Histopathological Examination Of Biopsy Research Articles

The Relationship Between Severity of Gastric Inflammation Due to Helicobacter pylori and Colorectal Malignancies

Objective: Several factors play role in colorectal carcinogenesis. Among these factors, helicobacter pylori infection is supposed to be one of the causative factors. Previous studies were focused on investigation of the relationship between helicobacter pylori existence and colon carcinomas by particular serological diagnostic tests. The aim of our study was to determine the effect of the helicobacter pylori infection and the severity of inflammation related to this infection on the colon carcinomas and non carcinoma colon mass lesions(tubular adenoma, tubulovillous adenoma, hyperplastic polyp). Method: A retrospective study was conducted at Kecioren Teaching - Research Hospital between 2010 to 2018. The files of 657 patients who underwent colonoscopy and were diagnosed as colon benign or malign mass lesions were examined retrospectively from the hospital database. Two hundred five patients who had undergone both upper gastrointestinal endoscopy and colonoscopies were included in the study. The presence and severity of inflammation due to helicobacter pylori were evaluated by histopathological examination of biopsies taken during upper gastrointestinal endoscopy. The severity of H. pylori inflammation was graded according to the Sydney classification Results: In the comparison of colon carcinoma with other colon mass lesions group, there was no statistical significance in terms of gender (P= 0.094) and H. pylori serology (P= 0.998). However, the degree of inflammation was significantly high in patients with colon carcinoma than other colon mass lesions (P< 0.001). Conclusions: The fact that the severity of helicobacter pylori inflammation is higher in patients with colon carcinoma than patients with non-carcinoma colonic mass lesions suggests that inflammation due to helicobacter pylori may be more important than the presence of helicobacter pylori in the carcinogenesis of colon cancer.

Pancreatic cancer with synchronous liver and colon metastases: A case report

BACKGROUNDMetastasis of pancreatic cancer to the colon is rare and the features need to be further elucidated. Herein, we report a rare case of pancreatic cancer with simultaneous liver and colon metastases.CASE SUMMARYA 48-year-old man with intrahepatic space-occupying lesions based on a computed tomography scan was admitted to our hospital for further treatment. Abdominal magnetic resonance imaging revealed a 6.4 cm × 4.2 cm mass in the tail of the pancreas and multiple low-density masses in the liver parenchyma. In addition, a mass of 2.2 cm × 1.6 cm with surface congestive erosions in the sigmoid colon was detected by colonoscopy. Histopathological examination of biopsies from both the liver and colon lesions revealed a moderately to poorly differentiated adenocarcinoma. Immunohistochemical staining of the colon tumor was positive for cytokeratin (CK) 7 and CK, but negative for colorectal adenocarcinoma-related markers CK 20, CDX2, and SATB2, thus indicating that the metastasis originated from the pancreas. Next-generation sequencing for genomic profiling of the liver and colon metastases both found mutations in KRAS (p.G12D) and TP53 (c.376-1delG), with microsatellite stable and low tumor mutational burden without actionable or cancer-predisposing gene mutations detected. The patient was subsequently treated with 12 cycles of FOLFIRINOX which led to a sustainable response, followed by ongoing maintenance treatment with irinotecan plus fluorouracil.CONCLUSIONFor this rare case, careful evaluation of histopathological and immunohistochemical staining results are required. The genomic profiling of colon lesions was revealed for the first time, and FOLFIRINOX showed good treatment efficacy in this patient.

Sigmoid volvulus; a rare complicated presentation of Hirschsprung's disease: A case report.

IntroductionSigmoid volvulus (SV) is a rare complication of Hirschsprung's disease (HD) with only 31 cases have been reported in the English literature. Although its diagnosis is challenging, unrecognized SV is a life-threatening condition requiring early recognition to decrease morbidity and mortality.Presentation of caseA 14-year-old male presented to our emergency department with massive abdominal distention. Plain erect abdominal X-ray showed massive colonic distention with multiple fluid levels. Colonoscopy failed to pass beyond 15 cm after entering dilated sigmoid loop. Open surgical exploration was done through a lower midline incision and revealed SV with massive distention of the entire colon. After detorsion, we found a markedly dilated sigmoid colon with an evident discrepancy at the lower sigmoid. Due to massive colonic dilatation, the decision was made for terminal ileostomy. Histopathological examination of biopsy from the narrow segment demonstrated aganglionosis and hypertrophic submucosal neural fibers confirming the diagnosis of HD.DiscussionSV is a rare serious complication of HD. Unrecognized SV is a serious life-threatening condition, so it should be considered in children with acute or recurrent abdominal pain, distension, constipation and vomiting as early recognition and management of volvulus is essential to decrease morbidity.ConclusionThe presented case highlights the possibility of SV as a rare complication of HD should be considered especially in children with a history of chronic constipation and abdominal distension who present with acute colonic distension and failure to decompress despite rectal washes.

