Isospora belli infection associated with chronic cholecystitis and sclerosing cholangitis in immuncompetent host : A case report.

Isospora belli (I. belli) is a spore-forming protozoa that primarily infects enterocyte. The clinical manifestation may very from asmptomatic to self-limited diarrhea in healthy persons. Rarely, in the normal hosts,5 chronic persistent or intermittent symptom may continue for many years.1,2 Treatment with cotrimoxazole is usually effective in both normal patients19 and patients with AIDS20,21 Nevertheless, relapse is common and is believed to be associated with the presence of extraintestinal infection.3,4,17 Few cases of extraintestinal I. belli infection have been documented in patients with AIDS,3-5 and one case in an immuncompetent patient.24 This report presents a unique case of isosporiasis in a 58-year-old anti-HIV negative Thai female suffering from chronic recurrent diarrhea due to I. belli, despite two episodes of complete 4-week cotrimoxazole and another course of nitazoxanide. Abdominal computer tomographic examination and ultrasonography identified sclerosing cholangitis and chronic cholecstitis. Histologic examination of the cholecystectomy specimen recovered schizonts and merozoites in the parasitophorous vacuoles located in gallbladder epithelium.

Adrenal cortical carcinoma presenting as liver abscess: Report of a case.

A 60 year-old woman presented with clinical signs and symptoms of liver abscess. She had a cystic mass on the right lobe of the liver. Liver needle aspiration was performed and anchovy-paste like material was obtained. She recovered after treatment with oral metronidazole even though investigations for Entamoeba histolytica were negative. Two and a half years later, she returned with the same clinical signs and symptoms. Liver needle aspirations were performed many times and the same anchovy-paste like material was obtained but no definite diagnosis was made. Finally, laparotomy showed an extrahepatic retroperitoneal cystic mass of the right adrenal gland adjacent to the liver. Intravenous pyelography, adrenal CT scan and adrenal angiography were performed. The tumor was removed and the final histopathological diagnosis was adrenal cortical carcinoma.

DNA analysis of hepatocellular carcinoma.

Specimens from 13 cases of resectable hepatocellular carcinoma (HCC) were studied using flow cytometry. The correlation between histological features and ploidy distribution showed those with higher histological grading (HCC grade III or IV) to display an increased tendency towards aneuploidy and polyploidy than those with low grade (HCC grade II and clear cell type of HCC). Along with the tumor’s increased tendency towards aneuploidy and polyploidy, the percent DNA distribution in the S- and G2 – phase was also found increased. The same applied to the DNA index, we also detected a strong correlation between proliferation index and ploidy pattern of HCC.

Hepatocellular carcinoma: Correlation of histological grading with immunohistochemical identification of proliferative hepatocytes with PC 10.

Sections from 31 liver needle biopsies of hepatocellular carcinomas(HCCs) were exa-mined for the histological grading of tumors with the expression of a labelling index, using monoclonal antibodies to proliferating cell nuclear antigen PC-10. The correlation between histological grading and the labelling index showed a statistically significant increase in the labelling index in grades III to IV of HCCs. A cut-off point of the labelling index at 49 per cent was proposed to indicate the prognosis of the patient. HCCs with a labelling index below 49 per cent has a better prognosis than HCCs with a labelling index above 49 per cent. A combination of histological grading and the labelling index indicated the prognosis of the patients with HCCs.

Mixed carcinoid – adenocarcinoma of vermifrom appendix: A case report.

Three histology types of appendiceal carcinoid are classified as: tubular carcinoid or classic carcinoid; goblet cell carcinoid or adenocarcinoid; and mixed carcinoid-adenocarcinoma. Each have a different prognosis and method of treatment. We report a 56-year-old Thai woman who presented with an intermittent abdominal pain in the right lower quadrant for nine months and was finally diagnosed as acute appendicitis. Appendicectomy was performed and the patients was unexpectedly found to have a mixed carcinoid-adenocarcinoma. Subsequently, hemicolectomy was carry out to provide appropriate treatment. Immunostains and ultratructural studies were performed to confirm the combination of endocrine and glandular differentiation.