Correlation of Carcinoma Percentage (CP) in Colorectal Adenocarcinoma with Several Clinical Pathological Aspects in Anatomical Pathology Department Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital Jakarta in Year 2012-2013

Background: Colorectal carcinoma is Malignant tumour of the large intestinal epithelial, where more than 90% of colorectal carcinoma is adenocarcinoma. Desmoplastic stroma in primary tumour holds an important role in tumour development process. Mesker et al described carcinoma percentage (CP) evaluation in routine preparations with Haematoxylin-eosin (HE) staining as one of the prognostic factors.Method: This retrospective study was performed by collecting forms and slides of colorectal carcinoma resection cases from the archives of Anatomical Pathology Department FMUI-CMGNH in 2 years period (2012-2013). Collection of clinical data and re-evaluation of HE slides by 2 people which were the writer and supervisor were performed to determine CP value by observing the comparison between tumour percentage and desmoplastic stroma.Results: We included 92 cases of colorectal adenocarcinoma within those 2 years period (2012-2013). Comparison of total cases between male and female was 3:2, age > 40 years old were the most commonly found; in regard to location in the colon, most were found in the left side compared to the right side of the colon with the ratio of 3:7. Tumour histological grading with good differentiation were the most commonly found and most pT value being found were pT3; most lymph node involvement was N1. The most CP value attained in every parameter was CP-Low.Conclusion: Carcinoma percentage (CP) which was divided as CP-High and CP-Low could be used as a prognostic factor. In this study, we found more cases of CP-Low compared to CP-High, either based on sex, age, location, degree of differentiation, pT value, or even lymph node involvement. CP-Low which showed worse prognosis could also be used as a marker of patients who were at higher risk of colorectal carcinoma

Cytokeratin 7 and Cytokeratin 19 Expressions in Oval Cells and Mature Cholangiocytes as Diagnostic and Prognostic Factors of Cholestasis

Background: The activity of liver progenitor cells as bipotent liver stem cells, such as the oval cells, has been observed. The presence of oval cells and mature cholangiocytes forming hepatobiliary ductules may be applied to distinguish extrahepatic and intrahepatic cholestasis of the infants. Method: This cross sectional study was performed on 40 paraffin-embedded sections consisting of 2 groups of 20 cases with extrahepatic and intrahepatic cholestasis of the infants from histophatological examination in Cipto Mangunkusumo hospital Jakarta between January 2000 and September 2011. The liver fibrosis grading was reevaluated by hematoxylin and eosin and also trichrome staining. The specimens were tested by immunohistochemical staining for cytokeratin (CK) 7 and CK 19 expressions in oval cells and mature cholangiocytes. The correlation between CK7/CK19 expressions in oval cells and liver fibrosis were analyzed by Spearman's correlation test. Results: Expressions of CK7 and CK 19 on oval cells and mature cholangiocytes performed in hepatobiliary ductules, were significantly higher in extrahepatic than intrahepatic cholestasis with p < 0.05. CK7 and CK19 expressions in oval cells showed strong correlation with the degree of liver fibrosis with r = 0.793; p < 0.05 for CK 7 and r = 0.827; p < 0.05 for CK 19. Conclusion: Expressions of CK7 and CK19, in oval cells and mature cholangiocytes, were higher at extrahepatic than intrahepatic cholestasis. Expressions of CK7 and CK19 in oval cells were directly proportional to the degree of liver fibrosis in cholestasis of the infants

Association Between HBV DNA Level and Intrahepatic HBcAg Protein Expression of Hepatocytes in Patients with Chronic Hepatitis B

