Diah Rini Handjari

Intestinal amoebiasis is a parasitic infection caused by Entamoeba histolytica. It is commonly found in developing countries with poor hygiene. A rare, life-threatening complication of amoebiasis is fulminant necrotizing amoebic colitis (FulNAC). We report a 59-year-old male with acute lower right abdominal pain. Before coming to our institution, he was diagnosed with acute appendicitis. Extensive necrosis near the caecum involving the appendix and colon was observed intraoperatively. The patient underwent a right hemicolectomy, followed by an ileostomy and colostomy. Histopathologic examination confirmed the diagnosis of FulNAC. After the surgery, the patient was transferred to the high care unit and treated with metronidazole after histopathologic findings confirmed the etiology. The patient showed excellent response to the antibiotic prescribed, and the symptoms subsided. He was discharged from the hospital on day nine. Additionally, we reviewed fifty-one existing case reports on invasive intestinal amoebiasis worldwide, confirmed by histopathological examination following their preoperative diagnosis, surgery, pharmacology treatment, and outcomes. The learning point of this case is that intestinal amoebiasis should be considered a differential diagnosis for patients around fifty years old with bowel symptoms and travel history or living in tight quarters. Blood tests, radiological examinations, and serological evaluations are valuable diagnostic modalities. Metronidazole should be given as early as possible, and health promotion is recommended to prevent this disease in the population.

BACKGROUND: Inflammatory bowel disease (IBD) diagnosis remains a challenge accompanied with high numbers of misdiagnosis causing suboptimal management. Tons of trials have been conducted to improve the diagnostic accuracy, one of which is the use of biomarker such as calprotectin. Calprotectin can be detected in tissue (intramucosal) and is becoming a potential marker of IBD. AIM: This study aims to determine intramucosal calprotectin expression in IBD, non-IBD colitis, and control. METHODS: This analytic retrospective study included consecutively sampled IBD and non-IBD colitis colorectal biopsy specimens, and control group obtained from Cipto Mangunkusumo Hospital registered from 2017 to 2019. Cases were included in the study if specimens were indicative of IBD and non-IBD clinically and histopathologically and no abnormality were found histopathologically in the control group. Specimens with non-adequate data from the hospital medical records or with missing tissue slides were excluded from the study. Calprotectin immunostaining was conducted to evaluate mean intramucosal calprotectin expression (cell/HPF) in each group. RESULTS: Most of the samples from IBD and non-IBD group (45 samples each) showed mild active inflammation. Mucosal calprotectin expression in aforementioned groups was higher than that of control group (p < 0.001). Subjects with active inflammation showed higher calprotectin expression compared to those with inactive inflammation (p < 0.001). Calprotectin expression was also related to activity grade. CONCLUSION: Higher calprotectin expression showed significant association with the presence of inflammation and disease activity. However, the application of intramucosal calprotectin immunohistochemistry test to determine inflammatory etiology (IBD vs. non-IBD) still needs to be further evaluated.

Background: Pancreatic ductal adenocarcinoma (PDAC) is deadly cancer with a poor prognosis. Molecular prognostic markers are needed to predict the patient’s survival. The cyclooxygenase-2 enzyme (COX-2) and its 2 major transcription factors––nuclear factorkappa B (NF-κB) and specificity protein 1 (Sp1)––are activated during inflammation caused by neoplasia. Several studies have investigated the association between the COX-2, NF-κB, and Sp1 tissue expressions with the patient’s overall survival. Therefore, we conducted this systematic review and meta-analysis to evaluate those studies. Methods: We searched for relevant articles from the MEDLINE database through June 2020. Studies were eligible if they included dichotomized tissue protein expression status and the overall survival as the outcome. We used RevMan and ProMeta programs to perform the meta-analysis. Results: We identified 11 eligible studies. The meta-analysis showed that COX-2 tissue expression was associated with decreased overall survival (crude HR = 1.35; 95% CI, 1.05-1.74), although the result was not significant when controlling for other covariates. The NF-κB tissue expression was associated with decreased overall survival (crude HR = 2.18; 95% CI, 1.49-3.18), although it was not significant when controlling for other covariates. The Sp1 tissue expression showed significantly decreased overall survival even when adjusted with other covariates (aHR = 3.47; 95% CI, 1.52-7.94). The limitations included searching only for English publications and the substantial heterogeneity among the studies. Conclusion: COX-2, NF-κB, and Sp1 tissue expressions have the potential to be used as prognostic markers in PDAC. Further studies are still needed to clarify the associations.