Esophageal Stricture: Not Your Usual Culprit?

Question: A 60-year-old woman with past medical history of ATTR amyloidosis and status post heart and liver transplantation presented with complaints of progressive esophageal dysphagia to solids and liquids. She was on tacrolimus, mycophenolate mofetil (MMF), and prednisone. Other pertinent medications included trimethoprim sulfamethoxazole and valganciclovir for infection prophylaxis. Physical examination and laboratory data were unremarkable. Esophagogastroduodenoscopy (EGD) with histopathologic examination of biopsies from the middle third of the esophagus showed the findings presented in Figure A and B. Despite high-dose proton pump inhibitor therapy and repeated dilations, symptoms were unchanged and little progress was made in maintaining an increase in luminal diameter. What is the most likely diagnosis? Look on page 400 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The EGD demonstrates a long, benign-appearing, intrinsic moderate stenosis with extensive fibrotic stricturing in the middle one-third of the esophagus (8 mm inner diameter × 4 cm in length) (Figure A). The stenosis was dilated with a through the scope dilator to 11 mm. Esophageal biopsies demonstrated extensive ulceration with fibrinopurulent exudate and inflamed granulation tissue (Figure B). No fungal or viral infection or malignancy was seen. The patient underwent placement of a percutaneous gastrostomy tube. Over the next year, despite continuous high-dose proton pump inhibitor therapy, she continued to experience dysphagia and required monthly dilations. After ruling out an infectious etiology, MMF was suspected as the possible culprit. Immediately upon withdrawal of MMF, the patient reported significant clinical improvement. A follow-up EGD 4 months later showed a widely patent esophageal lumen with only mild mucosal variance characterized by flattening and scarring in the mid esophagus. MMF has well-known gastrointestinal (GI) adverse effects, including nausea, vomiting and diarrhea. Although the entire GI tract is susceptible to MMF-related toxicity, the colon and, less commonly, the small bowel are the most affected areas.1Nguyen T. Park J.Y. Scudiere J.R. Montgomery E. Mycophenolic acid (CellCept and Myofortic) induced injury of the upper GI tract.Am J Surg Pathol. 2009; 33: 1355-1363Crossref PubMed Scopus (59) Google Scholar A variety of mucosal changes can be seen in the lower GI tract, ranging from inflammatory bowel disease–like changes to features akin to graft-versus-host disease. Upper GI tract toxicities of MMF have included features ranging from those compatible with nonsteroidal anti-inflammatory drug use with topical irritation and damage to ulcerative esophagitis, reactive gastropathy, and duodenal ulceration.2Panarelli N.C. Drug-induced injury in the gastrointestinal tract.Semin Diagn Pathol. 2014; 31: 165-175Crossref PubMed Scopus (24) Google Scholar MMF-related esophageal strictures are rare.3Kim J.J. Mulki R.H. Sebastian K.M. Recalcitrant esophageal stricture secondary to mycophenolate mofetil.Case Rep Gastrointest Med. 2020; 2020: 8817801PubMed Google Scholar This case highlights an uncommon cause of a refractory esophageal stricture that should be considered as a potential etiology for dysphagia, especially in a transplant recipient, when more common etiologies have been excluded or when esophagitis is refractory to proton pump inhibitor therapy.

Prevalence of Microscopic Colitis in Diarrhea-predominant Irittable Bowel Syndrome Patients: Cohort Study From Upper Egypt.

There is controversy about colonoscopy and taking biopsy from the normal colonic mucosa in patients with a clinical diagnosis of diarrhea-predominant irritable bowel syndrome (D-IBS). This study aims to estimate the prevalence of microscopic colitis (MC) in D-IBS patients and to select patients without the well-known alarming features who will benefit from colonoscopy and biopsies from the normal colonic mucosa. We performed a cohort cross-sectional study over 6 months duration in a total of 129 patients with Rome III criteria of D-IBS after excluding cases with features of organic diseases. Cases were subjected to colonoscopy and biopsies from the colonic mucosa that seemed normal. Histopathologic examination of biopsies taken from cases with normal colonic mucosa revealed 86 (71.66%) cases with nonspecific colitis, 26 (21.66%) cases with MC and 8 (6.66%) cases with ulcerative colitis. Concomitant immunologic diseases (P=0.00005) and triggering drugs intake (P=0.006) were significantly more common in the MC group. The mean duration of diarrhea in MC patients was significantly longer than that of nonspecific colitis and ulcerative colitis patients (P=0.0006). Prevalence of MC in D-IBS patients from Upper Egypt is relatively high (21.66%). Concomitant immunologic diseases, possible triggering drugs intake, and long duration of diarrhea are significant risk factors for undiagnosed MC in D-IBS patients.

