Pathologically different features and fibrosis scores in chronic hepatitis C genotypes 3 and 1.

BACKGROUND: Chronic hepatitis C genotypes 3 and 1 are the two most common genotypes in Thailand. OBJECTIVE: Identify the pathologically different features between genotypes 3 and land to compare the fibrosis score of Knodell HAI and Ishak modified HAI. MATERIAL AND METHOD: The pathological features of 114 liver biopsies were evaluated. RESULTS: Steatosis was more commonly found in genotype 3 than in genotype 1 (97.1% vs. 77.8%, p = 0.001). Portal lymphoid follicles were commonly found, but bile duct damage was uncommon. The majority of portal tracts showed partial involvement. The majority of patients had Knodell fibrosis 1 and Ishak fibrosis 3. CONCLUSION: Steatosis is significantly more common in genotype 3, while other features do not show any differences. The portal tracts show partial involvement because inflammatory cells tend to aggregate and form lymphoid follicles. The most comparable fibrosis scores are Knodell fibrosis 1 and Ishak fibrosis 3.

Hematemesis in infants induced by cow milk allergy.

This study was conducted in order to analyze the clinical manifestations, the endoscopic findings, the histology of the gastrointestinal mucosa, the treatments and the clinical course in infants who had hematemesis induced by cow milk allergy. The medical records were reviewed retrospectively. The criteria for the diagnosis of CMA included elimination of cow milk formula resulting in improvement of symptoms, specific endoscopic and histologic findings as well as the exclusion of other causes. Twenty-three infants with a diagnosis of hematemesis were analyzed, which included 20 infants with CMA and 3 infants with gastroesophageal reflux disease (GERD). In the CMA group were 12 girls and 8 boys whose ages were 4.3 +/- 1.4 months. The onset of vomiting after starting cow milk formulas was 70.6 +/- 48.9 days. Gastroduodenoscopy was performed on 15 patients showing erythema, erosion and friability of the gastric mucosa in all patients and lymphoid hyperplasia in the duodenal bulb in 7 patients. Eight patients had mild to moderate eosinophilic infiltration and 5 patients had eosinophilia. Cow milk formulas were changed to other formulas: two children were initially given extensively hydrolyzed casein formulas and later followed by a soy formula, 14 were given a soy formula and 4 were given partially whey hydrolyzed formulas. All patients showed clinical signs of improvement a few days later. Patients that were able to tolerate cow milk were 1.5 +/- 0.9 years old. During the follow-up period (2.6 +/- 1.8 years after treatment) 4 patients were diagnosed with asthma, 4 patients with chronic respiratory symptoms, 4 patients with constipation and 2 others with food allergies. CMA induced gastritis in infancy may not be classified as eosinophilic gastritis because of the low level of eosinophilic infiltration. The elimination of cow milk and subsequent substitution with a soy formula is the proper management.

A correlation between chronic gastrinic, helicobacter pylori, intestinal metaplasia and atrophic change with advanced gastric adenocarcinoma: A study in 139 gastrectomy.

Background: Atrophic gastritis with intestinal metaplasia is considered a precancerous lesion leading to intestinal type gastric adenocarcinoma. The current study aimed to describe the prevalence of gastric atrophy, intestinal metaplasia and H pylori infection in stomach with advanced gastric adenocarcinoma. Methods: One hundred and thirty-nine specimens of gastrectomy with the diagnosis of advanced gastric adenocarcinoma findings were reviewed for sits, location, size and macroscopic appearance of tumor. All section were reviewed for cancer type, degree of differentiation, and features of angiolymhatic invasion, perineurial invasion, depth of tumor invasion and lymph node metastasis. Sections were scored on a visual analogue scale to evaluation of chronic gastritis status, atrophic change, and intestinal metaplasia with subtype. Helicobacter pylori each location were identified. Results: Tumor was found more often in male than female with the ratio of 3:2 and predominantly in the age group of >=60 years old. No tumor was found in the age group of <30years. Most of the tumors were located in the posterior portion and lesser curvature of the antrum and the pylorus. Ulcerative type was found 65.9% followed by 15% of ulceroproliferative type, 15% of infiltrative type and 4% of fungating type. Adenocarcinoma was the common microscopic cell type (58.3%) followed by mixed adenocarcinoma and signet ring cell carcinoma 36.7% and pure signet ring cell carcinoma 5%. There was no statistically significant difference between cell types of tumor or cell differentiation with age group. More than 85% of tumor’s size was larger than 2 cm in diameter. Lymph node metastasis, angiolymphatic invasion and perineurial invasion were significantly found in tumor with larger than 2 cm in diameter. Ulcerative, ulceroproliferative infiltrative type had high incidences of angiolymhatic, perineurial invasion and lymph node metastasis comparing to fungating type. All microscopic cell carcinoma) had also high incidences of angiolyphatic, perineurial invasion and lymph node metastasis. Chronic gastritis was found 91.2%associated with the tumor. Atrophic change with chronic gastritis was found in age group of >=60 years. No significant statistical difference in comparing between macroscopic types and microscopic cell types of tumor with atrophic change. Intestinal metaplasia was found more common in male of age >=60 years at both body and antrum with the most common of type I (intestinal type). No different incidence of Helicobacter pylori infection in male and female or age groups was found. Helicobacter pylori were found most commonly in both body and antrum with evidence of glanditis and lymphoid aggregation. No significant statistical difference in comparing between macroscopic types and microscopic cell types of tumor with incidence of intestinal metaplasia of Helicobacter pylori infection was found. Conclusion: The pattern and distribution of the advancedgastric carcinoma in Thailand found to be the same as the national behavior of usual gastric carcinoma. The current hypothesis of gastric cancer in this country is believed to follow by the high incidence of gastritis with high H. pylori infection. Atrophic change and intestinal metaplasia may be blocked or prevented by dietary factors of excessive fresh fruits, vegetables and low salt intake. Thus, H. pylori is not insufficient to give rise to gastric carcinoma but many other cofactors or predisposing conditions must play a role in the etiology and pathogenesis of gastric carcinoma in Thailand.

Histologic identification of helicobacter pylori and gastric pathology in endoscopic biopsy specimens: A report of 213 cases.

Histology of gastric biopsy specimens from 213 patients was studied. Microscopic observation of hematoxylin & eosin stained sections was the main method for identification of Helicobacter pylori. Results of 200 cases were compared with biochemical test, Gram's stain and culture of concurrent specimens. Relations between presence of H. pylori and gastric pathology were analyzed. Histologic presence of H. pylori is significantly correlated with presence and activity of gastritis and intestinal metaplasia.

Immunohistochemical and ultrastructural studies of myofibroblasts in hepatocellular carcinoma.

Sections from 13 hepatocellular carcinomas (HCCs) were examined to determine the myofibroblasts (MFBs) in tumour fibrous stroma and cirrhotic fibrous stroma, using monoclonal antibodies to specific actins HHF-35, 1A4 and sarcomeric actin. Histological grading of tumours with the expression of a labelling index using monoclonal antibodies to proliferative cell nuclear antigen (PC-10) were correlated with the amount of MFBs. The results showed a statistically significant increase in the amount of MFBs in tumour fibrous stroma. However, no significant correlation was found between the amount of MFBs with histological grading or the labelling index. However, a good correlation with statistically significant differences between the histological grading of HCC with the labelling index was shown. In conclusion, MFBs found in the tumour fibrous septa of HCC were a response by the stromal reaction or a desmoplastic reaction intended to limit the tumour size by contraction.