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Intratumoral sampling variability in hepatocellular carcinoma: A case report

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World Journal of Gastroenterology 2007年第29期13卷 4019-4021页

作者： Giancarlo Senes Daniela Fanni Alessandro Cois Alessandro Uccheddu Gavino Faa dipartimento di Citomorfologia Divisione di Anatomia Patologica University of Cagliari Cagliari Italy dipartimento Chirurgico Materno Infantile e di Scienze delle Immagini Clinica Chirurgica University of Cagliari Cagliari Italy

The differential diagnosis between hepatocellular carcinoma （HCC） and regenerative liver nodules and other primary liver tumors may be very difficult, particularly when performed on liver biopsies. difficulties in histological typing may be often minimized by immunohistochemistry. Among the numerous markers proposed, CK18, Hep Par1 and glypican 3 （GPC3） are considered the most useful in HCC diagnosis. Here we report a case of HCC in a 72-year-old male with HBV- related chronic liver disease, characterized by a marked morphological and immunohistochemical intratumoral variability. In this case, tumor grading ranged from areas extremely well differentiated, similar to regenerative nodule, to undifferentiated regions, with large atypical multinucleated cells. While almost all sub nodules were immunostained by Hep Par 1, immunoreactivity for glypican 3 and for Ckl8 was patchy, with negative tumor region adjacent to the highly immunoreactive areas. Our case stresses the relevance of sampling variability in the diagnosis of HCC, and indicates that caution should be taken in grading an HCC and in the interpretation of immunohistochemical stains when only small core biopsies from liver nodules are available.

关键词： Liver Hepatocellular carcinoma Sampling variability Hep Par 1 GPC3 differentiation

Peliosis hepatis as an early histological finding in idiopathic portal hypertension: A case report

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World Journal of Gastroenterology 2006年第22期12卷 3612-3615页

作者： Annalisa Berzigotti Donatella Magalotti Paola Zappoli Cristina Rossi Francesco Callea Marco Zoli dipartimento di Medicina Interna Cardioangiologia EpatologiaPoliclinico S.Orsola-MalpighiUniversità di Bologna Italy dipartimento di Scienze Radiologiche ed Istocitopatologiche Policlinico S.Orsola-Malpighi Università di BolognaItaly servizio di anatomia patologica Ospedale Pediatrico Bambino Gesù IRCCSRomaItaly dipartimento di Medicina Interna Cardioangiologia EpatologiaPoliclinico S.Orsola-MalpighiUniversità di BolognaItaly

Peliosis hepatis is a rare condition characterized by dilatation of hepatic sinusoids and blood-filled spaces in the liver mainly observed in subjects exposed to toxic substances or estrogens, which is frequently asymptomatic. Non-cirrhotic idiopathic portal hypertension （NCIPH） is also a vascular disease of the liver rarely observed in European countries, which is usually diagnosed only when the hemorrhagic complications of portal hypertension occur. We report a case of NCIPH in a young Caucasian male who was diagnosed with liver peliosis, showing ultrasonographic and endoscopic signs of portal hypertension four years after. A second biopsy was diagnostic for NCIPH. Even if the pathogenesis remains obscure, peliosis hepatis can be considered as an early sign of vascular disease of the liver, which may progress to more definite conditions.

关键词： Peliosis hepatis Idiopathic portal hypertension Hepatic veins catheterisation

Giardia lamblia infection in patients with irritable bowel syndrome and dyspepsia:A prospective study

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World Journal of Gastroenterology 2006年第12期12卷 1941-1944页

作者： Barbara Grazioli Giovanni Matera Costanza Laratta Giuseppina Schipani Giovanni Guarnieri Ester Spiniello Maria Imeneo Andrea Amorosi Alfredo Focà Francesco Luzza dipartimento di Medicina Sperimentale e Clinica Cattedra di Gastroenterologia Università di Catanzaro 'Magma Graecia' Catanzaro Italy dipartimento di Scienze Mediche Istituto di Microbiologia Università di Catanzaro 'Magna Graecia' Catanzaro Italy dipartimento di Medicina Sperimentale e Clinica Cattedra di Anatomia Patologica Universith di Catanzaro 'Magna Graecia' Catanzaro Italy

