Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/epidemiologia , Segunda Neoplasia Primária/complicações , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/epidemiologia , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias , Fatores de Risco , Estadiamento de Neoplasias/tendências , Melfalan/uso terapêutico , Prednisona/uso terapêutico , Vincristina/uso terapêutico , Carmustina/uso terapêutico , Doxorrubicina/uso terapêutico , Dexametasona/uso terapêutico , Estudos RetrospectivosRESUMO
Primary non-function is an serious complication after orthotopic liver transplantation. A relationship between the severity of fatty infiltration in the donor liver and immediate graft function has been described. We present two cases of primary non-function, attributable to the presence of severe steatosis in the donor liver. They were two recipients with a deteriorated clinical status before liver transplantation. In both cases, liver fatty infiltration was not suspected because of the macroscopic aspect of the donor liver at procurement. In time 0 biopsies, hematoxyllin-eosin stained sections evaluated the degree of severity of the fatty infiltration as moderate (30-60% of hepatocytes involved), while the Sudan stained sections revealed more degree of severity (more than 60%). We believe that in case of moderate steatosis in liver donor the graft may be considered when it is not associated to another known risk factors as poor medical status of recipient and retransplantation.
Assuntos
Necrose Gordurosa/complicações , Transplante de Fígado/efeitos adversos , Adulto , Necrose Gordurosa/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de TratamentoRESUMO
Fatty change in donor livers is a risk factor for poor function after orthotopic liver transplantation. Various prevalences of steatosis have been reported in time 0 biopsies. The aim of this research was to determine, in a longitudinal study, the degree (percent of hepatocytes involved) and type (size of vacuoles) of fatty change shown by various histologic techniques. Four staining methods were used on sections from three liver wedge biopsies--at liver procurement, at the back-table, and after reperfusion--from 83 consecutive donor livers. Results in Sudan III-stained (SS) sections showed the greatest sensitivity (87.1%), negative predictive value (91.8%), and agreement rate (k = 0.77) when compared with results in thin (1 micron) plastic-embedded toluidine blue-stained (TBS) sections. High-grade steatosis (> 30% steatotic hepatocytes) was identified in 49.4% of SS sections, 46.9% of TBS sections, 38.5% of frozen hematoxylin-eosin (H&E)-stained sections, and 20.7% of deparaffinated H&E-stained sections. Microscopic observations disclosed two types of steatotic pattern: (1) A predominantly small-droplet lipid vacuolzation (high-grade microsteatosis), similar to the steatosis associated with Reye syndrome, was seen in 29% of SS sections and 25% of TBS sections--approximately one-fourth of grafts; and (2) a combined pattern of large and small fat drops (high-grade macromicrosteatosis) was seen in 20% of SS sections and 22% of TBS sections. We concluded that moderate to severe steatosis is a frequent finding in donor livers. The difficulty in detecting lipidic microvacuoles in H&E-stained sections may be the reason for underestimating the grade of fatty change or even for diagnosing as normal some biopsies with high-grade microsteatosis.
Assuntos
Fígado Gorduroso/patologia , Transplante de Fígado/patologia , Adolescente , Adulto , Idoso , Biópsia , Criança , Pré-Escolar , Fígado Gorduroso/epidemiologia , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Doadores de TecidosAssuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Recidiva Local de Neoplasia , Regressão Neoplásica Espontânea , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Tomografia Computadorizada por Raios XRESUMO
We report the case of a patient suffering from acquired immunodeficiency syndrome and hepatitis B and D virus-related cirrhosis of the liver who was diagnosed as subclinical Crohn's disease. We attribute this clinical course to abnormality of intestinal immune system induced by the human immunodeficiency virus. Concomitant hepatitis B and D virus infection may have contributed. This observation supports the hypothesis of helper-inducer T cells (CD4 T cells) having a critical role in the immunopathogenesis of Crohn's disease and its clinical expression.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doença de Crohn/complicações , Adulto , Humanos , MasculinoAssuntos
Herpesvirus Humano 4/isolamento & purificação , Transplante de Fígado/efeitos adversos , Transtornos Linfoproliferativos/microbiologia , Adolescente , Feminino , Humanos , Fígado/patologia , Linfonodos/imunologia , Linfonodos/patologia , Transtornos Linfoproliferativos/etiologia , Transtornos Linfoproliferativos/imunologiaRESUMO
We present a case of hepatic myelolipoma that was treated by performing a right hepatic lobectomy. These tumors are very uncommon and present great problems for the pre-operative diagnostic evaluation. Currently, the diagnosis is essentially histopathological with a definitive diagnosis being made by immunocytochemical staining. We have found no reports on this type of tumor in the Spanish literature; a review of the published cases confirms our observations and conclusions regarding hepatic myelolipoma.
