Histopathology Of Surgical Specimen Research Articles

Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-diagnostic cross-sectional imaging

BackgroundBiliary dilatation without obvious etiology on cross sectional imaging warrants further investigation. This study aimed to assess yield of endoscopic ultrasound in providing etiologic diagnosis in such situation.MethodsProspective cohort of consecutive patients with biliary dilatation & non diagnostic computed tomography (CT) and /or magnetic resonance imaging (MRI) underwent endoscopic ultrasound (EUS) with/without fine needle aspiration cytology (FNAC) and were followed clinically, biochemically with/without radiology for up to six months. The findings of EUS were corroborated with histopathology of surgical specimens and endoscopic retrograde cholangiography (ERCP) findings in relevant cases.ResultsMedian age of 121 patients completing follow up was 55 years. 98.2% patients were symptomatic and median common bile duct (CBD) diameter was 13 mm. EUS was able to identify lesions attributable for biliary dilatation in (67 out of 121) 55.4% cases with ampullary neoplasm being the commonest (29 out of 67 i.e. 43%). Multivariate logistic regression analysis identified jaundice as the predictor of positive diagnosis on EUS, of finding ampullary lesion and pancreatic lesion on EUS. EUS had sensitivity, specificity, positive predictive value and diagnostic accuracy of 95.65%, 94.23%, 95.65% and 95.04% respectively in providing etiologic diagnosis. Threshold value for baseline bilirubin of 10 mg%, for baseline CA 19.9 of 225 u/L and for largest CBD diameter of 16 mm were determined to have specificity of 98%, 95%, 92.5% respectively of finding a positive diagnosis on EUS.ConclusionEUS provides considerable diagnostic yield with high accuracy in biliary dilatation when cross sectional imaging fails to provide etiologic diagnosis.

Diagnostic accuracy and clinical value of [68Ga]Ga-FAPI-46 PET/CT for staging patients with ovarian cancer: study protocol for a prospective clinical trial

Background[18F]Fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) is recommended during diagnostic work-up for ovarian cancer; however, [18F]FDG PET has several inherent limitations. The novel oncologic PET-tracer fibroblast activation protein inhibitor (FAPI) has demonstrated promising results in multiple cancer types, including ovarian cancer, and could overcome the limitations of [18F]FDG PET; however, high-quality clinical studies are lacking. The primary objective of the present study is to compare the diagnostic accuracy of [68Ga]Ga-FAPI-46 PET/CT and [18F]FDG PET/CT in ovarian cancer patients and to investigate how this potential difference impacts staging and patient management.Methods and designFifty consecutive ovarian cancer patients will be recruited from Aalborg University Hospital, Denmark. This study will be a single-center, prospective, exploratory clinical trial that adheres to the standards for reporting diagnostic accuracy studies (STARD). This study will be conducted under continuous Good Clinical Practice monitoring. The eligibility criteria for patients are as follows: (1) biopsy verified newly diagnosed ovarian cancer or a high risk of ovarian cancer and referred for primary staging with [18F]FDG PET/CT; and (2) resectable disease, i.e., candidate for primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery. All recruited study subjects will undergo [68Ga]Ga-FAPI-46 PET/CT at primary staging, before primary debulking surgery or neoadjuvant chemotherapy (Group A + B), in addition to conventional imaging (including [18F]FDG PET/CT). Study subjects in Group B will undergo an additional [68Ga]Ga-FAPI-46 PET/CT following neoadjuvant chemotherapy prior to interval debulking surgery. The results of the study-related [68Ga]Ga-FAPI-46 PET/CTs will be blinded, and treatment allocation will be based on common clinical practice in accordance with current guidelines. The histopathology of surgical specimens will serve as a reference standard. A recruitment period of 2 years is estimated; the trial is currently recruiting.DiscussionTo our knowledge, this trial represents the largest, most extensive, and most meticulous prospective FAPI PET study conducted in patients with ovarian cancer thus far. This study aims to obtain a reliable estimation of the diagnostic accuracy of [68Ga]Ga-FAPI-46 PET/CT, shed light on the clinical importance of [68Ga]Ga-FAPI-46 PET/CT, and examine the potential applicability of [68Ga]Ga-FAPI-46 PET/CT for evaluating chemotherapy response.Trial registrationclinicaltrials.gov: NCT05903807, 2nd June 2023; and euclinicaltrials.eu EU CT Number: 2023-505938-98-00, authorized 11th September 2023.

Preoperative evaluation of prostate cancer by 68Ga-PMSA positron emission tomography/computed tomography: comparison with magnetic resonance imaging and with histopathological findings.

