Chuan-Pau Siauw

Cholangiocarcinoma in hepatolithiasis.

During the period 1979-1982, 10 cases of cholangiocarcinoma associated with hepatolithiasis were seen. We report the clinical features of 10 cases of cholangiocarcinoma in association with hepatolithiasis, along with detailed histopathology from the four resected specimens. Our observations suggest that whenever intrahepatic stones are encountered in patients over 50 years of age with a long history of recurrent cholangitis and intractable pain, further examination incuding echo-guided aspiration cytology, liver scanning, and peritoneoscopy should be performed to rule out a coexisting cholangiocarcinoma.

Acute Muscular Paralysis in an Adult With Subclinical Bartter's Syndrome Associated With Gentamicin Administration

We report an adult case of asymptomatic Bartters syndrome with the first presentation of hypokalemic paralysis triggered by gentamicin injection. Marked hypokalemia and hypomagnesemia associated with excessive kaliuresis and magnesiuria were found. Plasma renin activity and aldosterone concentration were high, but blood pressure was normal. Renal biopsy revealed hypercellularity of the renin-producing cell of the juxtaglomerular apparatus. Muscular paralysis subsided after potassium chloride supplementation. Hypokalemia was corrected with potassium and magnesium supplements and the use of diclofenac. To the best of our knowledge, there have been no reports of muscular paralysis associated with gentamicin in Bartters syndrome.

Clinical Experience of Esophageal Ulcers and Esophagitis in AIDS Patients

In Taiwan, numbers of patients with the acquired immunodeficiency syndrome (AIDS) have been increasing in recent years. We present esophageal disease of different causes in 5(16%) heterosexual men among 31 AIDS patients over a 5-year period. Major symptoms included mild dysphagia in 4 (80%) patients and odynophagia in 3 (60%) patients. The duration of symptoms varied from 3 days to 6 months. The symptoms occurred before the diagnosis of AIDS in 3 patients. At esophagogastroduodenoscopy (endoscopy), all 5 patients had esophagitis and/or esophageal ulcers proved by histopathologic evaluation. Four had Candida esophagitis, 3 had cytomegalovirus esophagitis/ulcers and 2 had idiopathic esophageal ulcerations (IEU). Three patients had different esophagitis/ulcers at the same time or during follow-up. The median CD4 lymphocyte count at the time of diagnosis of esophageal disease was 12.2 cells/mm3 (range, 3 to 35 cells/mm3). The endoscopic pictures of the different causes of esophagitis/ ulcers lack uniformity in number, size and appearance. These observations make a conclusion that all AIDS patients with an esophageal disease should undergo endoscopy with biopsy to obtain a definitive diagnosis.

Drug-induced liver disease - A review of 14 cases

The clinical and pathological features of 14 cases of acute drug-induced liver disease (DILD) were analyzed using the French group method for drug reaction assessment. Among them, 8 were of the cytotoxic type, 4 were of the cholestatic type and 2 were of the mixed type. Serum alkaline phosphatase (ALP) levels of the cytotoxic type DILD were all < 1.8 times the normal value, while those of the cholestatic type DILD > 1.8 times (P < 0.05). The alanine aminotransaminase and aspartate aminotransaminase (ALT and AST) levels of the cholestatic type were all < 13.1 times the normal value, while those of the cytotoxic type varied from 2.2 to 118 times the normal value. We found that steatosis was the major feature in the cytotoxic type with ALT and AST < 2.5 times the normal value. Piecemeal necrosis was noted only in all the cases with ALT and AST > 20 times the normal value. In the cholestatic type, the pathological features of the oral contraceptive-related DILD showed mainly cholestasis, whereas chlorpromazine-related DILD revealed additional portal inflammation. Meticulous taking of patient history and clinical assessment are mandatory for the diagnosis of DILD. The ALP levels were helpful in distinguishing different types of DILD. There are some correlations between biochemical changes and pathological features, and both are helpful in distinguishing different etiologies of DILD when the inciting drug is in doubt.

Congestive gastropathy in cirrhotic patients: correlation between endoscopic and histological findings.

Congestive gastropathy is a common cause of gastrointestinal bleeding in cirrhotic patients. Forty-six patients with cirrhosis of the liver and 225 control subjects matched in age and sex without cirrhosis of the liver entered the study. We studied the prevalence of congestive gastropathy in cirrhotic patients, and the relationship between endoscopic and histological findings. Congestive gastropathy seen endoscopically was found to be more common in the cirrhotic group than in the control (85% vs. 5%, P < 0.05). The sensitivity, specificity and positive predictive value were 85%, 95% and 76%, respectively. The presence of endoscopic congestive gastropathy was correlated with the severity of liver disease (P < 0.05), but not to the etiology of cirrhosis and the size of esophageal varices with or without red color sign. Endoscopic congestive gastropathy showed no correlation with the histological features including gastritis, interstitial edema, vessel ectasia/congestion and hemosiderin in endoscopic biopsy specimens. In conclusion, congestive gastropathy is a common finding in cirrhotic patients. Its appearance is closely correlated with the severity of liver disease. There is no good correlation between endoscopic congestive gastropathy and mucosal histology.

Giant Polypoid Carcinoid of the Stomach

Gastric carcinoids are epithelial tumors with potential malignancy. Generally they are small yellow or gray submucosal nodules. When tumors become enlarged, they are grossly indistinguishable from carcinomas. Some big gastric carcinoid tumors simulate Borrmann type II or III, rarely Borrmann type I gastric carcinomas macroscopically. We herein report a 76-year-old man with a giant polypoid carcinoid of the stomach, locating at the antrum, which is a rare morphological picture of gastric carcinoid in the literature.

Solid and Papillary Neoplasm of the Pancreas: A Case Report

A 20-year-old female was found to have a mass at left upper abdomen without remarkable clinical symptoms. Laparotomy revealed a well-encapsulated mass, 151×141×13cm in size, arising from the body and tail of the pancreas. Histologic examinaiion disclosed a solid and papillary neoplasm of the pancreas with the following features: 1) solid areas with polygonal shaped cells which were arranged uniformly around delicate fibrovascular stalks in papillary or pseudorosette features, 2) large foci of degeneration with cystic necrosis and hemorrhage, 3) huge size, well-encasulation with no evidence of invasiveness, and 4) the mucin and PAS stains were all negative. Ultrastructurally, the tumor cells contained zymogen-like granules. The patient has been followed up for half a year with no evidence of recurrence and metasiasis. Only a few cases of this tumor has been reported in the past. We report this rare case and review the relevant literature.