Marcelo Amante
Universidad de Buenos Aires, Pathology, Department Member
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El pronóstico de la enfermedad crónica hepática depende de la extensión y la progresión de la fibrosis hepática. Actualmente la biopsia hepática es la técnica de elección para determinar el grado de fibrosis, pero es una prueba invasiva,... more
El pronóstico de la enfermedad crónica hepática depende de la extensión y la progresión de la fibrosis hepática. Actualmente la biopsia hepática es la técnica de elección para determinar el grado de fibrosis, pero es una prueba invasiva, no exenta de complicaciones. Por ello, el desarrollo de marcadores no invasivos de fibrosis hepática se convirtió en una necesidad indiscutible. Se propuso la elastografìa por transición (Fibroscan®) para valorar la fibrosis hepática en pacientes con enfermedad crónica hepática, mediante la medición de la rigidez hepática. Nuestro objetivo fue evaluar la efectividad, la objetividad y la seguridad de esta técnica. Se estudiaron 68 pacientes a los que se les realizó una biopsia hepática en los 18 meses previos al estudio. Todos los procedimientos de elastografia y biopsia hepática fueron analizados por un mismo profesional (DA y MA, respectivamente). Para la valoración de la biopsia hepática se utilizó la escala METAVIR. El valor medio de rigidez en p...
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The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold... more
The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold standard for the staging and grading of fibrosis. Therefore, accurate noninvasive tests for liver injury are urgently needed. During the last years, transient elastography (Fibroscan®) has been proposed for the assessment of hepatic fibrosis in patients with chronic liver disease, by measuring liver stiffness. The aim of this study was to evaluate the effectiveness, objectivity and safety of this technique. We included 68 patients who underwent a liver biopsy in the last 18 months with a wide spectrum of chronic liver diseases. All procedures as well as the liver biopsies according to the METAVIR scoring system were analyzed by the same sonographer and the same specialist in pathology, respectively. Median value of stiffness with none or mild fibrosis (F...
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OBJECTIVE Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications... more
OBJECTIVE Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the topic from 1957. A 54-year-old patient presented with a lobulated 8x4x3 cm lesion in the balanopreputial groove over two years; he was treated initially with partial penectomy and subsequently with total penectomy We analyze the evolution, progression and adjuvant treatments of this rare pathology. METHODS/RESULTS We report one case with its clinical presentation, diagnostic tests performed for staging, treatment and follow-up. CONCLUSIONS The first case of penile leiomyosarcoma was described by Levi in 1930. In 1957 Ashley and Edwards reported the first case in the British literature and in 1963 Pack reported the first in the American literature. MacKenzie et al. were the first to recognize two types of leiomyosarcoma: superficial and deep. ...
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The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold... more
The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold standard for the staging and grading of fibrosis. Therefore, accurate noninvasive tests for liver injury are urgently needed. During the last years, transient elastography (Fibroscan®) has been proposed for the assessment of hepatic fibrosis in patients with chronic liver disease, by measuring liver stiffness. The aim of this study was to evaluate the effectiveness, objectivity and safety of this technique. We included 68 patients who underwent a liver biopsy in the last 18 months with a wide spectrum of chronic liver diseases. All procedures as well as the liver biopsies according to the METAVIR scoring system were analyzed by the same sonographer and the same specialist in pathology, respectively. Median value of stiffness with none or mild fibrosis (F...
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The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to... more
The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to IgG4 disease. A 40-year-old woman with a history of pruritus, anosmia, Sjögren's syndrome and diabetes, was referred for a pancreatic tumor. Alkaline phosphatase was 24-fold upper limit of normal (ULN), gamma-glutamyl transpeptidase 21-fold ULN, aspartate aminotransferase 3-fold ULN, alanine aminotransferase 2-fold ULN, cholesterol 408 mg/dL, bilirubin normal, gamma-globulin 3.92 g/dL, IgG4 4.6 g/L, antinuclear antibody positive (1/320), and antimitochondrial antibodies negative. Ultrasound scan (US) showed a mass in the pancreatic head and thickening of the gallbladder and the bile duct walls. Dilation and strictures of the main pancreatic duct and intrahepatic bile ducts were detected by MR cholangiopancreatography. Liver biopsy showed chronic ...