Histopathological Features of Bone Marrow and Extramedullary Sites in Patients with Multiple Myeloma

Background: Due to new imaging modalities such as low-dose whole body CT, MRI, and PET-CT which are characterized with high sensitivity and specificity extramedullary disease (EMD) is identified more frequently in patients (pts) with multiple myeloma (MM). There is not enough data concerning comparison bone marrow (BM) and EMD tumor morphology features.Aims: Comparison of BM biopsy histopathological examination results of MM pts with osseous plasmacytomas, extraosseous plasmacytomas and MM pts without EMD. Comparative analysis of osseous and extraosseous plasmacytomas biopsy features.Patients and Methods: From October 2013 to April 2017 35 pts with newly diagnosed MM (19 males, 16 females) 24-73 years old (median 56) were included in our study. The disease was diagnosed in accordance to IMWG criteria (2014). We defined EMD as osseous (plasma cell tumor extending from the intramedullary spaces of the bone marrow through the cortical bone) or extraosseous (spread to organs distant from bone) plasmacytomas. Through our pts 21 had EMD, including 14 pts with osseous plasmacytomas and 7 pts with extraosseous plasmacytomas. In 14 pts EMD was not found. In all cases BM trephine biopsy and EMD biopsy were performed. Cross-tabulation analysis was performed using freq procedure in SAS 9.4.Results: Three histopathological variants of BM in MM pts were identified:1. Interstitial loose infiltration with mature plasma cells, scattered among the elements of myelopoiesis, without cell aggregations.2. Massive infiltration with mature plasma cells or their numerous aggregations.3. Massive infiltration with immature myeloma cells (with different ratio of proplasmacyte-like and plasmablast-like cells).We conducted comparison of histopathologic pattern of bone marrow in MM pts with osseous plasmacytomas, extraosseous plasmacytomas and without EMD (Table 1). The groups of pts were comparable by sex, age and other clinical significant characteristics.The tumor substrate of BM in MM pts with extraosseous plasmacytomas represented by loose interstitial infiltration with mature plasma cells was significantly more frequent (p<0.025), than in MM pts with osseous plasmacytomas or without EMD, and in those 2 groups massive infiltration of BM with mature plasma cells was prevalent.Histopathological features of EMD were also studied (Table 2). Two histopathological variants of EMD were identified:1. Massive infiltration with mature plasma cells;2. Massive infiltration with immature myeloma cells (with different ratio of proplasmacyte-like and plasmablast-like cells).The substrate of extraosseous plasmacytomas was represented by immature tumour cells somewhat more frequently in comparison with the substrate of osseous plasmacytomas (57,1% vs 28,6%), through the difference was not significant.Conclusion: In this prospective study we found a significant difference of histopathological pattern of bone marrow in MM pts with extraosseous plasmacytomas. In contrast with the group of pts with osseous plasmacytomas or without EMD, bone marrow in MM pts with extraosseous plasmacytomas was characterised by loose interstitially infiltration with mature plasma cells. In the two other groups massive infiltration of bone marrow with mature plasma cells was seen. No significant differences were found between the morphology features of osseous and extraosseous plasmacytomas. We think that our results can be helpful in differential diagnosis. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Screening: a unique study of otorhinolaryngeal manifestations in 400 patients of pulmonary tuberculosis being diagnosed and treated under revised national tuberculosis control programme