Background: Correlation between serum Hepatitis B viral deoxyribonucleic acid (HBV DNA) and hepatitis B core antigen (HBcAg) protein expression in the liver regarding hepatitis B e-antigen (HBeAg) status have not been well studied. This study was aimed to demonstrate association between serum HBV DNA and HBeAg levels with HBcAg expressions in the liver. Method: A total of 55 naive chronic hepatitis B (CHB) patients were enrolled. All samples were tested for HBeAg serum by serological test enzyme-linked immunosorbent assay (ELISA) and HBV DNA was determined by polymerase chain reaction (PCR) HBsAg and HBcAg were evaluated immunohistochemically in the liver tissue Results: Of 55 patients, 44 (80%) were HBeAg positive and 11 (20%) were HBeAg negative. There was a positive correlation between serum HBV DNA and HBcAg expression in the nuclei (r: 0.383; p = 0.004). There was association between HBcAg expression in the nucleus and qualitative HBeAg (p = 0.017). Conclusion: In the patient with chronic HBV, there is a very significant positive correlation between the level of viral replication and HBcAg expression in the nucleus of hepatocytes. Moreover, there is association between HBcAg expression in the hepatocytes nucleus and HBeAg serum level. These finding lead to the proposition that nucleus localization of HBcAg protein function to amplify the pool of cccDNA in the replication cycle of HBV.

Clinical Manifestation and Diagnosis of Cryptosporidiosis in Adult Infected with HIV

Cryptosporidiosis is a rare infection caused by a coccidian parasite, Cryptosporidium, which could cause diarrhea in humans, especially those who are immunocompromised Cryptosporidiosis could cause self- limited diarrhea infection in immunocompetent hosts, but in immunocompromised hosts, especially those with AIDS, the diarrhea can be chronic and severe. To date, no known effective therapeutic agents have been identified. The following is one case report of cryptosporidiosis of a 27 year-old male admitted with chronic diarrhea since 2 months. Endoscopy of the ileum and colon showed hyperemia, erosion and edema, and biopsy was performed. Histopathological examination of ileum showed an atrophic villous and atypical degeneration. There was a number of circular cryptosporidium lining up along the surface of epithelium. There was inflammatory cell infiltration, consisting of lymphocytes, eosinophils and a few neutrophils in the lamina propria. Serological examination revealed an HIV-positive result

Colorectal Cancer Metastasis of and the Risk Factors

Background: Colorectal cancer (CRC) is the fourth most prevalent cancer in the world and is positioned the second most common cancer in the United States. Patients with CRC in Indonesia showed a greater proportion. In Jakarta, 47.85% of CRC cases occur under the age of 45 years. The purpose of this study is to determine metastasis and the factors that influence colorectal cancer patients. Method: This study was conducted retrospectively from January 2003-December 2007 in Cipto Mangunkusumo hospital. Patients are eligible if they underwent colonoscopy, tumor biopsy, anatomical pathology, abdominal CT scan, abdominal ultrasonography, and radiology procedures. Result: Of all 1,615 patients who underwent colonoscopy procedure, 377 patients were diagnosed with colorectal cancer. Subject that met the criteria consist of 86 patients, where 56 (65.1%) male. Most aged 51-60 years old (26.7%), mean age 47.90 ± 14.53 years old. The tumor is most commonly located in the rectum and sigmoid 40 (46.5%), in which 18 (45%) among them had metastasized. Compared with male patients, female patients experienced more metastases, but not statistically significant. Among the patients with metastasized CRC, 42.3% of them < 40 years old, 37.2% patients 41-60 years old, and 29.4% patients > 60 years old. Well-differentiated CRC produce larger number of metastatic cases than poorly-differentiated CRC. Poorly-differentiated CRC tend to produce adjacent metastasis, and also happened in relatively young age in compared with well-differentiated cancer. Conclusion: There was significant correlation between younger age group with a poor degree of histopathologic differentiation. Patients with CRC consist of more male patients than female ones. Factors sex, age group, histopathologic subtypes, and tumor location was not associated with metastasis

CD4+ and CD8+ Counts in Liver and Their Correlation with Necroinflammatory and Fibrosis Grades in Chronic Hepatitis C

