Unusual clinical course of metachronous melanomas of the upper digestive system

Melanoma of the gastrointestinal tract is a rare, highly malignant neoplasm of poor prognosis. This is description of an unusual case of surgically treated patient with two metachronous malignant melanomas of the stomach and the esophagus. The former lesion was located in the cardia and effectively treated with R0 total gastrectomy. The latter was recognized after 67 mo and appeared as irregular, flat, pigmented areas located in the mid esophagus. Subtotal esophagectomy via right-sided thoracotomy, laparotomy and left-sided cervicotomy was performed, but neoplastic cells were found in distal margin (R1). Fourteen months after esophagectomy multiple lung metastases were detected. Patient died 2 mo later.

Ultrastructure of oval cells in children with chronic hepatitis B,with special emphasis on the stage of liver fibrosis:The first pediatric study

AIM:To investigate the ultrastructure of oval cells in children with chronic hepatitis B,with special emphasis on their location in areas of collagen fibroplasia. METHODS:Morphological investigations were conducted on biopsy material obtained from 40 children,aged 3-16 years with chronic hepatitis B. The stage of fibrosis was assessed histologically using the arbitrary semiquantitative numerical scoring system proposed by Ishak et al. The material for ultrastructural investigation was fixed in glutaraldehyde and paraformaldehyde and processed for transmission-electron microscopic analysis. RESULTS:Ultrastructural examination of biopsy specimens obtained from children with chronic hepatitis B showed the presence of two types of oval cells,the hepatic progenitor cells and intermediate hepatic-like cells. These cells were present in the parenchyma and were seen most commonly in areas of intense periportal fibrosis (at least stage 2 according to Ishak et al) and in the vicinity of the limiting plate of the lobule. The activated nonparenchymal hepatic cells,i.e. transformed hepatic stellate cells and Kupffer cells were seen in close proximity to the intermediate hepatic-like cells. CONCLUSION:We found a distinct relationship between the prevalence of oval cells (hepatic progenitor cells and intermediate hepatocyte-like cells) and fibrosis stage in pediatric patients with chronic hepatitis B.

Pressurized intraperitoneal aerosol chemotheprapy after misdiagnosed gastric cancer: case report and review of the literature

We report the first application of pressurized intraperitoneal aerosol chemotherapy(PIPAC) as a rescue therapy before palliative D2 gastrectomy combined with liver metastasectomy performed in a 49-yearold woman with peritoneal carcinomatosis who was primarily diagnosed with and underwent surgery for a Krukenberg tumor. The PIPAC procedure was performed with the use of cisplatin at 7.5 mg/m2 and doxorubicin at 1.5 mg/m2 for 30 min at 37 ℃. Eight weeks after the PIPAC procedure, the patient underwent open classic D2 gastrectomy with the creation of a Roux-en-Y anastomosis(RNY) combined with liver metastasectomy. The patient underwent the classic protocol for chemotherapy combined with Xeloda. The patient felt better and returned to her daily activities. Multicenter data should be gathered to confirm the usefulness of PIPAC as a rescue or neoadjuvant supportive therapy in a very select group of patients who have been recently qualified to undergo classic chemotherapy or standard oncologic surgical procedures.

Histological outcome of chronic hepatitis B in children treated with interferon alpha

AIM: To evaluate the effect of interferon alpha (IFN-α)treatment on the liver histology in children with chronic hepatitis B and to evaluate the usefulness of various histological scoring systems of liver histology in this group of patients.METHODS: Fibrosis stage and inflammation grade were assessed according to Batts and Ludwig, Ishak et al., and METAVIR (only fibrosis stage) before and 12 mo after IFN-α treatment termination in 93 children aged 2-16years with chronic hepatitis B.RESULTS: None of the three numerical scoring systems for liverfibrosis showed statistically significant differences in liver fibrosis, while evolution of inflammatory activity revealed statistically significant improvement in the whole group of children with chronic hepatitis B treated with IFN-α and in responders. Significantly positive correlations were found between fibrosis stage and inflammation grade in the respective scoring systems.CONCLUSION: Treatment with IFN-α did not improve histological fibrosis but decreased inflammatory activity in children with chronic hepatitis B. The three semiquantitative scoring systems seem to be comparable in the estimation of the inflammation grade and fibrosis stage in this group of children.

