Regression of steatohepatitis-related cirrhosis.

The authors document regression of cirrhosis in an obese 56-year-old man after significant weight loss by sequential liver biopsies. The patient had a known history of steatohepatitis. His initial laboratory workup 6 years earlier revealed elevated liver enzyme activities and blood triglyceride levels, and negative viral hepatitis serology screen. A liver biopsy at that time showed histological features consistent with precirrhotic stage of active steatohepatitis. A liver biopsy performed 4 years later revealed progression of the disease to cirrhosis. Following this diagnosis he went on a special strict diet and lost 49 kg. His body mass index decreased from 46 to 28 during a 2-year period and his liver enzyme activities returned to normal. A liver biopsy at this time demonstrated significant regression of the liver fibrosis and disappearance of the steatosis and necroinflammation. In conclusion, massive weight loss resulted in resolution of liver fibrosis in this obese patient with steatohepatitis-related cirrhosis.

The role of H. pylori in the development of laryngeal squamous cell carcinoma.

AIM: This study aims to investigate the possible role of H. pylori as a cause of laryngeal squamous cell carcinoma. METHOD: This controlled study was performed with 31 consecutive laryngeal cancer and 28 cancer-free patients who underwent direct laryngoscopy and biopsy of laryngeal lesions. To document the previous H. pylori infection, serological analysis of the antibody titers was done. Immunohistochemical analyses were applied to the tissue samples. RESULTS: Serology was found positive at the 90.3% of the laryngeal cancer patients and 96.4% of the benign group. There were no statistically significant differences between the two groups (P > 0.05). Immunohistochemical analysis results were determined as negative at all of the specimens of laryngeal cancer patients and patients with benign lesions. CONCLUSION: There were no signs of colonization of H. pylori in laryngeal tissues of both groups' patients. It is thought that no relationship exists between the H. pylori infection and laryngeal squamous cell carcinoma.

Hashimoto thyroiditis associated with ataxia telangiectasia.

Ataxia telangiectasia is a rare genetic disease characterized by neurological manifestations, infections, and cancers. In addition to these cardinal features, different autoimmune diseases can be seen in patients with ataxia telangiectasia. Although there were reports of positive autoimmune thyroid antibodies associated with ataxia telangiectasia, to our knowledge, we report the first cases of nodular Hashimoto thyroiditis in two patients with ataxia telangiectasia in the English medical literature. These cases illustrate that despite the rarity of nodular Hashimoto thyroiditis associated with ataxia telangiectasia, physicians should be aware of this possibility. Furthermore, thyroid examination of patient with ataxia telangiectasia is recommended for early diagnosis.

[Retrospective evaluation of the alveolar echinococcosis cases between 1980-2010 in Erciyes University Hospital]. / Erciyes Üniversitesi Hastanesinde 1980-2010 Yillari Arasinda Alveoler Ekinokokkozis Saptanan Olgularin Retrospektif Degerlendirilmesi.

OBJECTIVE: Alveolar echinococcosis is an uncommon parasitic disesae confined to the Northern Hemisphere. There is limited data regarding the incidence of the disease in Kayseri. METHODS: Clinicopathologic features of the cases with the diagnosis of alveolar echinococcosis reviewed between 1980-2010. RESULTS: Twenty-nine cases of alveolar echinococcosis were found. There were no significant distribution differences during the study period. 28 of the 29 cases were localised in the liver, whereas one case was localised in the omentum. Sixteen of the 29 cases were male (55%) and 13 were female (45%). The age distribution of these cases varied between 33 and 80. Thirteen cases resided in Kayseri, 2 cases resided in Erzurum, 1 each case resided in Adana, Ardahan, Kars, Nigde, Nevsehir and Yozgat. We could not obtain information from the remaining 8 cases. Abdominal pain was the main symptom in 8 cases, jaundice in 2 cases and fatigue and fever in one case on admission. One case was detected incidentally. All of the cases were diagnosed by histologic examination. CONCLUSION: The data about the alveolar echinococcosis is limited due to its low prevelance. Alveolar echinococcosis cases were detected in Kayseri with a lower incidence than in the East Anatolian region. This report will add data about the incidence of the alveolar echinococcosis.

