Importance of Bile Composition for Diagnosis of Biliary Obstructions

Determination of the cause of a biliary obstruction is often inconclusive from serum analysis alone without further clinical tests. To this end, serum markers as well as the composition of bile of 74 patients with biliary obstructions were determined to improve the diagnoses. The samples were collected from the patients during an endoscopic retrograde cholangiopancreatography (ERCP). The concentration of eight bile salts, specifically sodium cholate, sodium glycocholate, sodium taurocholate, sodium glycodeoxycholate, sodium chenodeoxycholate, sodium glycochenodeoxycholate, sodium taurodeoxycholate, and sodium taurochenodeoxycholate as well as bile cholesterol were determined by HPLC-MS. Serum alanine aminotransferase (ALT), aspartate transaminase (AST), and bilirubin were measured before the ERCP. The aim was to determine a diagnostic factor and gain insights into the influence of serum bilirubin as well as bile salts on diseases. Ratios of conjugated/unconjugated, primary/secondary, and taurine/glycine conjugated bile salts were determined to facilitate the comparison to literature data. Receiver operating characteristic (ROC) curves were determined, and the cut-off values were calculated by determining the point closest to (0,1). It was found that serum bilirubin was a good indicator of the type of biliary obstruction; it was able to differentiate between benign obstructions such as choledocholithiasis (at the concentration of >11 µmol/L) and malignant changes such as pancreatic neoplasms or cholangiocarcinoma (at the concentration of >59 µmol/L). In addition, it was shown that conjugated/unconjugated bile salts confirm the presence of an obstruction. With lower levels of conjugated/unconjugated bile salts the possibility for inflammation and, thus, neoplasms increase.

Dysplasia Epiphysealis Hemimelica (Trevor’s Disease) in Children, Two New Cases: Diagnosis, Treatment, and Literature Review

Dysplasia epiphysealis hemimelica (DEH), also known as Trevor’s disease, is a rare nonhereditary skeletal disorder affecting one side of the epiphyses or the epiphyses-equivalents. It is often misdiagnosed for traumatic injuries, infections, or other tumors because of the nonspecific clinical features. The diagnosis is mostly based on radiographic involvement of one half of the epiphysis displaying an overgrowth; it is hard to distinguish between DEH and osteochondroma on the gross hystopathological exam. There are few immunohistochemical markers, as well as genetic tests, for EXT1 and EXT2 gene expression that can reveal a more accurate diagnosis. No evidence of malignant changes has been reported and no hereditary transmission or environmental factor has been incriminated as an etiological factor. The natural history of the disease is continuous growth of the lesions until skeletal maturity. Without treatment, the joint might suffer degenerative modification, and the patient can develop early onset osteoarthritis. In the present paper, we report two new cases of DEH of the ankle. The aim of this paper is to consider Trevor’s disease when encountering tumoral masses in the epiphyses of pediatric patients and to present our treatment approach and results.

Identification of Cell Surface Molecules That Determine the Macrophage Activation Threshold Associated With an Early Stage of Malignant Transformation

The ability of immune cells to sense changes associated with malignant transformation as early as possible is likely to be important for the successful outcome of cancer immunosurveillance. In this process, the immune system faces a trade-off between elimination of cells harboring premalignant or malignant changes, and autoimmune pathologies. We hypothesized that the immune system has therefore evolved a threshold for the stage of transformation from normal to fully malignant cells that first provides a threat (danger) signal requiring a response. We co-cultured human macrophages with a unique set of genetically related human cell lines that recapitulate successive stages in breast cancer development: MCF10A (immortalized, normal); MCFNeoT (benign hyperplasia); MCFT1 (atypical hyperplasia); MCFCA1 (invasive cancer). Using cytokines-based assays, we found that macrophages were inert towards MCF10A and MCFNeoT but were strongly activated by MCFT1 and MCFCA1 to produce inflammatory cytokines, placing the threshold for recognition between two premalignant stages, the earlier stage MCFNeoT and the more advanced MCFT1. The cytokine activation threshold paralleled the threshold for enhanced phagocytosis. Using proteomic and transcriptomic approaches, we identified surface molecules, some of which are well-known tumor-associated antigens, that were absent or expressed at low levels in MCF10A and MCFNeoT but turned on or over-expressed in MCFT1 and MCFCA1. Adding antibodies specific for two of these molecules, Annexin-A1 and CEACAM1, inhibited macrophage activation, supporting their role as cancer “danger signals” recognized by macrophages.

A Case of Laryngeal Mucosa Associated Lymphoid Tissue Lymphoma Mimicking Laryngeal Amyloidosis

Laryngeal amyloidosis is a rare disorder characterized by localized amyloid deposition and carries an excellent prognosis. On the other hand, mucosa associated lymphoid tissue (MALT) lymphoma is the most common type of marginal zone lymphoma. MALT lymphoma has a poorer prognosis compared to laryngeal amyloidosis due to more frequent local recurrence, distant metastasis and malignant changes. Despite the differences, as both are found in the form of benign mass and have slow progression, accurate diagnosis is necessary. This report deals with the case of a patient with voice change accompanied by a mass, in which the initial biopsy did not include enough specimen for an accurate diagnosis. However, in the second attempt, an adequate sample was obtained, hence the final diagnosis of laryngeal MALT lymphoma. Based on our recent experience and a review of related literature, we report a case of laryngeal MALT lymphoma mimicking laryngeal amyloidosis.

