Helicobacter Pylori Infection And Its Association With Histomorphological Changes In The Gall Bladder Of Patients With Chronic Cholecystitis

Role of H.pylori in chronic gastritis, peptic ulcers, gastric carcinoma and malignant lymphoma of gastric mucosa associated lymphoid tissue (MALToma) is well established. However its role in gall bladder diseases is still not clear. The aim of this study is to find the prevalence of H.pylori in patients with symptomatic cholelithiasis and to assess its role in various morphological changes in gall bladders of the patients with chronic cholecystitis. Our study comprised of 150 patients operated for chronic cholecystitis with cholelithiasis , with100 patients giving consent for gastric biopsies. Patients were divided into two groups depending on the presence and absence of H.pylori in gall bladder mucosa respectively. Histopathological changes were then assessed in both the groups and findings were analysed statistically. On comparing the morphological changes in gall bladders of patients in both groups, statistically significant difference were seen in mucosal hyperplasia (P=0.01926), mucosal metaplasia (P=0.01890) and in lymphocytic infiltrate (P=0.0307). Concomitant presence of H.pylori in gastric and gallbladder mucosa also showed positive correlation. As these lesions are believed to be key factor for the progress of numerous cancers, so the presence of H.pylori may be considered as potential risk factor for gallbladder cancers.

Endosonography as a predictive tool for first oesophagogastric variceal bleeding

Endosonography [EUS] is a useful tool for evaluating the fine details of the vascular structures at the gastroesophageal junction. The aim of this study is to evaluate the value of extraluminal gastroesophageal vascular collaterals as predictors for first variceal bleeding. Fifty cirrhotic patients with no history of previous upper gastrointestinal [GI] bleeding were recruited into this prospective cohort study. All patients were subjected to upper endoscopy and EUS for assessing the number and size of extramural vascular collaterals and perforating vessels. All patients were followed up for 24 +/- 7.5 months for upper gastrointestinal bleeding. Eighteen out of 50 patients [36%] had at least one attack of upper GI bleeding during the follow up period. All patients had one or more types of extraluminal venous collaterals. The presence of gastric varices [p = 0.02], perigastric collaterals [p = 0.03] and perforators [p = 0.02] were independent risk factors for first variceal bleeding. The presence of 3 or more paraoesophageal collaterals and the presence of perforators were significantly higher in bleeders when compared to non-bleeders [p = 0.034]. Perigastric and paragastric collateral sizes were significantly larger in bleeders than in non-bleeders [p = 0.019 and 0.038, respectively]. Perigastric and paragastric collaterals of size more than or equal to 2 mm and 6.20 mm, respectively were associated with significantly increased risk of first variceal bleeding. EUS may be a promising tool for predicting first variceal bleeding in cirrhotic patients

S100A1 protein as a potential discriminating marker between chromophobe renal cell carcinoma and renal oncocytoma

The morphological differentiation between chromophobe renal cell carcinoma [RCC] and renal oncocytoma [RO] may be difficult. This study evaluates S100A1 protein as a new marker for the differentiation between these two tumors. We selected twenty cases; fifteen of which were typically diagnosed after routine histopathological staining by hematoxylin and eosin [7 chromophobe RCC and 8 RO] while the remaining five cases showed confusing cytomorphological features and uncertainly diagnosed. Immunoperoxidase technique using atni-S100A1 antibody carried out semiquantitavely in all cases displayed a strong cytoplasmic positive granularity in five typical RO, moderate immunopositivity in two typical RO and weak reactivity in on typical RO while all seven typical chromophobe RCC cases were immunonegative. Regarding uncertainly diagnosed cases, three were immunopositive for S100A1 antibody [one strong, one moderate and one weakly reactive] in the same pattern as typical RO while the remaining two cases were immunonegative like typical chromophobe RCC cases. From our study, we concluded that S100A1 may be a potentially powerful marker to differentiate the chromophobe RCC from RO particularly when these tumors are in doubt about routine histologic diagnosis