1/10. Peripheral clear cell cholangiocarcinoma: a rare histologic variant.We present the case of a 50-year-old diabetic male who underwent open cholecystectomy for acute gangrenous cholecystitis. At the time of exploration, a 1.5-cm mass was found peripherally in the right lobe of his liver, and an incisional biopsy was performed. Microscopic examination revealed a distinct overgrowth of clear cells in an acinar pattern, with tumor cells emerging directly from bile ducts. The tumor cells were periodic acid-Schiff reactive and diastase resistant, indicating the presence of mucin. No bile canaliculi were demonstrated by immunostaining with carcinoembryonic antigen. CT scans of the chest and abdomen were otherwise normal. Based on these microscopic, immunohistochemical, and clinical data, a diagnosis of clear cell cholangiocarcinoma was established. The patient later underwent reexploration and generous hepatic wedge resection. He did well postoperatively and is free of disease after 12 months.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
2/10. An evaluation of antigen retrieval procedures for immunoelectron microscopic classification of amyloid deposits.The advantages of using immunoelectron microscopy in amyloid research and surgical pathology for the classification of amyloid deposits are well documented. The aim of this study was to improve single-labeling postembedding immunostaining by testing different antigen retrieval (AR) techniques. Etching and AR procedures were applied to sections from aldehyde-fixed and Epon-embedded autopsy specimens of patients who had suffered from generalized AA amyloidosis, systemic senile ATTR amyloidosis, or generalized kappa-light chain amyloidosis. The procedures used were no AR, H(2)O(2), saturated aqueous sodium metaperiodate (mPJ), heating in deionized water (dH(2)O), heating in sodium citrate buffer (SCB), heating in EDTA (each 91C, 30 min), and combinations of etching and heating. Little effect was evident after treatment with H(2)O(2), mPJ, and heating in dH(2)O, but the signal density markedly increased after heating in 1 mM EDTA. heating in SCB affected immunolabeling with anti-transthyretin and anti-kappa-light chain, whereas no effect was achieved for immunolabeling with anti-AA amyloid. We concluded that AR may significantly improve immunostaining of specimens that have undergone conventional fixation and embedding procedures for electron microscopy. The effect of AR on the detection of amyloid fibril proteins was probably mediated in part through chelation or binding of metal ions by the AR medium. (J Histochem Cytochem 47:1385-1394, 1999)- - - - - - - - - - ranking = 5keywords = antigen (Clic here for more details about this article) |
3/10. Isolation and characterization of a salmonella enterica serotype Typhi variant and its clinical and public health implications.We report the isolation and characterization of a member of the family enterobacteriaceae isolated from the gallbladder pus of a food handler. Conventional biochemical tests suggested salmonella enterica serotype Typhi, but the isolate agglutinated with poly(O), 2O, 9O, and Vi Salmonella antisera but not with poly(H) or any individual H Salmonella antisera. 16S rRNA gene sequencing showed that there were two base differences between the isolate and salmonella enterica serotype Montevideo, four base differences between the isolate and serotype Typhi, five base differences between the isolate and salmonella enterica serotype Typhimurium, and six base differences between the isolate and salmonella enterica serotype Dublin, indicating that the isolate was a strain of S. enterica. Electron microscopy confirmed that the isolate was aflagellated. The flagellin gene sequence of the isolate was 100% identical to that of the H1-d flagellin gene of serotype Typhi. Sequencing of the rfbE gene, which encoded the CDP-tyvelose epimerase of the isolate, showed that there was a point mutation at position 694 (G-->T), leading to an amino acid substitution (Gly-->Cys). This may have resulted in a protein of reduced catalytic activity and hence the presence of both 2O and 9O antigens. We therefore concluded that the isolate was a variant of serotype Typhi. Besides antibiotic therapy and cholecystectomy, removal of all stones in the biliary tree was performed for eradication of the carrier state.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