Primary hepatic carcinosarcoma.

BACKGROUND: Primary hepatic carcinosarcoma is a rare malignant tumor containing an intimate mixture of carcinomatous and sarcomatous elements. Reports on risk factors, epidemiology, and pathogenesis of the tumor as well as the experience in its treatment are limited. METHOD: We present a case of primary carcinosarcoma of the liver in a 69-year-old man who complained of right hypochondrial pain and weight loss for two months. RESULTS: Magnetic resonance imaging revealed a 14 x 12 cm mass in segments 7-8 and 4 of the liver with vena hepatica invasion. An ultrasonography-guided biopsy showed osteoid tissue without osteoblastic rimming. Vascular structures accompanied the osteoid tissue. The patient underwent surgery after a diagnosis of hemangioma. Intraoperative frozen sections revealed a carcinosarcoma associated with an osteosarcoma and cholangiocellular carcinoma components. CONCLUSIONS: Preoperative diagnosis of this rare primary hepatic malignant tumor may be difficult by biopsy owing to intratumoral heterogeneity. Highly mature areas of the osteosarcomatous component may lead to misdiagnosis of metaplastic bone tissue. Clinicopathologic features of this rare entity are discussed.

Lupus nephritis in a child with type I diabetes mellitus.

Patients with type 1 diabetes (T1D) are at increased risk for developing other autoimmune diseases, most commonly autoimmune thyroiditis and celiac disease. Few reports have described the association of systemic lupus erythematosus and T1D in the literature. To the best of our knowledge, this is the first report of lupus nephritis in a child with T1D.

Recurrent pulmonary alveolar proteinosis secondary to agammaglobulinemia.

Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of surfactant derived material in the lung of patients. PAP is rare in children. The patient presented with respiratory failure. In the history she was diagnosed with agammaglobulinemia at 8 months of age and has been treated by IVIG once in a month. She had two pulmonary alveolary proteinosis attacks before. Chest X-ray showed bilateral diffuse infiltrates. Initial diagnosis were pneumonia, ARDS, and lung edema. Whole-lung lavage revealed lipoproteinaceous material similar to surfactant. This findings and high level of LDH was as evaluated pulmonary alveolary proteinosis. She discharged from the hospital without any respiratory complication on the ninth day. This is the first case report recurrent PAP associated with agammaglobulinemia.

Plasma cell granuloma of the thyroid.

We report two cases of thyroidal plasma cell granuloma. Both patients underwent surgical resection after presenting with painless neck swelling. Histopathologic examination of the specimens revealed plasmacytes infiltrating the thyroid parenchyma and immunohistochemical studies showed the polyclonal nature of the plasma cells. Plasma cell granuloma is a benign lesion and its appearance in the thyroid gland is extremely rare. Eleven prior cases with thyroid localization have been reported to date in the English literature. Nine of the plasma cell granuloma cases occurred in women, four in men (including the present cases). The clinicopathologic features and diagnostic difficulties of this rare entity are described, and its relation to inflammatory pseudotumor of other sites is discussed with a review of the literature.

Significance of intraepithelial lymphocytes in appendix.

The aim of this study was to investigate the importance of the increase in intraepithelial lymphocytes (IELs) in the mucosa of the appendix. One hundred and four retrospective appendectomy specimens were examined to evaluate the IELs. Intraepithelial lymphocytosis was identified in 11.5% (12 cases) of the specimens. Of these 12 cases, 6 cases with intraepithelial lymphocytosis were associated with parasitic infection. No increase in IELs was found in the 36 appendices that were removed in other primary operations. A wide range of immunologic stimuli can raise IELs in the gastrointestinal system. However, in appendectomies with clinical signs of acute appendicitis, an increase in IELs is more likely to be related to parasitic infection. This increase should be considered for the diagnosis of parasitic infections.

