Acute esophageal necrosis associated with alcoholic hepatitis: is it black or is it white?

Acute esophageal necrosis is an uncommon condition diagnosed during endoscopy from the black appearance of the esophagus. We report three cases of acute esophageal necrosis, associated with severe alcoholic hepatitis. The pathogenesis was multifactorial in our patients, with gastroesophageal reflux combined with hypoperfusion probably being the key factor for the esophageal lesions. The patients presented a continuum of endoscopic appearances, ranging from the characteristic black esophageal mucosa with ulcerations to a thick white exudate that peeled away (pseudomembranes). However, esophageal biopsy specimens from all three patients had the same histological pattern of severe inflammation and necrosis. Thus, the possibility of acute esophageal necrosis should also be considered in patients with extensive necrosis covered by a white exudate, but without the characteristic pattern of a "black esophagus"; and the diagnosis should subsequently be confirmed by mucosal biopsies. Our report showed that ethanol-induced acute esophageal necrosis can appear in patients with a high alcohol intake, especially in immunosupressed patients with alcoholic hepatitis.

The coexistence of atypical intraductal hyperplasias with breast carcinoma.

We present a study made during 4 years (1992-1996), which pursued the underlining of the atypical intraductal hiperplasias (A.I.D.H.) lesions, met isolated or in the association with mamar carcinoma. Our study included a 188 number of the breast tumors, among: in the 23 cases we established the existence of the modification by the A.I.D.H, type at the fibrocystics disease associated or not with the other benign diseases of the breast (fibroadenosis, intraductal papiloma) and in the 63 cases there were the modification by the AIDH associated with in situ or invasiv carcinoma. Epithelial hyperplasia is frequently associated with the fibrocystic changes, being included in the category of fibrocystic or proliferating modifications. The synonymous terms used for the epithelial hyperplasia are the hiperplazia ductala, or the epitelioza, or the papilomatosis The last two are suggested by the proliferation possibility (papillary or linear) of the epithelial or the mio-epithelial cells. Regardless of the microscopic aspect of the lesion, that should be acknowledged and treated as it is, due to the increased risk of the development of a carcinoma later on, and also due to the ratio of association between the modification and the mammary carcinoma. The risk of occurrence of subsequent carcinoma is augmented in the presence of the epithelial atipii and also increases in the presence of a mammary carcinoma at the relatives of the first rank (1.3). In this context, the importance of the differential diagnosis between the simple intraductal hyperplasia and the atypical one, the difficulty of differentiation from intraductal carcinoma in some cases, and finally the association with an increased risk of subsequent occurrence of carcinoma, constitute into sufficient arguments to consider this topic separately.

Histopathologic and immunohistochemic correlations in virus B chronic hepatitis.

Complete diagnosis of chronic hepatitis relies on exploring the liver by bipsic punction, performing the classic histopathologic and immunohistochemic exams. We worked out viral antigens hepatocytes by using avidin-biotin-peroxidase complex technique as following: Ag HBs placed in cytoplasm or at the level of the cell membrane. Ag HBc preferably placed in nucleus and, a small part of it, in cytoplasm. Ag HD present especially in nucleus. A correlation between tissular antigen expression and hepatic histopathologic aspect was established. Two main types of viral expression were remarked: a regressive type reflected by cytoplasmatic Ag HBs in the absence of generalised nuclear Ag HBc--situations linked to persistent chronic hepatitis: an aggressive type characterised by the presence of the focal nuclear Ag HBc, cytoplasmatic Ag HBc or antigen HD--situations linked to active chronic hepatitis with various degrees of severity.

Pseudoepithelimatous hyperplasia positive and differential diagnosis.

Our study intended to describe some inflammatory and tumoral lesions associated to pseudoepithelimatous hyperplasia. In our casuistry, pseudoepithelimatous hyperplasia was determined by tuberculosis in two cases, granulomatous ulcerate epuils in 4 cases, myoblastoma in one case. Recognising these lesions is very important, since it helps differentiating between these tumors and some epidermal carcinomas, the two affections involving different therapies.

Histopathologic aspects in endometrium dysplasias.

The paper presents a study consisting of 87 cases of endometrial hyperplasias. Histopathologic examination allowed us to identify the singular glandulo-cystic and adenomatous hyperplasia and the coexistence of the two lesions, but also the association (for two cases) of chronic adenomatous hyperplasia to endometrial carcinoma. These aspects plead for considering hyperplasia as a precancerous lesion taking into account the physiological stage when it appears.

[Ocular manifestations in non-Hodgkin's lymphomas]. / Manifestari oculare în lifoamele non-hodgkiniene.

Ocular manifestation in non-Hodgkin lymphomas are rare and they evolute as non-specific uveitis. The paper presents the case of a 8-year-old boy presenting iridic nodular lesion which had appeared in the evolution of a non-Hodgkin malignant lymphoma. Various ocular manifestations which may evolute with a non-Hodgkin malignant lymphoma are also presented.