ultrastructural examination revealed no evidence of Birbeck granule. The literature concerning Rosai-Dorfman disease manifestating as breast tumor is reviewed. Since the diagnosis is often overlooked in the absence of lymphadenopathy, a high index of suspicion is required to recognize this rare cutaneous Rosai-Dorfman disease.

Transitional cell and uncommon urothelial carcinoma of renal pelvis/ureter and bladder: low incidence of human papilloma virus

BACKGROUND

Recently, it has been proposed that human papilloma virus (HPV) infection may play a role in the carcinogenesis of bladder urothelial malignancy. However, there is still controversy about the prevalence of HPV in such malignancies. With similar techniques of in situ hybridization (ISH) or polymerase chain reaction (PCR), either high or rare frequency have been detected. To evaluate the prevalence of HPV in the urothelial malignancies based on presentations here, 118 cases of urothelial malignancies were analysed, including those of the renal pelvis and ureter which have rarely been reported before.

METHODS

Non-isotopic ISH technique was used to detect HPV on paraffin sections, including 51 bladder transitional cell carcinoma (TCC), 48 renal pelvic/ureter TCC, 5 bladder adenocarcinoma, 3 bladder small cell carcinoma, 2 bladder undifferentiated carcinoma, 1 multiple synchronous pelvic and ureteric squamous cell carcinoma (SCC) and 8 bladder SCC. An FITC-labelled probe of wide spectrum HPV was used for screening, and probes of HPV 6/11, 16, 18, 31, 33 were used for typing.

RESULTS

By the technique of ISH, wide spectrum HPV was detected in only three of the eight cases of bladder SCC. Of the three positive cases, two were subsequently shown to be uterine cervical SCC with bladder invasion. Therefore, HPV was positive in only one case of primary bladder SCC, occurring in a patient with systemic lupus erythematosus under steroid and cyclophosphamide therapy. Further subtyping was negative for HPV 6/11, 16, 18, 31, and 33. The result indicated that the positive staining by wide spectrum probe was caused by types 30, 35, 45, 51, and/or 52. HPV was not detected in any of the 51 bladder TCC, 48 renal pelvic/ ureter TCC, 5 bladder adenocarcinoma, 3 bladder small cell carcinoma, and 2 bladder undifferentiated carcinoma.

CONCLUSIONS

The results are in agreement with the majority of recent reports which suggest that HPV is unlikely to be involved in the etiology of urothelial malignancies; however, it seems probable that immunosuppressed patients are at greater risk for HPV-associated bladder SCC.

Primary pleural thymoma

An unusual thymoma is reported in a 32-year-old woman. The tumor presented as diffuse pleural thickening with encasement of the left lung. Computed tomographic scan and pleural biopsy of this pleural-based lesion were interpreted as favoring a diffuse pleural mesothelioma. After pleuropneumonectomy, pathologic examination revealed a characteristic epithelial thymoma. However, neither mediastinal involvement nor a concurrent mediastinal mass was found at surgery or by radiographic examinations. To our knowledge, only six previous cases of thymomas have been reported as pleural-based tumors for which a mediastinal origin could be excluded (namely, primary pleural thymomas). It is emphasized that in clinical and pathologic diagnosis of a pleural-based lesion thymoma should be considered in the differential diagnosis.

Expression of glomerular antioxidant enzymes in human glomerulonephritis

Increased oxidative stress can be correlated with glomerular injury. By immunohistochemical studies, we found expression of glomerular antioxidant enzymes (AOEs), including CuZn-superoxide dismutase (SOD), Mn-SOD, and catalase, in a wide variety of glomerular diseases. The distribution of the AOEs was either localized the in mesangial region or along the luminal surface or epithelial surface of the glomerular capillary wall. There was no significant difference of glomerular AOE expression among minimal change disease (MCD), IgM nephropathy (IgM N), focal segmental glomerulosclerosis, and membranous glomerulonephritis (MGN). However, when compared with MCD, IgM N and MGN, the glomerulus of lupus nephritis and IgA nephropathy expressed a significantly higher positive rate of AOEs (p = 0.04-0.002). The expression of AOEs had a trend to be associated with increased proliferative cell nuclear antigen-positive cells in the glomerulus of diffuse proliferative lupus nephritis (p = 0.056). No association was found between infiltrating leukocytes and AOE expression in all the disease groups. The glomerulus in kidneys with renal cell carcinoma expressed a significantly higher positive rate of AOEs and therefore could not be regarded as a normal control group. In summary, the immunohistochemical evidence of glomerular AOE expression in this study provides supporting evidence of oxidative stress in a wide variety of glomerular diseases.

