Evaluation of serum HBV viral load, transaminases and histological features in chronic HBeAg-negative hepatitis B patients

Aim: To evaluate the association between biochemical, virologic and histologic features in patients with HBeAg-negative chronic hepatitis B [CHB]

Background: Hepatitis-B e-antigen [HBeAg]-negative is common in Iran, is progressive with poor prognosis. Therefore, it seems necessary to perform a comprehensive evaluation of different spectrum of laboratory measurements accompanying histological findings

Methods: HBeAg- negative CHB patients referring to two university hospitals during two years were enrolled. Alcohol consumption, liver mass, fatty liver and positive results of Anti HDV, Anti HCV or Anti HIV were excluded. The relationship between viral loads, liver enzymes [old and new cutoffs] and histopathological features was analyzed using descriptive and analytic statistical methods

Results: A total of 150 HBeAg-negative CHB [males=110, mean age=38.44 +/- 11.34 years] were assessed. ALT had a significant relation with the logarithm of serum HBV-DNA [P<0.0001], grade and stage on liver biopsy [P<0.001, P=0.034, respectively]. Serum viral load, AST and ALT were independent predictors of histological grade, age was the only independent predictor of the stage of liver fibrosis. There was a significant relationship between serum ALT and stage of liver fibrosis [P<0.0001] when new cutoff values for ALT were considered. We found that age had a significant relation with histological grade but it showed a reverse relation with ALT levels [P=0.009]

Conclusion: In HBeAg-negative CHB, AST had a better prediction for liver necrosis and inflammation. Age could be an independent predictor for liver fibrosis. New cutoff values for ALT had superiority over conventional values to identify higher risk of liver fibrosis

Resolution of bile duct adenoma over follow-up period; a case report

Bile duct adenoma [BDA] is a rare neoplasm of bile ducts with various clinical manifestations and imaging appearances. A few cases of BDA and their predisposing factors have been described. We report a 35-year-old woman with right upper quadrant pain who consumed oral contraceptive pills. Ultrasound study revealed three hypoechoic subcapsular liver masses; two of them were hypodense in computed tomography. Fine needle biopsy of the largest mass showed bile duct adenoma. Liver masses disappeared after discontinuing the pills over a 2-year follow-up. BDAs can manifest in imaging. Although previous studies have not reported tumor resolution over a follow-up period, we suggest paying more attention to predisposing factors in order to give an opportunity for tumor resolution by risk factor elimination

Frequency and risk factors of primary sclerosing cholangitis among patients with inflammatory bowel disease in North-East of Iran

To identify primary sclerosing cholangitis [PSC] predisposing factors in order to prevent inflammatory bowel disease [IBD] progression to PSC. IBD is commonly associated with PSC and there is no effective therapy for PSC except for liver transplantation. This retrospective study was conducted on 447 IBD patients from IBD Clinics of Ghaem and Emam Reza Hospitals. Data were collected by interview and through a review of the patients' medical records. Patients were divided into two groups: those with IBD and PSC [IBD-PSC] and those without PSC. Variables were compared between two groups and those with statistically significant differences in IBD-PSC group were considered as predictive factors for the development of PSC. The frequency of PSC in IBDs was 4.3% and all were ulcerative colitis. The mean age of patients with PSC was 39.1 +/- 11.33 years. The male to female proportion in PSCs was 3.8:1 and in IBDs was 0.9:1. There were statistically significant associations between PSC and gender, IBD duration and UC extension, mucocutaneous involvement, oral contraceptive pills [OCP] consumption, history of surgery and history of PSC in the first- degree relatives. PSC frequency among IBD patients in North-East of Iran was 4.3%. It is recommended to limit OCP consumption in IBD patients. Identification and modification of probable predisposing risk factors, as well as early diagnosis of PSC are necessary

rare case of colon cancer penetrated to the spleen

There is still been no report of splenic involvement in the wake of colon cancer. In this case, air was seen in the spleen and liver following the penetration of colon cancer to the continuous spleen. Colon cancers always do not present with clear and common symptoms. Some times with a non-specific and uncommon symptoms and signs present that would be amazed physicians and researchers. It is very rare that we present, a middle aged man who presented with abdominal pain and rectal bleeding and in our investigation was seen air in spleen and liver in CTscan study. After surgery we found that air in spleen and liver is due to infiltration and invasion of splenic flexure colon cancer to spleen. Has had no cases of invasive colon cancer that causes the air in the spleen and liver have been reported

