Analogies in medicine: anchovy paste in the liver

LETTER TO THE EDITOR

Analogies in medicine: anchovy paste in the liver

José de Souza Andrade-Filho

Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil, E-mail: [e-mail]

Belo Horizonte, May, 2012

Dear Sir,

Anchovy paste in the liver. The term "amibe" was given by Bery St. Vincent to the Proteus animalcule which has been described by earlier naturalists. The name was taken up in England but the term was referred to the original Greek derivation. It was given to a general group of animalcules which exhibit pseudopodia and was adopted as a generic name: amoeba, a change; thus a form of changing shape⁵.

Infection of the liver by Entamoeba histolytica is the most common extra-intestinal complication of amebiasis. The parasites (trophozoites) are carried to the liver by the portal vein. However, in more than half the patients there may be no evidence of amebic infection in the stool and no colonic lesions are present. Amebiasis occurs at all ages. The distribution is worldwide, but the disease is much more common in the tropics and subtropics, with a high incidence in India, tropical regions of Africa, Mexico and other countries of Central America and Amazonian Region¹.

The initial lesion is an area of enzymatic necrosis which only later breaks down to form a cavity ranging from eight to 12 cm in diameter. The right lobe is most frequently affected. In the large lytic lesions the cavity may contain reddish-brown, blood stained material, named amebic liver abscess. This is an inadequate denomination since neutrophils are absent or are in small numbers. Its content is formed by liquefying or degenerated hepatocytes, fat globules, bile, and hematic debris, besides the trophozoites. On gross examination, it is pastous, thick, inodorous, or similar to fresh meat smell, red-brown, likened to anchovy paste. Therefore, the term amebic liver "abscess" is a misnomer, although prescriptive. The correct expression should be amebic necrosis^1-4.

Anchovies are small, shiny, silver fish of the Anchoa (North America) or Engraulis (Mediterranean European) family. They are related to the herring and distinguished by a large mouth, almost always extending behind the eye, and by a separate pointed snout. They swim in large schools which may contain hundreds of individual fish. Anchovies are found and caught in vast numbers in the Mediterranean. Because they are small, generally 10-25 cm (four to 10 inches) in length, anchovies are often confused with sardines (Sardinella anchovia). Anchovy paste is readily available in many grocery and specialty stores, usually in the form of small tubes. Anchovy paste is a thick, concentrated paste made from ground anchovy fillets, vinegar, spices and a little sugar to counterpart their salty flavor. It was not possible to find who made the comparison between anchovy paste and the amebic liver necrosis.

• 1. Andrade DH, Andrade-Júnior DH. Amebíase. In: Veronesi R, Focaccia R, editores. Tratado de infectologia. São Paulo: Atheneu; 1996. p. 1149-59.
• 2. Andrade-Filho JS, Pena GP. Analogies in medicine. Int J Surg Pathol. 2001;9:345-6.
• 3. Macsween RNM, Anthony PP, Scheuer PJ. Pathology of the Liver. 2^nd ed. New York: Churchill Livingtone; 1987. p. 246-8.
• 4. Pena GP, Andrade-Filho JS. Analogies in medicine: valuable for learning, reasoning, remembering and naming. Adv Health Sci Educ Theory Pract. 2010;15:609-19. DOI: 10.1007/s10459-008-9126-2.
• 5. Skinner HA. The origin of medical terms. 2^nd ed. Baltimore: The Williams & Wilkins Company; 1961.

Publication Dates

• Publication in this collection
  25 July 2012
• Date of issue
  Aug 2012