FETAL ASCITES A Report of 3 Autopsy Cases

Three rare autopsy cases of fetal ascites were presented and the etiology of each case was described. Case 1 was a male neonate, delivered by cesarean section at 32 weeks’gestation, and died of respiratory failure. The abdomen was remarkably distended with 1020 ml of ascites. The etiology of Case 1 remained unknown even after macroscopic and microscopic examinations. We considered this as “idiopathic” fetal ascites. Case 2 was a female neonate, delivered at 31 weeks’gestation, with marked abdominal distension and cyanosis. Autopsy revealed 435 ml of ascites, and she was considered to have had “polysplenia syndrome” with cardiovascular malformations. Intrauterine heart failure due to cardiac anomalies was thought to be the cause of this ascites. In case 3 embryotomy was carried out under the diagnosis of fetal ascites by ultrasound examination at 22 weeks’gestation. An urachal cyst connected to the dilated urinary bladder and deficiency of musculature of the abdominal wall composed of loose connective tissue with calcification were observed. The abdominal wall was ruptured and 1,960 ml of ascites was measured. Polycystic kidney with renal dysplasia was also found. Case 3 showed “Prune-Berry syndrome” and fetal ascites may have arisen from these anomalies.     

Fetal ascites. A report of 3 autopsy cases

Three rare autopsy cases of fetal ascites were presented and the etiology of each case was described. Case 1 was a male neonate, delivered by cesarean section at 32 weeks' gestation, and died of respiratory failure. The abdomen was remarkably distended with 1020 ml of ascites. The etiology of Case 1 remained unknown even after macroscopic and microscopic examinations. We considered this as "idiopathic" fetal ascites. Case 2 was a female neonate, delivered at 31 weeks' gestation, with marked abdominal distension and cyanosis. Autopsy revealed 435 ml of ascites, and she was considered to have had "polysplenia syndrome" with cardiovascular malformations. Intrauterine heart failure due to cardiac anomalies was thought to be the cause of this ascites. In case 3 embryotomy was carried out under the diagnosis of fetal ascites by ultrasound examination at 22 weeks' gestation. An urachal cyst connected to the dilated urinary bladder and deficiency of musculature of the abdominal wall composed of loose connective tissue with calcification were observed. The abdominal wall was ruptured and 1,960 ml of ascites was measured. Polycystic kidney with renal dysplasia was also found. Case 3 showed "Prune-Berry syndrome" and fetal ascites may have arisen from these anomalies.     

Hydrops fetalis in an interstitial deletion of chromosome 10

We report the case of a premature neonate with ascites and dysmorphic facial features at birth. The chromosomal analysis showed an interstitial deletion of chromosome 10, that is, 46, XX, del(10)(q22.3q24.1). This is the first known case of a patient with interstitial deletion of chromosome 10 with symptoms of ascites and hydrops.     

Hydrocortisone protects cycloheximide-challenged mice pretreated with Ehrlich ascites tumour cells or with cell-free Ehrlich ascites tumour fluid

The invariably fatal outcome following cycloheximide challenge of mice pretreated 24 h earlier with either 1 x 10(7) washed Ehrlich ascites tumour cells i.v. or with 0.2 ml of cell-free Ehrlich ascites tumour fluid i.v. was prevented by hydrocortisone treatment. However, glucocorticosteroids failed to prevent the fatal outcome of cycloheximide challenge in mice bearing 5-day-old Ehrlich ascites tumours. The results are interpreted as indicating that there is a steroid demand which must be met to ensure survival of cycloheximide-challenged mice pretreated with tumour cells or with cell-free tumour ascites fluid and that an additional and essential requirement for uninterrupted protein synthesis exists in the case of mice with established ascites tumours and challenged with cycloheximide.     

A case of eosinophilic gastroenteritis complicated with ileus and ascites collection]

A 30-year-old woman was admitted to our hospital because of ileus and ascites. Laboratory data on admission demonstrated marked eosinophilia (42.5% of WBC) but negative CRP-value. Abdominal CT showed marked ascites and diffuse thickening of intestinal walls. Ascites examination revealed eosinophilic ascites. The level of IL-5 both in the serum and in the ascites were also high. No evidence of eosinophilic infiltration was noted both gastric and colonic mucosal biopsy specimens. Oral prednisolone treatment (50 mg/day) was effective for her. We diagnosed her as a case of sub-serosal type eosinophilic gastroenteritis. It is essential to obtain eosinophilic ascites for correct diagnosis of the disease. And it is possible that serum and ascites IL-5 value would be reliable indicator of the activity of this disease.     

