Multiple Biopsies Research Articles

Analysis of high risk factors for chronic atrophic gastritis.

Screening for chronic atrophic gastritis (CAG) is crucial for the prevention and early detection of gastric cancer. Endoscopy is the main method of CAG diagnosis, with high training requirements and limited accuracy, making it difficult to popularize. The study attempts to improve the positive rate and accuracy of CAG screening through non-invasive testing. A total of 2564 patients who underwent gastroscopy were included in this study. The results of gastroscopic evaluation, histological biopsy results (including H. pylori biopsy), urea breath test (UBT) results, serum pepsinogen, and testosterone were statistically analyzed. We found significant differences in the diagnosis of CAG between endoscopy and histological biopsy. Pepsinogen II and pepsinogen I/II ratio were more useful for the diagnosis of CAG compared with pepsinogen I. The risk of CAG was increased when pepsinogen II exceeded 11.05 μg/L, and the pepsinogen I/II ratio was less than 3.75. CAG positivity was higher in patients with positive H. pylori infection on UBT screening. In addition, higher levels of testosterone, SHBG and HSD17B2, and lower level of GNRH1 were found in CAG mucosa. Patients with high serum testosterone had a higher risk of CAG. CAG screening should be combined with endoscopic evaluation, biopsy, and other non-invasive tests. Non-invasive tests include the combination of serum pepsinogen II protein and pepsinogen I/II ratio and high level of serum testosterone. UBT combined with serum pepsinogen testing may improve the positive rate of CAG and reduce gastric mucosal damage from multiple biopsies.

Eosinophilic Gastroenteritis: An Unusual Disease of Gastrointestinal Tract

Eosinophilic gastroenteritis (EGE) is a rare gastrointestinal disease characterized by generalized abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding and weight loss. The etiology and pathogenesis are not well understood and mostly based on case reports. Clinical presentation may vary depending on sites and depth of involvement of the gastrointestinal tract. The diagnosis is usually confirmed by histology that shows eosinophilic infiltration and the absence of secondary cause of eosinophilia.The authors present a case report of a 47-year-old woman that was diagnosed with dyslipidemia, obesity and allergic rhinitis. She had no significant family history. She was admitted in internal medicine department with 2 weeks of abdominal pain, nausea, vomiting, diarrhea and weight loss (> 10%). Further study revealed increased eosinophil count, normocytic anemia, elevated erythrocyte sedimentation rate and normal Ig E levels. Digestive endoscopic study was performed, and multiple biopsy specimens showed moderate eosinophilic infiltration in stomach and duodenal mucosa.The patient was started on prednisolone, with clinical improvement. Follow-up go the patient twenty years after the beginning of this treatment showed stabilization of clinical symptoms and laboratory tests.So, eosinophilic gastroenteritis is characterized by three criteria - presence of gastrointestinal symptoms, histologic evidence of eosinophilic infiltration and exclusion of other causes of tissue eosinophilia. The treatment is based on the severity of symptoms. Corticosteroids are the mainstay of therapy, so the usual dose of prednisolone/prednisone is 20-40 mg daily for two weeks with tapering thereafter. In the literature, the use of montelukast and biologic agents have been reported.

Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: Aretrospective Cyto-Heme Interinstitutional Collaborative study.

Few studies have evaluated diagnostic yield of small volume biopsies (SVB) for the diagnosis and management of follicular lymphoma (FL). The authors performed a multi-institutional retrospective analysis of SVBs including fine-needle aspiration (FNA) and needle core biopsy (NCB) for initial FL diagnosis and suspected recurrence or transformation of FL. A total of 676 workups beginning with SVB were assessed for the mean number of biopsies per workup, the proportion of workups requiring multiple biopsies, and the proportion with a complete diagnosis including grade, on initial biopsy. Compared to workups performed for question transformation/recurrence, those done for initial FL diagnosis were significantly more likely to require multiple biopsies (p<.01), had a higher mean number of biopsies per workup (1.7 vs. 1.1, absolute standardized difference=1.1), and a lower complete diagnosis rate at initial biopsy (39% vs. 56%). At initial FL diagnosis, NCB +/- FNA was associated with fewer biopsies per workup compared to FNA +/- CB (1.2 vs. 1.9), fewer workups requiring multiple biopsies (23% vs. 83%), and a higher complete diagnosis rate (71% vs. 18%). In contrast, during assessment for transformation/recurrence, NCB and FNA showed a similar mean number of biopsies per workup (1.2 vs. 1.2) and few workups required multiple biopsies (6% vs. 19%). SVB at initial FL diagnosis often required additional biopsies to establish a complete diagnosis. In contrast, when assessing for transformed/recurrent FL, additional biopsies were generally not obtained regardless of SVB type, suggesting that in these clinical settings SVB may be sufficient for clinical decision-making.