To evaluate the accuracy of preoperative positron emission tomography/computed tomography with 68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA PET/CT) for staging prostate cancer and compare it with magnetic resonance imaging (MRI) using histopathology of surgical specimens as the gold standard. In this retrospective study, 65 patients with prostate cancer were analyzed. The accuracy of 68Ga-PSMA PET/CT for tumor detection was 95%, and that of MRI was 91%. There was no difference between 68Ga-PSMA PET/CT and MRI regarding localization of the lesion. The sensitivity of 68Ga-PSMA PET/CT for detecting extraprostatic extension was quite low (14%). For detection of seminal vesicle invasion, 68Ga-PSMA PET/CT showed a sensitivity of 57% and accuracy of 91%. There was a moderate correlation between the maximum standardized uptake value (SUVmax) and the serum level of prostate-specific antigen (p < 0.01; ρ = 0.368) and between the SUVmax and the International Society of Urological Pathology (ISUP) grade (p < 0.01; ρ = 0.513). 68Ga-PSMA PET/CT is a promising tool for detecting and evaluating the primary tumor, which can alter the staging and management of the disease.

Diagnostic Accuracy of Magnetic Resonance Enterography for the Evaluation of Active and Fibrotic Inflammation in Crohn's Disease.

BackgroundDespite the success of standard magnetic resonance enterography (MRE) in detecting Crohn’s disease (CD), characterization of strictures and, thus, therapy guidance is still limited. The aim of the study was to determine diagnostic accuracy of MRE in detecting or ruling out active inflammation and identifying fibrotic lesions in patients with terminal ileal CD with histopathology as reference.MethodsSixty-seven consecutive patients (median age 32 years, range 19–79 years) with terminal ileal CD were retrospectively enrolled between January 2015 and October 2020. The median interval between MRE and surgery was 9 days (range 0–86 days). Sensitivity, specificity, positive and negative predictive value (PPV and NPV, respectively), and area under the curve (AUC) with 95% confidence intervals (CIs) were calculated for the MRE-based AIS (acute inflammation score) using the histopathology of surgical specimens as the reference standard.ResultsSensitivity, specificity, PPV, and NPV for detecting or ruling out active inflammation were 100% (CI, 0.94–1.00; 0.44–1.00; 0.93–1.00; 0.31–1.00) using an AIS cut-off of >4.1. AUC was 1.00 (CI, 1.00–1.00; p < 0.01). In all patients with fibrotic changes only and no active inflammation, AIS was <4.1. Interobserver agreement was substantial (κ = 0.65, p < 0.01).ConclusionOur study has shown an excellent diagnostic performance of the MRE-based AIS for determining whether active inflammation is present or lesions are due to chronic changes in ileal CD using the histopathology of surgical specimens as reference. These findings indicate that the MRE-based AIS allows a better determination of the inflammatory stage of terminal ileal CD, which facilitates the decision to perform surgery.

Extent of surgical excision of the vestibule based on positive CD117 and PGP9.5 staining of mast cells in women with neuroproliferative vestibulodynia

ABSTRACT Introduction Neuroproliferative vestibulodynia (NPV) is a poorly understood chronic debilitating sexual pain condition associated with severe vestibular allodynia and hyperalgesia. In patients with NPV, histopathology of surgical specimens from the usual posterior and right and left anterior locations (1:00 - 11:00 o'clock) has shown high densities of CD117 and PGP9.5 positive staining cells consistent with excessive mast cells and nerves. Such pathologic findings have justified the excision of this usual location of the vestibule. There is, however, a lack of consensus regarding the total extent of complete surgical excision for vestibulectomy. Some of our patients demonstrated pain at the 12:00 region and underwent concomitant 12:00 excision along with the usual vestibule location. We wished to study excised vestibular tissue at the 12:00 region for the presence/absence of CD117 and PGP9.5 positive staining cells. This pathologic finding has critical clinical implications as to the extent of the surgical excision. Objective We assessed immunohistochemical densities of CD117 and PGP9.5 positive staining cells from the 12:00 region from each patient, comparing it to cells stained from posterior and left/right anterior vestibule. Methods We studied specimens from 26 women (mean age 27 +/- 12 years) with the presumptive diagnosis of NPV based on positive vestibular cotton swab testing at 12:00 as well as 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations who underwent complete vestibulectomy with vaginal advancement flap including the 12:00 region. Surgical specimens from the 12:00, the posterior and left/right anterior vestibule were prepared separately in formalin and embedded in paraffin blocks. Immunohistochemical staining using antibodies to CD117 and PGP 9.5 was performed on these blocks and sections cut for slides. These stained slides from multiple locations of the vestibule were examined and photographed using a Zeiss AxioCam HR high resolution digital microscope. The density of CD117 and PGP9.5 positive cells were determined by counting the number of dark brown stained cells per high-power field (HPF = x 20 magnifications). Based on the literature, control subjects have values of 8 mast cells or less per HPF. Results All 26 patients had elevated densities of CD117-positive cells in vestibular epithelium/stroma in the 12:00 (mean density 51 +/- 19 per HPF) as well as posterior and left/right anterior vestibule (mean density 47 +/- 18 per HPF). All 26 patients had high densities of PGP9.5-positive cells noted in vestibular stroma in the 12:00 (mean density 36 +/- 23 per HPF) and posterior and left/right anterior vestibule (mean density 38 +/- 22 per HPF). Conclusions In 100% of these patients NPV, the 12:00 region of the vestibule contained an increased number of CD117 and PGP9.5 positive staining cells similar to the posterior and left/right anterior vestibule. When performing a vestibulectomy in patients with positive cotton-tip swab testing including the 12:00, excision of the 12:00 vestibule should be considered to optimize treatment. Disclosure Work supported by industry: no.