A case of gastroenteritis associated with gastric trichuriasis

A rare human case of gastroenteritis and eosinophilic ascites associated with gastric trichuriasis is described. The patient was a 32-yr-old woman who was working in a farm near Pohang, Korea. She complained of abdominal pain, diarrhea, and vomiting. Endoscopic examination found focal linear hyperemia on the mucosa of the stomach antrum, and endoscopic biopsy confirmed eosinophilic inflammation of the mucosa and submucosa of the stomach, terminal ileum, and cecum. The biopsy specimen of the stomach included a female Trichuris trichiura which was covered by many inflammatory cells on its surface. Ascites and intestinal wall thickening was found by CT scan, and Douglas pouch centesis aspirated bloody ascites which included many eosinophils. She was medicated with prednisolone and albendazole and cured. She is the first case of eosinophilic inflammation of the gastrointestinal tract and ascites associated with trichuriasis in the stomach.     

10例胎儿腹水宫内诊断与治疗

目的对先天发育异常腹水胎儿进行脐静脉穿刺和腹水穿刺等产前诊断及宫内干预，了解胎儿腹水的病因病理，探讨胎儿腹水可行的诊疗方案。方法对10例孕23～35w，B超诊断腹水胎儿进行产前诊断，内容包括：母血Rh、ABO血型、地中海贫血、TORCH及脐静脉穿刺查胎血：血红蛋白电泳、血常规、细胞形态、染色体、TORCH及胎血生化肝功、心酶、B2－MG等指标；胎儿腹水穿刺行常规、生化、细菌学等检查；在产前诊断排除胎儿染色体、TORCH、重型地中海贫血等重大疾病基础上对胎儿进行腹水穿刺、经母补氧、补液等改善胎盘功能等对症处理。结果10例腹水胎儿5例获得良好预后；1例胎儿经干预病程向好，但其家属要求放弃；3例胎儿腹水治疗效果不满意，其中2例同意终止妊娠，另1例坚持妊娠，于34w胎死。结论胎儿不明原因腹水应该进行产前诊断，适当对症处理、观察，合理评估，部分可获得良好预后；不需盲目终止妊娠。     

Cytology of metastatic appendiceal goblet cell carcinoid in pleural effusion fluid: a case report

Goblet cell appendiceal carcinoid (GCAC) is a rare neoplasm. We described the case of a 72-year-old man who presented with symptoms related to ascites. A computed tomography (CT) scan showed a mass involving the base of the appendix, ascites and concomitant pleural effusion. Thoracentesis of the pleural fluid showed metastatic GCAC. The appendiceal mass was biopsied and diagnosed as a GCAC. We describe the cytologic features of the metastatic GCAC to pleural fluid. To our knowledge this is the first such described case.     

Spontaneous regression of Budd-Chiari syndrome (hepatic venous occlusion) in a young female

A case of occlusion of the hepatic veins in an 18-year-old girl is presented. The onset was sudden with massive ascites and markedly impaired general condition. The diagnosis was based on liver biopsy and angiograms of the caval and hepatic veins as well as of the celiac artery. No predisposing factors could be found. The patient was treated conservatively with laparocentesis and diuretics. Clear improvement was seen after two weeks, and after four weeks she had no ascites and could be discharged. All liver function tests were then normalized. After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered. The case illustrates that also widespread thrombi of the hepatic veins may sometimes rapidly dissolve spontaneously, with apparent total reconstitution of hepatic function. This case is unusual since previously reported cases have had high mortality rates and, in surviving cases, operative procedures or large doses of diuretics have been required to control the ascites.     

