Meconium periorchitis: An unusual cause of newborn scrotal mass.

A case of meconium periorchitis in a 2-month-old boy is reported. The patient was delivered normally, only a scrotal mass was noted which became harder in weeks. Clinical and intrauterine ultrasonographic fi ndings were suggestive of a neoplasm and orchidectomy was performed. Microscopic examination revealed separate nodules of myxoid stroma with varying amounts of calcifi cation separated by fi brous septa. The unexpected diagnosis of meconium periorchitis was confi rmed. This condition is due to infl ammatory reaction from the meconium within the scrotal sac and resulted from an intrauterine perforation of the gastrointestinal tract. Since solid benign or malignant paratesticular masses cannot be differentiated by ultrasonography, tissue biopsy or fresh frozen tissue examination is required for diagnosis.

Autopsy findings in severe malaria – a case report.

Severe malaria, caused by Plasmodium falciparum infection, has a high mortality rate and is the main cause of death in malaria. Since clinical autopsy is unpopular in Indonesia, autopsy examination in malaria cases is rarely done. We reported a forty three year old woman from non endemic area that was dead because of severe malaria. Diagnosis was concluded from autopsy, histopathology, and toxicology.

Hepatoid carcinoma of the gallbladder.

Hepatoid carcinoma is a special type of extrahepatic tumor associated with hepatic differentiation, and has the morphological and functional features of hepatocellular carcinoma. Hepatoid carcinoma of the gallbladder is very rarely reported in the literature. We report a case of hepatoid carcinoma of the gallbladder in a 71-year-old female who presented with abdominal pain and was first diagnosed as cholelithiasis with cholecystitis. The microscopic findings of the gallbladder after cholecystectomy showed an area of tumor with polygonal cells, eosinophilic cytoplasm, distinct cell borders, round vesicular nuclei and prominent nucleoli, arranged in trabecular pattern resembling hepatocellular carcinoma intermingled with areas of adenocarcinoma or cholangiocarcinoma. The specimen from the pancreas also showed the same type of tumor cells. Histochemically, some of tumor cells were positive for Victoria Blue, Stein, and PAS. The immunohistochemistry for alpha-fetoprotein (AFP) showed strong intra cytoplasmic positivity, both in tumor cells with hepatic differentiation and tumor cells with bile duct epithelium differentiation. Based on these findings, this case was diagnosed as hepatoid carcinoma of the gallbladder with metastasis to the pancreas. This is the first case that has been reported in our department.

Incidence of helicobacter pylori infection and gastric cancer : an 8-year hospital based study.

AIM: To observe the tendency of decreased prevalence of H pylori infection in a 14 year-period and observe the prevalence of intestinal metaplasia and gastric cancer. METHODS: All patients who were diagnosed with dyspepsia and underwent esophagogastroduodenoscopy in Cikini hospital Jakarta from January 1998 until December 2005 were evaluated. We evaluated the histopathologic result of H pylori, the presence of intestinal metaplasia and gastric cancer. Data was grouped for 1 year period of time and was presented descriptively. RESULTS: Decreased prevalence of H. Pylori infection was found, from 12.8% in 1998, 12.4% in 1999, 14.7% in 2000, 9.6% in 2001, 11.9 % in 2002, 3.8% in 2003, 2.3% in 2004, 2.9% in 2005. Intestinal metaplasia was 4.7% in 1998, 3.2% in 1999, 3.1% in 2000, 2.3 % in 2001, 7.6% in 2002, 8.3% in year 2003, 6.5% in 2004, 7.1% in 2005. Prevalence of gastric cancer was 2.2% in 1998, 0.25% in 1999, 1.1% in 2000, 1.1% in 2001, 1.1% in 2002, 1.8% in 2003, 1.7% in 2004, 3.9% in 2005. CONCLUSION: There was decreased prevalence of H pylori infection in 8 year-period but there was no decreased prevalence of intestinal metaplasia and gastric cancer found.

Multiple cysticercus nodules in skin and brain in a Balinese woman: A case report.