Determining Borders of Surgical Excision of the Vestibule Based on Positive CD117 and PGP9.5 Staining of Mast Cells in Women with Neuroproliferative Vestibulodynia

ABSTRACT Introduction Neuroproliferative vestibulodynia (NPV) is a poorly understood chronic debilitating sexual pain condition associated with severe vestibular allodynia and hyperalgesia. In patients with NPV, histopathology of surgical specimens from the usual posterior and right and left anterior locations (1:00 - 11:00 o'clock) has shown high densities of CD117 and PGP9.5 positive staining cells consistent with excessive mast cells and nerves. Such pathologic findings have justified the excision of this usual location of the vestibule. There is, however, a lack of consensus regarding the total extent of complete surgical excision for vestibulectomy. Some of our patients demonstrated pain at the 12:00 region and underwent concomitant 12:00 excision along with the usual vestibule location. We wished to study excised vestibular tissue at the 12:00 region for the presence/absence of CD117 and PGP9.5 positive staining cells. This pathologic finding has critical clinical implications as to the extent of the surgical excision. Objective We assessed immunohistochemical densities of CD117 and PGP9.5 positive staining cells from the 12:00 region Methods We studied specimens from 26 women (mean age 27 +/- 12 years) with the presumptive diagnosis of NPV based on positive vestibular cotton swab testing at 12:00 as well as 1:00, 3:00, 5:00, 6:00, 7:00, 9:00 and 11:00 locations who underwent complete vestibulectomy with vaginal advancement flap including the 12:00 region. Surgical specimens from the 12:00, the posterior and left/right anterior vestibule were prepared separately in formalin and embedded in paraffin blocks. Immunohistochemical staining using antibodies to CD117 and PGP 9.5 was performed on these blocks and sections cut for slides. These stained slides from multiple locations of the vestibule were examined and photographed using a Zeiss AxioCam HR high resolution digital microscope. The density of CD117 and PGP9.5 positive cells were determined by counting the number of dark brown stained cells per high-power field (HPF = x 20 magnifications). Based on the literature, control subjects have values of 8 mast cells or less per HPF. Results All 26 patients had elevated densities of CD117-positive cells in vestibular epithelium/stroma in the 12:00 (mean density 51 +/- 19 per HPF) as well as posterior and left/right anterior vestibule (mean density 47 +/- 18 per HPF). All 26 patients had high densities of PGP9.5-positive cells noted in vestibular stroma in the 12:00 (mean density 36 +/- 23 per HPF) and posterior and left/right anterior vestibule (mean density 38 +/- 22 per HPF). Conclusions In 100% of these patients NPV, the 12:00 region of the vestibule contained an increased number of CD117 and PGP9.5 positive staining cells similar to the posterior and left/right anterior vestibule. When performing a vestibulectomy in patients with positive cotton-tip swab testing including the 12:00, excision of the 12:00 vestibule should be considered to optimize treatment. Disclosure No

Endoscopic Ultrasound Plus Endoscopic Retrograde Cholangiopancreatography Based Tissue Sampling for Diagnosis of Proximal and Distal Biliary Stenosis Due to Cholangiocarcinoma: Results from a Retrospective Single-Center Study.

Simple SummaryThe diagnosis of cholangiocarcinoma depends on several factors, including growth pattern and location. Previous studies have evaluated the diagnostic accuracy of endoscopic retrograde cholangiopancreatography based tissue sampling and endoscopic ultrasound with either fine-needle aspiration or fine-needle biopsy, reporting values < 80% for each procedure. Here, we describe the performance of both methods in a group of patients with a stricture of the biliary tract suspicious for cholangiocarcinoma. Our analysis confirms the high diagnostic accuracy of the procedures when performed together in distinguishing between a primary malignant or benign biliary stenosis. Differentiating between benign and malignant biliary stenosis (BS) is challenging, where tissue diagnosis plays a crucial role. Endoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or biopsy (FNB) are used to obtain tissue specimens from BS. The aim of this retrospective study was to evaluate the diagnostic yield of EUS-FNA/B plus ERCP with brushing or forceps biopsy in BS. All endoscopic procedures performed in patients with BS at our gastroenterology unit were reviewed. The gold standard for diagnosis was histopathology of surgical specimens or the progression of the malignancy at radiological or clinical follow-up. A total of 70 endoscopic procedures were performed in 51 patients with BS. Final endoscopic diagnosis was reached in 96% of the patients and was malignant in 61.7% and benign in 38.3% of cases. Sensitivity, specificity, and diagnostic accuracy were 73.9%, 100%, and 80%, respectively, for EUS-FNA/B; 66.7%, 100%, and 82.5% for ERCP; and 83.3%, 100%, and 87.5% for both procedures carried out in the same session. The combination of EUS and ERCP tissue sampling seems to increase diagnostic accuracy in defining the etiology of BS. Performing both procedures in a single session reduces the time required for diagnostic work-up and optimizes resources.