Histopathological study of Sauropus androgynus-associated constrictive bronchiolitis obliterans: a new cause of constrictive bronchiolitis obliterans

The development of constrictive bronchiolitis obliterans in patients who have ingested Sauropus androgynus juice has not been previously reported. We describe four patients with S. androgynus-associated constrictive bronchiolitis obliterans who underwent open lung biopsies for histopathological analysis. This article aims to recognize the possible pathogenesis of the disease. The spectrum of histologic changes ranged from slight bronchiolar inflammation and fibrosis to marked submucosal fibrosis causing complete cicatricial obliteration of the lumen. A dense eosinophil infiltrate was noted in the bronchiolar submucosa or fibrotic tissue of the completely obliterated bronchioles in two patients. Immunohistochemical studies revealed that lymphocytic infiltrate consisted mainly of T lymphocytes in all patients. Immunofluorescent stains for immunoglobulin (Ig)G, IgA, IgM, C1q, C3, and C4 were negative. Electron microscopy disclosed no immune complex deposition in the specimens examined. Although the role of antibody- and complement-mediated reaction is not supported by the negative results of immunofluorescent and electron microscopic studies, the common finding of the predominant T-lymphocytic infiltrate suggests that a T-cell mediated immune response is involved in the pathogenesis of the disease. Furthermore, the finding of a heavy lymphocytic infiltrate in many bronchioles without significant collagen deposition suggests that the lymphocytic infiltrate may precede the tissue fibrosis. In addition, the presence of a dense eosinophil infiltrate may combine with lymphocytes and other immunologic and mesenchymal cells to promote antigen-specific stimulation of lymphocytes and induction of fibrosis.

The accuracy of the rapid urease test and 13C-urea breath test in the diagnosis of Helicobacter pylori infection

BACKGROUND

Helicobacter pylori (H. pylori) is an important predisposing factor in peptic ulcer disease. Many tests have been proposed, but there is no generally accepted single method for the detection of H. pylori. This study compared the four available methods in the detection of H. pylori.

METHODS

One hundred and thirteen patients were studied with endoscopic biopsy. Biopsy specimens were examined with modified Giemsa stain and rapid urease (CLO) test. Serology (ELISA) and 13C-urea breath test (13C-UBT) were also performed. The 13C-UBT results were expressed at an excess delta 13CO2 excretion of 5 per mil as the upper limit. Multiple breath samples were collected 15, 30 and 60 minutes following 13C-urea ingestion (t = 15, 30, 60) in the first 60 patients. Gastric inflammatory changes were graded according to the Whitehead classification. The diagnostic gold standard was defined when three or more of the four test parameters showed positive.

RESULTS

According to this diagnostic gold standard, the positive rates of H. pylori were 97.9% for duodenal ulcer, 81.8% for gastric ulcer, 47.6% for symptomatic gastritis and 13.6% for asymptomatics. Rapid urease test and the 13C-UBT had better sensitivity (93.6% and 96.2%) and accuracy (93.8% and 93.8%). The specificity and positive predictive value for rapid urease test was better than 13C-UBT (94.3% v.s. 88.6%, 97.3% v.s. 94.9% respectively). Modified Giemsa stain had the lowest sensitivity (87.2%), and the ELISA test had the lowest specificity (71.4%). Severity of the gastric inflammatory processes was directly correlated with the excess delta 13CO2 (r = 0.576).

CONCLUSIONS

Both the CLO and 13C-UBT had higher accuracy in the detection of H. pylori. When the CLO test result is positive, there is little additional diagnostic benefit from performing other tests. If patients refuse endoscopic examination, 13C-UBT is a good alternative for the detection of H. pylori, either during diagnosis or follow-up after therapy.