4/10. Biliary giardiasis in a patient with human immunodeficiency virus.A 41-year-old man with human immunodeficiency virus (hiv) (CD4 count, 446/mm3) developed a protracted course of abdominal pain, weight loss, and increasing liver function tests after undergoing a metronidazole treatment regimen for Giardia enteritis. Three months later, endoscopic retrograde cholangiography (ERCP) showed dilated common and intrahepatic bile ducts and luminal irregularities of the common bile duct. Seven months after the onset of his acute diarrhea, a repeat ERCP with aspiration demonstrated many Giardia trophozoites and cysts in the bile and continued structural abnormalities consistent with cholangiopathy. A 10-day course of high-dose intravenous metronidazole did not resolve these signs or symptoms. A gallbladder ultrasound showed a thickened wall. Laparoscopic cholecystectomy led to resolution of abdominal pain and normalization of serum alkaline phosphatase over an 8-month period. gallbladder histopathology revealed chronic cholecystitis, but no parasites were seen on hematoxylin and eosin staining or with Giardia antigen enzyme immunoassay testing of the gallbladder. The patient refused to undergo a follow-up ERCP, but a right upper quadrant ultrasound and computed tomography of the abdomen were normal.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
5/10. leptospirosis mimicking acute cholecystitis among athletes participating in a triathlon.leptospirosis, a disease acquired by exposure to contaminated water, is characterized by fever accompanied by various symptoms, including abdominal pain. An acute febrile illness occurred in athletes who participated in an illinois triathlon in which the swimming event took place in a freshwater lake. Of 876 athletes, 120 sought medical care and 22 were hospitalized. Two of the athletes had their gallbladders removed because of abdominal pain and clinical suspicion of acute cholecystitis. We applied an immunohistochemical test for leptospirosis to these gallbladders and demonstrated bacterial antigens staining (granular and filamentous patterns) around blood vessels of the serosa and muscle layer. Rare intact bacteria were seen in 1 case. These results show that leptospirosis can mimic the clinical symptoms of acute cholecystitis. If a cholecystectomy is performed in febrile patients with suspicious environmental or animal exposure, pathologic studies for leptospirosis on formalin-fixed, paraffin-embedded tissues may be of great value.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
6/10. Xanthogranulomatous cholecystitis mimicking stage IV gallbladder cancer.patients with xanthogranulomatous cholecystitis often undergo excessive surgical resections because of difficulty in distinguishing their condition from gallbladder cancer. Herein we present a patient with xanthogranulomatous cholecystitis mimicking stage IVA gallbladder cancer who underwent a hepatopancreatoduodenectomy. The 64-year-old man was admitted to the local hospital with a chief complaint of high fever, hypochondrolgia and jaundice. One month later, he transferred to Tsukuba University Hospital with a hard palpable fixed large tumor in the right hypochondrium. Computed tomography and ultrasonography showed a tumor originating from the gallbladder extending to the adjacent liver parenchyma, as well as nodes in the hepatoduodenal ligaments approaching the head of the pancreas. Endoscopic retrograde cholangiopancreatography failed to exhibit the gallbladder despite the visualization of irregular narrowing of the common hepatic duct. Angiography demonstrated encasement of the right hepatic artery and narrowing of the right portal vein. On the other hand, the level of serum carbohydrate antigen 19-9 was within normal range. Based on those findings, a right hepatic lobectomy with pancreaticoduodenectomy was conducted under the preoperative and intraoperative diagnosis of gallbladder cancer; stage IVA. The gross findings of the surgical specimen showed an ill-defined yellowish hard mass, but microscopic examination demonstrated xanthogranulomatous cholecystitis. The presented case shows that xanthogranulomatous cholecystitis can mimic an advanced gallbladder carcinoma when the severe chronic inflammatory changes have extended to the liver hilum down to the head of the pancreas. However, the normal level of tumor markers in all clinical courses might be a reason to consider xanthogranulomatous cholecystitis instead of gallbladder cancer. Even when the correct diagnosis is made, the possibility that the adjacent organs should be resected is not remote.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