Gastrointestinal stromal tumors in northeastern iran: 46 cases during 2003-2012

Gastrointestinal stromal tumors [GIST] are the most common mesenchymal tumors of the gastrointestinal [GI] tract. They are usually C-kit positive and seen slightly more common in men. These tumors are seen in the GI tract from the esophagus to the anus with occasional invasion or metastasis. In this retrospective study, we evaluated the prevalence of c-kit positive stromal tumors of the GI tract based on age, site of involvement, size of tumor, local invasion, and Immunohistochemical markers. The study was conducted in Mashhad University of Medical Sciences in Iran during 2003-2012. Of the total 46 patients, 18 [39.1%] were men and 28 [60.9%] were women with a mean age of 58.07 years [range: 18-93]. Common sites of tumor were stomach, small intestine, esophagus and rectum, respectively. The number of mitoses per 50 HPF varied between zero and 160 mitoses. Overall, 23 cases had 5 mitoses 50/HPF [50%] and 23 tumors expressed <5 mitoses/50 HPF [50%]. Local invasion and metastasis were observed in seven cases with extension to liver, pancreas, pregastric tissue, omentum, mesentery and appendix. Positive reaction for CD34, SI00, actin and desmin was seen in 47.8%, 13%, 21.7%, and 4.3% of the patients, respectively. Most patients were women. The prevalence of tumors in the esophagus was higher than the rectum. Invasion and metastasis did not correlate with mitotic rate, site and size of tumor. We suggest evaluation of genetic, racial and geographical or other unknown risk factors

Screening for celiac disease using anti tissue transglutaminase in patients with esophageal SCC between 2004 and 2009

Introduction: Esophageal Squamous-Cell Carcinoma [SCC] is one of the most common malignancies in Iran. To reduce the incidence of esophageal SCC, it is important to recognize the controllable risk factors and prevent them. Celiac disease is widely known as a possible risk factor for esophageal SCC. Thus, we decided to assess the frequency of celiac disease in esophageal SCC patients in North east of Iran in order to suggest correlation between two diseases

Materials and Methods: In a Cross-sectional study one hundred and fortythree cases of esophageal SCC were examined for anti tissue transglutaminase antibody [anti-tTG] between the years 2004 and 2009 in Ghaem and Omid Hospitals of Mashhad University of Medical Sciences, Iran. The enzyme-linked immunosorbent assay was the test of choice in this study since it provides the sensitivity and specificity needed for the diagnosis and screening of celiac disease. The results of this test were compared with those of the control group which were compatible in terms of sex and age. Data were analyzed through SPSS software and statistical analysis such as x2, exact x2 and T-test

Results: 19.6% patients [SCC] had positive anti-tTG [>20] which was significantly different to 7.9% in control group [p -value=0.005]. Comparing age groups of patients for positive anti_tTG using exact x square test showed significant difference in patients with <40 years old [P value=0.005]

Conclusion: There seems to be a correlation between positive anti_tTG and esophageal SCC; that is to say, celiac disease might play a role in the earlier manifestations of esophageal SCC

[ case report of primary glomus tumor of stomach in a 59 year old man]

Primary gastric Glomus tumour is rare and much less frequent than gastrointestinal stromal tumors[GIST].at least 150 of them have been reported in articles, but no one had been published in Iran. Patient was a 59 years old man with the chief complains of sense of epigastric fullness after meal. Endosonography showed a hypoechoic mass in muscularis mucosa with 29_14 mm dimentions. patient underwent wedge resection of gastric tumour. In microscopy, sheets and nodules of round to polyhedral uniform cells with bland round to oval nuclei in the background of branched hemangiopericytoma-like vascular stroma with hyalinised wall were seen. Smooth Muscle Actin, desmin, chromogranin and CD117 were determined immunohistochemicaly, the first marker was positive and the reminders were negative. Primary gastric Glomus tumour is essentially a benign neoplasm, in order to prevent unnecessary radical surgery, its differentiation from others malignant lesions is mandatory