A Case Study on Ayurvedic Management of Ovarian Endometrioma

Menstruation is purely a natural process occurring in a woman’s body each month. It is the visible manifestation of cyclic uterine bleeding due to shedding of endometrium. Endometriosis is a common health problem for women. It is the occurrence of benign ectopic endometrial tissues outside the uterus. Ovarian endometrioma is the most common form of endometriosis. It increases the risk of ovarian cancer in reproductive age group among woman. Although most of the endometriomas are benign, some of them may undergo malignant changes. This is the case report of a 38 year old lady who presented with increased menstrual bleeding with excessive clots, dysmenorrhoea, burning micturition, and dyspareunia. On USG she was detected to have bilateral hydrosalpinx and ovarian endometrioma. Based on the clinical features presented by the patient amapachana, kaphapittasamana and vataanulomana mode of management was given. After six months of internal medications symptoms reduced considerably and there was no endometrial cysts and features of hydrosalpinx in USG.

A rare combination of polyp, inverted papilloma and squamous cell carcinoma of sphenoid sinus

<p class="abstract">Inverted papilloma (IP) is a tumor most commonly originates from lateral wall of nose and benign in nature. Sphenoid sinus is a rare site of origin and involvement. Malignant changes are the rare possibility in the IP. In this case report we reported a rare case of squamous cell carcinoma in back ground of inverted papilloma of sphenoid sinus.</p>

The impact of classic bladder exstrophy-epispadias repair in adult patients without continence

Background: Bladder exstrophy-epispadias complex is a rare congenital anomaly. Very few patients grow with the condition intact in their adulthood which lead to compromise in the results of repair. We herein report our experience of correction of the defects in the adult patients in single stage without doing osteotomy andurinary diversion. Methods: The sample size was 13 patients over ten years. All were treated in single stage. Bladder neck repair was done using paraurethral tissue, primary abdominal closure was done without flap, epispadias repair was done using modified Cantwell-Ransley procedure and hernial repair was done without mesh. No osteotomy was done. All the patients were followed regularly. Minimum period of follow-up was one year. Urinary continence, change in habits and subjective assessment of well-being were also noted.Results: 86.4% patients were totally incontinent. Bladder and anterior abdominal wall were closed in all the patients. Complete epispadias was possible in15.3% patients and rest were converted into coronal hypospadias. Hernia was repaired in 23% patients. All the patients were satisfied with their cosmetic results and they were able to interact socially. Conclusions: Surgical correction of the exstrophy-epispadias complex is possible in adulthood in the hands of experts in single stage without osteotomy. Regular cystoscopic examination and urine cytology yearly are recommended to diagnose the malignant changes in the native bladder as early as possible. Psychological, social and self-level of satisfaction is high among these patients after the surgical correction.

Malignant Transformation of Liver Cysts Into Cholangiocarcinoma During Follow-up: Potential Dangers of Liver Cysts

Background: The liver cyst is a common disease in hepatobiliary surgery. Most patients have no apparent symptoms and are usually diagnosed accidentally during imaging examinations. The vast majority of patients with liver cysts follow a benign course, with very few serious complications and rare reports of malignant changes. Case Presentation: We present two cases of liver cysts that evolved into intrahepatic tumors during the follow-up process. The first patient had undergone a fenestration and drainage operation for the liver cyst, and the cancer was found at the cyst’s position in the third year after the procedure. Microscopically, bile duct cells formed the cyst wall. Tumor cells can be seen on the cyst wall and its surroundings to form adenoid structures of different sizes, shapes, and irregular arrangements, some of which are arranged in clusters. The second patient was regularly rechecked after discovering liver cysts, and a new mass appeared very close to the cyst. The clinical manifestations and laboratory examinations of the two patients lacked specificity, the preoperative diagnosis was unclear, and the postoperative pathology confirmed cholangiocarcinoma.Conclusions: Our cases indicate that liver cysts may lead to the occurrence of malignant intrahepatic cholangiocarcinoma. Therefore, follow-up of particular liver cysts is necessary, and the differential diagnosis of the intrahepatic cystic tumors needs to include cholangiocarcinoma.

Premalignant Conditions of Larynx

Premalignant conditions of larynx encompass a variety of lesions that have the potential to evolve into malignant changes. The dysplastic premalignant epithelial changes of larynx have significantly increased Risk of developing in cancer than the hyperplastic stage of epithelial changes and this transformation significantly depends on the grade of dysplasia. Therefore, early diagnosis & prompt treatment should thus prevent the development of invasive carcinoma requiring more debilitating surgical resection. The histopathological examination is diagnostic & the evolution of advanced laryngoscopic surgical procedures including CO2 laser and newer treatment methods such as photodynamic therapy has shown promising results in their management.