Surgical management of tuberculous epididymo-orchitis: a retrospective study of 81 cases with long-term follow-up

BackgroundNowadays, most studies of tuberculous epididymo-orchitis (TBEO) are case reports or small sample cohort series. Our study is aimed to present the largest series of TBEO with our management experiences and long-term follow-up outcomes.MethodsPatients diagnosed with TBEO after surgical procedures at Department of Urology, West China Hospital from 2008 to 2019 were included. All clinical features, auxiliary examination results, treatment and histopathological findings were extracted if available.ResultsEighty-one patients (mean age 50.77 ± 16.1 years) were included. Scrotal swelling (N = 47, 58.0%) and pain (N = 29, 35.8%) were the most common presenting complaint. Pyuria and microscopic hematuria were observed in twenty-two (27.2%) and eight patients (9.9%), respectively. Urine acid fast bacilli cultures were available in 16 patients and all were negative. The mean duration between the onset of symptoms and the definite diagnosis was 6.42 ± 7.0 months. TBEO was considered in 30 (37.0%), tumors in 28 (34.6%) and nonspecific bacterial epididymo-orchitis in 23 (28.4%) patients. All patients received triple therapy of chemotherapy-surgery-pharmacotherapy and definite diagnosis was confirmed through histopathology of surgical specimens. Fifty-five patients were followed up regularly (mean follow-up 82.35 ± 36.6 months). One patient (1.2%) died from liver cirrhosis and no recurrence was observed. Postoperative complications included erectile dysfunction in 4 patients (4.9%), premature ejaculation in 5 patients (6.2%) and sterility in 7 patients (8.6%).ConclusionsWe recommend patients with advanced TBEO to receive triple therapy of chemotherapy-surgery-pharmacotherapy. Physicians should pay more attention to patients’ sexual function and fertility during follow up after treatment completed.

Histopathological examination of thyroid specimens - a single center study from Peshawar, Khyber Pakhtunkhwa

Introduction: Thyroid gland enlargement is a surgical problem that affects about a third of the world's adults. Thyroid enlargement is best diagnosed by histopathology of surgical specimen and can also give a clue about different pattern of diseases that include simple goiter, multinodular goiter, thyroiditis, adenoma, and last but not the least, carcinoma.&#x0D; Objective: To determine presentation of thyroid lesions based on their histopathology in patients presenting to Rehman Medical Institute (RMI), Peshawar from August 2018 to July 2019.&#x0D; Materials &amp; Methods: This was a descriptive cross-sectional study, inclusive of all thyroid specimens, irrespective of age and gender, received in the Department of Pathology, Rehman Medical Institute (RMI), Peshawar, from August 2018 to July 2019. Data were retrieved and analyzed for descriptive statistics in MS Excel.&#x0D; Results: A total of 64 samples were collected; 56(87.5%) were non-neoplastic lesions while 08(12.5%) were neoplastic. 40(71%) multi nodular goiters, 11(19.64%) simple nodular goiter, 01(1.7%) case of Hashimoto’s thyroiditis, among neoplastic 04(50%) were found to be papillary carcinoma and 02(25%) each were follicular and medullary carcinoma. Female to male ratio was 5:3 or 1.67:1 in neoplastic lesions.&#x0D; Conclusion: The most common cause of goiter was multinodular goiter. Among the neoplastic lesions, follicular adenoma was the commonest, while papillary carcinoma was the most common malignant lesions.&#x0D; Keywords: Multinodular goiter, follicular adenoma, Papillary carcinoma, Fine needle aspiration cytology.