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The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to... more
The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to IgG4 disease. A 40-year-old woman with a history of pruritus, anosmia, Sjögren's syndrome and diabetes, was referred for a pancreatic tumor. Alkaline phosphatase was 24-fold upper limit of normal (ULN), gamma-glutamyl transpeptidase 21-fold ULN, aspartate aminotransferase 3-fold ULN, alanine aminotransferase 2-fold ULN, cholesterol 408 mg/dL, bilirubin normal, gamma-globulin 3.92 g/dL, IgG4 4.6 g/L, antinuclear antibody positive (1/320), and antimitochondrial antibodies negative. Ultrasound scan (US) showed a mass in the pancreatic head and thickening of the gallbladder and the bile duct walls. Dilation and strictures of the main pancreatic duct and intrahepatic bile ducts were detected by MR cholangiopancreatography. Liver biopsy showed chronic inflammatory lesions, ductal damage (autoimmune cholangitis) (METAVIRA2, F2) and IgG4 bearing plasmatic cells. A cervical lymph node showed IgG4 bearing plasmatic cells. After 2 weeks of treatment with meprednisone, ursodeoxycholic acid and insulin, pruritus and anosmia disappeared. After eleven months of treatment imaging studies showed disappearance of the pancreatic tumor, atrophy of the body and the pancreatic tail and normal biochemical parameters, except for alkaline phosphatase 2-fold ULN. The final diagnosis of our patient was autoimmune hepatitis with cholangitis associated to IgG4 systemic diseases.
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De los servicios De cirugía general y anatomía Patológica, HosPital general De aguDos cosme argericH, Buenos aires, argentina RESUMEN Antecedentes: la pancreatitis autoinmune (PAI) es una entidad clinicopatológica que habitualmente... more
De los servicios De cirugía general y anatomía Patológica, HosPital general De aguDos cosme argericH, Buenos aires, argentina RESUMEN Antecedentes: la pancreatitis autoinmune (PAI) es una entidad clinicopatológica que habitualmente responde al tratamiento con corticoides. Debido a que su forma de presentación simula el carcinoma pancreático, el diagnóstico exacto es imprescindible para evitar pancreatectomías innecesarias. Objetivo: Determinar la eficacia del sistema HISORt para el diagnóstico diferencial entre PAI y el carcinoma de páncreas. Lugar de aplicación: Centro terciario de referencia. Población: 36 pacientes con PAI tratados entre 1999 y 2009. Métodos: El diagnóstico de PAI fue confirmado mediante la anatomía patológica (biopsia o pieza quirúrgica) o mediante la combinación de la clínica, métodos por imágenes (TC, US, RNM), biopsia tru-cut en casos seleccionados y tratamiento de prueba con corticoides. A partir de 2004 se incorporó la determinación de los niveles de IgG sé...
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Lamotrigine is a non-aromatic antiepileptic drug. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe idiosyncratic reaction to drugs, especially anti-epileptic drugs. Associated clinical features include... more
Lamotrigine is a non-aromatic antiepileptic drug. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe idiosyncratic reaction to drugs, especially anti-epileptic drugs. Associated clinical features include cutaneous eruption, fever, multiple peripheral lymphadenopathies, and potentially life-threatening damage of one or more organs. We report a case of DRESS syndrome induced by lamotrigine presenting with a hypersensitivity syndrome and fulminant hepatic failure requiring liver transplant. A 21-year old female patient presented an episode of seizure with loss of conscience. CT and EEG studies performed were normal. Treatment with lamotrigine was prescribed. In the course of 30 days, the patient developed skin lesions, pruritus, cholestatic hepatitis, and systemic symptoms -fever, lymphadenopathies, extensive exfoliative erythematous maculopapular rash, and jaundice. Serologic and laboratory tests showed no other causes responsible for the clinical spectrum....
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FAP is an autosomal dominant inherited disease, characterized by systemic deposition of amyloid fibrils in various tissues. The purpose of this study is to describe the gross and microscopic findings of the explanted livers for FAP.10... more
FAP is an autosomal dominant inherited disease, characterized by systemic deposition of amyloid fibrils in various tissues. The purpose of this study is to describe the gross and microscopic findings of the explanted livers for FAP.10 patients were transplanted for FAP at our institution. Diagnosis was supported by positive familiar history, clinical data and detection of mutated TTR by electrospray ionization mass spectrometry with Val30Met mutation verified by PCR. All the explanted livers were photographed, fixed in formol and processed according to protocol. Later they were examined with HyE, reticulin, PAS diastasa, Masson trichromic, Congo red with polarised light and immunoreactivity against TTR. The gross aspect was normal. We obtained multiple samples representative of the organ and the hepatic hilium. All of the patients presented with deposits of amyloid substance in the lymph nodes and the nerves of the hepatic hilium These deposits were Congo red positive with a greenis...