Expression of estrogen and progesterone receptors in non-small-cell lung cancer: immunohistochemical study

Estrogen receptor (ER) and progesterone receptor (PgR) have been recognized as being involved in the tumourigenesis of non-small-cell lung cancer (NSCLC). Forty-nine resected NSCLC (39 males and 10 females) were studied immunohistochemically in formalin-fixed, paraffin-embedded sections for ER and PgR. There were 26 squamous cell carcinomas, 22 adenocarcinomas and one adenosquamous carcinoma. 38.8% (19/49)NSCLC had either a positive ER or PgR status of which one was ER+/PgR+, 2 were ER+/PgR- and 16 were ER-/PgR+. There was no statistical difference in hormone receptors status for sex and histological subtypes (p > 0.05). The immunohistochemical assay of formalin-fixed paraffin-embedded sections allows the retrospective analysis of ER and PgR in NSCLC. The ER-/PgR+ status was detected in about one third NSCLC. The discordance between these receptors is suggested to be due to either the presence of functioning variant ER or the constitutive synthesis of PgR independent of estrogen induction in certain ER-/PgR+ NSCLC.

Adult Wilms' tumor: a case report

Wilms' tumor (nephroblastoma) is the most common intraabdominal tumor in children; its three primary components are blastemal, epithelial and stromal, with predominance of tri-phasic lesion. The tumor is rare in adults, in whom the Wilms' tumor accounts for less than 1%. The case presented here concerns a case of 46-year-old female with stage II, Wilms' tumor, composed of purely mono-phasic differentiated epithelial component with favorable histology. The patient received radical nephrectomy, than post-operative chemotherapy and radiotherapy as recommended by National Wilms' Tumor Study. With the advent of modern chemotherapy, the adult Wilms' tumor can have a better prognosis than previously. Because of the rarity of adult Wilms' tumor and its unusual histo-morphology, this case is described and the literature, reviewed.

Benign mesenchymoma of the mediastinum: a case report

Benign mesenchymoma is an uncommon tumor containing at least two or more differentiated mesenchymal elements in addition to fibrous tissue. The case we presented here is a 60-year-old male who suffered from a superior posterior mediastinal mesenchymal tumor composed predominantly of mature adipose tissue separated by fascicular bundles of spindle cells admixed with cartilage and osseous tissue. The spindle cells were confirmed to be smooth muscle in nature by trichrome Masson stain and immunohistochemical studies, providing a picture consistent with that of benign mesenchymoma. Complete removal of this neoplasm proved possible, and no sign of recurrence or distant metastasis was present to date. This rare case of benign mesenchymoma in the mediastinum is described, and the literature is reviewed.

Clear cell meningioma: a case report

A case of clear cell meningioma in a 12-year-old male is reported. The tumor was located at the left side cerebellopontine angle, and characterized by sheets of patternless clear cells rich in cytoplasmic glycogen. Vague whorl formation and focal small clusters of typical meningothelial cells were the most important diagnostic features. The tumor cells showed positive immunoreactivity for vimentin, epithelial membrane antigen (EMA), and S100 protein. Cytokeratin and glial fibrillary acidic protein (GFAP) were negative. Ultrastructural features exhibited were abundant cytoplasmic glycogen particles, desmosome-like junctions and tangles of intermediate filaments, while cell membrane interdigitations were few. Clear cell meningioma is rare and is potentially aggressive in that it may recur, spread locally, and even metastasize, despite its bland histologic appearance. There is probably a predilection for younger age group. It is histologically unique but should be differentiated from other mimicking clear cell tumors of the central nervous system, including metastatic renal cell carcinoma, hemangioblastoma, oligodendroglioma, and clear cell ependymoma.

Determination of gentiopicroside, mangiferin, palmatine, berberine, baicalin, wogonin and glycyrrhizin in the traditional Chinese medicinal preparation sann-joong-kuey-jian-tang by high-performance liquid chromatography

High-performance liquid chromatography was employed to determine the contents of several marker substances such as gentiopicroside, mangiferin, palmatine, berberine, baicalin, wogonin and glycyrrhizin in Sann-Joong-Kuey-Jian-Tang. The separation was performed on a Cosmosil 5C18-AR column by gradient elution with 0.03% (v/v) phosphoric acid-acetonitrile (0 min, 90:10; 10 min, 87:13; 17-27 min, 77:23; 40 min, 62:38; 50 min, 55:45) as the mobile phase at a flow-rate of 1.0 ml/min, with detection at 254 nm. n-Propylparaben was used as the internal standard and seven regression equations revealed linear relationships between the peak-area ratios (marker substances/internal standard) and concentrations. The repeatability and reproducibility (relative standard deviation) of the method were in the ranges 0.02-1.78% and 1.44-4.95%, respectively.