AIM： To evaluate the prevalence of Giardia lamblia （G. lamblia） infection in patients with irritable bowel syndrome （IBS） and dyspepsia and to establish which is the most accurate test to diagnose the infection in this setting. METHODS： One hundred and thirty-seven patients who consecutively attended the Outpatient Gastroenterology Clinic for the first time between January 2002 and Decernber 2003 due to symptoms of IBS and/or dyspepsia were recruited. All patients underwent clinical evaluation, first-step haematology and chemistry tests, serologic assays for celiac disease, lactose-H2 breath test, abdominal ultrasonography, and esophagogastroduodenoscopy. Helicobacterpylon status was evaluated. In patients with symptoms of IBS older than 45 years, colonoscopy was also performed. In all patients, duodenal biopsies and stool samples were examined for trophozoites and cysts of G. lamblia by several methods. RESULTS： G. lamblia was identified in 9 patients. The following diagnoses were also made： IBS （100/137, 73%）, functional dyspepsia （62/137, 45%）, organic dyspepsia （33/137, 24%）, and lactose intolerance （75/137, 55%）. A significant association was found between giardiasis and H pylori infection （x^2= 6.632, OR= 12.4, CI= 1.5-68.1）. There were no symptoms that reliably allowed the recognition of giardiasis. direct search of the parasite in duodenal biopsy and stool sample examinations gave concordant results in all cases while histological examination of duodenal biopsies displayed a low sensitivity （e.g., 22.2%）. CONCLUSION： In this consecutive series, diagnosis of *** infection accounted for 6.5% of patients with IBS and dyspepsia. Duodenal biopsies for diagnosis of giardiasis may be unnecessary if stool sample examination is performed.

关键词： Dyspepsia Giardiasis H pylori Irritablebowel syndrome

Interleukin-6 and its soluble receptor in patients with liver cirrhosis and hepatocellular carcinoma

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World Journal of Gastroenterology 2006年第16期12卷 2563-2568页

作者： Soresi Maurizio Giannitrapani Lydia D'Antona Fabio Florena Ada Maria La Spada Emanuele Terranova Angela Cervello Melchiorre D'Alessandro Natale Montalto Giuseppe dipartimento di Medicina Clinica e delle Patologie Emergenti Policlinico UniversitarioPalermoItaly Istituto di anatomia ed Istologia patologica Policlinico UniversitarioPalermoItaly Istituto di Biomedicina ed Immunologia Molecolare C.N.R.PalermoItaly dipartimento di Scienze Farmacologiche Pohclinico UniversitarioPalermoItaly

AIM： To evaluate the immunohistochemical localization of interleukin-6 （IL-6） and IL-6 receptor （IL-6R） on tumor tissue specimens from patients with hepatocellular carcinoma （HCC） and the serum levels of IL-6 and sIL-6R in a group of patients with HCC as well as liver cirrhosis （LC） in a group of patients with LC alone and in a control group. METHODS： Three groups of subjects were studied： group Ⅰ （n =83） suffering from HCC and LC, group Ⅱ （n = 72） suffering from LC alone and group Ⅲ （n =42） as healthy controls. All patients had hepatitis C virus infection. Serum IL-6 and IL-6R levels were determined using a commercially available ELISA kit. Immunohistochemistry was performed using the streptavidin-biotin complex and rabbit polyclonal antibodies against IL-6 and IL-6R. RESULTS： Immunohistochemistry analysis showed a medium to strong cytoplasmic and membrane reactivity for IL-6 and IL-6R respectively, in at least 40% of cases of HCC, whereas liver cirrhosis patients and controls were negative for IL-6 or showed a very mild and focal dot-like cytoplasmic reaction for IL-6R. Serum IL-6 levels in HCC group were significantly higher than those in LC and control groups （P〈 0.0001）. There was no significant difference in sIL-6R concentrations among 3 groups. When the patients with HCC were divided into groups according to Okuda＇s classification, a significant serum increase of IL-6 and slL-6R level was observed from stage Ⅰ to stage Ⅲ （P〈0.02, P〈0.0005）. When HCC and LC patients were divided into 3 classes of cirrhosis severity according to Child-Pugh, values in HCC patients were significantly higher than those in LC patients for each corresponding class （P〈 0.01）. CONCLUSION： IL-6 serum levels in HCC patients are higher than those in LC patients and controls, suggesting an increased production of this cytokine by neoplastic cells, sIL-6R values are similar in all groups, increasing only in stage III HCC patients. These data suggest that they have a closer relationship wit