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Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the... more
Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the topic from 1957. A 54-year-old patient presented with a lobulated 8x4x3 cm lesion in the balanopreputial groove over two years; he was treated initially with partial penectomy and subsequently with total penectomy We analyze the evolution, progression and adjuvant treatments of this rare pathology. We report one case with its clinical presentation, diagnostic tests performed for staging, treatment and follow-up. The first case of penile leiomyosarcoma was described by Levi in 1930. In 1957 Ashley and Edwards reported the first case in the British literature and in 1963 Pack reported the first in the American literature. MacKenzie et al. were the first to recognize two types of leiomyosarcoma: superficial and deep. The first develop from smooth muscle c...
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Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for... more
Hepatoxicity of isoniazid, mainly in association with rifampin, is a rare secondary effect of tuberculostatic treatment. In the United States, it accounts for 0.2% of all pediatric orthotropic liver transplant, and 14% of transplants for drug hepatotoxicity. We report the case of a 10 year-old patient who presented with acute liver failure requiring orthotropic liver transplant after forty days of tuberculostatic treatment with isoniazid, rifampin and pyrazinamide.
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The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to... more
The IgG4-related sclerosing disease is characterized by the presence of plasmatic IgG4 positive cells and T-lymphocytes infiltration in different organs. We herein report a case of cholestasis due to autoimmune cholangitis associated to IgG4 disease. A 40-year-old woman with a history of pruritus, anosmia, Sjögren's syndrome and diabetes, was referred for a pancreatic tumor. Alkaline phosphatase was 24-fold upper limit of normal (ULN), gamma-glutamyl transpeptidase 21-fold ULN, aspartate aminotransferase 3-fold ULN, alanine aminotransferase 2-fold ULN, cholesterol 408 mg/dL, bilirubin normal, gamma-globulin 3.92 g/dL, IgG4 4.6 g/L, antinuclear antibody positive (1/320), and antimitochondrial antibodies negative. Ultrasound scan (US) showed a mass in the pancreatic head and thickening of the gallbladder and the bile duct walls. Dilation and strictures of the main pancreatic duct and intrahepatic bile ducts were detected by MR cholangiopancreatography. Liver biopsy showed chronic inflammatory lesions, ductal damage (autoimmune cholangitis) (METAVIRA2, F2) and IgG4 bearing plasmatic cells. A cervical lymph node showed IgG4 bearing plasmatic cells. After 2 weeks of treatment with meprednisone, ursodeoxycholic acid and insulin, pruritus and anosmia disappeared. After eleven months of treatment imaging studies showed disappearance of the pancreatic tumor, atrophy of the body and the pancreatic tail and normal biochemical parameters, except for alkaline phosphatase 2-fold ULN. The final diagnosis of our patient was autoimmune hepatitis with cholangitis associated to IgG4 systemic diseases.
Research Interests:
The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold... more
The prognosis and management of chronic liver disease largely depends on the extent and progression of liver fibrosis. Unfortunately, liver biopsy, an invasive and painful technique with several limitations, continues to be the gold standard for the staging and grading of fibrosis. Therefore, accurate noninvasive tests for liver injury are urgently needed. During the last years, transient elastography (Fibroscan®) has been proposed for the assessment of hepatic fibrosis in patients with chronic liver disease, by measuring liver stiffness. The aim of this study was to evaluate the effectiveness, objectivity and safety of this technique. We included 68 patients who underwent a liver biopsy in the last 18 months with a wide spectrum of chronic liver diseases. All procedures as well as the liver biopsies according to the METAVIR scoring system were analyzed by the same sonographer and the same specialist in pathology, respectively. Median value of stiffness with none or mild fibrosis (F...
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Servicio de Urología. Hospital Dr. Cosme Argerich. Buenos Aires . Argentina. España. ... Objetivo: El leiomiosarcoma primario de pene constituye una rara entidad. Desde 1930 hasta la actualidad han sido reportados solo 30 casos en la... more
Servicio de Urología. Hospital Dr. Cosme Argerich. Buenos Aires . Argentina. España. ... Objetivo: El leiomiosarcoma primario de pene constituye una rara entidad. Desde 1930 hasta la actualidad han sido reportados solo 30 casos en la literatura mundial. Además de ...