Anti-tissue Transglutaminase Enzyme-Linked Immunosorbent Assay for Screening of Celiac Disease in Moroccan Pediatric Patients

Celiac disease (CD) is an immune-mediated systemic disorder elicited by gluten which induces an enteropathy with atrophy of intestinal villi. No prevalence information was available for CD in Moroccan children because the diagnosis is based on multiple invasive duodenal biopsies. To simplify CD diagnosis, the objective of this work was to develop an Enzyme-linked Immunosorbent Assay (ELISA) for IgA and IgG tissue transglutaminase (tTG) antibodies detection suitable for Moroccan children. The concentration of the coated antigen and serum dilutions were optimized for the development of IgA anti- tTG and IgG anti-tTG ELISA detection in serum. The cut-off was calculated and the developed ELISAs were used for detecting IgA and IgG-tTG antibodies in 97 serum samples from 97 children aged 1 to 13 years, with variable clinical characteristics. After adjusting optimal working conditions of ELISA, the cut-offs were 0.04 and 0.156 AU for detecting anti-tTG and IgA anti-tTG IgG respectively. The use of IgG anti-tTG as CD marker (100 % of sensitivity) was better than the use of IgA anti-tTG in ELISA tests (90.3% sensitivity). In addition, the ELISA test shows a clear correlation between the IgG tTG antibodies titer and the degree of duodenal damage, estimated by the Marsh stages classification in patients with confirmed CD. Our results suggest that the assessment of the adapted IgG anti-tTG ELISA test can be used for CD in initial screening in Moroccan children after validation with a larger number of samples with CD for confirmation.

864 ISOLATED CARDIAC METASTASIS FROM CARCINOMA OF THE CERVIX: RARE CASE OF ACS-NSTE. CASE REPORT

Abstract Introduction The heart is a rare site of tumor metastasis. Although rarely, cardiac metastases may be secondary to a primary intra-abdominal tumor. Aim we report the case of a 60-years-old woman, ante-mortem finding of an isolated cardiac metastasis from cervical carcinoma presented as ACS-NSTE, who was evaluated in our Division of Cardiology. Materials and methods electrocardiogram, transthoracic echocardiography, angioTC, cardiac surgery and histopathologic analysis were performed. Results electrocardiogram showed incomplete right branch block with diffuse negative T waves. On the echocardiogram evidence of a voluminous hypo-isoechoic formation almost completely occupying the cavity of the right ventricule (RV) which appeared dilated and dysfunctional; D-shape aspect of the left ventricule as from the overload of the right sections and with moderate pericardial effusion, mildly reduced ejection fraction (EF50%Q). An urgent Angio-CT was performed and revealed a voluminous solid neoformation with inhomogeneous content and progressive contrast enhancement in the right ventricule. Following admission, the patient's haemodynamic status gradually worsened. Therefore, urgent cardiac surgery was performed. After drainage of abundant serum/haematic effusion, probably neoplastic infiltration of RV was seen. Therefore, given the extension it was decided to perform only multiple biopsies. Histopathological examination revealed moderately differentiated squamous cell carcinoma, as from metastasis from K. cervix. Conclusions there is no standardized therapy for the treatment of cardiac metastases, it is necessary to evaluate on a case-by-case basis. The most important prognostic factors are the obstructive effect of the intracardiac mass and the extent of any pericardial effusion. In fact, they can adversely affect hemodynamic stability.