关键词： Interleukin-6 Cytokine Chronic liver disease Immunohistochemistry

Ileal lesions in patients with ulcerative colitis after ileo-rectal anastomosis:Relationship with colonic metaplasia

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World Journal of Gastroenterology 2008年第34期14卷 5290-5300页

作者： Livia Biancone Emma Calabrese Giampiero Palmieri Carmelina Petruzziello Sara Onali Giuseppe Sigismondo Sica Marta Cossignani Giovanna Condino Kiron Moy Das Francesco Pallone Cattedra di Gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di anatomia ed Istologia patologica Università di "Tor Vergata" Cattedra di Gastroenterologia Dipartimento di Medicina InternaUniversità di "Tor Vergata" Cattedra di Chirurgia Generale Università di "Tor Vergata" Cattedra di Gastroenterologia Dipartimento di Medicina Interna Università di "Tor Vergata" GI Unit Department of Gastroenterology & Hepatology University of Medicine & Dentistry of New Brunswick

AIM:To assess whether in ulcerative colitis (UC) patients with ileo-rectal anastomosis (IRA), ileal lesions may develop in the neo-terminal-ileum and their possible relation with phenotypic changes towards colonic epithelium. METHODS: A total of 19 patients with IRA under regular follow up were enrolled, including 11 UC and 8 controls (6 Crohn’s disease, CD; 1 familial adenomatous polyposis, FAP; 1 colon cancer, colon K). Ileal lesions were identifi ed by ileoscopy with biopsies taken from the ileum (involved and uninvolved) and from the rectal stump. Staining included HE and immunohistochemistry using monoclonal antibodies against colonic epithelial protein CEP (Das-1) and human tropomyosin isoform 5, hTM5 (CG3). Possible relation between development of colonic metaplasia and ileal lesions was ***: Stenosing adenocarcinoma of the rectal stump was detected in 1 UC patient. The neo-terminal ileum was therefore investigated in 10/11 UC patients. Ileal ulcers were detected in 7/10 UC, associated with colonic metaplasia in 4/7 (57.1%) and Das-1 and CG3 reactivity in 3/4 UC. In controls, recurrence occurred in 4/6 CD, associated with colonic metaplasia in 3/4 and reactivity with Das-1 and CG3 in 2/3. CONCLUSION: Present fi ndings suggest that in UC, ileal lesions associated with changes towards colonic epithelium may develop also after IRA. Changes of the ileal content after colectomy may contribute to the development of colonic metaplasia, leading to ileal lesions both in the pouch and in the neo-terminal ileum after IRA.

关键词： Ulcerative colitis Ileo-rectal anastomosis Ileal lesions Colonic metaplasia

Magnetic resonance imaging:A new tool for diagnosis of acute ischemic colitis?

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World Journal of Gastroenterology 2012年第13期18卷 1496-1501页

作者： Francesca Iacobellis Daniela Berritto Francesco Somma Carlo Cavaliere Marco Corona Santolo Cozzolino Franco Fulciniti Salvatore Cappabianca Antonio Rotondo Roberto Grassi Institute of Radiology Second University of Naples80138 NaplesItaly Biotechnology Center A.O.R.N.Cardarelli80131 NaplesItaly S.S.D.di Citopatologia A.F.di Anatomia PatologicaIstituto Nazionale Tumori"Fondazione G.Pascale"80131 NaplesItaly