Human papillomavirus in cyclophosphamide and diverticulum-associated squamous cell carcinoma of urinary bladder: a case report

The association of cyclophosphamide therapy with the development of urothelial malignancy has been documented. Bladder diverticula associated with squamous cell carcinoma were also identified. In addition, incorporation of human papillomavirus (HPV) deoxyribonucleic acid (DNA) has been previously shown in urothelial carcinoma by in situ hybridization technique. Here a case is reported of bladder squamous cell carcinoma occurring four years after intravenous pulse therapy with cyclophosphamide in a patient with bladder diverticula where HPV was identified in the lesion. To present knowledge, this is the first case report of bladder squamous cell carcinoma with simultaneous occurrence of three risk factors for urothelial malignancy: cyclophosphamide therapy, diverticulum, and HPV infection.

Salmonella infections: a retrospective 10-year analysis of 134 cases in a regional hospital in Taiwan

A total of 134 cases of salmonella infections have been noted during the past 10 years in our hospital. Cases of non-typhoidal salmonellosis increased gradually but infections due to Salmonella typhi did not show the same trend. Gastroenteritis was the most prevalent diagnosis in patients below 1 year of age and non-typhoidal bacteraemia and localized infections were the most prevalent in patients over 50 years. Diabetes mellitus was an important underlying disease especially in patients with localized infections (86%). Travelling history played an important role in cases of enteric fever. The susceptibility pattern in non-typhoidal salmonella changed markedly over the study period; multiple drug resistance was noted. The susceptibility pattern of S. typhi showed no significant change. Seven deaths due to salmonella infections were noted (5.2%); all due to non-typhoidal salmonellosis, especially serogroup B. Age above 50 years, localized infection, infection with serogroup B and diabetes were poor prognostic factors.

Human papillomavirus detection in adenocarcinoma and adenosquamous carcinoma of the uterine cervix in Taiwan

BACKGROUND

The association of human papillomavirus (HPV) with cervical adenocarcinoma (ADC) and adenosquamous carcinoma (ADSC) is well documented. The relationship between HPV and the histopathology of ADC and ADSC is not clearly understood. This study proposed to evaluate: 1. the prevalence of HPV infection in cervical ADC and ADSC in Taiwan; 2. any correlation of HPV and histologic subtypes, grading and tumor staging of ADC and ADSC; 3. the possible role of HPV in cervical ADC and ADSC.

METHODS

HPV detection was carried out using a non-isotopic in situ hybridization (ISH) technique on paraffin sections of 33 cervical ADC and 12 ADSC. An FITC-labelled probe of wide spectrum HPV was used for screening, and probes of HPV 6/11, 16, 18, 31, 33 were used for typing.

RESULTS

Of the 33 cases of cervical adenocarcinoma, 15 (45%) were HPV positive; of these, 10 (30%) were HPV 18, and 4 (12%) were HPV 16. In ADSC, 7 (58%) cases contained HPV DNA, of which HPV 18 was detected in 2 (17%), and type 16 in 3 (25%). Unidentified HPV types were found in one and in two cases of ADC and ADSC, respectively. There were no significant correlations between HPV status and histologic subtypes, grading and tumor staging. All the HPV-positive ADC contained punctate nuclear HPV signals. In ADSC, the signal pattern was heterogeneous. HPV DNA was integrated in all but one viral positive cases.

CONCLUSIONS

These results indicate that ADC and ADSC of cervix in Taiwan were associated with HPV infection. HPV 18 was predominant in ADC similar to the reports from most other regions. There was no correlation between HPV and histopathologic findings of ADC and ADSC. The punctate signals suggestive of viral DNA integration were found in all but one HPV positive cases. The result supports the hypothesis that HPV may play an important role in pathogenesis of cervical ADC and ADSC.

