Validity and reliability of the nonalcoholic fatty liver diseases activity score (NAS) in Korean NAFLD patients and its correlation with clinical factors / 대한간학회지

BACKGROUND/AIMS: Nonalcoholic steatohepatitis (NASH) is commonly diagnosed using the semi-quantitative grading and staging system proposed by Brunt et al. in 1999. The Pathology Committee of the NASH established the nonalcoholic fatty liver diseases (NAFLD) activity score (NAS) in 2005. The aim of this study was to elucidate the validity and reliability of the NAS in Korean NAFLD patients. METHODS: Fifty-six patients on whom sonography-guided liver biopsy for well-defined NAFLD was performed between 1999 and 2007 were identified retrospectively. Two pathologists evaluated each biopsy sample. NAFLD was evaluated using both the grading system developed by Brunt et al. and the NAS. Each pathologist was blinded to the patients' clinical data and scored independently. We evaluated the body mass index (BMI), liver enzymes, lipid profile, peripheral insulin resistance, leptin, insulin/c-peptide ratio, ferritin, and fasting blood glucose. RESULTS: The patients were aged 32.1+/-12.5 years (mean+/-SD) and comprised 44 males (78.6%). Patients with different grades at the two grading systems had mild steatosis or ballooning changes with fibrosis, and 36.6% of them were borderline cases (NAS of 3 or 4). The interobserver agreement on diagnostic category was 0.748 (P<0.001) for the NAS (using weighted kappa statistics). Elevated fasting glucose, ALT, and triglyceride were associated with the NAS. CONCLUSIONS: The simple and reproducible NAS was found to be a useful pathologic grading system in Korean NAFLD patients. However, the proportion of borderline cases based on the NAS was high. The "wait and see" strategy is necessary for evaluating the long-term prognosis.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

A case of pelvic actinomyosis presenting as an advanced ovarian malignancy / 대한산부인과학회지

Pelvic actinomycosis is an infrequent chronic suppurative granulomatous disease, caused by a gram-positive bands Actinomyces israelii. It is often reported as a complicated case of an intrauterine device (IUD). Ureteral obstruction and subsequent hydronephrosis are rare complications of pelvic inflammatory disease. Sometimes pelvic actinomyosis is simulating ovarian malignancy. We report a case combined with hydronephrosis, multiple pelvic lymph nodes enlargements and elevated CA 125 as complications of pelvic actinomycosis.

Diffuse Micronodular Pattern of Bronchiolitis Obliterans Organizing Pneumonia: A Case Report

The typical radiographic findings of bronchiolitis obliterans organizing pneumonia (BOOP) are known to be patchy air-space consolidation that is often subpleural, and with or without ground-glass opacities. However, there are scant radiologic reports about the micronodular pattern of BOOP. We report here on a case of BOOP that manifested as diffusely scattered ill-defined centrilobular micronodules on HRCT.

A Case of Papillary Adenocarcinoma of Intrahepatic Duct: Malignant Transformation from Papillary Adenoma / 대한소화기내시경학회지

Biliary papilloma usually consists of single or multiple papillary adenomas in the biliary tract and has a potential for recurrence and malignant transformation. We described herein a case of papillary adenoma of intrahepatic duct that transformed into papillary adenocarcinoma. A 49-year-old male patient was admitted to our hospital because of right upper quadrant pain. A CT scan revealed marked dilatation of S7 segmental duct and cholangioscopy and biopsy revealed mucin-secreting papillary adenoma in the right intrahepatic duct. Three years later, a follow up of CT scan showed aggravated S7 ductal dilatation and inner ill-defined mass. Cholangioscopy revealed multiple papillary mucosal projections with large amount of mucin in the right intrahepatic duct and biopsy revealed well differentiated papillary adenocarcinoma. The patient underwent right lobectomy, the papillary adenocarcinoma was extended in the dilated right intrahepatic duct and also showed hepatic parenchymal invasion.

Fibrosing cholestatic hepatitis: a report of three cases

Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We report three cases of fibrosing cholestatic hepatitis in various clinical situations. Case 1 was a 50-year-old man who underwent a liver transplant for hepatitis B virus (HBV)-associated liver cirrhosis. Two and a half years after the transplant, he complained of fever and jaundice, and liver enzymes were slightly elevated. Serum HBsAg was positive. Case 2 was a 30-year-old man in an immunosuppressed state after chemotherapy for acute lymphoblastic leukemia. He was a HBV carrier. Liver enzymes and total bilirubin were markedly elevated. Case 3 was a 50-year-old man who underwent renal transplantation as a known HBV carrier. One year after the transplant, jaundice developed abruptly, but liver enzymes were not significantly elevated. Microscopically lobules were markedly disarrayed, showing ballooning degeneration of hepatocytes, prominent pericellular fibrosis, and marked canalicular or intracytoplasmic cholestasis. Portal inflammation was mild, but interphase activity was definite and cholangiolar proliferation was prominent. Hepatocytes were diffusely positive for HBsAg and HBcAg in various patterns. Patients died of liver failure within 1 to 3 months after liver biopsy in spite of anti-viral treatment.