Pathology of autoimmune hepatitis

Autoimmune hepatitis (AIH) is a relatively rare non-resolving chronic liver disease, which mainly affects women. It is characterized by hypergammaglobulinemia, circulating autoantibodies, interface hepatitis on liver histology and a favourable response to immunosuppression. The putative mechanism for the development of autoimmune hepatitis is thought to be the interaction between genetic predisposition, environmental triggers and failure of the native immune system. AIH still remains a major diagnostic and therapeutic challenge, mainly because it is a very heterogeneous disease. Prompt and timely diagnosis is crucial since, if left untreated, AIH has a high mortality rate. Histological demonstration of hepatitis is required for the diagnosis of AIH and, therefore, liver biopsy is mandatory in the initial diagnostic work-up, before treatment. In this review, we summarize the histological features of AIH with the main aim of highlighting the most important clinical-pathological hallmarks useful in the routine diagnostic practice

Ameloblastic fibroma in a 12-year-old girl: a clinical case

OBJECTIVES Ameloblastic fibroma is a rare benign odontogenic tumor com-posed of epithelial and mesen-chymal tissue, mostly located in the mandible premolar-molar region of young male patients. Its etiology is unknown and since it is asymptomatic, it can be diag-nosed during routine oral examination or with an orthopanoram-ic radiograph. In most cases this lesion is associated with an impacted tooth and from the histo-logical point of view, it is charac-terized by plump fibroblasts and collagen fibrils. MATERIALS AND METHODS A 12-year-old girl presented a suspicious neoplastic lesion of the left posterior region of the mandible, associated with an impacted tooth. Clinical and radiographic examination were compatible with the diagnosis of pediatric ameloblastic fibroma. The lesion was treated with complete enucleation and bone curettage; mandibular left sec-ond molar was also extracted. RESULTS The histopathological examination confirmed the diagnosis of ameloblastic fibroma. One year follow-up orthopantomography and computed tomography showed bone defect healing and no evidence of recurrence. CONCLUSIONS Recognizing ameloblastic fibroma and initiating early treatment is crucial to avoid complications and ensure the well-being of patients. Ameloblastic fibroma, a relatively uncommon odonto-genic tumor, presents a range of treatment options: conservative therapy is typically recommend-ed for small and asymptomatic lesions, while aggressive surgery is less frequently employed for extensive or locally recurring cases. CLINICAL SIGNIFICANCE Timely recognition of ameloblas-tic fibroma is crucial to prevent complications. Treatment options range from conservative to surgical, depending on size and symptoms. Long-term follow-up is essential for monitoring recur-rence and malignant transfor-mation. Surgical enucleation with bone curettage is a com-mon approach. Accurate diagnosis and early treatment improve clinical outcomes and patient well-being

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

Pancreatic cystic neoplasms (PCNs) are a frequent incidental finding during an ultrasound or other radiological investigations. As PCNs may have a potential of malignancy, a precise differential diagnosis between a malignant and benign lesion is crucial to define appropriate management of patients with this kind of lesions. Radiology, with computed tomography (CT) and magnetic resonance imaging, may not be conclusive in the diagnostic assessment of PCNs. Endoscopic ultrasound (EUS), a simple and relatively low invasive technique, is able to identify intra-cystic worrisome features suggesting malignancy. Fine-needle aspiration (FNA) of the cystic fluid or of intra-cystic tissue nodule during EUS is an adjunctive procedure for reaching a conclusive diagnosis. As EUS-FNA is burdened by complications, the use of intravenous contrast may increase the diagnostic accuracy of EUS allowing in many cases a correct diagnosis of PCN at high risk of malignancy, without additional risk of complication during the procedure. The present report deals with the case of a cystic lesion found by CT scan in the pancreatic head of a 59-year-old woman suffering from mild epigastric pain. Once submitted to EUS, malignant nature of PCN was suspected due to the finding of a typical worrisome feature, the presence of a mural nodule. The intravenous administration of contrast medium during the EUS confirmed malignancy and the patient was immediately sent to the surgeon for pancreatic resection. Histology revealed an intraductal papillary mucinous neoplasm, with areas of high-grade dysplasia in the main and secondary ducts, progressed toward an invasive carcinoma

Inflammatory bowel disease versus Chlamydia trachomatis infection: a case report and revision of the literature

Infectious proctitis may mimic inflammatory bowel disease, particularly when limited to the rectum. The present case report includes findings from a 50-year-old man, soldier, referring to our Inflammatory Bowel Disease Unit with a diagnosis of rectal Crohn's disease, refractory to conventional treatments. Mild anemia, hypergammaglobulinemia and HIV-antibodies seronegativity were detected. Entero-MRI and stool examinations were negative. Ileocolonoscopy detected few rectal ulcers with irregular edges. Endosonography showed marked thickening of the rectal wall and enlarged perirectal lymphnodes. Nodal and rectal fine needle aspirate did not show atypia (PAN CK-). Rectal biopsies showed flogistic granular tissue (PAN CK-): Warthin-Starry stain was negative. Previous Treponema pallidum infection was detected. Clinical history revealed habits at risk for sexually transmitted infection. Rectal swabs for RT-PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, and Herpes Simplex Virus 1-2 lead to a diagnosis of lymphogranuloma venereum. Doxycycline 100 mg and Azitromicyn 500 mg t.i.d. were given for 21 days, followed by negativity for RT-PCR for Chlamydia trachomatis at rectal swabs. Complete disappearance of symptoms and mucosal healing occurred. Due to the increased frequency of infectious diseases, sexually transmitted infection (including lymphogranuloma venereum) should be considered as possible differential diagnosis when assessing patients with inflammatory bowel disease limited to the rectum