872: UNCOMMON PRESENTATION OF A RARE NEOPLASM: AN ENDOBRONCHIAL PAPILLOMA PRESENTING AS SEPSIS

Introduction: Endobronchial papilloma’s (EBP) are rare neoplasms associated with nicotine use and Human Papilloma Virus (HPV). We present a case of a non-smoking, HPV negative male who presented to the hospital with obstructive pneumonia and sepsis due to a lower respiratory tract EBP. Description: A 75-year-old male presented to his primary care doctor with two weeks of dyspnea and productive cough. He was a non-smoker and presented with a medical history of end stage renal disease on hemodialysis, and atrial fibrillation (AF). At his primary care doctor’s office, he was found to be hypoxic and sent to the Emergency Department for further evaluation. Computed tomography-pulmonary angiogram revealed complete atelectasis of his left upper lobe, with consolidation present of the left lower lung. This raised suspicion for an intra-bronchial lesion and pneumonia. Ceftriaxone and azithromycin were initiated, and the patient underwent video fiberoptic white light bronchoscopy. Findings were notable for a lesion completely obstructing the anterior, apical, and posterior segments of the left upper lobe. The lesion was excised, and multiple biopsies were obtained. Pathology revealed glandular papilloma with chronic inflammation. HPV serotyping for 16, 18, 31, 33, and 51 were negative. The patient was kept on a ventilator post-operatively due to hypercapnia and uncontrolled AF. He was extubated less than 24 hours later. He was discharged home with oral cefdinir for 14 days, and 2 L/min of oxygen. He followed up with his pulmonologist one week later in clinic, recovering well, and without complication. Discussion: EBP are benign neoplasms, which represent less than 1% of all lung tumors. Due to their slow growing nature, they primarily present with chronic respiratory symptoms such as exertional dyspnea or cough. This case represents an uncommon presentation of EBP, specifically sepsis. Our patient did not have classic risk factors such as HPV or smoking history. Although rare, clinicians should keep EBP in mind when patients present with sepsis if endobronchial lesions are suspected.

GASTRIC ULCER PENETRATING TO THE DUODENOJEJUNAL FLEXURE – MANAGEMENT AND PITFALLS. CASE REPORT AND REVIEW OF THE LITERATURE

Introduction: The penetration into adjacent organs is a classical complication of peptic ulcer despite being less frequent than the other complications. The current work presents a rare case of gastric ulcer penetrating the duodenojejunal flexure and discusses the diagnostic difficulties, pitfalls, and current treatment strategy. Case report: A 63-years-old woman was admitted complaining of intermittent black stools defecations, and a weight of 44 kg. The referral gastroscopy revealed a 10 cm ulcer on the posterior wall of the stomach. The histology demonstrated severe gastritis with atypical cells. The hemoglobin level was 88g/l. The patient was scheduled for elective resection for suspected gastric cancer. The intraoperative finding was completely different – there was an ulcer approximately 4-5 cm in diameter infiltrating the transverse mesocolon and duodenojejunal flexure. The case was considered T4 cancer and we decided against elective gastrectomy. The postoperative CT showed an ulcer penetrating the duodenojejunal flexure. The second gastroscopy found an ulcer with a size of 3-4 cm. The multiple biopsies showed exacerbated chronic peptic ulcer with H. pylori infection, which was treated with proton pump inhibitors and antibiotics. The follow-up gastroscopy four months later demonstrated shrinkage of the ulcer to 15 mm with complete epithelization. One year later she gained 23 kg and was free of complaints. Conclusion: Penetration and fistulization to the duodenojejunal flexure are uncommon but possible complications of peptic ulcer disease. They are not an absolute indication for surgery. Decision-making should take into account the clinical presentation, patient age, and comorbidity.

Multiple receptor conversions during the course of metastatic breast cancer therapy: a case report and review of the literature

BackgroundAdjuvant systemic therapy decreases recurrence and death from breast cancer, but late relapse still occurs. Therapeutic decisions are based heavily on receptor tissue characterization. Even though the vast majority of metastatic sites do not have receptor conversions, they can occur at the time of metastasis and/or during the course of treatment. However, multiple receptor conversions are uncommon.Case presentationWe present an unusual case of a Caucasian patient originally diagnosed with an estrogen receptor-positive, progesterone receptor-positive, and human epidermal growth factor receptor 2-negative primary breast cancer who had a recurrence after 15 years of therapy. Her metastatic tumor had a different receptor status than the original tumor. During the course of therapy, at the time of progression, a new biopsy showed that her tumor had changed once more.Conclusion/DiscussionTracking receptor conversions is important in metastatic breast cancer treatment. Single receptor conversions have been documented to occur, but not much is known of multiple receptor conversions. This case sheds light on the possibility of patients having multiple receptor conversions and the importance of performing multiple biopsies during the course of metastatic treatment.

An Unusual Case of Significant Cervical Esophageal Stricture

Question: A 65-year-old man was referred to our facility for solid-food dysphagia without other disease history. He lived a happy and healthy life without abuse of alcohol or tobacco. The symptom started about 2 years before, without accompanying heartburn and regurgitation, and did not progress significantly. A stricture at the upper orifice of the esophagus was found (Figure A) and hampered the routine endoscopic examination (GIF-Q260; Olympus). Instead, an ultrathin endoscope (GIF-XP290N; Olympus) was used, which revealed a well demarcated translucent white scaly lesion with shaggy surface distributed in a two-thirds circumferential arrangement from 15 cm to 25 cm of the esophagus distal to the incisors (Figure B, Video A). Narrow-band imaging endoscopy showed a distinct white irregular map-like area (Figure C, Video A). Computer tomography (CT) did not show any neck mass or thickness of the cervical esophageal wall (Figure D). Multiple biopsies were obtained from the proximal esophagus. No malignancy was confirmed pathologically (Figure E).

