[Vesico-cutaneous fistula revealing abdominal wall malakoplakia accompanied by Boeck's sarcoidosis]. / Vesicocutan fistulával járó hasfali malacoplakia Boeck-sarcoidosis mellett.

UNLABELLED: Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is hardly known, but it thought to be secondary to an acquired bactericidal defect in macrophages occurring mostly in immunosuppressed patients. CASE REPORT: 63-year-old female patient had been treated with methylprednisolone for ten years, because of pulmonary sarcoidosis. For six month, recurrent abdominal abscess and vesico-cutaneous fistula developed. Histological examination proved malakoplakia, and Escherichia coli was detected in the abscess cavity. METHODS: Hematoxyline eosin staining, periodic acid-Schiff, Berlin-blue and Kossa reactions were performed. RESULTS: Microscopically malakoplakia consists of mainly macrophages, known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. In our presented case, after urological-surgical intervention and antibiotic therapy, the patient became free from complaints and symptoms. DISCUSSION: Malakoplakia has been described in numerous anatomic locations, mainly in the urogenital tract. Malakoplakia may be complicated with fistulas in different locations: vesico-coccygeal, rectoprostatic, anorectal fistulas have been were reported in the literature, while 6 cases of malakoplakia with Boeck's sarcoidosis are published. CONCLUSION: In the presented case sarcoidosis and the 10-year immunosuppressive treatment with methylprednisolone might have been in the background of abdominal wall malakoplakia, complicated by vesico-cutaneous fistula. The patient was successfully treated with surgery and the followed antibiotic therapy.

[Late gastrointestinal metastases of invasive lobular breast carcinoma mimicking Crohn's disease]. / Crohn-betegséget utánzó késoi gyomor-bél traktusi metasztázisokat adó invazív lobularis emlocarcinoma.

Invasive lobular carcinoma--comprising approximately 10 percent of breast cancers--is considered to be a histologically, molecular genetically, clinically distinct entity metastasizing mainly the gastrointestinal tract. Gastrointestinal system is much more likely involved in advanced invasive lobular carcinoma, than it is in invasive ductal carcinoma. They manifest after 3-20 years from the recognition of the primary tumor and they appear to be inflammatory disease or a secondary tumor. Here we show the case of a female patient with breast cancer, who died at the age of 53 years. 8 years after tumor-free state upper abdominal spastic pain emerged irradiating into the back with belt-like pattern. Radiologically, Crohn's disease was diagnosed. Ileum biopsy was negative. Patient was treated ex juvantibus with methylprednisolon. In the background of mechanic ileus the resection of the terminal ileum and partly the ascended colon was surgically removed. The patient died in 3 weeks after the operation. Microscopically the thickened wall of the terminal ileum showed diffuse small cell carcinomatous infiltration. Immuno-histochemically the metastatic carcinoma cells were reacting with Breast Carcinoma Antigen (BRCA 1) and CA 15-3. The patient had AB blood group according to her red blood cell phenotype. Lectins and monoclonal antibodies with ABH blood group specificity reacted strongly with the metastatic carcinoma cells.

[Diffuse splenic metastasis of occult breast cancer with incompatible blood group antigenic determinants]. / Occult emlócarcinoma diffúz lépmetastasisa incompatibilis vércsoportantigén-determinánsokkal.