Assuntos
Lipoma , Neoplasias Hepáticas , Fígado/patologia , Adulto , Humanos , Lipoma/epidemiologia , Lipoma/patologia , Lipoma/cirurgia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Espanha/epidemiologiaRESUMO
We describe the case of a 63-year-old woman who had recently developed dysphagia. Oral endoscopy revealed an ulcerated fungating lesion in the middle third of the esophagus. The histologic examination showed granulomas with caseous central necrosis, and the culture in a Lowenstein medium produced M. tuberculosis. There were mediastinic adenopathies, but no other organic involvement with this mycobacterium was demonstrated. We review the other 21 cases reported in the English and Spanish literature over the past ten years.
Assuntos
Doenças do Esôfago/diagnóstico , Tuberculose/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Three cases of Ménétrier's disease diagnosed and treated in our hospital during the last 15 years are presented. We describe the clinical manifestations as well as the pathological findings; one of the cases was complicated by carcinomatous degeneration. On the basis of our experience, we briefly review the controversial clinical, diagnostic and therapeutic aspects of this rare condition.
Assuntos
Gastrite Hipertrófica/patologia , Gastrite/patologia , Adulto , Gastrite Hipertrófica/complicações , Gastrite Hipertrófica/diagnóstico , Gastrite Hipertrófica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/etiologia , Neoplasias Gástricas/etiologiaRESUMO
Carbimazole, an antithyroid agent of the thioimidazole group, can induce unpredictable liver alterations, presumably by hypersensitivity. We describe the case of a hyperthyroid woman who suffered acute submassive cholestatic hepatitis in the course of treatment with this drug. We also review the other seven cases of carbimazole hepatotoxicity previously communicated in the literature.
Assuntos
Carbimazol/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Colestase/induzido quimicamente , Doença Aguda , Idoso , Doença Hepática Induzida por Substâncias e Drogas/complicações , Doença Hepática Induzida por Substâncias e Drogas/patologia , Colestase/complicações , Colestase/patologia , Feminino , HumanosAssuntos
Fígado Gorduroso/patologia , Hepatite/patologia , Adulto , Idoso , Diagnóstico Diferencial , Fígado Gorduroso/diagnóstico , Feminino , Hepatite/diagnóstico , Humanos , Fígado/patologia , Hepatopatias Alcoólicas/diagnóstico , Hepatopatias Alcoólicas/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
The Toxic Syndrome (TS) caused by ingestion of adulterated rapeseed oil in Spain is a new disease of multisystemic character whose aetiology and pathogenesis remains unknown. The most prominent pathological feature is a peculiar non-necrotizing vasculitis, that affects mainly the intima and involves vessels of every type and size in practically every organ. The TS begins with an acute clinical picture with pleuropneumopathy, fever, headaches, exanthems and eosinophilia. In these early clinical phases the main pathological findings were observed in the lungs and consisted of intense pulmonary interstitial oedema with scanty inflammatory mononuclear infiltrates. Ultrastructural study revealed hydropic degeneration of pneumocytes types I and II with desquamation of type I. The patients in this phase died of respiratory failure, later deaths were due to thromboembolic complications. Later still the patients developed a neuromuscular syndrome, sclerodermiform skin lesions and severe weight loss and died predominantly of infectious complications and respiratory failure. The anatomopathological picture in the peripheral nerves was that of inflammatory neuropathy with a lymphocytic perineuritis that led to perineural fibrosis with secondary axonal degeneration. The muscle presented an interstitial inflammatory myopathy at first followed by a neurogenic muscular atrophy. The skin lesions in the late phases consisted in dermal or dermal and subdermal fibrosclerosis, with vasculitis of the small arteries in the lower dermis. The salivary glands and pancreas showed vasculitis and interstitial inflammation which progressed to interstitial fibrosis and parenchymal atrophy.