[The histopathology of chronic viral hepatitis].
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Biopsy↗
Biomedical subjects
M L Caruso
Publications and source records attributed to M L Caruso.
Carcinoma and synchronous hyperplastic polyps of the large bowel.
The prognostic and biological meaning of the association of colonic cancer with hyperplastic polyps (HP) is not as well known as that with adenomatous polyps (AP). In order to gain some insights into this matter, we have retrospectively studied two hundred and twelve patients with colon-rectal carcinoma in which 64 (30.18%) had synchronous AP, 24 (11.32%) had synchronous HP, 13 (6.13%) had both AP and HP and 111 had no synchronous polyps (52.36%). The 34 cases of synchronous HP, whether or not associated with AP, were located in the same colonic segments of the cancer and were found usually in the sigmoid-rectum. The AP were found throughout the colon-rectum with a similar rate of association with the cancer in each segment. The cancer associated with HP have a higher prevalence in the better prognostic stages of both Dukes and Jass-Morson systems. Conversely both AP and AP+HP associated cancers exhibit prevalences rates higher in the worst prognostic stages. Our observations suggest that separate factors might promote the growth of HP and AP and that a relationship between colonic cancer and synchronous HP might exist and differ from that demonstrated for AP and colonic cancer.
Adenomatous Polyps↗
[DNA content in colorectal carcinomas: application of image analysis to archival material].
The most studied biological parameter of human tumours is the DNA nuclear content. In the present study we assessed the DNA content of 197 colorectal cancers from 180 patients using archival material (tissues routinely processed and paraffin-embedded) for image analysis. The metastatic lymph nodes were also included in the study in 54 Dukes "C" stage cases and 19/25 Dukes "D" stage cases. A total of 452 sections, 5 mu thick, were submitted to image analysis in static cytometry. DNA diploid pattern was found in 72/452 samples (15.9%) and the DNA-aneuploid pattern in 380/452 (84.1%). Two different areas for each tumour were examined but we found a concordance of diploid pattern in only 23 cases. DNA-aneuploidy, regarded as presence of at least one sample with an aneuploid peak in the same tumour, reached 88% in our study. In conclusion the image analysis of several samples obtained from different areas of the same tumour clearly revealed: a pronounced heterogeneity of ploidy patterns in colon cancer; an overall prevalence of DNA-aneuploidy in colon cancer; a prevalence of diploid pattern in tumours localized in right portion of the colon and in younger patients.
Adenocarcinoma↗
[Granulomatous hepatitis in a hospital population in southern Italy].
In a southern Italy hospital, in five years 1523 liver biopsy specimens have been performed and histologically examined. Granulomas are found in specimens from 15 patient (1%). They are seven females and eight males with an average age of 57 years (range 43-71). Seven of the 15 specimens are Menghini-type percutaneous needle, five are surgical and three are laparoscopic bioptic specimens. Four patients are correlated with infectious diseases: 2 with hepatitis C virus (HCV), 1 with hepatitis B virus (HBV) and 1 with Mycobacterium Tuberculosis. In three patients the diagnosis is primary biliary cirrhosis (PBC), in two sarcoidosis, in other two pseudosarcoid reaction to abdominal tumours (a gall-bladder cancer and a non-Hodgkin lymphoma of the stomach). Finally there are 2 lipogranulomas, 1 foreign-body granuloma and 1 cholesterin granuloma. This work underlines the high prevalence in our series of PBC and sarcoidosis in the etiology of hepatic granulomas and the high frequency of patients with markers of HCV or HBV in granulomatous hepatitis.
Adult↗
Can peanut agglutinin distinguish between pseudo and true invasion in colonic adenomas?