Background: Studies on the characteristics CD4+ and CD8+ in hepatitis C and their correlation with the severity of the disease have been rarely conducted. This study was aimed to obtain the mean difference between CD4+ and CD8+ count in liver to evaluate their correlation with fibrosis and necroinflammatory grades in chronic hepatitis C. Method: A cross-sectional study was conducted between March and July 2010 with 30 liver biopsies obtained from patients with non-B and non-HIV chronic hepatitis C who visited the Outpatient Clinic of Hepatology Unit at Cipto Mangunkusumo Hospital in January 2008–February 2010. Fibrosis and necroinflammatory grades were determined using METAVIR methods on liver biopsies. The mean values of CD4+ and CD8+ in portal tracts and hepatic lobules in liver biopsy specimens were evaluated. Statistical analysis was performed by using independent T-test and Spearman test. Results: There was a difference in mean CD4+ counts between portal tracts and the lobules (95% CI = 4.3-17.9; p = 0.002) and also differences in mean CD8+ counts in portal tracts and hepatic lobules (95% CI = 15.4-35.6; p < 0.001). There was no correlation between CD4+ and CD8+ counts, either in portal tracts or the lobules, and inflammatory grades as well as the liver fibrosis. Conclusion: CD4+ and CD8+ counts are greater in portal area compared to the hepatic lobules, with greater CD8+ counts than CD4+. However, both CD4+ and CD8+ counts are not correlated to the severity of liver damage

Influence of Fucoidan in Mucus Thickness of Gastric Mucosa in Patients with Chronic Gastritis

Background: Chronic gastritis is commonly found with complains of dyspepsia, which may decrease work productivity. Imbalance between agressive and defensive factors is the cause of chronic gastritis. Therapy is mostly directed to the agressive factors, particularly gastric acid and very few studies are directed on defensive factors. Mucus is the first defense mechanism of gastric mucosa. Fucoidan is a phytopharmaca, which is thought to increase the thickness of gastric mucosa. The objective of this study was to know the thickness of gastric mucosa in patients with chronic gastritis and to evaluate the effect of fucoidan to the gastric mucosa thickness in patients with chronic gastritis. Method: In this double-blinded randomized clinical trial study, 41 patients in the Endoscopy Unit Cipto Mangunkusumo Hospital between October 2009 and October 2010 were enrolled consecutively. Selected patients were divided into 2 groups: a group was given fucoidan and another group was given placebo. Statistical analysis was done using T-test. Results: Of 41 chronic gastritis patients, only 34 patients completed this study. There was difference of mucus thickness of gastric mucosa in patients with chronic gastritis; in the antrum 42.59 µ m (± 8.67) and in the corpus 44.28 µ m (± 9.64). This study also showed that fucoidan administration increased the mucus thickness in the antrum by 7.42 µ m and in the corpus by 7.74 µ m compared to placebo significantly. Conclusion: Fucoidan increased the mucus thickness of gastric mucosa in patients with chronic gastritis

Demographic Characteristic of Fundic Gland Polyp and Its Association with Gastritis in Pathology Anatomy Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital

Background: Fundic gland polyp (FGP) is the most common polyp found in the stomach with the incidence of 47% from all stomach polyps. FGP is more common to be found in female with the ratio of 5:1 and occurs in the average age of 53-year-old. Gastrin is a hormone produced by G cell, which function is to facilitate epithelial cell proliferation. Gastritis is a frequently found digestive tract disturbance. Torbenson et al showed the presence of chronic gastritis in FGP patients. The aim of this study is to observe the demographic characteristics of FGP and to identify the association between number of polyps with morphologic appearances of gastritis in Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital in year 2012-2014.Method: This retrospective study was a descriptive analytical study. This study was performed by reviewing the slides of FGP cases and evaluating the severity of gastritis based on visual analog scale from Sydney System (SS).Results: Study of FGP demographic obtained 44 cases with predominantly female aged 30 (68.2%), patients\u27 average age was 55.4 year old with dominant age group in age group 51-60 year old which accounted for 16 (36.4%). This study was performed in 38 cases. The frequency of single polyp was 18 and multiple polyp was 20. Most cases were chronic inflammation which accounted for 21 (55.3%) and mild atrophy 18 (47.4%). Mild intestinal metaplasia was found in 1 case. There was no case of neutrophil infiltration, H. pylori infection or dysplasia. Chi-square test revealed that there was no significant association between number of polyps with gastritis.Conclusion: Chi-square test which was performed in this study showed there is no significant association between number of polyps with gastritis