Diagnostic accuracy of serum biochemical fibrosis markers in children with chronic hepatitis B evaluated by receiver operating characteristics analysis

AIM: To investigate the diagnostic accuracy of potent serum biochemical fibrosis markers in children with chronic hepatitis B evaluated by receiver operating characteristics (ROC) analysis.METHODS: We determined the serum level of apolipoprotein A-I (APO A-I), haptoglobin (HPT) and a-2macroglobulin (A2M) with an automatic nephelometer in 63 children (age range 4-17 years, mean 10 years)with biopsy-verified chronic HBeAg-positive hepatitis B.Fibrosis stage and inflammation grade were assessed in a blinded fashion according to Batts and Ludwig. We defined mild liver fibrosis as a score ≤2 and advanced fibrosis as a score equal to 3. ROC analysis was used to calculate the power of the assays to detect advanced liver fibrosis (AccuROC, Canada).RESULTS: Serum concentrations of APO A-I, HPT and A2M were not significantly different in patients with chronic hepatitis B compared to controls. However, APO A-I level of 1.19 ng/L had a sensitivity of 85.7% and a specificity of 60.7% (AUC = 0.7117, P = 0.035) to predict advanced fibrosis. All other serum biochemical markers and their combination did not allow a useful prediction.None of these markers was a good predictor of histologic inflammation.CONCLUSION: Apolipoprotein A-I may be a suitable serum marker to predict advanced liver fibrosis in children with chronic hepatitis B.

Ultrastructure of Kupffer cells and hepatocytes in the Dubin-Johnson syndrome:A case report

在肝 bioptate 的 Kupffer 房间和 hepatocytes 的超微结构与 Dubin-Johnson 症候群(DJS ) 在一个 17 岁的男孩被评估。针活体检视获得的肝织物在 glutaraldehyde 和帕拉甲醛被修理并且习惯性地为电子处理了显微镜的分析。肝 bioptate 的极端结构的考试揭示了膜界限的累积，在 hepatocytes 的细胞质以内的电子稠密的 lysosomal 小粒， DJS 特征。他们主要位于胆汁的杆的附近，并且优先地，在小叶中心区域，那对应于在轻显微镜下面看见的颜料存款。小粒的存在被无粒内质网和帕拉的扩大元素伴随水晶的 mitochondrial 包括以及胆汁 canaliculi 的膨胀。在 hepatocytes 的变化与显著刺激共存了并且提高了 Kupffer 房间的吞噬细胞的活动。这在他们对应于在 hepatocytes 观察的那些的细胞质以内在颜料存款的累积被表明。涉及对从瓦解的 hepatocytes 发源的颜料的材料的反应的中央 Kupffer 房间可以玩的活动过度的仙子在 DJS 的发展的一个必要角色。

Matrix-derived serum markers in monitoring liver fibrosis in children with chronic hepatitis B treated with interferon alpha

瞄准：为了有希望地评估， 4 选择了浆液纤维变性标记(tenascin， hyaluronan，骨胶原 VI， TIMP-1 ) 以前，在期间并且在有长期的肝炎 B 的孩子的 IFN 治疗以后的 12 瞬间。方法：有长期的肝炎 B 的 47 个连续病人(范围 4-16 年，平均数 8 年) 经历了 IFN 治疗(为 20 wk 的 3 亩 tiw ) 。纤维变性舞台和发炎等级以前以一种使失明的方式被估计并且在治疗的结束以后的 12 瞬间。浆液纤维变性标记用自动化试金被决定。结果：IFN 治疗改进了组织学的发炎但是没在整个组或在亚群改变纤维变性。仅仅 hyaluronan 与组织学的纤维变性显著地相关(r = 0.3383， P = 0.021 ) 。基础纤维变性标记没在应答者(42.5%) 之间并且非不同应答者(57.5%) 。在 IFN 治疗期间，仅仅浆液 tenascin 在整个组并且在显著地减少了非应答者。预告的处理价值什么时候与相比，在治疗以后珍视 12 瞬间， TIMP-1 在所有病人并且在增加了非，应答者，和 hyaluronan 在所有病人并且在应答者减少了。结论：Tenascin 反映与长期的肝炎 B 在孩子的 IFN 治疗期间减少的肝的纤维发生和发炎。TIMP-1 相互关联与非有组织学的纤维变性的反应和 hyaluronan。