7/10. hepatitis b-related polyarteritis nodosa presenting necrotizing vasculitis in the hepatobiliary system successfully treated with lamivudine, plasmapheresis and glucocorticoid.A 64-year-old man was admitted for alithiasic cholecystitis. Necrotizing vasculitis was detected in a gallbladder obtained at the cholecystectomy. Slight elevation of transaminases, HBe antigens and hepatitis b-dna (HBV-dna) were detected in the patient. Intrahepatic necrotizing vasculitis was also detected in the liver biopsy specimen, and he also suffered from peripheral neuropathy of suddenly onset. Based on the diagnosis of hepatitis b-related polyarteritis nodosa, lamivudine was initially administered, followed by plasmapheresis and glucocorticoid steroid therapy. These treatments brought satisfactory improvement of polyarteritis nodosa without exacerbation of liver function.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
8/10. Mannan and D-arabinitol concentrations in serum from a patient with candida albicans endocarditis.In an attempt to clarify the comparative values of serological and microbiological examinations for the early diagnosis of systemic candidiasis, antibodies against candida albicans, serum mannan, and the D-arabinitol creatinine ratio were investigated in a patient with aortic valve endocarditis associated with carcinoma of the bile duct. Candida precipitins and the antibody titer against Candida cell wall mannan were examined by an immunodiffusion technique and hemagglutination test, respectively. serum mannan was tested by enzyme-linked immunosorbent assay (ELISA) using the biotin-streptavidin procedure. The upper limit of negativity of the assay was determined by adding 0.06 to the absorbance of pooled serum from healthy laboratory workers. This value was about 0.8 ng/ml with ELISA. The D-arabinitol concentration in serum was examined by an enzymatic fluorometric method. Rising antibody titers against C. albicans, mannan antigenemia, and an elevated D-arabinitol creatinine ratio were first observed between the 11th and 12th hospital days. Blood cultures obtained on 8th, 9th, and 11th hospital days grew C. albicans after 3 to 4 days of incubation. Of 11 serum samples, 5 were positive for mannan, whereas D-arabinitol creatinine ratio was positive in 7 of 9 samples. Blood cultures was the earliest evidence of Candida infections in our cases. However, because of saprophytic nature of Candida species, tests for antibodies, antigenemia, and the D-arabinitol creatinine ratio in combination with blood cultures are necessary to confirm systemic candidiasis at an early stage of infection.- - - - - - - - - - ranking = 2keywords = antigen (Clic here for more details about this article) |
9/10. mirizzi syndrome caused by xanthogranulomatous cholecystitis: report of a case.Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. In severe cases, inflammation extends to adjacent structures, and XGC is sometimes confused with a malignant neoplasm. We recently diagnosed XGC as the preoperative cause of mirizzi syndrome in a patient based on the clinical course. The patient was admitted because of obstructive jaundice, with gallbladder carcinoma as the suspected cause. The gallbladder was swollen with gallstones and the serum level of carbohydrate antigen 19-9 (CA19-9) was 3070 U/ml at admission. A percutaneous transhepatic cholangiodrainage (PTCD) was done, and the common hepatic duct as well as the right and left hepatic ducts were found to be obstructed. Later, the CA19-9 level and swelling of the gallbladder decreased and the obstruction of the bile ducts disappeared. A cholecystectomy was performed and the intraoperative pathohistological diagnosis of chronic cholecystitis was made from frozen sections. The pathohistological diagnosis of XGC was made from paraffin-embedded sections. mirizzi syndrome such as that seen in our patient is a rare complication of XGC. XGC occasionally causes extensive inflammation; thus, performing a conventional cholecystectomy can be unsafe. However, in our opinion, a total, not subtotal, cholecystectomy should be done whenever possible because the incidence of gallbladder carcinoma accompanied with XGC is higher than that with ordinary cholecystitis or gallstones.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
10/10. Increased serum CA19-9 in patients with xanthogranulomatous cholecystitis.We present three cases of xanthogranulomatous cholecystitis (XGC) with an increased serum carbohydrate antigen 19-9 (CA19-9). All of the patients were elderly females and had gallstones lodged in the neck of the gallbladder. Preoperative serum CA19-9 levels were 709 U/ml, 87 U/ml, and 400 U/ml, respectively. A cholecystectomy with or without bile duct exploration was performed, and the histological diagnosis of XGC was made. serum CA19-9 levels fell to normal levels in two patients who recovered uneventfully, but rose again in one patient who died of cholangitis. Clinicians must remember that XGC is a possible cause of increased serum CA19-9 levels.- - - - - - - - - - ranking = 1keywords = antigen (Clic here for more details about this article) |
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