Alpha-fetoprotein producing gastric cancer with divergent differentiation: Report of a rare case with review of literature.

ABSTRACT: Alpha-fetoprotein-producing gastric cancer is a rare variant of gastric adenocarcinoma. This tumor is likely to be misdiagnosed, particularly in patients with liver metastasis. This rare subgroup of gastric carcinoma may show divergent differentiation on histology and may pose a diagnostic challenge to the pathologist. They have an aggressive course with a dismal prognosis.

Is Indian childhood cirrhosis an extinct disease now?--An observational study.

OBJECTIVE: Indian childhood cirrhosis (ICC), an unique liver disease that has been endemic in most parts of India and advocated by some to be caused by hepatotoxic effect of excess dietary copper is generally believed now to have virtually disappeared from the country. In the face of this the authors report here five cases of ICC encountered in one children hospital over the last 10 y period. METHODS: Cases histologically categorized as ICC were initially picked up from the records of the department of Pathology. Their clinical, investigational and follow up information retrieved from hospital data base along with pathologic features of liver biopsies were reviewed in detail. RESULTS: The age range of the three male and two female children were from 1 ½ to 12 y and on clinical and investigational features all 5 cases were labeled as non-Wilsonian liver disease of uncertain etiology. Histopathologic findings in each case however, was characteristic of accepted established phase of ICC. Three of the five children died in hospital while the other two left the hospital and were lost to follow up. None of the children had exposure to excess dietary copper. CONCLUSIONS: Cases of ICC continue to occur in Andhra Pradesh and very likely in other parts of India. Established and non-typical cases are possibly being missed because of no histologic confirmation and unawareness of the protean manifestation and natural history of this disease. Dietary copper overload is unlikely to play a causal role in ICC.

Unsuspected invasive neonatal gastrointestinal mucormycosis: A clinicopathological study of six cases from a tertiary care hospital.

AIM: To analyse the clinicopathological features of neonatal mucormycosis MATERIALS AND METHODS: Retrospective analysis of cases of neonatal gastrointestinal mucormycosis. RESULTS: THERE WERE SIX NEONATES WITH MALE: female ratio of 1:1. Except one all were preterm babies. The clinical presentation was abdominal distension in the majority. All were clinically diagnosed as either NEC or toxic megacolon with perforation. Neonatal gastrointestinal mucormycosis was not suspected clinically in any. All the children were explored immediately. Biopsy revealed transmural hemorrhagic necrosis/infarction of the intestinal wall with fungal hyphae. CONCLUSIONS: The physicians should have a high index of suspicion for gastrointestinal tract mucormycosis in neonates with metabolic disturbances who present with abdominal distension and pneumoperitoneum. Early diagnosis and aggressive medical and surgical treatment may improve the outcome of neonates with this potentially lethal invasive disease.

Adherent Escherichia coli in colorectal mucosal biopsies: a histological and ultrastructural evaluation.

BACKGROUND: Colorectal mucosal biopsies occasionally demonstrate the presence of bacteria adherent to the epithelium. This study evaluated the histological and ultrastructural correlates of such bacterial adherence. MATERIALS AND METHODS: Rectal mucosal biopsies from eight patients in whom histopathological examination of biopsies had earlier demonstrated adherent bacteria were examined by electron microscopy and by bacterial culture. Colorectal biopsies of 69 patients with adherent bacteria detected histologically were retrospectively evaluated for histological changes at sites proximal and distant to adherent bacteria. RESULTS: Escherichia coli of different serogroups were isolated from 7 of 8 rectal biopsies demonstrating bacterial adherence. All isolates showed diffuse or focal adherence to HEp-2 cell monolayers. Ultrastructural changes noted included microvillus damage, pedestal formation, actin web condensation, and protrusions of the apical cytoplasm of epithelial cells into the lumen towards the bacteria. Histological changes noted at light microscopy included reduction in epithelial cell height, focal epithelial cell degeneration, cryptitis and neutrophil infiltration at sites of bacterial adherence whereas these were usually absent at sites distant to adherent bacteria. Bacterial adherence was noted more often in biopsies from Crohn's disease patients than in patients without this diagnosis (P<0.001). CONCLUSION: Adherent Escherichia coli in colorectal biopsies were associated with focal epithelial damage and showed an association with Crohn's disease.