Fulminant amebic colitis: A study of six cases.

Background: Amebic colitis although common, rarely presents as fulminant colitis which has a high morbidity and mortality unless treated promptly and appropriately. Aim: To study the clinical, morphological features and outcome of fulminant amebic colitis (FAC). Materials and m0 ethods: A retrospective study of six patients who underwent surgical resections from 2002-06 and were diagnosed with FAC, was carried out. The morphological features assessed included the average number of trophozoites per high-power field and the depth of invasion of trophozoites into the muscularis propria. Results: The study included five adults and one child who underwent surgery for fulminant colitis. Interestingly, a definite preoperative diagnosis of amebic colitis was made only in one patient and suspected in another. Intraoperatively, multiple perforations of the intestine with peritonitis were the most common findings. Gross examination typically revealed multiple ulcers with exudate and intervening normal mucosa. Microscopically, ulceration and myonecrosis with trophozoites within the exudate were seen in all cases. Trophozoites invading the muscularis propria were seen in five cases. Of the cases that showed myoinvasion by trophozoites, two patients expired within two weeks of surgery. One of the patients who expired also showed co-infection with Actinomyces. Conclusion: FAC is an uncommon outcome in amebic colitis with a high mortality requiring prompt surgical intervention.

Early mycosis fungoides vs. inflammatory mimics: how reliable is histology?

BACKGROUND: The histologic diagnosis of early mycosis fungoides (MF) and its distinction from inflammatory dermatoses is challenging, owing to the overlap of several features. AIMS: 1) To assess the efficacy of histologic criteria to diagnose early MF, 2) to study their utility in differentiating inflammatory mimics of MF. METHODS: We retrospectively reviewed slides from 50 cases clinically/histologically suspicious for MF. The diagnoses were established based on response to treatment and follow-up. The slides were analyzed double-blinded by two observers independently. Twenty-eight histologic criteria were assessed and each criterion was graded. Univariate analysis was performed on the results. RESULTS: There were 17 cases of MF and 33 of inflammatory dermatoses. Of the 28 criteria, the following 15 achieved significance on univariate analysis: disproportionate epidermotropism, tagging of lymphocytes along the basal layer, haloed lymphocytes, convoluted lymphocytes, Pautrier's abscesses, larger epidermal lymphocytes, wiry dermal collagen, absence of edema, eccrine infiltration, folliculotropism, follicular mucin, involvement of papillary and reticular dermis, monomorphous infiltrates, and atypia of dermal lymphocytes. The criteria that were 100% specific for MF included convoluted lymphocytes, eccrine infiltration, and follicular mucin. Absence of edema was 100% sensitive and specific in distinguishing MF from its inflammatory mimics. CONCLUSIONS: A combination of histologic patterns and cytology of lymphocytes is reliable in distinguishing MF from inflammatory dermatoses. No single criterion is effective in achieving this. Rather than merely recording the presence or absence of a criterion, grading each of them adds objectivity to the diagnosis.

Direct immunofluorescence in cutaneous vesiculobullous lesions.

Direct Immunofluorescence (DIF) is invaluable in the diagnosis of cutaneous vesiculobullous lesions (VBL). It is limited by technical factors and disease nature. 1) To record the sensitivity of DIF in VBL 2) To correlate DIF with clinical, histologic findings and analyse discrepancies. Material and Methods: A retrospective study of 100 DIFs on suspected VBL of skin. DIF, histology and clinical data were reviewed. 73/100 cases showed DIF patterns concordant with clinical/histologic diagnosis. The sensitivity of DIF was 88% in Pemphigus group (39/ 44), 82% in Bullous Pemphigoid (BP) (23/28), and 20% in Dermatitis Herpetiformis (DH) (1/5).18 cases of histologically proven VBL were negative and of these, 4 had no epidermis. The remaining 9 cases were discordant with clinical/histologic features, including 4 BP and 5 DH, whose histology was non-specific and will be discussed in detail. One case of DH showed an aberrant vasculitic pattern. DIF is of great value in the diagnosis of VBL, specially in clinical/histologic dilemmas. In DH, neither biopsy nor DIF were very useful and response to therapy was the standard. Sampling errors contributed to false negative results. Proper selection of cases and judicious use are mandatory to optimize its' utility.