99mTc‑labeled single-domain antibody for SPECT/CT assessment of HER2 expression in diverse cancer types

The expression status of human epidermal growth factor receptor 2 (HER2) in cancer predicts response to HER2-targeted therapy. Therefore, its accurate determination is of utmost importance. In recent years, there has been an increase in research on noninvasive techniques for molecular imaging, as this method offers the advantages of a more accurate determination of HER2 status without the need for multiple biopsies. The technetium-labeled single-domain antibody RAD201, previously known as 99mTc-NM-02, has been shown to be safe for use in breast cancer imaging with reasonable radiation doses, favorable biodistribution, and imaging characteristics.MethodsA total of six HER2-positive, heavily pretreated patients with different cancer types aged between 42 and 69 years (5 women and 1 man; the median age of 55.5) have been examined. In six of seven scans, the patients were administered 500 ml of Gelofusine® solution (40 mg/ml) for radiation protection before the tracer injection (434 ± 42 MBq). Planar scans were acquired with the patient supine at 10 min, 60 min, 160 min, 20 h, and 24 h after injection. A CT scan was acquired at 95 min, followed by local tomographic SPECT imaging.ResultsOne patient was scanned twice with RAD201, 3 months apart, resulting in a total of seven scans for six patients. Here, we show that the use of RAD201 in our patient group shows the same favorable biodistribution as in a previous study with RAD201 (NCT04040686) and that the radiation dose to the critical organ kidney can be reduced by the application of the plasma expander Gelofusine® by almost 50%.ConclusionRAD201 appears safe for use in humans and is a promising noninvasive tool for discriminating HER2 status in metastatic (breast) cancer, regardless of ongoing HER2-targeted antibody treatment.

Novel Technique in Performing Standard Transperineal Template Prostate Biopsies Under Local Anaesthetic.

Transperineal template prostate biopsies (TPTPB) are now increasingly commonly performed for the diagnosis of prostate cancer. TPTPB are traditionally performed under general anaesthetic. However, this poses a significant strain on hospital theatre capacity. As such, local anaesthetic (LA) TPTPB are becoming more popular. We describe a novel technique in performing the standard TPTPB under LA in the outpatient setting. Between February 2019- February 2021, 254 consecutive men (median age 69; range: 44-80 years) with a median PSA of 8.7 ng/ml (range: 2.2-76) underwent L/A TPTPB using our novel technique. This is whereby 50mls of 1% prilocaine was injected partially around the perineal skin and partially deep bilateral periprostatic areas. Multiple simultaneous prostate biopsies were then taken with the standard template grid and stepper. A total of 250/254 (98.4%) men underwent successful L/A TPTPB with a median visual analogue pain score of 4 (range: 2-8). The median prostate volume was 49cc (range: 14-240cc). The median number of cores taken were 18 (range: 14-24). A total of 163/250 men (65.2%) had a positive histology for prostate cancer with a median of 5 cores being involved with prostate cancer (range: 1-18). In addition, 101/163 men (62.0%) diagnosed with prostate cancer had either Gleason score 3+4=7 or greater. None experienced urosepsis and only 2/250 men (0.8%) had temporary urinary retention. Our novel LA technique in performing the standard TPTPB is safe, feasible and well tolerated and associated with a high rate of prostate cancer detection.

Toward digital histopathological assessment in surgery for central nervous system tumors using stimulated Raman histology.