Primary malignant lymphoma of the central nervous system presenting with ascites and pleural effusion

A 70-year-old woman was admitted to our hospital owing to ascites and pleural effusion. Though malignant cells (B-cell type lymphoma) were detected in both the ascites and pleural effusion, neither lymph node swelling nor a tumor was detected upon chest, abdominal and pelvic computed tomography (CT). After weekly THP-COP therapy for 8 weeks, the ascites and pleural effusion completely disappeared. Two years after the first admission, she was re-admitted because of a disturbance of consciousness, and a brain tumor was detected on CT scan. The immunohistological and genetic data for the brain tumor were identical to those of the malignant cells in the pleural effusion and ascites detected 2 years previously. Whereas the symptoms at onset of a primary lymphoma of the central nervous system (CNS) are usually neurological ones, in this rare case of primary CNS lymphoma, the symptoms at onset were the ascites and pleural effusion without neurological symptoms.     

Ascites als Komplikation hepatischer Speicherung von Hydroxyethylstärke (HES) bei Langzeitdialyse

Summary Three adult dialysis patients developed ascites after having received repeatedly the plasma substitue hydroxyethyl starch (HES 40/0.5). In two cases (total dose 180, and 330 g HES, respectively) the ascites was reversible after discontinuation of the HES administration. In the third case (total dose 915 g HES) the ascites could be controlled only by implantation of a Denver shunt. In this latter case it was shown by histological, electron microscopical, and biochemical findings that the ascites was caused by hepatic sinusoidal obstruction due to an extreme storage of HES in the sinusoidal lining cells. Additional storage was detected in hepatocytes, bile duct epithelia, endothelial cells, and fibroblasts in the portal tracts. Biochemically HES was found in liver tissue at a concentration of 4% (w/w). Although in renal impairment plasma clearance of HES is not significantly different from normal individuals, long-term administration of HES must be regarded inadvisable because of tissue storage which apparently is especially significant in this condition.

     

Cytologic features of ascites in malignant fibrous histiocytoma of the colon

The cytologic features of ascitic fluid in a case of malignant fibrous histiocytoma (MFH) of the colon are described. At autopsy, two solid tumor masses were found around the ascending and transverse colon, accompanied by about 3,000 ml of ascites. Tumor cells had infiltrated diffusely into the outer layers of almost all of the gastrointestinal wall, simulating peritonitis carcinomatosa. Cytologic examination of the ascites revealed various kinds of tumor cells; short spindle-like cells, multinucleated giant cells, and round cells with an invaginated nuclear margin, forming small clusters. These cytologic findings were considered to be very useful in the diagnosis of MFH, especially in cytologic examinations of ascites.     

Unusual primary peritonitis due to Streptococcus pyogenes in a young healthy woman

We describe the first case of primary peritonitis in Korea of a healthy person due to Streptococcus pyogenes. In the absence of comorbid conditions, such as liver cirrhosis, immunosuppression, or nephrotic syndrome, primary peritonitis is uncommon in a young healthy woman. Abdomen computed tomography revealed ascites in the lower abdomen and peritoneal enhancement suggesting peritonitis. In diagnostic laparoscopy, purulent ascites was found in the pelvic cavity but both ovaries and fallopian tubes were intact. There were no intra-abdominal abnormalities such as bowel perforation, appendicitis, or necrosis. The reports of blood culture, ascites culture, and cervical swab culture confirmed S. pyogenes. After use of antibiotics, the patient was cured and discharged without sequelae.     

GIANT CELL CARCINOMA OF THE PANCREAS

A case of giant cell carcinom of the pancreas is reported herein. The patient is a 67-year-old Japanese woman complaining of ascites, general fatigue, loss of weight, abdominal distention, nausea, and vomiting. Cytological diagnosis of ascites revealed adenocarcinoma. At autopsy, a whitish tumor measuring around 5 cm in diameter was found at the head of the pancreas. Metastasis was seen only in the liver. Histological examination displayed bizarre multinucleated giant cells occasionally phagocytosing the tumor cells and neutrophils.     

Intra-abdominal desmoplastic small cell tumour--a case report

Intra-abdominal desmoplastic small cell tumour is a rare malignant neoplasm of childhood. We report a case of this uncommon tumour in a 14-year-old boy. The tumour originated from transverse mesocolon. The case is notable because there was no pain and ascites on presentation and there was transmural infiltration of the transverse colon.     