We verified the binding of peanut agglutinin (PNA) in 28 pedunculated adenomas (10 with pseudo and 18 with true invasion, respectively) of the large bowel. The distribution of glycoproteins was assessed in the normal mucosa of the stalk, in the surface dysplastic mucosa and in the mucosa of the pseudo-invasion or cancerization areas. The aims of the study were to verify: the PNA role in the differential diagnosis between pseudo and true invasion; the changes in PNA binding during transformation of mucosa from the normal to dysplastic and neoplastic status; the PNA ability as a predictive marker in the neoplastic transformation. The total percentage of PNA positivity in our samples was not significatively higher in carcinomatous than in pseudoinvasive areas (83.3% vs 50%). But the analysis of semiquantitative expression of PNA binding showed that an analogous, or reduced expression of marker in the epithelium in the submucosa compared to the dysplastic surface was consistent with the diagnosis of pseudoinvasion, while its increase strengthened the diagnosis of true invasion. In addition, we found a progressive increase of expression of PNA from the normal to dysplastic and neoplastic mucosa; therefore our data confirmed the quantitative relationship of this marker with malignant transformation. Finally, when we compared the expression of the PNA binding in solely superficial adenomatous tissue of benign and malignant polyps, we found an equal percentage of positive cases (66.6% in the carcinomatous vs 70% in the benign adenomas). Therefore, PNA does not recognize the risk of actual malignant evolution in an adenoma but is indicative of carcinomatous transformation when it is strongly positive.
Adenoma↗
Primary Hodgkin's disease of the stomach. A case report.
Primary gastric Hodgkin's disease is rare and has been reported in only 2% of patients with primary gastric lymphomas. Its existence is quite controversial, and new immunohistochemical techniques and flow cytometry have reduced the frequency of diagnosis of this pathology. The authors describe a case of primary gastric Hodgkin's disease in a 61-year-old woman.
Female↗
A prospective study on duodenogastric reflux and on histological changes in gastric mucosa after cholecystectomy.
The authors carried out a prospective study to evaluate variations with time in postcholecystectomy duodenogastric reflux (expressed as "fasting bile reflux" in mumol/h) and in gastric mucosal damage. Ten patients underwent (before cholecystectomy, 6 months after surgery and after a median period of 4 years from surgery) a gastric drainage to assess total (enzymatic method) and single (high performance liquid chromatography) intragastric bile acids, and a gastroscopy with biopsies of the antrum and gastric body to assess histological damage to the mucosa. The results showed that there was a progressive increase in the fasting bile reflux of total bile acids with time (precholecystectomy median value 0.295 mumol/h; 6 months control median value 12.045 mumol/h; late control medial value 19.9 mumol/h; Friedman test, P = 0.0022). Examination of the gastric mucosa at the three moments of the study showed that histological damage worsened progressively. In fact chronic atrophic gastritis of the antrum was present in 10 percent of cases before surgery and in 50 percent 4 years after, and the prevalence of chronic superficial gastritis of the body progressed from 0 to 40 percent. Studies on larger groups of patients are necessary to evaluate whether these two phenomena are correlated.
Adult↗
In vitro gallbladder motility in patients with radiolucent and radiopaque stones.
Twenty-five gallbladders were studied in vitro. Sixteen had radiolucent gallstones and 9 had radiopaque gallstones. The radiolucent gallstones had a cholesterol content of 94.17 +/- 3.76% and the radiopaque gallstones had a cholesterol content of 56.6 +/- 4.46%. Half the maximal response (ED50) to cholecystokinin octapeptide (CCK-OP) and to carbachol in strips from patients with radiolucent gallstones was 0.8 +/- 0.15 and 27.01 +/- 3.74 x 10(-7) M, respectively. In strips from patients with radiopaque gallstones, the ED50 was 0.4 +/- 0.08 and 14.92 +/- 3.07 x 10(-7) M, respectively. The ED50 values to CCK-OP and carbachol were greater in strips from specimens with radiolucent gallstones than in strips from specimens with radiopaque gallstones (p less than 0.05). There was no significant difference in the maximal contractile response of the two groups. It can be concluded that gallbladder sensitivity to CCK-OP and carbachol can be modified in relation to differences in the cholesterol and calcium content of the stones.
Adult↗
Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty.
Sixteen patients who had undergone cholecystectomy plus sphincteroplasty, 14 cholecystectomized patients and ten control patients were studied to evaluate whether differences existed in duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa. Duodenogastric bile reflux during fasting was evaluated by measuring the concentration of total bile acids (by an enzymatic method) and single bile acids in the gastric juice by high performance liquid chromatography. The damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach. There was a statistically significant difference in fasting bile reflux between the three groups (Kruskal-Wallis test, P less than 0.001), and the group that underwent cholecystectomy plus sphincteroplasty had a significantly higher median value than the cholecystectomized group (P less than 0.05) and the control group (P less than 0.01). The distribution of chronic antral atrophic and superficial gastritis was different in the three groups (chi 2 test, P less than 0.005). Chronic atrophic gastritis was associated with cholecystectomy plus sphincteroplasty (P less than 0.01), while chronic superficial gastritis was more frequent in cholecystectomized patients. These results suggest that there may be more duodenogastric reflux after cholecystectomy plus sphincteroplasty than after cholecystectomy alone, and that there may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage.
