Mucinous anal gland carcinoma with perianal Pagetoid spread.
Wong AY. Rahilly MA. Adams W. Lee CS.
Division of Anatomical Pathology, St George Hospital, NSW, Australia.
We report a case of well differentiated perianal mucinous carcinoma with associated dysplasia of the adjacent anal gland epithelium. Anal gland dysplasia is only rarely demonstrable histologically in cases of adenocarcinoma of suspected anal gland origin. The tumor was not associated with chronic perianal abscess or fistula formation, which had been regarded as important in the pathogenesis of perianal mucinous carcinoma. There was associated, clinically unsuspected Pegetoid intra-epidermal spread of adenocarcinoma in the perianal skin.
Helicobacter pylori in ectopic gastric mucosa in Meckels diverticulum.
Hill P. Rode J.
Department of Anatomical Pathology, St Vincent's Hospital, Melbourne, Australia.
We report a case of a 25-year-old man who presented with a large rectal bleed and positive Meckel's scan followed by surgical excision of a Meckel's diverticulum. The diverticulum was lined by gastric body type mucosa showing evidence of active chronic gastritis associated with the presence of Helicobacter pylori organisms, these being identified immunohistochemically with a specific polyclonal antibody. We have reviewed another 21 cases of Meckel's diverticula removed at St Vincent's Hospital between 1984 and 1997: in nine of these cases the diverticulum was lined by ectopic gastric body type mucosa and in one of these there was an active chronic gastritis associated with Helicobacter pylori. There has been considerable controversy regarding both the presence and significance of Helicobacter organisms in Meckel's diverticula. This is the first study to use immunohistochemistry specifically to identify Helicobacter pylori within two cases of Meckel's diverticula. Both cases demonstrated an active chronic gastritis present within the gastric body type mucosa, thus suggesting that the organisms play a pathogenic role.
Thickened gastric mucosal capillary wall: a histological marker for portal hypertension.
Misra V. Misra SP. Dwivedi M.
Department of Gastroenterology, M.L.N. Medical College, Allahabad, India.
To evaluate whether the diameter or thickness of the wall of mucosal capillaries in the stomach could be a useful histological marker of portal hypertension, gastric mucosal biopsies were taken from the fundus and antrum of 73 patients with cirrhosis of the liver and 64 healthy volunteers. The mean +/- SD diameter of mucosal capillaries in the fundus of patients was not significantly different from that in the control group (59.4 +/- 16.8 microns vs 53.5 +/- 16.5 microns, respectively; P = NS). However, the mean +/- SD diameter of the antral mucosal capillaries was significantly greater in patients compared to controls (61.3 +/- 18.1 microns vs 47.6 +/- 12.7 microns, respectively; P < 0.001). The mean +/- SD thickness of the fundal and antral capillary wall in the patients group (6.8 +/- 2.4 microns and 7.2 +/- 2.4 microns, respectively) was significantly greater than that in the control group (3.5 +/- 1.5 microns and 3.3 +/- 1.5 microns, respectively) (P < 0.001 for each). The overall diagnostic accuracy of antral mucosal capillary diameter to diagnose portal hypertension was 50%, while that of thickened fundal and antral mucosal capillary wall was 84% and 85%, respectively. It is concluded that the gastric mucosal capillary walls are thicker in patients with portal hypertension and that this is a more reliable histological marker of portal hypertension than dilated gastric mucosal capillaries.
Actinomycosis of the cholecystic duct: case report and review.
Ormsby AH. Bauer TW. Hall GS.
Department of Anatomical Pathology, Cleveland Clinic Foundation, Ohio, USA.
Actinomycosis of the gall bladder, cholecystic duct or common bile duct is rare, with only 16 cases reported to our knowledge. We report a case of actinomycosis in the cholecystic duct remnant of an 80-year-old woman with a history of cholecystitis, choledocholithiasis and cholecystoduodenal fistula requiring cholecystectomy and fistula closure three years prior. Histologic sections of the cystic duct remnant showed several dense basophilic masses containing numerous, dark blue, Gram-positive branching bacilli compatible with actinomycotic granules. Fluorescent antibody staining was positive for Actinomyces naeslundii. Staining for acid-fast bacilli was negative. The pathogenesis, presentation, diagnosis and management of abdominal actinomycosis with specific reference to disease involving the gall bladder are discussed.