ABSTRACT— A case of chronic non‐A, non‐B (NANB) hepatitis in a 17‐year‐old male is reported. The special feature was microtubular aggregates described so far only in experimental NANB hepatitis in chimpanzees. Additional characteristics were a severe chronic active hepatitis with confluent necrosis in a late stage, multinucleated hepatocytic giant cells and nuclear aggregates of 20–27 nm viruslike particles.
Bowen's disease of the anal region is a rare, slow-growing, intraepidermal squamous-cell carcinoma (carcinoma in situ). If surgical excision is incomplete, there is a risk of subsequent development of malignancy and metastasis. Between 1980 and 1995 we treated 11 patients (8 female, 3 male) with anal Bowen's disease. The mean age was 55 (34-75) years. The main reason for excision was: pain (4), itching (3), bleeding (3) and a disturbing lump (3). The intraoperative findings were in all cases a lesion at the anocutaneous line: perianal or intra-anal tumor (6), erosion (2) or ulceration (2) as well as lichenoid lesion (4) or hyperpigmentation (3). The procedure was excision of the lesion in 10 cases. Only in one case was a biopsy taken. 3 patients had to be operated on a second time for reasons of radicality. 5 years after primary diagnosis, one patient developed a recurrent invasive squamous-cell carcinoma and had to undergo perineo-abdominal rectum amputation with postoperative radiotherapy (2 years after operation). Only one patient underwent a biopsy, which produced the diagnosis of invasive squamous-cell carcinoma. He underwent combined chemo-radiotherapy. The symptoms of anal Bowen's disease are unspecific and the clinical findings are uncharacteristic. The recommended therapy is complete surgical excision. With complete excision no recurrences do occur.
We report on the medical history of a 44 year old woman, who has been diagnosed to suffer from ulcerative colitis, first diagnosed in 1991. Until 1994, when she had finally a colectomy, recurrent episodes occurred under full medical treatment. After colectomy the diagnosis had to be revised as histology revealed Crohn's disease. Only a few months after surgery a new episode of Crohns disease developed including the occurrence of an anal fistula.
In an electron microscopic study, nuclear aggregates of virus-like spherical and tubular particles measuring 20 to 29 nm in diameter were found in 5 of 7 clinically healthy volunteers with normal liver histology, 6 of 10 patients with hepatitis B and 17 of 18 patients with hepatitis non-A, non-B. The incidence of hepatocytes containing nuclear particles was approximately 0.5 to 2% in all three groups. We conclude that these nuclear particles are not specific ultrastructural markers of hepatitis non-A, non-B in man as originally claimed for experimental hepatitis non-A, non-B in chimpanzees.
Due to the central role in predicting response to herceptin and possibly also other anticancer drugs, accurate and reproducible detection of the HER2 status is important. Fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) are the most commonly used methods for HER2 analysis. It is a disadvantage of FISH that a fraction of cases remain not interpretable probably due to suboptimal tissue handling before analysis. To investigate a possible influence of tissue damage on the results of HER2 IHC we compared the HER2 IHC results obtained in tumors with and without interpretable FISH in a breast cancer tissue microarray. The HER2 IHC results differed greatly between 1551 tumors with interpretable HER2 FISH signals and 405 breast cancers showing no FISH signals. FISH informative tumors had an IHC score of 3+ in 12.6%, 2+ in 3% and 1+ in 9.2% of cases. FISH non-informative tumors showed significantly lower IHC scores (p < 0.0001). They were IHC 3+ in 3.9%, 2+ in 3.7% and 1+ in 4.4% of cases. Overall, the data show that not only FISH but also IHC results are dependent on good tissue quality for successful analysis. Poor tissue quality can be easily identified in FISH analyses because of a lack of hybridization signals. Inappropriate tissue handling is more dangerous in IHC because an artificial lack of staining can be regarded as 'negative' result.
Abstract Purpose: KIT (CD117) is a transmembrane tyrosine kinase representing a target for STI571 (Glivec) therapy. Some KIT-overexpressing solid tumors have responded favorably to STI571, potentially because of the presence of KIT-activating mutations. Experimental Design: To investigate the epidemiology of KIT overexpression and mutations, we investigated a series of 1654 breast cancers. All tumors were analyzed by immunohistochemistry in a tissue microarray format. Results: KIT expression was always present in normal breast epithelium. However, cancer analysis revealed the only 43 of 1654 (2.6%) tumors were KIT-positive. KIT expression was more frequent in medullary cancer (9 of 47 positive; 19.1%) than in any other histological tumor subtype (P < 0.001). KIT expression was significantly associated with high tumor grade (P < 0.0001) but unrelated to pT and pN categories or patient survival. Mutation analysis of exons 2, 8, 9, 11, 13, and 17 was negative in 10 KIT-positive tumors. Conclusions: Overall, our data show that a high level of KIT expression occurs infrequently in breast cancer. KIT-positive breast cancers may not reflect “KIT up-regulation” because KIT is also expressed in normal breast epithelium. The lack of KIT mutations also argues against the therapeutic efficacy of STI571 in breast cancer.
Background: Eosinophilic esophagitis (EE) is often associated with concomitant atopic diseases. In children with EE in whom food allergens have been identified as causative factors, elemental and elimination diets result in an improvement or resolution of symptoms. Most adult EE patients are sensitized to aeroallergens, which cross‐react with plant‐derived food allergens, most commonly to grass pollen and cereals. Aims of the study: To investigate the clinical relevance of the sensitization to wheat and rye, and the efficacy of an allergen‐specific elimination diet in adult EE patients. Methods: Six patients (five men, one women) with permanently active EE sensitized to grass pollen and the cereals wheat and rye underwent a double‐blind placebo‐controlled food challenge and were kept on an elimination diet avoiding wheat and rye for 6 weeks. Results: The challenge tests with wheat and rye did not provoke any EE symptoms in all patients. The elimination diet failed in reducing disease activity. Although one patient noticed an improvement of symptoms, endoscopic and histopathologic findings remained unchanged. Conclusions: In adult EE patients, sensitization to wheat and rye does not seem causative for EE. Elimination diet is not a reliable and efficient therapeutic measure in EE patients sensitized to wheat and rye. Low specific immunoglobulin‐E levels to wheat and rye may be a consequence of the underlying grass pollen allergy.