INTRODUCTION: Cancer cells with immunogenic properties having modified blood group substances are widely studied (Kannagi, 1988, Hakomori, 1999). CASE REPORT: A 78-year-old female patient was admitted to the hospital in terminal state with unsusceptible circulatory failure. At autopsy the spleen (weight: 420 g) was extremely firm with diffuse blackberried colored cut surface. There were no signs of carcinomatous process at autopsy. MATERIAL/METHOD: By histology the spleen showed diffuse metastatic carcinomatous infiltration. Antibody to Breast carcinoma antigen (BioGenex) labelled metastatic cells of the spleen and bone marrow. The patient had O blood group according to her blood group phenotype. The authors used lectins with and without blood group antigen (BGA) specificity and monoclonal antibodies, too. RESULTS: They found that the B blood group specific Bandeiraea simplicifolia agglutinin I lectin and the anti-B mab were labelled intensively all the metastatic cells of spleen and bone marrow. The A BGAs (with anti-A mab and Dolichos biflorus agglutinin) were completely negative. CONCLUSIONS: These observations raise the possibility that the detected incompatible B blood group antigen determinants on the metastatic cells were immunogenic. The authors propose, that the survived carcinoma cells found place of refuge from the immune surveillance in the spleen and in the bone marrow, where the complement mediated tumor cell lysis, immune-rejection was not effective.

[Laparoscopic treatment of bile leakage from the Luschka duct after laparoscopic cholecystectomy]. / Luschka-járati epecsorgás laparoszkópos ellátása laparoszkópos cholecystectomia után.

The possible reasons for bile leakage following laparoscopic cholecystectomy are the injury of the common bile duct, the insufficient treatment of cystic duct (non competent or non closing, or spontaneously removing clip, stumpnecrosis due to electrocoagulation near to clipp, rupture adjacent to the clipp) or the opening of an aberrant bile duct. The latter often may occur in case of the anatomic variation described by Hubert von Luschka (1820-1875) a German anatomist as the duct named after Luschka. In a favorable case the accessory bile duct closes by itself, but occasionally developing biloma and/or biliary peritonitis need to be operated on. The authors write about the case of a 52 years old female patient, who underwent laparoscopic cholecystectomy, and 3 days later the complication was averted through the application of relaparoscopy with intracorporal suture. In connection with this case the authors acquaint the readers with the biography, the academic carrier of Hubert von Luschka, and the literature related to Luschka duct is surveyed.

Case report: diffuse splenic metastasis of occult breast cancer with incompatible blood group antigenic determinants.

Cancer cells with immunogenic properties having altered protein glycosilation, modified blood group substances have been widely studied [Kannagi R, Miyake M, Zenita KM, Itai S, Hiraiwa N, Shigeta K, et al. Cancer-associated carbohydrate antigens: modified blood group substances and oncodevelopmental antigens on tumor cells. Gann Monogr Cancer Res 1988; 34: p. 15-28; Hakomori S. Antigen structure and genetic basis of histo-blood groups A, B and O their changes associated with human cancer. Biochem Biophys Acta 1999; 1473: p. 247-266; Brooks SA, Carter TM, Royle L, Harvey DJ, Fry SA, Kinch C, et al. Altered glycosilation of proteins in cancer: what is the potential for new anti-tumour strategies. Anticancer Agents Med Chem 2008; 8: p. 2-21]. In the study reported here, a 78-year-old female patient was admitted to the hospital with circulatory failure. At autopsy, the spleen (weight: 420 g) was extremely firm with a diffusely blackberry-colored cut surface. There were no signs of carcinomatous process at autopsy. By histology, the spleen showed diffuse metastatic carcinomatous infiltration. Using immunohistochemistry, an antibody to breast carcinoma antigen (BioGenex) labelled metastatic cells of the spleen and bone marrow. The patient was blood group O. Labelling for binding of lectins with and without blood group antigen specificity and monoclonal antibodies was carried out. The B blood group specific Banderiaea simplicifolia agglutinin I and an anti-B blood group monoclonal antibody labelled all the metastatic cells of spleen and bone marrow intensely. There was no detection of blood group A antigen by either binding of Dolichos biflorus agglutinin or anti-blood group A monoclonal antibodies. These observations raise the possibility that the detected incompatible B blood group antigen determinants on the metastatic cells were immunogenic. The surviving carcinoma cells may have found a place of refuge from immune surveillance in the spleen and in the bone marrow, where the complement-mediated tumor cell lysis immune rejection was not effective.