Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report.

BACKGROUND: The mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal. CASE PRESENTATION: We encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure. DISCUSSION: Although the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding. CONCLUSIONS: The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.

Immunohistological comparison of the World Health Organization (WHO) and Ljubljana classifications on the grading of preneoplastic lesions of the larynx.

There is still controversy about the classification of laryngeal preneoplastic lesions. In this study, we compared the World Health Organization (WHO) and Ljubljana histological classifications with regard to laryngeal epithelial hyperplastic-dysplastic lesions in a single series to determine their relation to statistically significant criteria when the mechanisms of neoplastic progression are considered. Emphasis was put on p53 expression, proliferative activity, and angiogenesis. Fifty-four laryngeal biopsies with preneoplastic changes were re-evaluated and classified according to both classifications. The streptavidin-biotin method was used for immunohistochemical staining for Ki-67, p53, and CD34 antibodies. A positive correlation was obtained between the histological categories and Ki-67, p53, and CD34 expressions using both classifications (Spearman's Correlation test). There was a significant difference between the histological categories of both the WHO and the Ljubljana classifications, when the expression of the three markers was compared (Kruskal Wallis test, p = 0.000 for each). Further evaluation revealed a statistically significant difference between all categories of both classifications, excluding the p53 overexpression scores and vessel counts in mild and moderate dysplasia categories (Mann-Whitney U-test, p = 0.209, and 0.091 respectively), and the p53 overexpression scores in severe dysplasia and carcinoma in situ categories (Mann-Whitney U-test, p = 0.249) of the WHO classification. Similarly, no significant differences were found between severe dysplasia and carcinoma in situ, as well as between atypical hyperplasia and carcinoma in situ categories using both classifications for the Ki-67 expression (Mann-Whitney U-test, p = 0.806, and 0.111, respectively). Our results suggest that regarding the mechanisms of neoplastic progression such as p53 expression and angiogenesis, the histological categories of the Ljubljana classification seem to depend on additional evidence. Therefore, we support the use of the Ljubljana classification.

Histopathology of candidal hyperplastic lesions of the larynx.

Candidiasis of the larynx is rare, and candidal involvement of the larynx mostly occurs after pulmonary, pharyngeal and esophageal candidiasis, or as part of disseminated disease. We here report our morphologic observations made in five cases of laryngeal candidiasis. These cases had the following morphologic features in common: 1. pronounced epithelial hyperplasia, which may show a verrucous pattern, 2. prominent ortho-parakeratosis, and 3. predominantly neutrophilic infiltration located in the upper layers of the mucosal epithelium. Our morphologic observations were similar to the morphologic changes encountered in chronic hyperplastic candidosis of the oral mucosa. As this type of candidal lesions contains fewer hyphae than the usual thrush, fungal infection may be easily overlooked. Pronounced epithelial hyperplasia and prominent ortho-parakeratosis may mimic squamous cell and verrucous carcinomas. In conclusion, we suggest performing special stains for fungi of laryngeal biopsies that have the morphologic features mentioned above. In that way, it is possible to detect a candidal infection, keeping in mind that the fungal organisms may be very few in number and morphologically distorted.

Histochemical and immunohistochemical features of a case showing association of meningioma and prolactinoma containing amyloid.

We report the rare case of a 43-year-old woman with a simultaneous meningioma of the sphenoid wing and an amyloid-containing prolactinoma. The patient, who presented with a 17-year history of amenorrhea, and galactorrhea, was found to have a 10-mm mass in the pituitary gland. During excision of this lesion, another mass was noticed, which was located in the sphenoid wing. Both lesions were completely excised. Histopathological examination revealed that the pituitary tumor was a prolactinoma with diffuse amyloid deposition and that the second tumor was a typical meningioma. The coexistence of a prolactinoma containing amyloid and a meningioma is very rare in the literature, so this case is presented here with its histochemical and immunohistochemical features. We discuss the significance of prolactinoma containing amyloid and the simultaneous presentation of these two tumors.