Burkitt Lymphoma of the Appendix with an Insidious Clinical Picture

Burkitt lymphoma (BL) is a highly aggressive B cell non-Hodgkin lymphoma, which represents the fastest growing human tumor with doubling time as short as 25 hours. Three distinct clinical forms of BL have been described: endemic, sporadic, and immunodeficiency-associated. Although the sporadic form of Burkitt lymphoma usually has an abdominal presentation, with ascites and large masses in the distal ileum, primary infiltration of the appendix is rare. Even in these cases, the clinical picture resembles that of acute appendicitis. We present here the case of a patient with sporadic Burkitt lymphoma of the appendix whose only presenting symptom was scrotal pain. After thorough imaging evaluation, the inconsistency between clinical-laboratory and radiological findings prompted exploratory laparoscopy. The patient underwent laparoscopic appendectomy and omental biopsy. Final diagnosis was made based on histopathology of surgical specimen. To the best of our knowledge, this is the first report of primary BL of the appendix presenting without typical symptoms and signs of acute appendicitis.

Perfusion-weighted imaging in differentiating ring-enhancing lesions in brain

Context: Ring-enhancing lesions in the brain always raise questions among radiologists and given the many possible differential diagnosis, it may sometimes be difficult to reach a diagnosis with conventional magnetic resonance imaging (MRI). The introduction of advanced imaging techniques, such as perfusion- and diffusion-weighted imaging, has contributed to the differentiation. Aim: The aim of the study was to differentiate various ring-enhancing lesions in the brain using perfusion-weighted imaging (PWI) on the basis of relative cerebral blood volume (rCBV). Materials and Methods: This prospective study was conducted on 39 consecutive patients, from rural and suburban areas of Tirupati, in the time frame of 14 months and included neoplastic (24 cases) and infectious (15 cases) lesions showing ring-shaped contrast enhancement on conventional MRI. PWI was performed and the rCBV values were obtained. The final diagnosis was made by histopathology of surgical specimen (in operated cases) and on response to treatment in the form of symptom improvement and lesion clearance on follow-up imaging (computed tomography or MRI) done at 1–6 months after appropriate therapy in unoperated cases. Results: Neoplastic lesions had higher rCBV values (5.04 ± 1.86) than infectious lesions (0.90 ± 0.43) (P Statistical Analysis: We compared the rCBV values between the two groups using Student's t-test. We used receiver operating characteristic curve analysis to assess the performance of the diagnostic test. Conclusion: PWI is an efficient advanced imaging technique in ring-enhancing brain lesions and is a useful complementary tool to routine structural MRI in distinguishing between infectious and neoplastic brain lesions.

Isolated ovarian tuberculosis in an Immuno- competent woman in the post partum period: case report

BackgroundPelvic tuberculosis is a rare form of extrapulmonary tuberculosis. It commonly involves the fallopian tubes and the uterus from a lympho-hematogeneous spread. The presentation of pelvic tuberculosis as an isolated ovarian abscess is extremely rare and is reported only twice.Case presentationa 25 yrs. old para III mother in the post partum period undergone laparotomy for suspected tuboovarian abscess/ovarian tumor after presenting with abdominal pain, pelvic mass and fever. Intra-operatively, Isolated right ovarian mass with caseation in the cavity but no significant pelvic adhesions was detected and right oophorectomy was done. Post operative Histopathology of surgical specimens revealed tuberculous leision and patient recovered well after anti-tuberculosis treatment.ConclusionIsolated ovarian tuberculosis is a very rare form of Genital Tuberculosis which should always be considered in the evaluation of a woman presenting with any adnexal mass in highly prevalent areas.

MP18-12 DIFFUSION WEIGHTED IMAGING: DIFFERENTIATION OF CLEAR CELL FROM PAPILLARY RENAL CELL CARCINOMA

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2017MP18-12 DIFFUSION WEIGHTED IMAGING: DIFFERENTIATION OF CLEAR CELL FROM PAPILLARY RENAL CELL CARCINOMA S. Mojdeh Mirmomen, Moozhan Nikpanah, Rabindra Gautam, Adam Metwalli, Amir Pourmorteza, William Linehan, and Ashkan Malayeri S. Mojdeh MirmomenS. Mojdeh Mirmomen More articles by this author , Moozhan NikpanahMoozhan Nikpanah More articles by this author , Rabindra GautamRabindra Gautam More articles by this author , Adam MetwalliAdam Metwalli More articles by this author , Amir PourmortezaAmir Pourmorteza More articles by this author , William LinehanWilliam Linehan More articles by this author , and Ashkan MalayeriAshkan Malayeri More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.622AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to the differences in tumor behavior and prognosis, discriminating different subtypes of renal cell carcinoma (RCC) is important. The purpose of this study was to investigate the role of diffusion weighted imaging (DWI) derived apparent diffusion coefficient (ADC) maps in differentiating clear cell renal carcinoma (ccRCC) from papillary subtype (pRCC). METHODS ADC maps from 97 renal cell carcinoma lesions (20 papillary and 77 clear cell type) from 42 patients were segmented for volumetric and pixel based histogram analysis. Mean, standard deviation, skewness and kurtosis and different quantiles of the histogram were calculated for the segmented lesions. The standard of reference for diagnosis of different types of RCC was histopathology of surgical specimens. Receiver operating characteristic (ROC) analysis was performed for each of the extracted features. RESULTS Amongst all the above mentioned features, the analysis of the quantiles yielded the highest sensitivity and specificity for differentiation of the two subtypes. The ADC range was between 258 to 3407 and 246 to 3686 mm2/sec for pRCC and ccRCC, respectively. Quantile 30 by ADC threshold of 1500 resulted in 96% sensitivity and 84% specificity that provided the highest sensitivity and specificity among the all features. Area under the curve (AUC) was 0.95. CONCLUSIONS Volumetric pixel based analysis of the ADC maps is an objective method that can accurately differentiate pRCC from ccRCC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e224-e225 Advertisement Copyright & Permissions© 2017MetricsAuthor Information S. Mojdeh Mirmomen More articles by this author Moozhan Nikpanah More articles by this author Rabindra Gautam More articles by this author Adam Metwalli More articles by this author Amir Pourmorteza More articles by this author William Linehan More articles by this author Ashkan Malayeri More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Differential diagnosis of solid pancreatic masses: contrast-enhanced harmonic (CEH-EUS), quantitative-elastography (QE-EUS), or both?

Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and quantitative-elastography endoscopic ultrasound (QE-EUS) are considered useful tools for the evaluation of solid pancreatic tumors (SPT). The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS, QE-EUS, and the combination of both for the differential diagnosis of SPT. Sixty-two consecutive patients (mean age 64.3 years, range 32-89 years, 44 male) who underwent EUS for the evaluation of SPT were prospectively included. EUS was performed with a linear Pentax-EUS and a Hitachi-Preirus processor. The mass (area A) and a reference area B were selected during QE-EUS, and results expressed as B/A (strain ratio). A strain histogram of the mass was also evaluated. Microvascularization of the tumor was evaluated over 2 min during CEH-EUS after intravenous injection of 4.8 mL SonoVue. Final diagnosis was based on histopathology of surgical specimens or EUS-guided tissue acquisition and clinical follow-up in non-operated cases. Diagnostic accuracy of CEH-EUS, QE-EUS, and their combination was calculated. Median size of the masses was 32 mm (range 12-111). Final diagnosis was pancreatic adenocarcinoma (n = 45), neuroendocrine tumor (n = 3), inflammatory mass (n = 10), pancreatic metastasis (n = 2), autoimmune pancreatitis (n = 1), and a mucinous cystadenocarcinoma (n = 1). Overall accuracies for determination of malignancy using QE-EUS, CEH-EUS, their combination, and EUS-guided tissue acquisition were 98.4% (95% confidence interval (CI): 91.4-99.7), 85.5% (95% CI: 74.7-92.2), 91.9% (95% CI: 82.5-96.5), and 91.5% (95% CI: 83.6-99.5), respectively. The combination of QE-EUS and CEH-EUS is a useful tool for the differential diagnosis of SPT, giving complementary information. However, this combination does not significantly increase the diagnostic accuracy of either of the techniques performed alone.

TP53 germline mutation may affect response to anticancer treatments: analysis of an intensively treated Li-Fraumeni family.

Li-Fraumeni syndrome (LFS) is a rare autosomal dominant inherited disorder associated with the occurrence of a wide spectrum of early-onset malignancies, the most prevalent being breast cancer and sarcoma. The presence of TP53 germline mutations in the majority of LFS patients suggests a genetic basis for the cancer predisposition. No special recommendations for the treatment of LFS patients have been made to date, except that of minimizing radiation. We hypothesized that TP53 germline mutations may be associated not only with cancer predisposition, but also with lack of response to chemo- and radiotherapy. Here, we present an Austrian LFS family whose members were intensively treated with chemo- and radiotherapy due to cancers that occurred at a predominantly young age, including eight breast cancers in six patients. Material from seven family members was screened for p53 mutation by Sanger sequencing and immunohistochemistry. A rare missense mutation in the tetramerization domain of exon 10 of the TP53 gene was found to segregate with malignant disease in this family. Lack of response to various chemotherapies and radiotherapy could be ascertained by histopathology of surgical specimens after neoadjuvant treatment, by cancer relapse occurring while receiving adjuvant systemic treatment and by the occurrence of second primaries in areas of adjuvant radiation. Our observations suggest that current standards of cancer treatment may not be valid for patients with LFS. In patients with TP53 germline mutation, cytotoxic treatment may bear not only the risk of tumor induction but also the risk of treatment failure.

Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens

To prospectively compare conventional MRI sequences, dynamic contrast enhanced (DCE) MRI and diffusion weighted imaging (DWI) with histopathology of surgical specimens in Crohn's disease. 3-T MR enterography was performed in consecutive Crohn's disease patients scheduled for surgery within 4weeks. One to four sections of interest per patient were chosen for analysis. Evaluated parameters included mural thickness, T1 ratio, T2 ratio; on DCE-MRI maximum enhancement (ME), initial slope of increase (ISI), time-to-peak (TTP); and on DWI apparent diffusion coefficient (ADC). These were compared with location-matched histopathological grading of inflammation (AIS) and fibrosis (FS) using Spearman correlation, Kruskal-Wallis and Chi-squared tests. Twenty patients (mean age 38years, 12 female) were included and 50 sections (35 terminal ileum, 11 ascending colon, 2 transverse colon, 2 descending colon) were matched to AIS and FS. Mural thickness, T1 ratio, T2 ratio, ME and ISI correlated significantly with AIS, with moderate correlation (r = 0.634, 0.392, 0.485, 0.509, 0.525, respectively; all P < 0.05). Mural thickness, T1 ratio, T2 ratio, ME, ISI and ADC correlated significantly with FS (all P < 0.05). Quantitative parameters from conventional, DCE-MRI and DWI sequences correlate with histopathological scores of surgical specimens. DCE-MRI and DWI parameters provide additional information. • Conventional MR enterography can be used to assess Crohn's disease activity. • Several MRI parameters correlate with inflammation and fibrosis scores from histopathology. • Dynamic contrast enhanced imaging and diffusion weighted imaging give additional information. • Quantitative MRI parameters can be used as biomarkers to evaluate Crohn's disease activity.

Differential diagnosis of solid pancreatic masses: Contrast-enhanced harmonic EUS (CEHEUS), quantitative EUS-elastography (QE-EUS) or both?

Background: Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) and quantitative-elastography endoscopic ultrasound (QE-EUS) are considered useful tools for the evaluation of solid pancreatic tumors (SPT). The aim of our study was to evaluate the diagnostic accuracy of CEH-EUS, QE-EUS, and the combination of both for the differential diagnosis of SPT. Methods: Sixty-two consecutive patients (mean age 64.3 years, range 32–89 years, 44 male) who underwent EUS for the evaluation of SPT were prospectively included. EUS was performed with a linear Pentax-EUS and a Hitachi-Preirus processor. The mass (area A) and a reference area B were selected during QE-EUS, and results expressed as B/A (strain ratio). A strain histogram of the mass was also evaluated. Microvascularization of the tumor was evaluated over 2 min during CEH-EUS after intravenous injection of 4.8 mL SonoVue. Final diagnosis was based on histopathology of surgical specimens or EUS-guided tissue acquisition and clinical follow-up in non-operated cases. Diagnostic accuracy of CEH-EUS, QE-EUS, and their combination was calculated. Results: Median size of the masses was 32 mm (range 12-111). Final diagnosis was pancreatic adenocarcinoma (n1⁄4 45), neuroendocrine tumor (n1⁄4 3), inflammatory mass (n1⁄4 10), pancreatic metastasis (n1⁄4 2), autoimmune pancreatitis (n1⁄4 1), and a mucinous cystadenocarcinoma (n1⁄4 1). Overall accuracies for determination of malignancy using QE-EUS, CEH-EUS, their combination, and EUS-guided tissue acquisition were 98.4% (95% confidence interval (CI): 91.4–99.7), 85.5% (95% CI: 74.7–92.2), 91.9% (95% CI: 82.5–96.5), and 91.5% (95% CI: 83.6–99.5), respectively. Conclusion: The combination of QE-EUS and CEH-EUS is a useful tool for the differential diagnosis of SPT, giving complementary information. However, this combination does not significantly increase the diagnostic accuracy of either of the techniques performed alone.

Factors Determining Diagnostic Yield of Endoscopic Ultrasound Guided Fine-Needle Aspiration for Pancreatic Cystic Lesions: A Multicentre Asian Study

The purpose of this study was to determine (1) the diagnostic yield for endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with pancreatic cystic lesions, (2) additional value of EUS-FNA over EUS alone in the diagnosis of pancreatic cysts, and (3) diagnostic sensitivity and specificity of EUS and EUS-FNA in the subset of patients where histopathology of surgical specimens were available. All patients who underwent EUS examination for the evaluation of pancreatic cystic lesions in six Asian centres were included in the study. Of 298 patients with pancreatic cysts who underwent EUS, 132 (44.3 %) underwent FNA. In the entire cohort, pseudocysts and intraductal papillary mucinous neoplasm (IPMN) were the predominant cystic lesions. The cytologic yield of EUS-FNA was 47 %. On univariate analysis, factors associated with higher cytologic yield included vascular involvement on EUS, presence of solid cystic component, and increased number of needle passes during EUS-FNA. On multivariate analysis, presence of solid cystic components and increased number of needle passes during EUS-FNA were associated with higher diagnostic yield of EUS-FNA. For pancreatic cysts with a solid component, the diagnostic yield of EUS-FNA increased significantly from 44 % with one pass to 78 % with more than one pass (p = 0.016). In the absence of a solid component, the diagnostic yield was 29 % with one pass and was not significantly different from the diagnostic yield of 50 % with more than one pass, p = 0.081. The cytologic yield of EUS-FNA was 47 %. When a solid component was present in the cyst, doing more than one pass during EUS-FNA increased its diagnostic yield.