Background Early diagnosis of GERD is very important because chronic reflux esophagitis is a major risk factor for Barrett esophagus, which is a precursor lesion for esophageal adenocarcinoma. The aim of this study is to determine the frequency, demographic characteristics, histomorphological profile based on Esohisto criteria and endoscopic features of reflux esophagitis in FKUI/RSCM in 2016-2018. Methods A cross-sectional study was conducted in Anatomical Pathology Department, Cipto Mangunkusumo General Hospital from January 2016 to December 2018. Assessment criteria include demographic characteristics, histomorphological profiles, and endoscopic features. Histomorphological assessment of reflux esophagitis in this study used the Esohisto criteria, by assessing basal cell hyperplasia, elevated papillae, dilated intercellular spaces and intraepithelial eosinophils. Assessment of the lesion severity is classified as normal mucosa, mild lesion and severe lesion. Results There were 65 cases of reflux esophagitis in adults over a period of 3 years in the Department of Anatomical Pathology FKUI/RSCM. Reviewing demographic data in January 2016-December 2018. The assessment criteria included demographic characteristics, histomorphological profiles, and endoscopic features. Histomorphological assessment of reflux esophagitis in this study used the Esohisto criteria, by assessing basal cell hyperplasia, elevated papillae, dilated intercellular spaces in 65 cases found 33 cases (50.8%) in men and 32 cases (49.2%) in women, with an average sample age of 56 years. The location of the most lesions was distal esophagus in 30 cases (46.2%). Clinical manifestations in 13 cases (20%) were esophagitis. The most common clinical symptoms were dysphagia in 21 cases (32.3%). Most endoscopic features were laryngopharyngeal reflux in 12 cases (18.5%), followed by grade C esophagitis in 9 cases (13.8%). The lesion severity of reflux esophagitis lesions based on Esohisto criteria found 37 cases (56.9%) mild lesion followed by severe lesion as many as 28 cases (43.1%) Conclusion The Esohisto criteria can be used to help diagnose the lesion severity of reflux esophagitis with endoscopic pictures

Background. Hepatocellular carcinoma (HCC), the most common primary liver cancer. In addition to its high incidence, the disease burden is high due to its poor prognosis and high recurrence rate. Some of the currently known clinicopathologic prognostic factors include alpha-fetoprotein (AFP) level, histologic grade, and microvascular invasion. At the molecular level, β-catenin is one of the most common driver mutation found in HCC. The Wnt/β-catenin pathway regulates cellular processes related to initiation, growth, survival, migration, differentiation, and apoptosis. Although the underlying pathogenesis of hepatocarcinogenesis is known, clinical application warrants a greater understanding of the molecular characteristics and tumor phenotype, especially for determining the prognosis. This study aims to analyze the expression of β-catenin and its association with AFP, histologic grade, and microvascular invasion. Materials and methods. Thirty-five samples of surgically resected HCCs at Cipto Mangunkusumo National Referral Hospital were examined. Diagnoses were made based on histopathological and immunohistochemical findings followed by β-catenin staining. β-catenin expression was analyzed to determine difference between variables. Results and conclusions. Here we show that β-catenin expression is significantly associated with low serum alpha-fetoprotein and well to moderate differentiation Implications. Strong nuclear β-catenin expression implies better prognosis in HCC.