Granulomatous, hepatolithiasis and hepatomegaly caused by Capillaria hepatica infection: first case report of Thailand.

This is the first case report in Thailand of a Capillaria hepatica infection causing a granulomatous hepatic lesion, bile duct dilatation, hepatolithiasis and hepatomegaly. The patient's chief complaint was abdominal pain with fever and chills. Imaging of the liver revealed a 3-cm mass in the postero-inferior sub-segment of the right lobe of the liver with bile duct dilatation. Right hepatectomy and cholecystectomy were performed. Gross pathology of the right hepatectomy revealed focal intrahepatic duct dilatation with prominent periductal fibrosis. The histopathological section revealed chronic inflammation and some granuloma formation surrounding the bile ducts, generalized portal infiltration, prominence of eosinophils and hepatolithiasis. Histopathotogical section revealed oblique sections of C. hepatica egg (size 35.4+/-6.38 microm in width) and brown amorphous pigment.

Insulinoma in childhood.

A 9-year-old boy with convulsions is herein described. He was diagnosed and treated for epilepsy and insufficient adrenal function for four years with no response. Hypoglycemia from hyperinsulinism was found and the source of the hyperinsulinism was a tumor of the tail of the pancreas--located by computerized tomographic scan and magnetic resonance imaging. Distal pancreatectomy was performed with good results. Histology of the tumor showed islet cell tumors with capsular invasion. For this type of patient, long-term follow-up should include: prevention of metastasis or recurrence, and testing for multiple endocrine neoplasia type 1.

Imprint cytology from a childhood case of metastatic papillary thyroid carcinoma.

A 9-year-old girl with a history of a palpable multinodular hard mass in the right lobe of the thyroid gland was biopsied. On diagnosis of a papillary carcinoma, total thyroidectomy and right radical neck dissection were performed. Examination of frozen sections demonstrated metastasis in the right but not the left cervical lymph nodes. Imprint cytology revealed small papillary sheets of neoplastic cells with a high proportion of cytoplasmic inclusions and a few nuclear grooves. These nuclear details allowed a specific diagnosis of metastatic papillary thyroid carcinoma. Papillary thyroid carcinoma can be easily diagnosed by imprint cytology. In places such as small and country hospitals that do not have pathology laboratories, it can also be used successfully as an alternative to frozen section histology. The efficiency, simplicity and rapidity of this method make it a very useful procedure.