Autoimmune liver diseases (ALD) comprise two broad categories: those with a hepatic predominance, autoimmune hepatitis (AIH), and those with a predominance of cholestatic features including primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). An overlap syndrome (OS) is thought to exist where a patient appears with clinical features of more than one immune-mediated liver disease. Based on one personal observation we report a case of histologically proven OS. The relevant literature is briefly reviewed. A 68-year-old male was admitted in our department with general malaise, anorexia and jaundice. Trans-abdominal ultrasonography as well as computerized tomography showed a slightly enlarged liver with mild fatty deposition and the patient was submitted to transcutaneous liver biopsy. Histological features included inflammatory infiltration of intra-hepatic bile ducts with the presence of endoepithelial lymphocytes and plasma cells, degenerative distortions and even focal damage of relevant epithelial cellular structures, periductal fibrosis, portal inflammation, interface hepatitis, ductular proliferation and canalicular cholestasis. It is apparent that exact definitions pertaining the OS are limited and general consensus on the precise determinations of overlap/variant syndromes is warranted in order to enable more accurate future research and establish common guidelines in the management of the condition.
Intracystic papillary carcinoma (IPC) of the breast in men is an extremely infrequent disease, and it appears to have a good prognosis. Because of this, histological findings are of great importance in the decision-making process regarding treatment. Clinical examination, radiological and histological assessments are required for early detection. Adequate surgical excision with negative margins is mandatory. However, the role of sentinel node biopsy has not been evaluated in male IPC. It appears that sentinel node biopsy may be an excellent alternative to radical axillary dissection in patients with IPC and associated ductal carcinoma in situ or invasive carcinoma. Nevertheless, due to the rarity of IPC and its confusing histopathological classification and staging, there are still no clear guidelines as far as IPC treatment is concerned.
Correspondence to Professor Iordanis N Papadopoulos, ipapado@med.uoa.gr DESCRIPTIONA 76-year-old woman with a history of myelogenous leukaemia was admitted with haematochesia fever (38.3°C) and slight abdominal pain. Haemoglobin was 8 g/l, WBC 8.2×10 9 /l, platelets were 55×10 9 /l and partial thromboplastin time was 23 s. Gastroscopy was normal, colonoscopy did not reveal the source of haemorrhage, but a CT-angiography indicated the source at the ileo-caecal region.Non-surgical therapy including 8 units of blood and 8 units of fresh frozen plasma was performed in 3 days, but haemorrhage continued, (HB 6 g/l).A right hemicolectomy was performed including en-block resection of 40 cm of the terminal ileum. Intraluminal absence of blood and focal thickening around the ulcers guided the extent of resection. The presence of multiple ulcers was confirmed before closing the abdomen, figures 1 and 2. Histology revealed no malignant infiltration, but inflammation with intracellular inclusion bodies and serology consisting of IgG anti-cytomegalovirus (CMV), and IgM anti-CMV indicated the CMV as the aetiology of the ulcers.Postoperatively, the haemorrhage did not recur but the patient developed a low-output entero-cutaneous fistula (3rd week). She initially showed improvement by total parenteral nutrition, antibiotics and ganciclovir.Nevertheless, the patient's haematological status remained poor and she died 70 days after surgery in sepsis due to pneumonia. CMV 1 2 is a herpes virus with a propensity to affect immunocompromised patients as transplant recipients, patients with AIDS, haematological malignancies and inflammatory bowel disease. Pneumonia, gastrointestinal inflammation, ulcerations and haemorrhage, hepatitis and Learning points▸ The multiplicity and wide spread of ileal and colonic ulcers make the assessment of the extent of surgical resection difficult. ▸ Surgery should be reserved for life-threatening complications as haemorrhage and perforation. ▸ Long-term prognosis is largely determined by the underlying haematologic disease.
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