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tuberculosis (TB) is primarily a disease of lungs but can affect any part of the body. Among extrapulmonary TB, tuberculosis of otorhinolaryngeal region is uncommon but not rare. Despite the best efforts of the RNTCP, tuberculosis is still a major health problem in India. In our study screening of the pulmonary tuberculosis patients was done to know the incidence and pattern of otorhinoloryngeal manifestations and also to know the treatment outcome after follow up of patient till completion of DOTS therapy under RNTCP.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study included 400 pulmonary tuberculosis patients, both sputum positive and sputum negative (200 patients in each group) of newly treated (ND) and previously treated (PT) categories. After complete history, physical and local examination, suspected patients were evaluated for otorhinolaryngeal manifestations of tuberculosis. The diagnosis was confirmed after culture swabs, fine needle aspiration cytology (FNAC) and biopsy for histopathological examination (HPE).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of total 400 patients majority of patients belong to 21-30 years age group. Out of total 400 patients, 5 (1.25%) patients were having laryngeal tuberculosis, 1 (0.25%) patient of tubercular otitis media and 2 (0.5%) patients were having nasal TB. Results of our study are consistent with previously done studies despite RNTCP treatment. The treatment outcome was good after completion of ATT.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Every patient of pulmonary TB with complaint related to otorhinolaryngeal region should be examined and followed up with high suspicion of ENT related tuberculosis.&lt;/p&gt;

CORRELATIVE STUDY OF HISTOPATHOLOGICAL DIAGNOSIS WITH CLINICAL &amp; ENDOSCOPIC DIAGNOSIS IN UPPER GASTROINTESTINAL ENDOSCOPIC BIOPSY AT TERTIARY CARE CENTER

Lesions of Upper gastrointestinal tract (GIT) is commonly seen in surgical department patients. These patients are subjected to endoscopic examination and biopsy is taken for further histopathological diagnosis. A clinical, endoscopic and histopathological diagnosis is made. This study was done to compare and correlate the results of histopathological diagnosis with endoscopic and clinical findings.&#x0D; Study Designed: A total 50 Upper Gastrointestinal tract biopsy cases received in histopathology lab were analyzed. &#x0D; Material and Method: All endoscopic biopsies from upper GIT were received and processed. Paraffin blocks were made and sections were cut at 4 microns thickness and stained with routine hematoxylin and eosin stain. Their clinical and endoscopic reports were collected and compared with histopathological diagnosis.&#x0D; Result: After analyzing statistically the data, we found that endoscopy results were better than clinical diagnosis and more closer to histopathological diagnosis.&#x0D; Conclusion: Relation of histopathological diagnosis with endoscopic findings &amp; clinical diagnosis was done in our study. We conclude that endoscopy is incomplete without histopathological examination of biopsy &amp; so, the combinations of both plays an important role in diagnosis &amp; management of upper gastrointestinal tract disorders. Histopathological examination remains the gold standard.&#x0D; Keywords: Histopathology, endoscopy, gastrointestinal lesions.

Role of circulating micro-RNA-21 as a noninvasive biomarker for detection of colorectal cancer

ObjectiveTo assess serum micro-RNA-21 (miR-21) expression level as a stable blood-based biomarker for colorectal cancer (CRC).BackgroundCRC represents the third most common tumor worldwide with male predominance, with significant morbidity and mortality despite the recent therapeutic improvements. Therefore, a noninvasive diagnostic marker with good sensitivity and specificity is very important, which leads to better clinical outcomes. MiR-21 is an oncogenic miRNA that modulates the expression of multiple cancer-related target genes. MiR-21 expression was upregulated in the serum and in the malignant tissues in relation to the normal tissues. Its elevated level is claimed to be associated with poor survival and poor response to treatment.Patients and methodsThis cross-sectional study was carried on 50 patients and measured their serum miR-21 (CYBR Green). The cases group comprised 20 consecutive patients with CRC proved by colonoscopy and histopathological biopsy examination, the second group comprised 20 patients with colorectal polyps with no malignant transformation proved by histopathological examination, and the third group included 10 patients with normal colonoscopy finding as the control group. The studied cases were attending the Endoscopy Unit Menoufia University Hospital and Nasser Institute. The three groups agreed to written consent to participate in this study after the approval of the local ethical committee.ResultsSerum miR-21 expression was significantly upregulated in the cases group of patients with CRC compared with the other groups, with P value less than 0.001, showing sensitivity of 85% and specificity of 83.3% at a cutoff point of −2.31.ConclusionMi-RNA-21 shows upregulation in the serum in CRC cases, with statistically significant difference compared with the control group and the polyp group, showing promising results as a noninvasive biomarker of CRC.

Clinical, Radiologic, and Pathologic Characteristics of Pulmonary Hamartomas With Uncommon Presentation.

