Malakoplakia of the large intestine: an incidental extremely rare finding.

Malakoplakia is a rare inflammatory disease, most commonly found in the urinary tract. It appears be related to a functional deficiency of macrophages, resulting in an inability to destroy digested bacteria and it is associated with various conditions that cause immunodeficiency. A rare case of malakoplakia of the colon in a healthy 68-year old male is presented. The patient underwent emergency surgery with colon resection and an end stoma with closure of the distal bowel (Hartmann's procedure), due to incarcerated ventral hernia and sigmoid-colon rupture. He underwent reversal of the Hartmann's procedure four months after the initial operation. The histological examination from the anastomotic rings revealed Michaelis-Gutmann bodies that are pathognomonic of malakoplakia. He received per os ciprofloxacin, bethanecol and ascorbic acid for 12 months. Follow-up endoscopy did not exhibit any signs of the disease. A case of a healthy patient presenting with malakoplakia without any underlying disease that causes immunodeficiency is extremely rare. Treatment of malakoplakia involves the eradication of microorganisms. Cholinergic agonists, such as bethanechol and ascorbic acid, as well as antimicrobial treatment with trimpethoprim/sulphamethoxazol and rifampicin are most commonly being used. Long-term antimicrobial treatment has been reported (6 months to 3 years).

Parietal cell/oncocytic gastric carcinoma: systematic review and first-time assessment of HER2 status in two new cases.

INTRODUCTION: Parietal cell/oncocytic gastric carcinomas are very rare and various aspects of this group remain unclear. The human epithelial growth factor receptor 2 (HER2) status of these tumours is largely unknown. METHODS: We performed a systematic electronic search of the literature and clinicopathological presentation of two cases including first-time complete assessment of HER2 status. Thirty-two patients with a mean age of 64.3 years, 87.5% of whom were male, were included in this review. FINDINGS: Half of the cases were recorded in Asia. Median follow-up was 24 months. There was no predominant site of development, while underlying histological abnormalities were present in 25%. At initial presentation, lymph node involvement was evident in 46.6% while distant metastatic disease was present in 9.3%. Presentation at stage I occurred in 55.6%. Potentially curative surgical/interventional treatment was intended in 90.6%. Recurrence occurred in 6.6%, while death was recorded in 19.2%, with cancer-related deaths reaching 11.5%. The one- and three-year survival rates were 84.2% and 79%, respectively. Our two cases displayed negative HER2 expression. CONCLUSIONS: This systematic review demonstrates that this group of malignancies is very rare but possibly underdiagnosed. The disease commonly presents at early stage, mainly affecting middle-aged men. The prognosis is generally favourable even in cases of advanced disease. The HER2 expression and its correlation with the outcomes need to be further explored.

Prognostic predictors of gastrointestinal stromal tumors: a multi-institutional analysis of 102 patients with definition of a prognostic index.

AIMS: The aim of this study is to identify prognostic factors influencing survival in patients with gastrointestinal stromal tumors (GISTs) and to identify a mathematical model that can predict lifetime expectation. METHODS: One hundred and two patients with GISTs, were followed retrospectively for a median period of 32 months (from 1 to 82 months). Complete follow-up data were available in 72 cases. All tumors were surgically resected and examined by conventional light microscopy, immunohistochemistry and image analysis. The tumors' location, size, histologic characteristics, immunophenotype, proliferative activity index (assessed by proliferating cell nuclear antigen (PCNA) and Ki-67 immunoreactivity) and the apoptotic markers bcl-2 and bax, were considered as potential prognostic factors and were correlated with patient survival. RESULTS: Tumor size >8 cm (p<0.03), presence of necrosis (p<0.02), number of mitoses >5/10 HPF (p<0.01), metastasis (p<0.001), and PCNA index >10% (p<0.004) were significant predictors of poor survival. Bcl-2 protein (p<0.0007) was a favorable prognostic indicator. If all tumors were treated as of uncertain malignant potential, the following mathematic model named GISTs Prognostic Index (GPI), could be formed by the linear regression technique: GPI exp=(49.6 months-Status of metastasis x 22.9185-Size in cm x 0.6801+bcl-2 expression% x 0.2569) (r(2)=0.67) (Prob>F=0.0001). CONCLUSIONS: Tumors' size, necrosis, mitoses, metastasis and PCNA index are independent poor prognosticators, while bcl-2 protein is associated with favorable prognosis. An interesting equation for survival in patient with GISTs has been reported.

Malakoplakia of the testis.

Malakoplakia of the testis presenting as painless enlargement of the testis in an 80-year-old man is described. The literature is reviewed.

Malakoplakia of the testis. Case report.

Malakoplakia of the testis presenting as painless enlargement of the testis in an 80-year-old man is described. The literature is reviewed.

Carcinosarcoma of the bladder.

We present a case of carcinosarcoma of the bladder, the first in our experience. This tumour is generally considered to be a rare one, has uncertain aetiology and poor prognosis. At present, radical cystectomy is the treatment of choice.

A case of epidermoid cyst of the testis role of conservative surgery.

We report one case of an epidermoid cyst of the testis in a 15 year-old boy. Pre-operative testicular ultrasound may help to establish the diagnosis without resorting to orchiectomy. In such a selected case local excision alone should be considered adequate without violating accepted surgical principles.

Primary transitional cell carcinoma of anterior male urethra: a rare case.

We report a rare case of primary transitional cell carcinoma in a man aged 56 years old. Approximately 600 cases of primary carcinoma of the male urethra have been accumulated until today (1). The 30 to 50 per cent of these neoplasms originate in the anterior urethra and only the 15 per cent are of the transitional cell type (2).

