Kaposi's sarcoma (KS) is the most common neoplasm among HIV-infected individuals. The frequency of involvement of KS in the gastrointestinal (GI) tract and the associated epidemiological, immune, endoscopic, and histopathological features in HIV-infected patients, were evaluated in this study. A review of the medical and endoscopy reports of 1428 HIV-infected patients, who had undergone upper GI endoscopy at the Endoscopy Service, Clinical Hospital, Faculty of Medicine of Ribeirão Preto between January 1999 and June 2009, was performed. Clinical, epidemiological, immunological, endoscopic, and histological data were collected. Twenty-seven (1.9%) patients were diagnosed with GI KS. Patients were predominantly male (81.5%). Sexual activity was the main route of HIV transmission (81.5%). Cutaneous involvement was noted in 21 patients (78%). Fifteen patients (55%) received highly active antiretroviral therapy for a mean duration of 12.6 weeks (range 2-52 weeks) before endoscopy. GI lesions were mainly found in the stomach (55%). Analysis of the immunohistochemical methods HHV8 LNA-1, CD31, and CD34 for the diagnosis of gastric KS indicated high agreement (kappa=0.63, 95% confidence interval 0.32-0.94). There was no relationship between CD4 levels (p=0.34) or HIV viral load (p=0.99) and HHV8 LNA-1 positivity in gastric KS. GI KS is an infrequent finding in patients with HIV infection. Among those with GI KS, 80% had concomitant skin lesions. Immunohistochemical methods for CD31, CD34, and LNA-1 were important tools in the diagnostic assessment of lesions suggestive of KS in the GI tract. Further studies are required to confirm these data, and the need for routine endoscopic investigation of the GI tract in HIV-infected patients with cutaneous KS should be assessed.

Trypanosomiasis induces a remarkable myenteric neuronal degeneration leading to megacolon. Very little is known about the risk for colon cancer in chagasic megacolon patients. To clarify whether chagasic megacolon impacts on colon carcinogenesis, we investigated the risk for colon cancer in Trypanosoma cruzi (T. cruzi) infected patients and rats. Colon samples from T. cruzi-infected and uninfected patients and rats were histopathologically investigated with colon cancer biomarkers. An experimental model for chemical myenteric denervation was also performed to verify the myenteric neuronal effects on colon carcinogenesis. All experiments complied the guidelines and approval of ethical institutional review boards. No colon tumors were found in chagasic megacolon samples. A significant myenteric neuronal denervation was observed. Epithelial cell proliferation and hyperplasia were found increased in chagasic megacolon. Analyzing the argyrophilic nucleolar organiser regions within the cryptal bottom revealed reduced risk for colon cancer in Chagas’ megacolon patients. T. cruzi-infected rats showed a significant myenteric neuronal denervation and decreased numbers of colon preneoplastic lesions. In chemical myenteric denervated rats preneoplastic lesions were reduced from the 2^nd wk onward, which ensued having the colon myenteric denervation significantly induced. Our data suggest that the trypanosomiasis-related myenteric neuronal degeneration protects the colon tissue from carcinogenic events. Current findings highlight potential mechanisms in tropical diseases and cancer research. The myenteric neuronal activity on colon carcinogenesis is a matter of debate. Chagas disease (a trypanosomiasis-related chronic infection) induces megacolon damaging myenteric neurons. Puzzling, tumors have been rarely reported in chagasic megacolon patients. We reveal here hyperplasia-related high-proliferation occurs in chagasic megacolon, although the risk for colon cancer is reduced. Having carcinogen-exposed rats infected with Trypanosoma cruzi reduced the numbers of myenteric neurons and colon preneoplastic lesions. An experimental model for chemical myenteric denervation was applied in carcinogen-exposed rats revealing that myenteric neurons promote the development of colon preneoplastic lesions. Yet, activity of the fecal content had to be secluded from the myenteric neuronal activity on colon carcinogenesis. Hartmann’s surgical procedure enabled that. This was applied together with carcinogenic exposure and myenteric neuronal denervation ensuring that the neuronal activity is associated with enhanced development of colon carcinogenesis. Taken together, we believe colon tumors are not found within the chagasic megacolon region because the myenteric neuronal density is impaired. These observations shed lights on novel potential cell to cell interactions promoting the colon cancer development.

Background: It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. Aim: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. Methods: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. Results: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. Conclusions: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.

Esophageal ulcer (EU) represents an important comorbidity in AIDS. We evaluated the prevalence of EU, the accuracy of the endoscopic and histologic methods used to investigate viral EU in HIV-positive Brazilian patients and the numerical relevance of tissue sampling. A total of 399 HIV-positive patients underwent upper gastrointestinal (UGI) endoscopy. HIV-positive patients with EU determined by UGI endoscopy followed by biopsies were analyzed by the hematoxylin-eosin (HE) and immunohistochemical (IH) methods. EU was detected in 41 patients (mean age, 39.2 years; 23 males), with a prevalence of 10.27%. The median CD4 count was 49 cells/mm(3) (range, 1-361 cells/mm(3)) and the viral load was 58,869 copies per milliliter (range, 50-77,3290 copies per milliliter). UGI endoscopy detected 29 of 41 EU suggestive of cytomegalovirus (CMV) infection and 7 of 41 indicating herpes simplex virus (HSV) infection. HE histology confirmed 4 of 29 ulcers induced by CMV, 2 of 7 induced by HSV, and 1 of 7 induced by HSV plus CMV. IH for CMV and HSV confirmed the HE findings and detected one additional CMV-induced case. UGI endoscopy showed 100% sensitivity and 15% specificity for the diagnosis of EU due to CMV or HSV compared to HE and IH. HE proved to be an adequate method for etiologic evaluation, with 87% sensitivity and 100% specificity compared to IH. The number of samples did not influence the etiologic evaluation. The data support the importance of IH as a complementary method for HE in the diagnosis of EU of viral etiology.

Paracoccidioiodomycosis (PCM) is a systemic and deep mycosis endemic in Latin America, especially in Brazil. In patients infected with human immunodeficiency virus (HIV), PCM can manifest with prominent involvement of the reticuloendothelial system. There are no reports in the literature of esophageal involvement by PCM in that population. We report a case of PCM with pulmonary and esophageal involvement without radiologic evidence of an esophageal-bronchial fistula in an HIV-infected patient.