Adult↗
Duodenogastric reflux of bile acids, gastrin and parietal cells, and gastric acid secretion before and 6 months after cholecystectomy.
In order to evaluate the effect of cholecystectomy on the gastric mucosa, the duodenogastric reflux of total and single bile acids, the number of parietal and gastrin cells, and the volume of gastric acid secretion were examined in 15 patients with gallstones and functioning gallbladders before and 6 months after cholecystectomy. The duodenogastric reflux of the total bile acids increased from a mean preoperative value of 1.9 mumol/hour to a mean postoperative value of 21 mumol/hour (p = 0.008). The duodenogastric reflux of all single bile acids increased after cholecystectomy, with a higher increase in glycoconjugated compared with tauroconjugated bile acids. The parietal cells decreased from a mean preoperative value of 82.8 to a mean postoperative value of 68.7 (p = 0.05), whereas there was only a mild increase in the number of gastrin cells; the output of gastric acid remained unchanged. The variation of the gastrin cells before and after cholecystectomy was negatively correlated only with the variation of taurocholic acid (r = -0.50, p = 0.05), while the variation of the parietal cells was mildly correlated with all single bile acids (r = 0.35-0.50, 0.05 less than p less than 0.02). These findings show an increased duodenogastric reflux of bile acids 6 months after cholecystectomy with a mild morphologic alteration of the gastric mucosa.
Adult↗
Cancer family syndrome: cytogenetic investigations, in vitro tetraploidy, and biomarker studies in a large family.
Fifty-five members of a family with the cancer family syndrome (CFS) were investigated for the following potential biomarkers for cancer proneness: (1) cytogenetics of peripheral blood lymphocytes and skin fibroblasts; (2) in vitro tetraploidy of dermal fibroblast monolayer cultures; (3) quantitative serum immunoglobulin determinations; (4) study of genetic linkage with respect to eight blood group markers including Kidd. Biological specimens were obtained from 14 patients affected with cancer, 21 subjects at risk, and 20 healthy subjects. None of the markers tested in this family, in order to identify a biomarker for the status of CFS gene carrier, was found to be useful. Our search for linkage to other biological markers (DNA RFLPs and NK cells) is in progress.
Adult↗
Sex steroid hormone receptors and human gallbladder motility in vitro.
This study was designed to investigate the relationship between estrogen and progesterone receptor levels and in vitro contractile response of gallbladder muscle strips to stimulation by carbachol and cholecystokinin-octapeptide (CCK-OP). Seventeen female postmenopausal patients cholecystectomized for gallstones were studied. Samples of the gallbladder wall were used for histological examination; motility was studied by Keane et al. [Surg Gynecol Obstet 1986; 163:555-560]; the estrogen and progesterone receptor levels were evaluated by immunoenzymatic assay. Positive correlations were found between the progesterone receptor level and the carbachol concentration that produced half the maximal response (ED50), and between the estrogen receptor level and the ED50 of CCK-OP. Our data confirm the presence of estrogen and progesterone receptors in the gallbladder and suggest that sex steroid hormones act on gallbladder motility by modulating the affinity of gallbladder receptors to CCK-OP and carbachol.
Carbachol↗
Histological identification of Helicobacter pylori in early and advanced gastric cancer.
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Aged↗
Composite carcinoid-adenocarcinoma of the stomach associated with multiple gastric carcinoids and nonantral gastric atrophy.
A case of multiple gastric carcinoids and nonantral atrophic gastritis in which the larger tumor was a composite carcinoid-adenocarcinoma is presented. The two components of the composite tumor immunohistochemically showed clear-cut diverging functional differentiations although the available evidence supported a common histogenesis from the metaplastic intestinal epithelium of the gastric mucosa. The carcinoid tissue of the composite tumor, which showed "atypical" features, also differed from the other, pure carcinoids, in which the histologic appearance was "typical." Total gastrectomy performed 1 month after the original gastric resection with antrectomy disclosed regressive changes in the endocrine cell proliferations of the gastric stump consistent with the withdrawal of a stimulating effect of the antral gastrin.