To investigate the clinicopathologic and radiologic features of pulmonary hamartomas (PHs) with uncommon clinical presentation. A retrospective clinicopathologic and radiologic review was performed for patients diagnosed (1999-2019) with multiple hamartomas, lesions arising adjacent to a coexisting pulmonary malignancy, and tumors with predominantly extrapulmonary localization. Of 979 patients diagnosed with PHs, 6 (0.6%) had multiple hamartomas, 4 (0.4%) had hamartomas adjacent to lung adenocarcinoma, and 2 (0.2%) had large mediastinal masses. Patients with multiple lesions had a median age of 65 years and mean tumor size of 0.9 cm; 1 patient had 3 hamartomas, and 5 patients had 2. Lesions next to adenocarcinomas had a mean size of 1.4 cm, and affected patients had a median age of 69 years. Predominantly mediastinal PHs, diagnosed in a 63-year-old woman and a 68-year-old man, measured 4.1 to 6 cm and were connected to the lung. All lesions were solid on imaging with absence of definitive fat or calcification, concerning for granuloma or malignancy. All cases had typical histology of PH, although one of the mediastinal tumors had an unusual amount of epithelial hyperplasia. PHs can be clinically and radiologically challenging to diagnose. Histopathologic examination of biopsies and resection specimens is diagnostically crucial in this setting.

Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients.

BACKGROUNDBowel ultrasound and magnetic resonance enterography (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up.AIMTo compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease (IBD) patients in Egypt.METHODSThe study was conducted on 40 patients with IBD. All patients were subjected to clinical assessment, laboratory investigations, bowel ultrasound, MRE, and colonoscopy up to the terminal ileum with biopsies for histopathological examination.RESULTSThis study was conducted on 14 patients (35%) with ulcerative colitis and 26 patients (65%) with Crohn's disease; 34 (85%) of these patients had active disease. Bowel ultrasound detected different bowel lesions with the following accuracies: ileum (85%), large bowel (70%), fistula (95%), stricture and proximal dilatation (95%) and abscesses (100%). Also, it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.CONCLUSIONIn comparison to MRE, bowel ultrasound is a useful, non-invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients when performed by the attending physician.

Effectiveness of Rapid Urease Diagnostic Test in Diagnosing Helicobacter Pylori Infection in Patients with Dyspepsia in Gastrointestinal Endoscopy Centre

Background: Helicobacter pylori is one of the most important infectious agents in the world. These bacteria infect 50% of the world population. Gastritis due to H. Pylori has been associated with the incidence of peptic ulcer, B cell primary lymphoma in the stomach, and gastric carcinoma. In dyspepsia, eradication of H. Pylori helps symptoms improvement and treatment cost efficiency. This study aimed to evaluate urease test in diagnosing H. Pylori infection in dyspepsia patients. It is expected that we could obtain a scientific evidence which can become the basis of routine use of urease examination in diagnosing H. Pylori infection.Method: This study used diagnostic study design. This study was performed in adult dyspepsia patients who underwent endoscopy examination in Gastrointestinal Endoscopy Centre Cipto Mangunkusumo General Hospital in January – November 2018. One biopsy sample was intended for rapid urease test using Helicotec which was performed according to the standard procedure and was interpreted 2 hours later. Biopsy for histopathological examination was preserved in formalin solution and sent to Histopathology Department for analysis and identification of H. Pylori bacteria. Results: Prevalence of H. pylori infection based on histopathology examination was 7.2%. From seven positive results in histopathology examination, four samples were Helocitec positive. The sensitivity and specificity of Helicotec was 57.1% and 98.9%. The positive predictive value and negative predictive value were 80% and 96.7%. Conclusion: Rapid urease examination using Helicotec is one of H. pylori diagnostic tools that is good enough to diagnose faster and cheaper. Interpretation of rapid urease test also need to consider clinical condition of patients who are tested.

MON-LB58 The Use of 11C Methionine PET CT In Localization of ACTH Dependent Cushing’s Disease