Is there an oxidative stress in children with Helicobacter pylori infection?

OBJECTIVE: To investigate the status of oxidative stress in children with Helicobacter pylori (HP) infection and their relationship with inflammatory parameters. METHODS: At the Pediatric Gastroenterology Department of Erciyes University, Kayseri, Turkey, between January 2004 to August 2005, 39 children undergoing upper gastrointestinal endoscopy were investigated for malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity in gastric tissue and erythrocytes, and presence of HP infection by means of histology. RESULTS: There is an increase of the oxidative stress parameter, MDA, in gastric tissue, but not in erythrocytes in HP (+) patients. The antioxidant enzyme, SOD, levels both in gastric tissue and erythrocytes were not different between HP (+) and HP (-) patients. In 8 HP infected children after treatment with an anti-HP regimen, no change was observed except for tissue SOD activity, which is increased after therapy. No correlation was observed between histological findings and tissue, and erythrocyte MDA levels and SOD activities. CONCLUSION: Oxidative stress has some role in tissue damage in HP infection in children.

A case of Langerhans cell histiocytosis presented with pneumothorax.

Pneumothorax (PTX) is an unusual complication of Langerhans cell histiocytosis (LCH) in childhood. Spontaneous PTX is rare in childhood, and it is very rare in infancy. There are no specific recommendations for the treatment of PTX from LCH described in the literature. We are presenting a 19-month-old boy, who suddenly developed left-sided PTX with infiltrations in both lungs. He presented with PTX and skin lesions. He had a prolonged cardiac arrest, and although resuscitation was successful he required continuing ventilatory support (intermittent positive-pressure ventilation). Because he suddenly developed right-sided PTX and died on the second day of the admission, his LCH diagnosis was made only postmortem. So, he did not receive chemotherapy. It is likely that intermittent positive-pressure ventilation during the operation induced the development of much more multiple lung bullae, which subsequently ruptured, and/or it facilitated the development of the right-sided PTX. The patients with PTX and skin lesions, including babies, most likely have LCH and specific chemotherapy should be started in emergency, even before the final diagnosis is achieved.

Localized gastric amyloidosis: a case report.

Local deposition of amyloid without systemic involvement is rather uncommon and has been found in many organs. A 67-year- old man was admitted to our hospital presenting with weight loss, fatigue and poor appetite. Blood work and bone marrow examination revealed megaloblastic anemia. Upper gastrointestinal endoscopy reveeled e purple polypoid wass lesion of 5mm eliameter in the paracardiac region. Histopathologic examination of the gastric biopsy showed the deposition of amyloid materials in the mucosa. The patient had no evidence suggesting systemic amyloidosis. We report a rare case of localized amyloidosis of the stomach. The clinical and pathological features of this rare condition and association with megaloblastic anemia are discussed.

The prevalence of unrecognized adult celiac disease in Central Anatolia.

BACKGROUND: The aim of this study is to assess the prevalence of unrecognized adult celiac disease in Central Anatolia of Turkey and establish if prevalence figures are similar to other reports in the international literature. METHODS: Subjects were randomly selected from patients at the time of blood sampling because of a routine examination or suspicion of some disorder other than celiac diseases and were screened with anti-tissue transglutaminase IgA and serum IgA measurements. Duodenal biopsies were taken from the patients who were found positive for anti-tissue transglutaminase IgA and had low IgA levels. RESULTS: A total of 906 subjects between 20 and 59 years of age were included. Small bowel biopsies were performed for 55 of the 906 participants. Fifty-two of 55 participants taken biopsies had anti-tissue transglutaminase IgA levels greater than 15 IU/mL and 3 of them had low IgA levels. Celiac disease was diagnosed as 9 of 906 (0.99%). The majority of the patients with celiac disease had nonspecific gastrointestinal symptoms. There was no correlation between the titers of anti-tissue transglutaminase IgA and the severity of histopathologic findings. CONCLUSIONS: In this study, we found that unrecognized adult celiac disease in Central Anatolia affects approximately 1% of the population, and the major constellation of symptoms are nonspecific gastrointestinal related. Serologic data are not adequate for a definite diagnosis, but the anti-tissue transglutaminase IgA test has high diagnostic value and may be used as screening tool. Confirmation with intestinal biopsy is required for a definite diagnosis.