A case of multiple subcutaneous and cerebral cysticercosis in a 33-year-old Balinese female, is reported. The patient suffered from seizures since adolescence, which was not treated. Since three years before admission she started developing multiple nodules in the skin, starting from her forehead and since a year ago also in other parts of the head and body such as shoulders, chest and back. Serum sample tested against cysticercus antigen by immunoblot assay against antigen of Taenia solium was positive. The copro-antigen test was also positive, indicating the presence of the adult worm in the intestines. The patient was treated with praziquantel for the adult T. solium infection and thereafter with albendazole for the larval stages, which resulted in obvious reduction of the cerebral cysts and most of the subcutaneous nodules disappeared. However the adult worm was not recovered in the 24 hours stool specimen and after one year the immunoblot test was still positive.

Pathological features of glomerulonephritis in Jakarta.

All cases of renal biopsies received during a 10-year period from 1990-1999 were collected and analyzed. There were a totat of 1344 cases, comprising 390 pediatric cases, 9 I 8 adult cases and 36 cases of unknown age. Immunofluorescence microscopy was performed on 1089 cases (81.0%). The purpose of this study is to have an overview of the pattem and spectrum of glomerular diseases in Indonesia, especially in Jakarta and surroundings, with special emphasis on the cases with nephrotic syndrome, lupus nephritis and IgA nephropathy, and to compare the findings with previous reports from Indonesia and afew other countries. There were 250 cases of childhood nephrotic syndrome and 479 adult cases. The most frequent histopathological appearance in both groups was minimal change disease, i.e. 58.2% and 44.7% respectively. Males were more often affected than females with a ratio of 2.0:1 for children and 1.4:1 for adults. Lupus nephritis comprised 124 cases, among which three cases were not representative. The male to female ratio was 1:7.9. Most cases were in the fourth decade, i.e. 47 cases (38.5%), and the most frequent histopathological appearance was WHO class IV with 71 cases (58.7%). There were 97 cases of IgA nephropathy with an age range between 3 to 58 years. The peak incidence was in the fourth decade with 32 cases (33%). The male to female ratio was L7: I. The most frequent histopathological appearances were diffuse sclerosing lesion 34 cases (35%) and mesangial proliftrative lesion 33 cases (34%).

Possible factors influencing high serum Prostate-specific Antigen (PSA) in Indonesian patients with Benign Prostatic Hyperplasia (BPH).

Benign prostatic hyperplasia (BPH) cases in Indonesia frequently associated with high serum prostate specific antigen (PSA). To explore possible factors that could increase serum PSA level, we performed a retrospective, cross-sectional study on 805 consecutive patients in Sumber Waras and Dr. Cipto Mangunkusumo Hospitals from 1994 to 1997. Clinical manifestations were evaluated and prostate biopsies were performed if indicated. Complete histopathological data were only available in 82 BPH patients with no urinary retention from 1998-1999 and a thin section of paraffin blocks of BPH patients which still could be found from 1994-1999 was analyzed using flow cytometer to obtain the S-phase fraction as a parameter of proliferative activity, From 805 patients, 461 (57%) presented with urinary retention and need to be catheteized. Catheteization significantly increased PSA level if compared to noncatheterized patients (16.3 vs. 6,8 ng/mL, p= 0,000). Another data of 82 uncatheteized patients from 1998-1999 has revealed that 79 patients (96.3%) had chronic prostatitis and 19 (23.2%) showed the presence of prostatic-intraepithelial neoplasia (PIN) with an increase of PSA level (5.4 ng/mL). The S-phase fraction of BPH without PIN cases was significantly higher in cases with PSA > 4 ng/ml than patients with PSA ≤ 4 ng/ml (I3.1% vs. 8.9%, p=0,008). As conclusion, the high serum PSA level was mostly due to urethral catheteization and increased prostate volume. There was a tendency of increasing PSA in subclinical inflammation and PIN. Cases with high PSA also showed high proliferative activities which is suggestive of mitogenic activity.