Renal cell carcinoma presenting as a large abdominal mass with an extensive peritoneal metastasis.

We report a case of renal cell carcinoma with an extensive intraperitoneal metastasis at the time of diagnosis. This type of metastasis is very rare for renal cell carcinoma and is identified in only 1% of the metastases at autopsy. The findings of computed tomography are presented.

Malignant schwannoma of the adrenals. A rare case.

This a rare case of malignant adrenal schwannoma in a woman aged 38 years old without family history of neurofibromatosis. A diagnosis is impossible before surgery.

Differences in manometry and 24-H ambulatory pH-metry between patients with and without endoscopic or histological esophagitis in gastroesophageal reflux disease.

UNLABELLED: In this study, our objective was to examine prospectively, by endoscopy and histology of the esophageal mucosa, the severity of reflux esophagitis and any possible correlation between endoscopic and histological findings on the one hand, and manometric and 24-h ambulatory pH-metry measurements on the other. Forty-two patients with gastroesophageal reflux were prospectively examined. The results were compared with those of 18 healthy controls. Methods used were: 1) upper alimentary endoscopy and grading of severity of esophagitis, 2) esophageal mucosa biopsies, to estimate severity of esophagitis on histology, 3) standard esophageal manometry, by using a water perfused catheter with four side holes, and 4) standard 24-h ambulatory esophageal pH-metry. RESULTS: The severity of esophagitis as determined by both endoscopy and histology was significantly inversely related to the amplitude (p < 0.001) and duration (p < 0.01) of esophageal peristalsis at 5 cm proximal to LES; it was significantly related to the pH-metry total composite score (p < 0.001 for endoscopy, p < 0.05-0.01 for histology), the total reflux time (p < 0.001 for endoscopy, p < 0.01 for histology), the duration of longest reflux episode (p < 0.001 for endoscopy, p < 0.01 for histology), the number of reflux episodes lasting more than 5 min (p < 0.05 for endoscopy), and the frequency-duration index of reflux episodes (p < 0.001 for endoscopy, p < 0.01 for histology). Furthermore, strength reduction of peristalsis (< 60 mm Hg x s) was associated with acid exposure greater than 40%, in esophagitis patients. We conclude that the severity of reflux esophagitis, not only through endoscopy but also histologically, is related to the amount of reflux, as expressed by the duration and frequency of the reflux episodes. A very high amount of reflux is in turn associated with impairment of the esophageal body motility, as expressed by the amplitude and strength of esophageal body peristalsis.

Reconstructing and predicting the hepatitis C virus epidemic in Greece: increasing trends of cirrhosis and hepatocellular carcinoma despite the decline in incidence of HCV infection.

In this study, a comprehensive methodology for modelling the hepatitis C virus (HCV) epidemic is proposed to predict the future disease burden and assess whether the recent decline in the incidence of HCV may affect the future occurrence of cirrhosis and hepatocellular carcinoma (HCC) cases. Using the prevalence of HCV, the distribution of chronic hepatitis C (CHC) patients within the various transmission groups and their infection-onset times, it was possible to reconstruct the incident infections per year in the past that progressed to CHC in Greece. The natural history of the disease was simulated in subcohorts of newly infected subjects using transition probabilities derived either empirically between fibrosis stages 0-4 or from literature review. Annual estimates of the incidence and prevalence of CHC by fibrosis stage, HCC and mortality in Greece were obtained up to 2030. HCV incidence peaked in the late 1980s at five new infections/10,000 person-years. Under the assumption of 20-100% decline in HCV incidence after 1990, the cumulative number of incident cirrhosis and HCC cases from 2002-2030 was projected to be lower by 9.6-48.2% and 5.9-29.5%, respectively, than that estimated under the assumption of no decline. However, the prevalent cirrhotic/HCC cases and HCV-related deaths are predicted to decline in the next 30 years only under the assumption of complete elimination of new HCV infections after 1990. Despite the progress in the reduction of HCV transmission, primary prevention does not seem adequate to reverse the rise in the incidence of cirrhosis and HCC.

Pathological prognostic factors in the second British Stomach Cancer Group trial of adjuvant therapy in resectable gastric cancer.

The second British Stomach Cancer Group trial was a prospective randomised controlled trial of adjuvant radiotherapy or cytotoxic chemotherapy after gastrectomy for adenocarcinoma. It recruited between 1981 and 1986. No survival advantage has been demonstrated for the patients receiving either type of adjuvant therapy compared with those undergoing surgery alone. We report on 436 patients randomised into the trial together with 203 patients, who did not fulfil the trial criteria, referred to the trial. A univariate (log-rank) analysis of pathological factors obtained from the local referring centres showed that tumour size, macroscopic type, number os sites involved, depth of invasion, involvement of resection lines and lymph nodes and histological grade were significant determinants of survival. Histological review by two experienced histopathologists found that the Lauren classification and histological grade, but not the Ming classification, were significant prognostic factors. The degree of lymphocytic and eosinophilic infiltration and presence of dysplasia assessed by one of the pathologists showed a significant correlation with survival. However, inter-observer correlation for these histological parameters and grade was poor. Multivariate analysis identified only depth of invasion, resection line and nodal involvement as significant independent pathological variables influencing survival. This study confirms the need for expert preparation of the resected specimen to obtain the important information on depth of invasion and nodal status and also reveals some variation in histological assessment, particularly grading, in gastric carcinoma.