CYTOLOGIC FEATURES OF ASCITES IN MALIGNANT FIBROUS HISTIOCYTOMA OF THE COLON

The cytologic features of ascitic fluid in a case of malignant fibrous histiocytoma (MFH) of the colon are described. At autopsy, two solid tumor masses were found around the ascending and transverse colon, accompanied by about 3,000 ml of ascites. Tumor cells had infiltrated diffusely into the outer layers of almost all of the gastrointestinal wall, simulating peritonitis carcinomatosa. Cytologic examination of the ascites revealed various kinds of tumor cells; short spindle-like cells, multinucleated giant cells, and round cells with an invaginated nuclear margin, forming small clusters. These cytologic findings were considered to be very useful in the diagnosis of MFH, especially in cytologic examinations of ascites. ACTA PATHOL JPN 38: 921 ∼ 928, 1988.     

简易高钠血液透析在慢性肾功能衰竭（CRF）合并浆膜腔积液中的特殊应用

北京市朝阳区第二医院(朝阳区血液净化中心)近10年来共收治慢性肾功能衰竭维持性血液透析病人约2．5万余例次,其中有42例合并有浆膜腔积液(腹腔或胸腔或心包腔)。经用价格低廉的简易高钠透析治疗观察,发现这是个简单易行、安全有效、经济实用的治疗方法。方法：无需特殊设备,只需一般普通血液透析机,定时定量静脉注射高渗氯化钠溶液观察疗效。在42例病人中,有20例大量腹水,5例心包积液,12例胸水。同时合并：胸腹水2例,腹水及心包积液1例,胸水、腹水、心包积液三腔均有2例。结果：经高钠透析治疗后的42例病历,88％的CRF合并浆膜腔积液(腹水、胸水或心包积液)均取得了满意效果,解除了患症状,提高了生活质量。结论：简易高钠血液透析是一种简单易行、安全可靠、价格低廉、适合于基层医院推广的良好透析方法。     

Acardiac amorphous twin with prune belly sequence in the co-twin

We describe a twin with acardia acephalus or "Twin Reversed Arterial Perfusion Sequence" and prune belly sequence in the co-twin. In a former quite similar case a prune belly appearance of the co-twin of an acardiac fetus was found to be secondary to the ascites caused by cardiac failure. In the present case, we are dealing with the prune belly sequence as a separate condition, given the fact there were no signs of ascites or cardiac failure. We also found associated anomalies: agenesis of the left ureter and kidney, dysplastic right kidney and anal atresia. Urinary tract obstruction has never been described in the co-twin of an acardiac amorphous fetus.     

A case of successful detection of disseminated gastrointestinal stromal tumors by ascites smear cytology using cell block preparation with DOG1 immunostaining

Cytological features of gastrointestinal stromal tumors (GISTs) have been reported, especially regarding fine‐needle aspiration cytology, including immunostaining for c‐kit and DOG1. Meanwhile, cytological findings of GISTs on ascites cytology have rarely been reported, which may be owing to the rare appearance of GIST tumor cells in ascites. Herein, we present a 66‐year‐old woman who had disseminated GISTs in the abdomen. The GIST tumor cells appeared sparsely in the ascites smear cytology using ascites obtained at the time of autopsy. Even when widespread intra‐abdominal dissemination takes place, GISTs may be hard to detect in ascites smear cytology, based on the experience of this case. However, immunohistochemistry of DOG1 using a cell block preparation was found to clearly visualize the GIST tumor cells, although they were sparsely present. Immunostaining of c‐kit did not provide as clear an identification of the tumor cells as DOG1 did. When suspicious about GISTs, it is wise to prepare a cell block to make it possible to visualize the tumor cells immunohistochemically. Diagn. Cytopathol. 2016;44:137–140. © 2015 Wiley Periodicals, Inc.     

Novel nosocomial infections by Stenotrophomonas maltophilia: first reported case from Lucknow,North India

We describe a case of empyema with infected ascites caused by Stenotrophomonas maltophilia, which has rarely been reported as pathogenic. The source was determined to a disinfectant solution. The isolate was sensitive to a newer carbapenem-meropenem, and the patient was treated successfully. This case represents a novel dual presentation of a nosocomial infection by the isolate in question.