Portal vein resection for a portal vein thrombus caused by nonfunctioning islet cell carcinoma: report of a case.

We report a case of nonfunctioning islet cell carcinoma of the pancreas causing a tumor thrombus in the portal vein. The patient was a 60-year-old woman whose presenting symptoms were abdominal pain, vomiting, and weight loss. We performed a subtotal pancreatectomy and splenectomy combined with partial resection of the portal vein. Histopathological studies confirmed the diagnosis of nonfunctioning islet cell carcinoma of the pancreas with a tumor thrombus in the portal vein. The patient's postoperative course was uneventful and she is doing well 25 months after the operation.

Spontaneous bacterial peritonitis due to Brucella infection.

Brucella infection is a systemic disease, but the microorganism rarely causes infections in the gastrointestinal system such as hepatitis, cholecystitis, colitis and pancreatitis. Spontaneous bacterial peritonitis due to Brucella is extremely rare. Herein, we report a case of cirrhosis complicated with nongranulomatous hepatitis and peritonitis, both due to Brucella. A 63 year-old man with diabetes mellitus was admitted to hospital with complaints of weakness, backache, abdominal pain and abdominal swelling. On the basis of physical examination and laboratory findings, cryptogenic cirrhosis and spontaneous bacterial peritonitis were diagnosed. Due to persistent fever and backache, serum Brucella agglutination test was performed and found to be positive. Brucella melitensis was isolated from ascitic fluid culture. Liver biopsy findings revealed cirrhosis and a nongranulomatous hepatitis which was thought might be due to Brucella infection. Doxycycline and rifampicin, in addition to diuretics were administered for spontaneous ascites infection due to Brucella. A week later, the patient's condition improved and he became afebrile. After two months of therapy, the ascites had almost disappeared.

Hydatic cyst in the thyroid gland diagnosed by fine-needle aspiration biopsy.

A 33-year-old man was admitted with a swelling in the right lobe of the thyroid gland of 1 years duration. Laboratory investigations and thyroid function tests were normal. Thyroid scanning showed a cold nodule in the lower pole of the right thyroid lobe. Thyroid ultrasonography showed multiple cystic nodules in the thyroid gland. To make a differential diagnosis of the thyroid nodule, fine-needle aspiration biopsy (FNAB) was performed and hydatic cyst of the thyroid gland was diagnosed. Subtotal thyroidectomy was carried out and histopathologic examination confirmed the diagnosis. During aspiration biopsy, the patient did not present a clinical picture of anaphylactic reaction. To our knowledge, this is the first case of thyroid hydatic cyst diagnosed by FNAB reported in the literature.

Adrenocortical adenoma associated with inadequately treated congenital adrenal hyperplasia.

We report a 6 year-old boy with the simple virilizing form of 21-hydroxylase deficiency in whom an adrenal adenoma developed following 5 years of steroid treatment. Extremely high levels of basal serum 17alpha-hydroxyprogesterone as well as an exaggerated response of 17alpha-hydroxyprogesterone to adrenocorticotropic hormone confirmed congenital adrenal hyperplasia at 7 years of age. Initially elevated serum steroid levels were restrained by high dose hydrocortisone therapy, but he chronically tended to take inadequate doses of glucocorticoid. At 12 years of age an adenoma was found in the cortex of the hyperplastic right adrenal gland. The importance of early diagnosis and compliance with medication in the simple virilizing form of 21-hydroxylase deficiency is stressed.