Presence of human papillomavirus in pterygium in Taiwan.

PURPOSE: To evaluate the prevalence and possible role of human papillomavirus (HPV) in the formation of pterygia in patients in Taiwan, a tropical country with high prevalence of pterygium. METHODS: A total of 62 patients with 65 pterygia were retrospectively examined. Ten normal conjunctiva, 8 conjunctival nevi, and 2 malignant conjunctival melanomas served as controls. HPV detection and typing were accomplished using polymerase chain reaction amplification of the viral sequences. HPV-positive specimens underwent further investigation with fluorescence in situ hybridization. Clinical histories were recorded for each patient. RESULTS: Based on polymerase chain reaction analysis, 2 of 65 pterygia harbored HPV type 18, and they were also fluorescence in situ hybridization positive. No conjunctival control had HPV. There was no statistically significant correlation between pterygium and the presence of HPV. The presence of HPV was not significantly different between primary and recurrent pterygia. CONCLUSIONS: The limited presence of HPV DNA in pterygium does not conclude that HPV is necessary or acting alone in the formation of pterygium, but HPV may still be implicated to play a role in some pterygia in Taiwan.

Herpes simplex virus and pterygium in Taiwan.

PURPOSE: To evaluate the presence of herpes simplex virus (HSV) in pterygia to study the possible association between HSV and pterygia in Taiwan, a tropical country with a high prevalence of pterygium. METHODS: Sixty-five pterygia, 10 normal conjunctiva, 8 conjunctival nevi, and 2 malignant conjunctival melanomas were obtained. Clinical histories were recorded for each patient. HSV detection was accomplished by polymerase chain reaction amplification of viral sequences. HSV-positive specimens underwent subsequent DNA in situ hybridization. Results were statistically analyzed. RESULTS: By using polymerase chain reaction, HSV was detected in 3 (5%) pterygia, and no conjunctival control displayed HSV. All 3 HSV-positive pterygia studies were DNA in situ hybridization negative. There was no statistically significant correlation between pterygium and the presence of HSV. CONCLUSIONS: HSV is not associated with pterygium formation in Taiwan; the pathogenesis of pterygia is still incompletely understood.

Immunohistochemical expression of OCT4 in primary central nervous system germ cell tumours.

OCT4 is a POU-domain transcription factor that is expressed in embryonic stem cells and germ cells. OCT4 has been detected in specific types of testicular germ cell tumour (GCT), including seminoma and embryonal carcinoma. The aim of this study was to evaluate the role of OCT4 expression in the diagnosis of primary central nervous system (CNS) pure and mixed GCT. Seventeen formalin-fixed, paraffin-embedded tissues of primary CNS GCT were immunohistochemically studied. The 12 pure GCT samples comprised germinoma (5), yolk sac tumour (3), mature teratoma (2), and immature teratoma (2). The five cases of mixed GCT contained various components as follows: yolk sac tumour (4), embryonal carcinoma (3), mature teratoma (1), germinoma (2), polyembryoma (1) and immature teratoma (1). Diffuse and strong nuclear staining indicating OCT4 expression was detected in all cases of pure germinoma (5), and in all cases of mixed GCT containing embryonal carcinoma (3) and/or germinoma (2). There was no corresponding staining in pure GCT of yolk sac tumour, mature teratoma, or immature teratoma except in a primitive neuroectodermal component, or in mixed GCT containing components of yolk sac tumour, mature teratoma or immature teratoma. In conclusion, we found that OCT4 immunostaining is a useful diagnostic tool to assist in the identification of primary CNS embryonal carcinoma and germinoma. In CNS mixed GCT, OCT4 expression can be detected provided that the components include embryonal carcinoma and/or germinoma.

Paecilomyces lilacinus scleritis with secondary keratitis.