Background and objective: Hypercortisolism is the hall mark of ACTH Cushing’s syndrome, which is a benign ACTH secreting tumor resulting in high morbidity and mortality. The diagnosis is based on an elevated serum ACTH, elevated 24h urinary cortisol or a non-suppressible ACTH after dexamethasone suppression test. Confirmation of ACTH hypersecretion is followed by localization of the adenoma which can be pituitary in origin or peripheral. Dynamic MRI of the pituitary gland is the gold standard for diagnosis of pituitary tumors, and contrast enhanced CT scan is the gold standard for ectopic lesions which are usually lung tumors. The localization of the lesion is often a challenge because conventional MRI fail to show pituitary lesions and sometimes requiring inferior petrosal sinus sampling to confirm pituitary origin. Transsphenoidal surgery is the treatment of choice for Cushing’s disease, even without MRI evidence of pituitary tumors, if pituitary origin is confirmed by inferior petrosal sinus sampling. This causes increase in the incidence of treatment failure and complications. Thus, the diagnosis of Cushing’s disease urges exploring new diagnostic modalities. In our study we test the sensitivity of 11C methionine PET CT together with dynamic pituitary MRI in localization of ACTH dependent Cushing’s disease. Materials and methods This is an interventional, prospective study, forty-one subjects: newly diagnosed ACTH dependent Cushing’s Syndrome (n=29). (indicated by non-suppressible ACTH on dexamethasone suppression test) or persistent hypercortisolism following transsphenoidal surgery (n=12). 11C methionine PET CT was done in all cases in addition to dynamic pituitary MRI. All patients underwent 11 C-methionine PET-CT in addition to dynamic pituitary MRI This allowed us to determine whether suspected adenomas seen on structural imaging exhibited focal tracer uptake on functional imaging.Inclusion Criteria:• Aged 18 years old or over• Patient with a diagnosed Cushing’s disease confirmed by non-suppressible ACTH on dexamethasone suppression test.• Patient with persistent ACTH dependent Cushing’s disease following transsphenoidal surgery.• Patient not enrolled in other interventional studies.Exclusion Criteria:• Contraindication to MRI• Pregnant woman, breastfeeding RESULTS: Patients with newly diagnosed ACTH dependent Cushing: 24 out of 29 of the cases showed adenoma on dynamic MRI of the pituitary; 5 out of 29 cases failed to showed any lesions on dynamic MRI of the pituitary; Inferior petrosal sampling was done and confirmed pituitary origin in 4 out of 5 and 1 out of 5 was found to have ectopic ACTH secretion. In patients with persistent hypercortisolism following transsphenoidal surgery; 3 out of 12 of the cases showed adenoma on dynamic MRI of the pituitary and 7 out of 12 cases failed to showed any lesions on dynamic MRI of the pituitary and inferior petrosal sampling was done and confirmed pituitary origin in all 12 cases. All 41 cases underwent 11C methionine PET CT scan; 39 patients showed tracer uptake on 11c methionine PET CT scan in the pituitary area, 36 of which had unilateral asymmetrical tracer uptake. All 40 subjects with suspected pituitary lesions were confirmed to be of pituitary origin by histopathological examination of biopsies taken intraoperatively. CONCLUSIONS 11C methionine PET CT has proven to be of very high sensitivity in detecting ACTH secreting adenomas, further studies should be done on a larger scale as this modality can address the pitfalls in localization of ACTH secreting lesions.

Colonoscopic and Histopathological Findings in Patients with Various Lower Gastrointestinal Symptoms: A Single-Center Experience

Background: Early diagnosis of lower gastrointestinal (GI) diseases constitutes a challenge. While colonoscopy helps in the detection of these diseases; histopathological analysis of obtained biopsies is of greater importance. Aim: This study aimed at the identification of colonic lesions associated with common lower GI manifestations based on colonoscopy and histopathological examination of biopsies. Materials and Methods: In a retrospective cross-sectional study, we included medical records of 710 patients involving their personal, clinical, endoscopic, and pathological data. Included data were of patients who presented with lower GI manifestations, and underwent colonoscopy and biopsy taking in the period from January 2016 to June 2020. Results: The most found pathology was non-specific chronic colitis (NSCC) (59.7%), followed by malignancy 19.3%) then inflammatory bowel disease (IBD) (15.6%), hyperplastic inflammatory polyp in 3.7%. Meanwhile, bilharzial colitis was diagnosed in 1.3% of patients. Significant predictors of both NSCC and malignancy were advanced age (<0.001), diabetes, hypertension, abdominal pain, diarrhea, and bloody diarrhea. In addition, bleeding per rectum and weight loss were also found to be specific predictors in malignancy. The only predictors of IBD were abdominal pain and bloody diarrhea and weight loss. Conclusions: NSCC, malignancy, and IBD are the most common causes of lower GI manifestations. Moreover, clinical predictors of these diseases are useful in the early diagnosis and management of colonic lesions.