AIM： To define the evolution of ischemic lesions with 7T magnetic resonance imaging （7T-MRI） in an animal model of acute colonic ischemia. METHODS： Adult Sprague-Dawley rats were divided into two groups. Group I underwent inferior mesenteric artery （IMA） ligation followed by macroscopic observa- tions and histological analysis. In group H, 7T-MRI was performed before and after IMA ligation and followed by histological analysis. RESULTS： Morphological alterations started to develop 1 h after IMA ligation, when pale areas became evident in the splenic flexure mesentery and progressively wors-ened up to 8 h thereafter, when the mesentery was less pale, and the splenic flexure loop appeared very dark. The 7T-MRI results reflected these alterations, showing a hyperintense signal in both the intraperitoneal space and the colonic loop wall 1 h after IMA ligation; the lat- ter progressively increased to demonstrate a reduction in the colonic loop lumen at 6 h. Eight hours after IMA ligation, MRI showed a persistent colonic mural hyper- intensity associated with a reduction in peritoneal free fluid. The 7T-MRI findings were correlated with histolog- ical alterations, varying from an attenuated epithelium with glandular apex lesions at 1 h to coagulative necro- sis and loss of the surface epithelium detected 8 h after IMA ligation. CONCLUSION： MRI may be used as a substitute for invasive procedures in diagnosing and grading acute ischemic colitis, allowing for the early identification of pathological findings.

关键词： Ischemic colitis Animal models Sprague-Dawley rats Magnetic resonance imaging Histopathology

Repeated anastomotic recurrence of colorectal tumors: Genetic analysis of two cases

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World Journal of Gastroenterology 2011年第32期17卷 3752-3758页

作者： Renato Costi Cinzia Azzoni Federico Marchesi Lorena Bottarelli Vincenzo Violi Cesare Bordi dipartimento di Scienze Chirurgiche Università degli Studi di Parma 43100 Parma Italy Département de Chirurgie digestive et Endocrinienne H pital Cochin Assistance Publique-H pitaux de Paris Université Paris Descartes 75679 Paris France dipartimento di Patologia e Medicina di Laboratorio Sezione di Anatomia ed Istologia Patologica Università degli Studi di Parma 43100 Parma Italy

AIM: To investigate genetics of two cases of colorectal tumor local recurrence and throw some light on the etiopathogenesis of anastomotic recurrence. METHODS: Two cases are presented: a 65-year-old female receiving two colonic resections for primary anastomotic recurrences within 21 mo, and a 57-year-old female undergoing two local excisions of recurrent anastomotic adenomas within 26 mo. A loss of heterozygosity (LOH) study of 25 microsatellite markers and a mutational analysis of genes BRAF , K-RAS and APC were performed in samples of neoplastic and normal colonic mucosa collected over the years. RESULTS: A diffuse genetic instability was present in all samples, including neoplastic and normal colonic mucosa. Two different patterns of genetic alterations (LOH at 5q21 and 18p11.23 in the first case, and LOH at 1p34 and 3p14 in the second) were found to be associated with carcinogenesis over the years. A role for the genes MYC-L (mapping at 1p34) and FIHT (mapping at 3p14.2) is suggested, whereas a role for APC (mapping at 5q21) is not shown. CONCLUSION: The study challenges the most credited intraluminal implantation and metachronous carcinogenesis theories, and suggests a persistent, patient-specific alteration as the trigger of colorectal cancer anastomotic recurrence.

关键词： Anastomotic recurrence Colorectal cancer Allelic loss Genetic alterations

Mismatch repair proteins and microsatellite instability in solid pseudopapillary neoplasm of the pancreas

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Hepatobiliary & Pancreatic diseases International 2019年第5期18卷 491-492页

作者： Claudia Covelli Paola Parente Francesco Pepe Pasquale Pisapia Fabiola Fiordelisi Umberto Malapelle UOC di anatomia patologica Fondazione Casa Sollievo della SofferenzaViale Cappuccini 171013 San Giovanni RotondoFGItaly Department of Public Health University of Naples Federico ⅡVia Pansini 580131 NapoliItaly

Solid pseudopapillary neoplasms (SPNs) are rare solid pancreatic tumors mainly affecting young women. Despite the high percentage of favorable prognosis, they are considered as low grade malignant neoplasms, and metastases occur in 5%-15% of patients. Almost all SPNs (95%) have somatic activating mutations in the β-catenin gene [1].

关键词： Solid pseudopapillary neoplasms (SPNs) Mismatch repair proteins microsatellite instability

A histomorphometric,prospective long-term study of bone loss in glucocorticoid treated patients:prednisone versus deflazacort

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A histomorphometric,prospective long-term study of bone loss...