Adenocarcinoma↗
Depressed level of natural killer cells in cancer family syndrome.
Individuals from kindred with cancer family syndrome (CFS) have an increased genetic risk for the development of adenocarcinoma of the colon as well as of several other organs. Previous studies have suggested that this high occurrence of adenocarcinoma in this as in other hereditary neoplastic syndromes may be correlated to an underlying abnormality in immunological tumor surveillance. In attempt to define a marker that might identify individuals within CFS kindred at risk of developing cancer, we determined natural killer (NK) cell number and NK cell function in affected and healthy members of a CFS family. We studied 13 cancer-affected patients, 20 unaffected but "at-risk" subjects, 20 healthy subjects and 26 normal individuals matched to the patients with colon cancer on the basis of sex and age. We determined the number of NK cells and their function concurrently, using a monoclonal antibody and a 51Cr-release assay with K562 as target cells. We found that the number of NK cells was significantly (P = 0.00004) reduced in cancer patients as compared with healthy subjects and normal controls. Of the 20 at-risk individuals 9 had levels lower than the norm, while 11 showed normal-values. Consequently, the mean percentage of NK cells of this group does not differ either from that of normal subjects or from that of cancer patients. Mean NK cell function was lower in cancer patients than in healthy members of the CFS family but the differences were not statistically significant. Therefore, the mean NK cell function per single cell, expressed as a ratio between cytotoxicity (LU) and the number of NK1-positive cells, resulted paradoxically in an increase when compared with that of normal subjects. The possible mechanisms for this dichotomy were examined.
Adolescent↗
Ulcerative colitis in remission: it is possible to predict the risk of relapse?
A series of anamnestic, clinical, endoscopic and histologic parameters was evaluated in 64 patients with ulcerative colitis in remission to assess whether any of these had predictive value of relapse. All patients with quiescent disease were followed for at least 6 months. The statistical analysis was carried out by means of likelihood chi 2 test, receiver operating characteristic curve, Youden index and stepwise logistic regression. Eighteen patients out of 64 (28%) had a relapse, in a mean period of 9 months after the beginning of the study. The findings of our study suggest that only three factors were useful in selecting a subpopulation with a higher risk of recurrence: (a) a fiber-poor diet; (b) a number of previous episodes of relapse higher than 10, and (c) the presence of extraintestinal manifestations.
Adolescent↗
[Intragastric pH determination as a screening test in the diagnosis of chronic atrophic gastritis].
A simple routine endoscopic screening test has been sought for the diagnosis of chronic atrophic gastritis. An endoscopic-bioptic study was therefore carried out on 850 subjects presenting consecutively at a Digestive Endoscopy Department with dyspeptic-pain symptomatology. In a first sample of 389 patients, 2 biopsies of the gastric body and 2 of the gastric antrum were carried out, independently of the endoscopically documented macroscopic picture. Atrophic changes were in this way encountered in 65 patients (16.7%). In a second group of 461 patients, intragastric pH was determined extemporaneously during endoscopy. pH was = or greater than the chosen threshold value (3.5) in 117 patients and less than this value in 344. In all subjects with pH greater than 3.5 and, by comparison, in 130 with pH less than 3.5 biopsy was carried out on the gastric mucosa, 2 biopsies of the body and 2 of the antrum. Using this approach it was possible to determine the presence of atrophic changes in the gastric mucosa in 57 of 117 (48%) and in 25 of 130 (20%) respectively. In total, chronic atrophic gastritis was diagnosed in 83 of 461 subjects (18%). This percentage is comparable to that observed in the frequency of chronic atrophic gastritis using the more demanding and less selective test of bioptic sampling indiscriminately for all patient. So, the straight-forward determination of intragastric pH in a sample of gastric juice taken during digestive endoscopy would appear to meet the criteria demanded for a screening test and its wider use is recommended in routine endoscopic practice.
Adolescent↗
Jejunal adenocarcinoma in congenital heterotopic gastric mucosa.
We describe an adenocarcinoma of the jejunum that developed in congenital heterotopic gastric mucosa, a rare event. In our patient, the absence of other intestinal malformation and the presence of gastric glands with variable grades of dysplasia, together with the histological pattern of the tumor, strongly favor the possible origin of the neoplasia from the heterotopic gastric glands, rather than from intestinal ones.
Adenocarcinoma↗