Laryngeal histoplasmosis mimicking glottic cancer in an immunocompetent host

We report an interesting case of laryngeal histoplasmosis which clinically mimicked a malignant glottic growth and is unusual in that it involved an immunocompetent host. Also, an isolated laryngeal involvement is very rare. A 63 year old farmer presented with complaints of hoarseness of voice. Indirect layngoscopy revealed a friable growth in the middle of the right vocal cord. Histopathological examination of biopsy taken from the growth showed presence of numerous tiny intracellular organisms within collections of macrophages and epithelioid cells. Confirmation was done with periodic acid Schiff and Gomori’s methanamine silver stain. The patient was administered amphotericin B 1 mg/kg body weight for 2 weeks followed by itraconazole 200 mg, twice a day for 8 weeks and discharged on oral itraconazole. A dramatic improvement in voice quality was seen in follow-up after two months. Repeat endoscopy showed regression of growth. The otolaryngologist should be aware of the existence of laryngeal histoplasmosis and consider it as one of the differential diagnosis when a patient shows signs of granulomatous inflammation or laryngeal masses, to perform specific diagnostic tests for fungi and provide optimal and timely treatment, avoiding unnecessary aggressive interventions.

Distant Intramuscular Metastases of Head and Neck Squamous Cell Carcinoma.

Metastasis of head and neck squamous cell carcinoma (HNSCC) usually occurs regionally in the neck lymph nodes, but also more infrequently at distant organs (eg, the lungs, bone, and liver). Intramuscular metastasis (IMM) has rarely been described. Therefore, we aimed to identify this disease characteristic and to evaluate available medical management options. Data of surgically treated HNSCC patients (n = 1150) at the Chi Mei Medical Center, Taiwan (2005-2015), were retrospectively reviewed. Literature searches were also conducted (1985-2015) to analyze the behavior of HNSCC with distant IMMs. We identified 1 HNSCC patient with histopathologically proven IMMs. Ten similar cases were also identified in the available literature. Two-thirds of lesions arose in patients with laryngeal/hypopharyngeal malignancies, and two-thirds of lesions were located in the lower limbs. Lesions were subjectively painful and usually had rim enhancement with central hypoattenuation in contrast-enhanced computed tomography/magnetic resonance imaging. The mean duration between primary tumor diagnosis and secondary lesion detection was 13.7 months. No patient survived more than 2 years after establishing a diagnosis of HNSCC with IMMs. Distant IMMs are extremely rare in HNSCC patients and have a poor clinical outcome. Differentiating this disease from sarcoma via anatomic distribution or diagnostic imaging studies is not straightforward. Biopsies for histopathologic examination are mandatory. Treatment of HNSCC patients with IMMs is mainly palliative for life quality preservation and not lifetime prolongation. Radiotherapy is established as a first-line treatment for symptom control with surgical intervention usually preserved for refractory cases.

Laser Confocal Refractive Microscopy and Early Detection of Oral Cancer: A Narrative Review

Laser confocal refractive microscopy is a modern technique that aids in the detection of early malignancies in recent years. However, it is inappropriately explored in oral oncology. To date, the gold standard for diagnosis of oral malignancies is still a biopsy for histopathological examination as this is an invasive method, and it causes discomfort for the patients. In this concern, the focus of this present article is to understand how this laser confocal microscopy could be used in the diagnosis of oral malignancies without the actual need for biopsy. Thus, it can be an effective noninvasive diagnostic aid for detecting oral malignancies.

INNV-16. COMPLETE RESPONSE OF THALAMIC IDH WILDTYPE GLIOBLASTOMA AFTER PROTON THERAPY FOLLOWED BY CHEMOTHERAPY TOGETHER WITH TUMOR TREATING FIELDS