Molecular detection of circulating thyroid specific transcripts (TSHR/Tg-mRNAs) in thyroid cancer patients: Their diagnostic significance

Thyroid cancer is the most prevalent endocrine malignancy. The preoperative diagnosis of differentiated thyroid cancer (DTC) that relies solely on fine-needle aspiration (FNAC) biopsy, sometimes possesses conflicting results. New molecular markers for thyroid cancer have been investigated with most of them based on the detection in thyroid nodules or tumor tissue specimens. Recently, it was possible to detect thyroid cancer cells in the circulation by measuring the mRNA of thyroid specific genes. Among these, thyroglobulin and more recently thyroid stimulating hormone receptor mRNAs, TSHR/Tg-mRNAs in peripheral blood might serve as cancer-specific markers. These have become promising new circulating markers for thyroid cancer. The purpose of this study is to assess TSHR/Tg-mRNAs as diagnostic molecular markers for thyroid cancer and if they can be used preoperatively in synergy with FNAC. This study was performed on 60 subjects; 20 healthy volunteers and 40 patients; including 16 patients with benign thyroid diseases, 24 patients with thyroid cancer; 18 patients with newly diagnosed (DTC) and 6 patients with recurrent thyroid cancer. Diagnosis of cancer was based on FNAC and histopathology of surgical specimens. All subjects had TSHR/Tg-mRNAs in peripheral blood measured by reverse transcriptase (RT)-PCR. Based on cytology/pathology; 18 patients had newly diagnosed DTC and 11 had benign thyroid disease. Preoperative FNAC was performed on 29 of 40 patients; FNAC was diagnostic in 11/18 of malignant lesions (61.1%), in 8/11 of benign lesions (72.7%), while 10/29 (34.5%) were indeterminate. TSHR/Tg-mRNAs correctly diagnosed DTC in 20/24 and 19/24 (sensitivity 83.3% and 79.1%) and benign disease in 14/16 and 13/16 (specificity 87.5% and 81.3%), respectively. With indeterminate FNA, TSHR/Tg-mRNAs correctly diagnosed DTC (follicular type) in 5/7 and benign disease in 2/3 (combined sensitivity 71.4%; specificity 66.7%). There was high concordance between RT-PCR results for TSHR-mRNA and Tg-mRNA. Of the controls 19/20 (95%) and 16/20 (80%) were negative for both TSHR- and Tg-mRNAs. With the use of a carefully selected primer pair and qualitative RT-PCR; our results indicate that TSHR/Tg-mRNAs in peripheral blood are both equally sensitive and specific markers for detection of thyroid cancer cells. Combining TSHR/Tg-mRNAs and FNAC and ultrasound enhances the preoperative detection of cancer in patients with thyroid nodules, reducing unnecessary surgeries and correctly classified most follicular cancers and could have spared surgery in patients with benign disease.

Genomic microdeletions associated with epilepsy: Not a contraindication to resective surgery

PurposeSeveral recent reports of genomic microdeletions in epilepsy will generate further research; discovery of more microdeletions and other important classes of variants may follow. Detection of such genetic abnormalities in patients being evaluated for surgical treatment might raise concern that a genetic defect, possibly widely expressed in the brain, will affect surgical outcome.MethodsA reevaluation was undertaken of clinical presurgical data, histopathology of surgical specimen, and postsurgical outcome in patients with mesial temporal lobe epilepsy (MTLE) who have had surgical treatment for their drug-resistant seizures, and who have been found to have particular genomic microdeletions.Key FindingsThree thousand eight hundred twelve patients with epilepsy were genotyped and had a genome-wide screen to identify copy number variation. Ten patients with MTLE, who had resective epilepsy surgery, were found to have 16p13.11 microdeletions or other microdeletions >1 Mb. On histopathology, eight had classical hippocampal sclerosis (HS), one had nonspecific findings, and one had a hamartoma. Median postsurgical follow-up time was 48 months (range 10–156 months). All patients with HS were seizure-free after surgery, International League Against Epilepsy (ILAE) outcome class 1, at last follow-up; the patient with nonspecific pathology had recurrence of infrequent seizures after 7 years of seizure freedom. The patient with a hamartoma never became seizure-free.SignificanceLarge microdeletions can be found in patients with “typical” MTLE. In this small series, patients with MTLE who meet criteria for resective surgery and harbor large microdeletions, at least those we have detected, can have a good postsurgical outcome. Our findings add to the spectrum of causal heterogeneity of MTLE + HS.