News - Part 67

Well-differentiated intrahepatic cholangiocarcinoma in the setting of biliary papillomatosis: CASE PRESENTATION (Part 2)

At laparotomy, the tumour was soft and fleshy, making it difficult to palpate the margins of the lesions. Intraoperative ultrasound was therefore important for defining the extent of resection. The patient underwent an uncomplicated left hepa-tectomy (segments 2, 3 and 4) and made an uneventful recovery.

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Well-differentiated intrahepatic cholangiocarcinoma in the setting of biliary papillomatosis: CASE PRESENTATION (Part 1)

Well-differentiated intrahepatic cholangiocarcinoma in the setting of biliary papillomatosis: CASE PRESENTATION (Part 1)A 64-year-old man was investigated for long-standing, vague, epigastric abdominal pain. His pain had a recurring and relapsing time course. He had a history of peptic ulcer disease, hypertension and insulin-dependent , and he had undergone a laparoscopic cholecystectomy in the previous year. The patient had no history of jaundice, liver disease, hepatitis or alcohol abuse. His physical examination was normal. He was investigated with colonoscopy, chest x-ray, abdominal ultrasound, liver function tests and alpha-fetoprotein, all of which were normal. His hepatitis serology was negative. Read more »

Infection of ileum mesothelium: Conclusions

Numerous calretinin-positive mesothelial cells also had HSV cytopathic atypia and reacted with HSV IHC antibodies (Figure 3).

To our knowledge, this was the first documentation of HSV type II infecting the mesothelium. This finding was not surprising because other herpes virus subtypes are known to infect mesothelium. Human herpes virus-8 was identified in mesothelial cells of three of five patients with pleural effusions and Kaposi’s sarcoma or Castleman’s disease in a recent publication. Read more »

Infection of ileum mesothelium: Discussion (Part 4)

HSV colon infectionHSV colon infection is classically a diffuse colitis with confluent ulceration. Ulcers may be diamond-shaped and most numerous in the sigmoid. Five of the 10 reported ante-mortem cases had a pancolitis. However, in one case, ulcers were described as symmetric and possibly diamond shaped. Other descriptions included aphthoid, punctate, stric-turing and indurated ulceration in one case each. Three of 10 patients had perforating ulcers. Read more »

Infection of ileum mesothelium: Discussion (Part 3)

HSV infection is usually restricted to the anorectum in the homosexual population, but rare examples of fulminant left-sided colitis have been identified. Of the 10 reported cases of HSV enteritis/colitis diagnosed antemortem, seven subjects were immunocompromised or on immunosuppressive therapy. One of the remaining three had type IIb diabetes mellitus as a predisposing condition . One patient had confirmed Epstein-Barr virus pharyngitis and another had undergone colon carcinoma resection two months previously. Our patient is the second reported case of herpes enteritis/colitis complicating diabetes mellitus (Table 1). Read more »

Infection of ileum mesothelium: Discussion (Part 2)

substandard immunityIndividuals with substandard immunity (pregnancy and newborns) have a greater propensity for HSV-related illnesses. Anecdotal cases of HSV viremia, proctocolitis and hemorrhagic cystitis have also been described in patients with diabetes mellitus. HSV infection in immunocompetent patients is usually a localized mucocutaneous or neural ganglia disease. However, data suggest that subclinical dissemination may be common. Acute HSV infection of genitalia is associated with a mild elevation of aminotransferases in 14% of otherwise healthy adults. Read more »

Infection of ileum mesothelium: Discussion (Part 1)

High power examination of the submucosal ulcer bed delineated rare spindle shaped cells with a ground glass nuclear appearance, circumscribed by a rim of dense chromatin. These cells also had irregular nuclear membranes and were occasionally multinucleated. Similar cytopathic atypia was in the vicinity of the serosa beneath the ulcer. No viral atypia was detected in endothelial cells or mucosal epithelium.

Cells with viral cytopathic effect in the ulcer bed had a HSV type I, HSV type II, vimentin and a focally actin-positive IHC phenotype. Such cells were negative for CMV, CD1a, CD68, CD45, CD20, CD31, S-100 and PGP9.5. Serosal cells with viral inclusions were HSV type I-, HSV type II-and calretinin-positive. These cells were also negative for those antigens that ulcer bed cells failed to react with. Read more »

Infection of ileum mesothelium: Results

Positive HSV sequences are 474 base pairs versus 241 base pairs for VZV . All specimens were also analyzed for genes p27 and p21 to quantitate the DNA and screen for PCR inhibitors.

Real-time (light cycler) PCR used DNA extracted from paraffin blocks according to the QIAamp DNA Mini Kit (Qiagen, Canada) recommendations. Extracted DNA was tested on the LightCycler employing the LightCycler HSV xh Detection Kit (Roche Diagnostics, Canada) and its recommended parameters. Melting curve data were generated and analyzed by the LightCycler software. Read more »

Infection of ileum mesothelium: Methods IHC (Part 2)

hybridizationIn situ hybridization

Dewaxed and dehydrated sections were digested with 100 ^L of pepsin (Carezyme II, Biocare Medical, USA) at 37°C for 5 min. Slides were rinsed in Tris-buffered saline, dehydrated in ethanol and air dried. Ten microlitres to 20 ^L of biotin-labelled HSV type I, HSV type II, CMV and adenovirus probes (ENZOLife Sciences Inc, USA) were placed on slides and cover slipped. The sections with probes were denatured at 95°C for 5 min and the slides incubated at 37°C overnight. Read more »

Infection of ileum mesothelium: Methods IHC (Part 1)

Confirmation of HSV overgrowth at the bowel perforation site (by histology, IHC, ISH and PCR) and in bronchial secretions (direct fluorescence antibody) prompted intravenous acyclovir therapy. She defervesced two days later with improvement of hypoxia and the radiological pulmonary infiltrates. At no time were mucocutaneous vesicles identified in oral, genital or perianal sites. A negative lumbar puncture excluded encephalitis. Serology was negative for HIV and immunoglobulin subsets were normal. She had a complicated course and care was withdrawn 23 days after admission. Read more »

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