Abstract BACKGROUND Proton therapy is able to apply high radiation doses to the tumor while sparing healthy tissues by reducing integral dose. Tumor Treating Fields (TTFields) are low intensity (1–3 V/cm) and intermediate frequency (100–300 kHz) alternating electric fields that demonstrated significantly increased survival rates in combination with adjuvant temozolomide (TMZ) in patients with newly diagnosed glioblastoma (ndGBM). Here, we report on a patient with biopsied ndGBM IDH wildtype with complete radiological response. MATERIAL AND METHODS Brain MRI demonstrated an occlusive hydrocephalus and a ring enhancing lesion in the right posterior thalamus in a 42 year old male. After endoscopic ventriculostomy and stereotactic biopsy histopathological examination resulted in the diagnosis of a glioblastoma (WHO grade IV), IDH 1 wildtype (R132), IDH 2 wildtype (R172), HIST1H3B/C wildtype, TERT wildtype (C228 and C250), BRAF wildtype, and unmethylated MGMT promotor. The patient received definitive chemoradiation with TMZ to a total dose of 60Gy incl. proton boost of 5x2 GyRBE. TTFields therapy in combination with TMZ was initiated 4 weeks after completion of chemoradiation, TMZ maintenance was completed per protocol after 6 cycles. TTFields therapy was continued for more than 13 month and to-date the patient is still on therapy. RESULTS Current follow up time is 20 months after initial diagnosis with the patient showing a radiological complete response. In a MRI 9 months after proton therapy, partial response and perfusion restriction in the tumor area was observed. Another MRI 3 months later showed a complete response without perfusion signal in the tumor area. CONCLUSION Complete response was observed following combination treatment of chemoradiation with TMZ including proton boost, TMZ maintenance and TTFields in a patient with pathologically confirmed GBM IDH wildtype. To our knowledge, this is the first report on a ndGBM patient receiving proton therapy followed by TTFields therapy.

Ten Years Audit of Neoplastic Colorectal Polyps at Lagos University Teaching Hospital, Nigeria

Abstract Introduction Death from colorectal cancer is still a major concern in low- and middle-income countries. According to GLOBOCAN 2018 report, 1,096,601 new cases of colorectal cancer were reported worldwide and about 551,269 would die from the disease process. Colorectal cancer is the fifth most common cancer and accounts for 5.8% of all new cases seen annually in Nigeria. It has been shown incontrovertibly that neoplastic polyps are precursors to adenocarcinomas, even though the rate is lower among blacks. The increasing awareness and availability of colonoscopy in Nigeria have resulted in an increased volume of colonic biopsy for histopathologic examination. This has resulted in increased frequency of detection of colorectal neoplastic polyps. Aim This study aims at auditing colorectal neoplastic polyps histopathologic reporting in Lagos University Teaching Hospital over a 10-year period (2009-2018). Methods All reports of colorectal polyps within the study period (2008-2018) were retrieved from the departmental database. The histologic type, microscopic dimensions, and anatomic locations of these polyps were documented and analyzed. Results Seventy-two colorectal neoplastic polyps were reported with an M:F ratio of 2:1. The peak incidence was in the fifth decade, with 98% of the polyps in the colon. A breakdown of the adenomatous polyps showed that most (66.7%) were tubular, and 33.2% were tubulovillous adenoma and a case of villous adenoma. Majority of the lesions had low-grade dysplasia while 30% had high-grade dysplasia. There was no mention of excision margins, and in some cases, the biopsy site was not stated. Conclusion Some of these polyps, particularly those with high-grade dysplasia, may likely progress to colorectal carcinoma following the adenoma-carcinoma sequence. Epidemiological data of precursor lesions are relevant as an accurate predictor of colorectal cancer incidence in the coming decade and as a determinant in the evaluation of screening and surveillance practices.

The Accuracy of Histopathological and Cytopathological Techniques in the Identification of the Mycetoma Causative Agents

Mycetoma is a devastating neglected tropical disease, caused by various fungal and bacterial pathogens. Correct diagnosis to the species level is mandatory for proper treatment. In endemic areas, various diagnostic tests and techniques are in use to achieve that, and that includes grain culture, surgical biopsy histopathological examination, fine needle aspiration cytological (FNAC) examination and in certain centres molecular diagnosis such as PCR. In this retrospective study, the sensitivity, specificity and diagnostic accuracy of grain culture, surgical biopsy histopathological examination and FNAC to identify the mycetoma causative organisms were determined. The histopathological examination appeared to have better sensitivity and specificity. The histological examination results were correct in 714 (97.5%) out of 750 patients infected with Madurella mycetomatis, in 133 (93.6%) out of 142 patients infected with Streptomyces somaliensis, in 53 (74.6%) out of 71 patients infected with Actinomadura madurae and in 12 (75%) out of 16 patients infected with Actinomadura pelletierii. FNAC results were correct in 604 (80.5%) out of 750 patients with Madurella mycetomatis eumycetoma, in 50 (37.5%) out of 133 Streptomyces somaliensis patients, 43 (60.5%) out of 71 Actinomadura madurae patients and 11 (68.7%) out of 16 Actinomadura pelletierii. The mean time required to obtain the FNAC result was one day, and for the histopathological examinations results it was 3.5 days, and for grain it was a mean of 16 days. In conclusion, histopathological examination and FNAC are more practical techniques for rapid species identification than grain culture in many endemic regions.