PURPOSE: To report a case of Paecilomyces lilacinus scleritis with secondary keratitis after initially diagnosed immune-based scleritis. METHODS: An 82-year-old man was diagnosed with immune-based scleritis and treated with oral cyclophosphamide 50 mg twice daily. However, multiple scleral abscesses and a fibrinoid aqueous reaction developed 3 months later. Infectious scleritis was suspected. The culture from the necrotic sclera grew P. lilacinus. Despite treatment with antimicrobials, the infection progressed to the cornea. The medication included topical natamycin suspension 5% and fluconazole 2 mg/mL hourly, as well as oral itraconazole 100 mg daily. Debridement of the necrotic tissue and intracameral injection with amphotericin-B were performed. RESULTS: The infection resolved 4 months later, although its resolution was accompanied by development of phthisis bulbi, and the visual acuity remained light perception. CONCLUSION: Infection by P. lilacinus can occur in a patient with scleritis. Infectious scleritis is a particular risk in cases involving diabetes mellitus, prior scleritis, previous surgery, and immunosuppression. Early detection of the microorganism and aggressive treatment are necessary to eradicate such an infection; however, the prognosis for vision recovery can remain poor despite treatment.

Aortic dissection in a young patient without any predisposing factors.

Aortic dissection is rare in the pediatric and young adult population. We hereby present a case of a 17-year- old male patient, without any predisposing factors, who developed an aortic dissection. The initial presentation was acute abdominal pain with massive retroperitoneal hematoma. His clinical condition deteriorated rapidly, did not respond to surgical hemostasis, and died within 36 hours of admission. The major autopsy finding was dissection of the descending aorta, extending from 2 cm distal from the origin of the left Subclavian artery. Microscopically, the aortic sections showed intimal thickening and tearing, medial smooth muscle loss, which was replaced by fibrous tissue, fragmentation of elastic lamellae with widening of interlamellar spaces, and cystic medial degeneration. The morphological features represented degenerative changes of the aorta, which were unusual in such a young patient. The pathophysiology, predisposing factors and relevant reports in the literature of aortic dissection in young patients are reviewed.

Simultaneous occurrence of Hodgkin's lymphoma and Kaposi's sarcoma within the same lymph nodes of a non-AIDS patient.

We report a case of simultaneous occurrence of Hodgkin's lymphoma and Kaposi's sarcoma within the same lymph nodes of a 61-year-old woman without human immunodeficiency virus (HIV) infection. Epstein-Barr virus (EBV) was detected in the Hodgkin cells and Reed-Sternberg cells by EBV LMP-1 immunostaining and Epstein-Barr virus encoded early RNA (EBER) in situ hybridization. In contrast, Kaposi's sarcoma cells were positive for human herpes virus 8. This case is documented because the occurrence of 2 independent tumors infected by 2 unrelated viruses within the same lymph nodes of a patient without HIV infection has rarely been observed.

Clinical and endoscopic features for alimentary tract cytomegalovirus disease: report of 20 cases with gastrointestinal cytomegalovirus disease.

BACKGROUND: The clinical presentations and endoscopic features of cytomegalovirus (CMV) infection in the gastrointestinal (GI) tract are diverse, and can mimic other inflammatory gastrointestinal diseases. METHODS: From 1987 to 2003 at Chang-Gung Medical Center, 20 patients with CMV infections of the GI tract who were assessed using endoscopic examinations and diagnosed via pathologic studies were retrospectively reviewed. RESULTS: Most of the patients were adults with immunocompromised conditions (10/20). GI tract bleeding was the most common clinical manifestation (11/20). Five patients presented with abdominal pain, and two patients presented with diarrhea. Fifteen patients suffered from fever. The endoscopic abnormalities could be classified into four main groups: inflammatory mucosa alone (3/20), ulceration alone (7/20), inflammatory mucosa associated with ulcer (9/20) and sub-mucosal tumor with ulcer (1/20). Of the 17 patients with ulcer lesions, ten had multiple ulcers and 12 had large ulcers exceeding 2 centimeters in diameter. Of the six patients followed up with colonoscopy, one was free of disease, one had a single ulcer, and four had colitis and were CMV positive on repeat biopsy. Two patients had colon strictures with persistent CMV colitis. CONCLUSION: Many patients with GI tract CMV infection are immunocompromised. Gastrointestinal bleeding is the most common initial presentation of gastrointestinal CMV disease. Fever is the most common associated toxic sign. Sigmoidoscopy cannot replace colonoscopy for detecting CMV colitis. The most common feature is multiple ulcers with at least one large ulcer. Endoscopic follow-up in patients with CMV colitis is recommended to investigate for possible persistent colitis and strictures.