Biomedical subjects
Publications and source records attributed to J L Blaauwgeers.
A 40-year-old woman presented with prolonged abdominal complaints, weight loss and iron deficiency anaemia. Coloscopic biopsy revealed a nematode infestation, probably by Strongyloides stercoralis.
A thoracic skin tag was removed in a woman aged 69 years. Macroscopical and microscopical examination revealed a castor bean tick (Ixodes ricinus).
An 18-year-old woman presented with solitary molluscum contagiosum in the skin of the thorax.
A 56-year-old man, from Turkey, with upper abdominal pain and nausea had an echinococcal cyst in the liver.
A 65-year old man had gout and a secondary infection of a tophus with Pseudomonas at the metatarsophalangeal joint of the right first toe.
A 23-year-old woman suffered from vaginal bleeding during pregnancy caused by a mola hydratidosa.
A 43-year-old woman had pain and a palpable swelling in the lower left abdomen. At laparotomy a mature teratoma of the ovary was removed.
An 80-year-old woman was taken to the hospital because of acute abdominal pain. At laparotomy, necrosis of a segment of the small bowel was found, caused by mesenteric vein thrombosis.
A 34-year-old woman suffered from progressive abdominal pain and diarrhoea. Laparotomy revealed colonic perforation due to amebic colitis.
In a 28-year-old woman Crohn's disease was diagnosed. She had drug treatment but the situation deteriorated and ileocoecal resection was carried out. In the surgical specimen the diagnosis was confirmed.
A 48-year-old man had high fever and paralysis of the left leg, caused by an infectious endocarditis from which Staphylococcus aureus was cultured.
5-Fluorouracil (5FU)-based therapy is given to patients with advanced colorectal cancer and as adjuvant treatment. Thymidylate synthase (TS) is the target for 5FU, and may have a prognostic role for the outcome of 5FU-based therapy together with proliferation markers such as p53 and Ki67. Thymidine phosphorylase (TP, also known as platelet-derived endothelial cell growth factor) may be of importance both in the 5FU drug activation pathway and in tumor angiogenesis, similar to vascular endothelial growth factor (VEGF). TS and TP levels were determined biochemically in fresh-frozen tumor specimens of 32 untreated patients with colorectal cancer, whereas in paraffin-embedded tissue samples, immunohistochemistry was performed for TS, TP, and additional prognostic markers such as p53, Ki67, and VEGF as well as microvessel density. All factors were correlated with patient characteristics such as age, gender, Dukes' stage, angio-invasion, and differentiation grade. TS and TP as measured by various assays were correlated with overall and disease-free survival in this patient group. TP enzyme activity and protein expression correlated with each other. A significant correlation was found between TP enzyme activity and 5-fluoro-2'-deoxyuridine-5'-monophosphate binding activity. VEGF expression correlated significantly with TP immunostaining and Ki67 index. Survival analysis revealed a significant relation of TS levels to the overall survival in this small patient group and a significant correlation between TP activity and disease-free survival. TS and TP both were of prognostic significance in these patients with colorectal cancer. The interesting relationship of TS and TP with angiogenesis and proliferation needs further investigation.
Three patients, two women aged 64 and 52 years and one man aged 78 years, had non-specific symptoms and they had signs of a tumour at imaging examination. Immunohistochemical study of operation preparations led to the diagnosis of 'gastrointestinal stromal tumour' (GIST). It is important to consider the possibility of a GIST at surgery, because the potential malignancy requires a resection with free margins.
AIM: To determine the interobserver variation in scoring presence and grade of vulvar intraepithelial neoplasia (VIN) in haematoxylin/eosin (H/E) slides, MIB 1 slides, and the combined use of H/E and MIB 1 slides. METHODS: 10 slides were stained with H/E and MIB 1 with each of the following diagnoses: normal vulvar skin, VIN 1, VIN 2, and VIN 3. Six observers first scored the H/E slides separately from the MIB 1 slides and second the combined H/E and MIB 1 slides. RESULTS: Unweighted group kappa for MIB 1 was 0.62 and the weighted group kappa was 0.91. This was significantly better than the unweighted group kappa for H/E slides (0.47, p = 0.023) as well as the weighted group kappa for H/E slides (0.82, p = 0.014). There was no improvement by the combined use of H/E and MIB 1 slides. VIN 2 is far less confused with VIN 3 in the combined use of H/E and MIB 1 slides (9%) than in H/E slides (38%) (p = 0.007). There is a tendency to grade VIN in a two tailed grading system rather than a three tailed grading system, which became more apparent with the combined use of H/E and MIB 1 slides. CONCLUSIONS: The interobserver variation with sole use of MIB 1 is better than with the use of H/E stain in VIN. The use of MIB 1 in grading VIN diminishes confusion between VIN 2 and VIN 3 fourfold. A two tailed grading system for VIN seems already to work in daily practice.
In this case report the diagnostic process is discussed leading to a rather late correct diagnosis of immature teratoma. The authors advice preoperative determination of alpha-fetoprotein in all women with ovarian tumours under 40 years of age. The limitations for pathologists to assess immaturity within a teratoma are stressed.
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In a 32-year-old female patient, born and grown up in the Netherlands, echinococcal cysts were diagnosed in the lung and the liver. She had probably been infected seven years earlier on a holiday in Turkey. She recovered after surgical removal of the cysts under albendazole treatment.
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