Value of CK14 and CD56 immunostaining in distinguishing small cell carcinoma from squamous cell carcinoma of the esophagus.

Primary small cell carcinoma of esophagus (SCC) is a rare disease but has more aggressive behavior than esophageal squamous cell carcinoma (SQC). The distinction of SCC from SQC is very important therapeutically. Few systematic studies of immunohistochemical analysis to differentiate primary esophageal SCC with concomitant SQC, and adjacent normal esophageal epithelium have been reported. The objective of this study is to know the immunohistochemical markers in distinguishing SCC from SQC of esophagus. We studied 6 cases of primary esophageal SCC histologically and immunohistochemically using 15 different antibodies including a cytokeratin (CK) panel and neuroendocrine markers. Pure SCCs were identified in 2 of the 6 cases (33.3%), and the remaining 4 cases (66.7%) were found to exhibit combined SCC with an SQC component. Among the combined types, in situ SQC was observed in all 4 cases (100.0%) and invasive SQC was observed in 3 cases (75.0%). Among the normal esophageal epithelia specimens (n=7), CK14 expression was seen 6 out of 7 (85.7%) specimens and CKAE1/3 in 5 out of 7 (71.4%) specimens. CD56 was more frequently expressed among the SCC specimens (4/6; 66.7%) than among the SQC specimens (0/4; 0%; p = 0.07). The expression of p53 protein in SCC (4/6; 66.7%) and SQC (3/4; 75.0%) specimens was significantly more frequent than in normal esophageal epithelium (0/7; 0%; p = 0.02 each). Neurone-specific enolase (NSE), synaptophysin, and CKAE1/3 were expressed in 83.3%, 66.7%, and 66.7% of the SCC cases (n=6), respectively. NSE expression was significantly more frequent in SCC specimens (5/6; 83.3%) (p = 0.02) than in normal esophageal epithelium (0/7; 0%; p = 0.02). However, the frequencies of NSE expression in SCC (5/6; 83.3%) and SQC (2/4; 50%) were not significantly different. All of the SQC specimens (n=4) expressed CK14 and CKAE1/3. The CK14 expression was significantly more frequent in SQC specimens (4/4; 100.0%) than in (p = 0.04) SCC specimens (1/6; 16.6%; p = 0.04). These findings suggest that the CK14 and CD56 may be useful markers for differentiating SQC from SCC and vice versa. The p53 may also be useful to differentiate normal esophageal epithelium from SCC or SQC tissue.

Study on enteric parasitosis and nutritional status of school children in remote hilly areas in Nepal.

We examined the effect of enteric parasitosis on nutritional status of school children in remote hilly areas in Nepal. A total of 325 school children aged 6 to 19 years (boys: 214; girls: 111) who provided both blood and stool samples were included. The height (Ht) (cm), weight (Wt) (kg), age, sex, ethnic of each child were recorded. Fecal samples were examined by direct smear method in duplicate. The blood hemoglobin (Hb) was estimated by Sahli's method in the field (Nepal) whereas the serum protein (Prot), albumin (Alb), Alb/globulin ratio (A/G), serum glutamate pyruvate transaminase (SGPT), cholesterol (Chol), triglycerides (Trig), and serum iron (SI) were measured in Japan. Of the total, 201 (61.8%) had enteric parasites, predominantly the soil transmitted helminths. Ascaris lumbricoides was the most common parasite detected (72.6%) followed by hookworm (16.2%) and others. Protozoan infections were very low (<6.0%). Of the total 201 parasite positive children, 15.4% had multiple infections. No significant differences in Ht and Wt in parasite positive and negative boys and girls of both age groups (< 11 and 11-19 years) were observed (P>0.05). Overall, no significant differences in levels of Hb, Prot, A/G, SGPT, Chol, Trig and SI in the parasite positive and negative children were observed (P>0. 05) but in Alb level (P<0.05). When, the levels of these parameters were compared in the age groups of <11 and 11-19 years, similar findings were observed in both the age groups. But, in the age group of 11-19 years, a significant difference was observed in Trig level (P<0.05). No differences were found in the levels of these parameters in the parasitic positive and negative children belonging to Dalits and different ethnic namely, Indo-Aryan and Tibeto-Burman, respectively.

Kikuchi-Fujimoto disease in Nepal: a study of 6 cases.

CONTEXT: Kikuchi-Fujimoto disease is a benign disorder, predominantly affecting young women with a predilection for cervical lymphadenopathy. Although the disease has been recognized worldwide, to our knowledge no cases have been reported previously from Nepal. OBJECTIVES: To determine the prevalence of Kikuchi-Fujimoto disease in Nepal and to analyze clinicopathologic features. METHODS: We reviewed 6 cases of Kikuchi-Fujimoto disease recorded at 3 different hospitals in Nepal during a period from June 1998 to June 2002. Clinical data and histopathology are presented. RESULTS: This study included 5 females and 1 boy, aged 13 to 32 years. These patients presented with prolonged fever and lymphadenopathy. The 5 female patients had cervical lymphadenopathy, and the boy had axillary lymphadenopathy. Complete blood counts revealed raised erythrocyte sedimentation rates in all patients and anemia in 2 patients. The size of excised lymph nodes (in greatest dimension) ranged from 1.5 to 5 cm. Typical histologic features were seen, namely, architectural effacement due to presence of pale nodular lymphohistiocytic foci with karyorrhectic debris, coagulation necrosis, eosinophilic debris, and absence of granulocytic infiltration. In a follow-up of the cases, disease recurrence was not found. CONCLUSION: Our study emphasizes that Kikuchi-Fujimoto disease should be considered as one of the differential diagnoses in patients with prolonged fever and cervical lymphadenopathy and that it should be differentiated from tuberculous lymphadenitis in regions where tuberculosis is prevalent.

Toxoplasma infection in selected patients in Kathmandu, Nepal.

Seroprevalence of Toxoplasma infections in 272 patients with ocular diseases (uveitis, retinochoroiditis), malignancy (including leukemia), women with bad obstetric history (BOH) and others (patients with fever, lymphadenitis and encephalitis) have been was studied. Toxoplasma antibodies were detected by microlatex agglutination and IgM ELISA techniques. Overall, 50.7% (138/272) patients included in this study had Toxoplasma antibodies, out of which 5.7% (8/138) had IgM antibodies. Patients with malignancy had highest positive rate [68.7% (22/32)] followed by group of others. Of the different groups, women with BOH had highest Toxoplasma IgM positive rate [25.0%; (2/8)].