Diah Rini Handjari

Diagnostic Findings of Sclerosing Mesenteritis and the Disease Correlations with Caecal Adenocarcinoma

Sclerosing mesenteritis (SM) is a rare disease with non-specific clinical manifestations and should be supported by radiological examination and confirmed by histopathological evaluation. Its relationship with cancer especially caecal adenocarcinoma is still unclear. This case report describes a young man who was diagnosed as having SM and poorly-differentiated caecal adenocarcinoma.

Prevalence of Crohns Disease in Endoscopic Unit Cipto Mangunkusumo Hospital

Background: The cumulative number of inflammatory bowel disease patients in Asia has raised three times since early 1990s, although Crohn’s disease is still less common than ulcerative colitis. The objective of this study was to provide clinical and demographic data of Crohn’s disease patients seen in Endoscopic Unit Cipto Mangunkusumo Hospital and compare the Results with other Asian countries. Method: This study was done retrospectively cross-sectional descriptive from medical records of all patients underwent colonoscopy at Endoscopic Unit, Cipto Mangunkusumo Hospital, and histological evaluation in the Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia, between 2007 and 2008. Data was analyzed using SPSS version 17. Results: Of 921 patients who underwent colonoscopy, 19 (2.1%) patients were diagnosed with Crohn’s disease. There was no sex preponderance. The mean age was 47.7 years with a peak age at presentation between 51 and 60 years. The main clinical complaints were diarrhea (42.1%), lower gastrointestinal bleeding (36.8%), abdominal pain (10.5%) and upper gastrointestinal bleeding (5.3%). Colonoscopic findings were hyperemia in 94.7%, edema in 57.9%, erosions in 63.2%, ulcerations in 89.5%, pseudopolyp in 31.6%, fragile lesion in 10.5%, stenosis, fistulation, and cobblestone appearance in 5.3%. Involvement of isolated left colon was 26.3%; other manifestations were isolated right colon (10.5%), pancolitis (57.9%), ileitis (5.3%), ileocolitis (36.8%) and skip lesion (5.3%). Conclusion: The prevalence of Crohn’s disease in this study was similar to the findings in previous studies in Asian countries, with diarrhea as the main clinical complaint, and pancolitis as the dominant finding in colonoscopy examination. Keywords: Crohn’s disease, prevalence, clinical complaints, colonoscopy description

The Cyclooxygenase-2 and Nuclear Factor-kappa B Expressions in Colorectal Polyps

Background: Cyclooxygenase-2 (COX-2) is the rate-limiting enzyme in prostaglandin synthesis, while nuclear factor kappa B (NF-kB) is a family of transcription factors. Both play an important role in tumorigenesis. In the present study, we examined NF-kB and COX-2 expressions pattern, and their association in neoplastic and non-neoplastic colorectal polyps (CP). Method: Formalin-fixed and paraffin embedded tissue blocks from 77 patients with CP were immunostained with anti-NF-kB (p 65) and anti-COX-2. Expressions of NF-kB, and COX-2 were detected immunohistochemically. The relationship between these expressions and the two types of CP, and other clinicopathological findings were evaluated Results: The expressions of NF-kB and COX-2 in patients with neoplastic and non-neoplastic CP were high. The results of this study indicated that generally in CP, NF-kB was associated with COX-2 and the association was also seen in neoplastic and non-neoplastic polyps. There was no significant difference of NF-kB and COX-2 expressions in terms of patient’s age, sex, histologic type, and location of the CP. Neoplastic CPs were more common in the distal colon, female patients and older patients (> 60 years) compared with non-neoplastic CPs. Neoplastic CP were located more at the distal colon, more in female, and more in older (> 60 years) patients as compared with the non-neoplastic CP. Further studies are needed to elaborate the role of inflammation in sporadic colorectal carcinogenesis. Conclusion: The expressions of NF-kB and COX-2 in patients with CP were high, and strong correlated each other. There were no significant differences between expression of NF-kB and COX-2 in neoplastic and non-neoplastic polyps. Keywords: colorectal polyps (CP), NF- B, COX-2, inflammation

Alteration of Subcellular Beta Catenin Expression in Normal Mucosa, Adenoma and Carcinoma in Relation to Colorectal Carcinogenesis

Background: Adenomatous polyposis coli (APC) gene mutation was found in up to 80% of cases of sporadic colorectal cancers and adenomas. Loss of APC protein function has been known as one of the early process in colorectal carcinogenesis. This event leads to the accumulation of beta catenin in the cytoplasm and nucleus and subsequently activates target genes that regulate cell proliferation and apoptosis. The aim of this study was to investigate the alteration of subcellular beta catenin expression in the progression of colorectal cancer. Method : This cross-sectional study was conducted with 30 paraffin-embedded tissue sections each of normal colorectal mucosa, adenomas and carcinomas. Alteration of beta catenin expression in membranous, cytoplasmic, and nuclear compartments were evaluated by immunohistochemical staining. Results: Beta catenin immunoreactivity was detected in all cases, of which 87 (96.7%) cases showed membranous expression, 78 (86.7%) cases had cytoplasmic and 51 cases (56.7%) had nuclear expression. Such results were statistically significant (p 0.05). Conclusion: Altered subcellular expression of beta catenin occurs as the oncogenic process develops from adenoma into carcinoma. Such finding reflects the importance of beta-catenin in colorectal carcinogenesis. Keywords: beta catenin, colorectal cancer, adenoma, colorectal cancer progression

Hepatocellular Carcinoma in an Infant due to HBV Vertical Transmission

Hepatocellular carcinoma (HCC) is one of the common tumors in the world. The incidence of HCC generally increases with age in all population but there is a tendency of decreasing incidence in the elderly and it is very rare in children. This is a case report of HCC in a 9-month-old boy, who was admitted to the hospital with palpable abdominal mass in the right upper quadrant. Imaging modality by ultrasonography could not adequately demonstrate definite findings demonstrating that the tumor was derived from liver, and the diagnosis was neuroblastoma. Intra-operatively, the tumor mass appeared to be derived from the surface of the posterior edge of the liver, so it was a pedunculated tumor. The histopathological examination revealed a pedunculatedhepatocellular carcinoma grade 3. The Victorian blue staining and immunohistochemical staining were done afterward, which showed HBsAg positive result as found in non-tumor lesion as well as inneoplastic lesion of liver tissue. Keywords : hepatocellular carcinoma, pedunculated HCC, infant HCC, occult hepatitis B virus infection