We found complete membranous staining of C-erbB2 in 9.4% of GBC which was frequent in well differentiated and stage II to stage IV tumors. C-erbB2 tumors had longer median survival than C-erbB2 negative tumors. C-erbB2 is not involved early in the carcinogenetic process as none of the dysplasia showed expression. C-erbB2 over-expression may be considered as target for therapy in advanced stage of GBC.

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Background and aim: Microsatellite instability and fragile histidine triad (FHIT) loss have been seen to be involved in gallbladder carcinogenesis. We studied expression loss of mismatch repair (MMR) proteins and loss of FHIT expression in gallbladder cancer by immunohistochemistry using antibodies against MLH1, MSH2 and MSH6 proteins. Methods: One hundred and two consecutive cases of gallbladder cancer were retrospectively collected and expression of MLH1, MSH2 and MSH6 and FHIT protein was studied. The expression pattern was correlated with various clinicopathologic parameters and survival. Results: Expression loss of MMR proteins was found in 52.9% and loss of FHIT expression was found in 45% cases of gallbladder cancer. Loss of FHIT expression was seen in 12% of dysplasia associated with carcinoma. Expression loss of MMR proteins was found in 16% of dysplasia associated with chronic cholecystitis and 32.6% of dysplasia associated with carcinoma. Expression loss of MMR proteins had significant positive correlation with tumor stage and had worse survival compared with patients with intact expression. Loss of FHIT expression was significantly correlated with both tumor grade and stage. Conclusions: Frequency of expression loss of MMR proteins and loss of FHIT expression increased from dysplasia to carcinoma suggesting that both these abnormalities have a role in pathogenesis and occur at an early stage in carcinogenesis of gallbladder. Fifty three percent of gallbladder cancer with expression loss of MMR proteins also showed loss of FHIT expression and were frequent in advanced stage disease suggesting that reduced FHIT expression may be correlated with expression loss of MMR proteins on immunohistochemistry.

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QUESTIONA 27-year-old male was admitted with high-grade fever, right upper quadrant pain and malaise of 2 weeks duration. There was no history of diarrhoea, dysentery or vomiting. On examination, he was pale, toxic, febrile (102 8F), with pulse 94 beats/min, blood pressure 110/ 80 mmHg and respiratory rate 24 breaths/min.The liver was palpable 2 cm below the right costal margin and was firm, tender and smooth. Examination of cardiovascular, respiratory and central nervous systems was unremarkable. Ultrasonography of abdomen (USG) revealed right lobe liver abscess with loculated right-sided pleural effusion. Laboratory examinations showed leucocytosis with normal serum bilirubin and serum creatinine. Blood culture was sterile and amoebic serology was negative.Under local anaesthesia, a percutaneous drainage catheter (PCD) was placed into the abscess cavity and intravenous ceftriaxone (1 g 12 hourly) and metronidazole (intravenous 750 mg thrice daily) were started. Four hundred millilitres of pus was drained on the table and 40-50 ml of similar pus drained daily for next 8 days. However, the patient continued to be febrile over this period. In view of persistent symptoms, blood and drain culture were repeated and computed tomography (CT) of abdomen ( Figure 1) and 2D echocardiography were requested (Figure 2). He was started on appropriate antibiotics based on culture report. His fever subsided and percutaneous drainage gradually decreased. Repeat echocardiography revealed resolution of previous lesions.