Abdominal cocoon: uncommon cause of intestinal obstruction in peritoneal dialysis patient.

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Subcutaneous Phaeohyphomycotic Nodule Due to Phialemoniopsis hongkongensis sp. nov.

Phialemoniopsis species are ubiquitous dematiaceous molds associated with a wide variety of superficial and systemic infections in human. In this study, we isolated a mold from the forearm nodule biopsy specimen from a patient with underlying liver cirrhosis, ankylosing spondylosis, and tuberculosis. He was treated with itraconazole, but unfortunately, he succumbed as a result of disseminated tuberculosis with multiorgan failure. The histology results of the skin biopsy showed necrotizing granulomas in which numerous fungal elements were found. On Sabouraud dextrose agar, the fungal isolate grew as white-to-cream and smooth-to-velvety colonies. Microscopically, oval-to-cylindrical conidia were observed from abundant adelophialides, which possessed barely visible parallel collarettes but no basal septa. The azole drugs voriconazole, itraconazole, and posaconazole, as well as amphotericin B, showed high activities against this fungus. Internal transcribed spacer, 28S nuclear ribosomal DNA (nrDNA), and β-actin and β-tubulin gene sequencing showed that this fungus is most closely related to but distinct from Phialemonium curvata. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and hierarchical cluster analysis showed that the MALDI-TOF MS spectrum of this fungus is most closely related to that of Phialemonium pluriloculosa. We propose a new species, Phialemoniopsis hongkongensis sp. nov., to describe this fungus

Reduction of covalently closed circular DNA with long-term nucleos(t)ide analogue treatment in chronic hepatitis B

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Pathology of the Fallopian Tube

The fallopian tubes are subjected to a variety of inflammatory and neoplastic lesions. Reactive changes secondary to inflammation may potentially mimic malignancy. Many reactive and benign conditions may also result in tubal narrowing or occlusion and are often the underlying causes of ectopic pregnancy. The tube is the most frequent site of an ectopic pregnancy but is rare for primary gestational trophoblastic diseases. The latter are usually secondary to a lesion from the corpus. Tubal hyperplasia is a poorly defined and overlapping entity; in many cases, they represent precursor lesions of tubal borderline or malignant lesions. Recent advances in genetic testing for BRCA mutations in high-risk families had led to the recognition of early carcinomas of the fallopian tube in prophylactic bilateral salpingo-oophorectomy specimens. Tubal intraepithelial carcinoma has become the topic of vigorous research in recent years, and this lesion, particularly when found in the fimbriae, is now recognized as the source some ovarian and peritoneal high-grade serous carcinomas. Secondary involvement of the tubes by ovarian carcinomas or those of other sites is more common than primary tubal carcinomas. The commonest primary carcinomas of the fallopian tube are of serous differentiation, followed by endometrioid and transitional cell. Mesenchymal tumors are rare. Benign and malignant tumors of the broad ligament are similar to those arising from the ovaries in many aspects. Identification of sites of origin may sometimes be difficult

Mucinous Neoplasms of the Ovary

Primary mucinous tumors represent 15 % of all ovarian tumors and are classified as either benign, borderline, or malignant. More than 80 % of mucinous tumors are benign, while only 2–7 % are malignant. An overwhelming majority of tumors show gastrointestinal differentiation. Those of Müllerian differentiation are more commonly borderline tumors and rarely benign or malignant. Distinction between intestinal- and Müllerian-type carcinomas may not always be easy, owing to tumor heterogeneity and the fact that some tumors are mixed, such that components of benign, borderline, and carcinoma often coexist within an individual lesion. The diagnostic difficulty is further compounded by the fact that some tumors do not fit agreeably into the three biologic subcategories. Benign tumors containing <10 % of borderline features have been designated cystadenomas with focal atypia or focal proliferation. They are biologically benign. Borderline tumors have mild-to-moderate cytologic atypia, and almost all are followed by an uneventful outcome. In those with severe atypia and a complex architecture but without stromal invasion, the term mucinous borderline tumor with intraepithelial carcinoma is used. These latter tumors have a very low risk of recurrence. Microinvasion refers to borderline tumors, whether with or without intraepithelial carcinoma, that have ≥1 foci of tumor cells infiltrating the stroma but with each focus <10 mm2. Provided the tumor has been adequately sampled to exclude occult foci of frank carcinoma, microinvasion does not seem to be an adverse prognostic factor. For mucinous carcinomas, the pattern of invasion is prognostically more relevant than grading, especially for stage I. Expansile-type stromal invasion refers to florid epithelial proliferation without intervening stroma. In infiltrative-type stromal invasion, there is irregular infiltration of the stroma by cells associated with stromal desmoplasia. The latter pattern is significantly associated with an adverse outcome

Uterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP): A clinicopathologic analysis of 16 cases

Background: The current World Health Organization classification indicates that a uterine smooth muscle tumor that cannot be histologically diagnosed as unequivocally benign or malignant should be termed "smooth muscle tumor of uncertain malignant potential" (STUMP). STUMPs represent a heterogeneous group of rare tumors that have been the subject of only a few published studies, some of which lack detailed clinicopathologic details and/or follow-up data. More recently, it has been suggested that immunohistochemical staining may be helpful in the diagnosis of STUMPs. Design: The clinicopathologic features of 16 cases of STUMP that exhibited usual smooth muscle differentiation, diagnosed between 1992 and 2006 from 11 hospitals, were studied and classified into 4 subgroups using terminology and criteria described by Stanford investigators. Immunohistochemical stains for p16, p53, MIB1 (ki-67), and estrogen and progesterone receptors were performed. The results were compared with those in the literature. Results: The tumors were classified as follows: 6 as "atypical leiomyoma with limited experience", 7 as "smooth muscle tumor of low malignant potential", 2 as "atypical leiomyoma, low risk of recurrence," and 1 as "mitotically active leiomyoma, limited experience." Follow-up was 21 to 192 months (mean, 80.8 and median, 51.5). Only 2 tumors recurred, at 15 and 51 months, respectively; both were atypical leiomyoma with limited experience (multifocal moderate-to-severe atypia, no tumor cell necrosis, and mitotic counts of 4 and 5 mitotic figures /10 highpower fields, respectively). Both tumors had areas that were indistinguishable from benign leiomyoma and both had diffuse immunoreactivity for p16 and p53. Six other tumors that had focal staining for these markers all had a benign outcome. Both patients with recurrence were alive at last follow-up (at 40 and 74 mo). All the other patients were alive and disease-free. Conclusions: This and other studies suggest that uterine tumors classified as STUMPs using criteria proposed by Stanford investigators are usually clinically benign but should be considered tumors of low malignant potential because they can occasionally recur, in some cases, years after hysterectomy. After a mean follow-up of 80.8 months, only 2 of 16 tumors in this study recurred. Both of the latter tumors fulfilled the criteria for atypical leiomyoma with limited experience. Notably, the 2 recurrent tumors were the only ones that were strongly immunoreactive for p16 and p53, supporting earlier observations that these markers may be helpful in the prediction of the behavior of STUMPs. Patients diagnosed with STUMPs should receive long-term surveillance. © 2009 by Lippincott Williams & Wilkins.link_to_subscribed_fulltex