Kleophant Thakerngpol

Clofazimine-induced crystal-storing histiocytosis producing chronic abdominal pain in a leprosy patient.

Clofazimine-induced crystal-storing histiocytosis is a rare but well-recognized condition in the literature. Besides the common reddish discoloration of the skin, clofazimine produces gastrointestinal disturbances-sometimes severe abdominal pain, prompting exploratory laparotomy, because pathologic and radiologic findings can produce diagnostic difficulties if the pathologic changes caused by clofazimine are not recognized. The authors report such a case in a leprosy patient to emphasize the importance of history taking, the radiologic abnormalities of the small intestine, and the pathologic findings in small intestine and lymph node biopsies. Clofazimine crystals are red in the frozen section and exhibit bright-red birefringence. However, they are clear in routinely processed histologic sections because they dissolve in alcohol and organic solvents. They also appear as clear crystal spaces during electron microscopic study, but some osmiophilic bodies can be observed. Histiocytosis caused by clofazimine crystals produces infiltrative lesions in radiologic studies mimicking malignant lymphoma or other infiltrative disorders. Associated plasmacytosis in the histologic sections can simulate lymphoplasmacytic lymphoma or multiple myeloma with crystal-storing histiocytosis. With the knowledge of this rare condition caused by clofazimine, appropriate management to avoid an unnecessary laparotomy is possible.

Liver injury due to iron overload in thalassemia: histopathologic and ultrastructural studies

The livers of 30 cases of thalassemia (19/β-thal/HbE, seven thal/HbH and four β-thal major) were studied histopathologically and electron microscopically, in an effort to define the morphologic alterations due to iron overload. The results of light and electron microscopy were similar in most cases. Iron accumulation and fibrosis were the common features found in these patients, except that thal/HbH exhibited lesser hepatic damage. The degrees of iron deposition and fibrosis were found to be higher in splenectomized and cirrhotic than non-splenectomized and non-cirrhotic patients. The subcellular changes were swollen mitochondria, with the presence of an electron dense matrix and ruptured mitochondrial membrane. Proliferation of smooth endoplasmic reticulum (ER) and dilated rough ER was observed. Increases in lysosomal hemosiderin in hepatocytes and in Kupffer cells were demonstrated. The possible ways by which the iron compounds or free radicals mediated membrane damage are mentioned. The pattern of liver cell damage is similar to that of viral hepatitis.

Adenosquamous carcinoma and carcinoidal differentiation of the colon. Report of a case

A case of colonic tumor demonstrating both adenosquamous carcinomatous and carcinoidal features is reported. Previous record of such an occurrence has not been encountered. The relationship between the three elements appears to be an intimate one. It is not regarded as purely coincidental, but supports the possibility of a close histogenetic relationship between the three components.

Abnormal form of Aspergillus terreus isolated from mycotic abscesses

A remarkable outer cell-wall thickening (up to 1.5 μm) was observed on septate hyphae obtained from pus collected from multiple abscesses of a 25-year-old female patient. Ultrastructural examination of the hyphae showed a thick electron dense layer of microfibrillar material surrounding the electron transparent cell wall. The organism was able to grow only on hypertonic media upon initial isolation but on later subculture it grew on normal isotonic media. The thick microfibrillar material diminished progressively upon subculture but could be demonstrated in 7 day secondary cultures in isotonic liquid medium. There, microfibrillar bridges appeared to bind hyphae together. The observations suggested that this microfibrillar material was a true extracellular component. The immunological status of the patient was not examined, but her 10 year history of multiple mycotic abscesses and dermatophytoses suggested some abnormalities.

Enzyme histochemical study of primary hepatic carcinoma in thailand

A histochemical study of a number of hydrolytic and oxidative enzymes was made on 29 surgical biopsy and 15 postmortem specimens of primary hepatic carcinoma. Alkaline phosphatase could not be demonstrated in tumor tissue from any of the 44 cases studied. Lactate and isocitric dehydrogenases, and DPNH‐diaphorase showed greater intensities of reaction in a majority of the tumors as compared with nontumorous parenchyma on the same slides. Enzyme reactions appeared to be greater in the liver tissue than in the tumor nodules in a majority of cases for glucose‐6‐phosphate, glutamate, beta‐hydroxybutyric, and 6‐phosphogluconate dehydrogenases. This difference was most prominent in the last 2 enzymes. Dihydro‐orotate dehydrogenase and TPNH‐diaphorase gave variable results. Similar results were obtained in both surgical biopsy and postmortem specimens. No consistent differences in the reactions of the tumor tissues were observed in relation to the presence or absence of cirrhosis. Enzymatic activities of carcinomas of the liver were not related with the morphological grade of differentiation.