Salmonella pericarditis and empyema: a case report

A 54-year-old female diabetic patient who had been under regular oral hypoglycemic agent control for 2 years was admitted because of having dyspnea and orthopnea for several days. Massive pericardial effusion and a moderate amount of bilateral pleural effusion were noted at the time of admission. Pericardiocentesis and thoracocentesis were performed; both cultures grew Salmonella typhimurium. Antibiotic therapy was started immediately, but pleural effusion persisted. After repeated thoracocentesis and pleural effusion drainage, the patient was discharged 51 days later with complete recovery. Pericarditis and empyema are rare complications of Salmonella infections. Coexistence is even more rare, and only three cases have been reported in the English literature. Therefore, this case is presented with a review of the previous literature followed by discussion.

Assessment of p53 expression in nasopharyngeal carcinoma

We analyzed the expression of the p53 protein by immunohistochemical methods from 101 patients with nasopharyngeal carcinoma (NPC): 24 with NPC and dysplastic lesions adjacent to carcinoma and 14 with primary and metastatic specimens. Ninety-six of 101 lesions (95%) had detectable p53 protein in the nuclei of tumor cells, indicating that overexpression of the p53 protein might be closely associated with NPC. Among 24 patients who had NPC and dysplastic lesions adjacent to carcinoma, 19 of the dysplastic lesions (79.2%) and 22 of the carcinomas (91.7%) showed positive staining for the p53 protein. In dysplastic epithelia p53 antigenicity was generally in a basal location. The significant association of p53 expression in NPC and dysplastic lesions adjacent to carcinoma (P < .0001, Fisher's exact probability test) suggests that p53 overexpression seems to occur at an early stage in the development of NPC. p53 expression in NPC does not correlate with histological grading, degree of lymphocytic infiltration between tumor cells, clinical stage, sex, or age (P > .05, chi-squared test). A comparison of p53 expression between primary and metastatic NPC was performed in 14 lesions. Although the p53 protein was consistently expressed in primary and metastatic tumor cells, there was no significant difference in p53 expression in both distinct but related lesions (P > .05, paired t-test). Our results suggest that the association of overexpression of the p53 protein in NPC may not be indicative of a mutant type p53 protein.

Assessment of immunocytochemical and histochemical stainings in the distinction between reactive mesothelial cells and adenocarcinoma cells in body effusions

BACKGROUND

The accumulation of fluid in body cavities is a common event in both neoplastic and non-neoplastic diseases. However, the distinction between cells of reactive process and those of malignancy in cytology is not always possible. It is especially difficult when reactive mesothelial cells and adenocarcinoma cells are encountered. The aim of the present study was to find out the most accurate or reliable immunocytochemical and histochemical stains to distinguish reactive mesothelial cells from adenocarcinoma cells, and to serve as a standard method in the future when dealing with equivocal cases.

METHODS

Ninety-nine cases of malignant epithelial effusion were collected from 755 cases of effusion obtained from 3 large body cavities in the past one-year period. Among them, 71 cases were histologically as adenocarcinoma and 13 cases as non-adenocarcinoma. The other 15 cases were carcinoma proved by image as well as clinical symptoms and signs. These 99 cases, plus 10 cases of non-malignant effusion, underwent immunocytochemical and histochemical stainings. Five common commercial antibodies used in this immunocytochemical study were epithelial membrane antigen (EMA), carcinoembryonal antigen (CEA), cytokeratin, vimentin and Leu-M1. The histochemical study included periodic acid-Schiff diastase (D-PAS) and mucicarmine stains.

RESULTS

The immunocytochemical study showed that EMA had a high frequency of positive staining with malignant epithelial cells and a negative staining with mesothelial cells. Cytokeratin always stained with malignant epithelial cells but it also stained with mesothelial cells. Almost all the proved adenocarcinomas expressed CEA which was not expressed in the proved non-adenocarcinomas. However, CEA occasionally stained mesothelial cells. Leu-M1 showed a low frequency of staining with the proved adenocarcinoma cells, but it did not stain proved non-adenocarcinoma cells and mesothelial cells. On the contrary, vimentin stained with all mesothelial cells but occasionally with malignant epithelial cells, especially the proved adenocarcinoma cells. In the histochemical study, both mucicarmine and D-PAS showed a low sensitivity but high specificity in detecting the adenocarcinoma cells.

CONCLUSIONS

No single marker is absolutely reliable to distinguish exfoliated, reactive mesothelial cells from adenocarcinoma cells in effusions. However, a panel of 3 antibodies containing EMA, CEA and vimentin, together with D-PAS and mucicarmine stains may help solve this problem.