Intraoperative neuropathological assessment with conventional frozen sections supports the neurosurgeon in optimizing the surgical strategy. However, preparation and review of frozen sections can take as long as 45 minutes. Stimulated Raman histology (SRH) was introduced as a novel technique to provide rapid high-resolution digital images of unprocessed tissue samples directly in the operating room that are comparable to conventional histopathological images. Additionally, SRH images are simultaneously and easily accessible for neuropathological judgment. Recently, the first study showed promising results regarding the accuracy and feasibility of SRH compared with conventional histopathology. Thus, the aim of this study was to compare SRH with conventional H&E images and frozen sections in a large cohort of patients with different suspected central nervous system (CNS) tumors. The authors included patients who underwent resection or stereotactic biopsy of suspected CNS neoplasm, including brain and spinal tumors. Intraoperatively, tissue samples were safely collected and SRH analysis was performed directly in the operating room. To enable optimal comparison of SRH with H&E images and frozen sections, the authors created a digital databank that included images obtained with all 3 imaging modalities. Subsequently, 2 neuropathologists investigated the diagnostic accuracy, tumor cellularity, and presence of diagnostic histopathological characteristics (score 0 [not present] through 3 [excellent]) determined with SRH images and compared these data to those of H&E images and frozen sections, if available. In total, 94 patients with various suspected CNS tumors were included, and the application of SRH directly in the operating room was feasible in all cases. The diagnostic accuracy based on SRH images was 99% when compared with the final histopathological diagnosis based on H&E images. Additionally, the same histopathological diagnosis was established in all SRH images (100%) when compared with that of the corresponding frozen sections. Moreover, the authors found a statistically significant correlation in tumor cellularity between SRH images and corresponding H&E images (p < 0.0005 and R = 0.867, Pearson correlation coefficient). Finally, excellent (score 3) or good (2) accordance between diagnostic histopathological characteristics and H&E images was present in 95% of cases. The results of this retrospective analysis demonstrate the near-perfect diagnostic accuracy and capability of visualizing relevant histopathological characteristics with SRH compared with conventional H&E staining and frozen sections. Therefore, digital SRH histopathology seems especially useful for rapid intraoperative investigation to confirm the presence of diagnostic tumor tissue and the precise tumor entity, as well as to rapidly analyze multiple tissue biopsies from the suspected tumor margin. A real-time analysis comparing SRH images and conventional histological images at the time of surgery should be performed as the next step in future studies.

Role of conservative therapy prior to surgery in xanthogranulomatous mastitis: a case report

Xanthogranulomatous mastitis is an extremely rare condition that is characterised by the infiltration of the breast parenchyma by foamy histiocytes. There have been only 26 reported cases amongst 10 publications. The clinical and radiological presentation of xanthogranulomatous mastitis often causes diagnostic confusion due to its similarity to breast cancer and other forms of chronic inflammatory mastitis. A histological diagnosis is often required either by core needle biopsy or excisional biopsy. Upon review of the literature, surgical excision was the most predominant mode of management. We present a case of xanthogranulomatous mastitis in a 40-year-old female who presented with clinical and radiological features of breast malignancy. This was a significantly large mass with a dimension of 90.7 mm by 36.4 mm, which if surgically excised, would have led to permanent cosmetic changes. Multiple core needle biopsies were completed to consider other differentials of histiocytic lesions including cystic neutrophilic granulomatous mastitis, histiocytoid lobular breast carcinoma, Rosai-Dorfman disease and Erdheim-Chester disease. Clinical improvement was noted with reduction in size from prolonged antibiotic therapy suggesting an initial conservative approach in the management of xanthogranulomatous mastitis. By contributing our experience with xanthogranulomatous mastitis, we also present a review of literature on its aetiology, clinical features, and management of this pathology.

A Masked Marjolin Ulcer despite of Multiple Biopsies Performed at the Outpatient Clinic

A Masked Marjolin Ulcer despite of Multiple Biopsies Performed at the Outpatient Clinic

Diagnostic Value of Pleural Fluid Adenosine Deaminase In Patients With Pleural Tuberculosis

Background and Objectives Extra-pulmonary tuberculosis occurs in about 10-20% of patients with tuberculosis. It most commonly manifests as tuberculous lymphadenitis or pleural effusion. Pleural fluid Adenosine deaminase (ADA) activity considered as a useful biomarker for detecting pleural tuberculosis. The purpose of this study was to evaluate the diagnostic accuracy of pleural fluid adenosine deaminase level in patients with pleural tuberculosis. Methods In this study, 113 patients with exudative pleural effusion with unknown underlying diagnosis, were enrolled. Physical examination, chest CT, ADA level of pleural fluid, direct thoracoscopic examination, and biopsy of pleura were obtained for all individuals. ADA level and thoracoscipoc appearance of the lesions was then compaierd among the patients with regard to the pleural biopsy report as the diagnostic goldstandard. Results The diagnosis of tuberculous pleurisy was established in 40 individuals based on the pathology reports. The mean ADA level of the TB and the non-TB group was 39.90±22.93 IU/L and 30.74±38.27 IU/L, respectively (P-value=0.167). Sensitivity, specificity, positive predictive value, and negative predictive value of ADA test were 35%, 86.30%, 58.33%, and 70.79%, respectively. Conclusion Based insuffiecient sensitivity and specificity of ADA, in patients with unexplained exudative pleural effusion especially in those with a high suspicion of tuberculous pleurisy, despite the low level of ADA, direct thoracoscopic pleural evaluation with obtaining multiple biopsies of pleura is highly recommended.

Esophageal stenosis in a child with eosinophilic esophagitis: diagnosis and positive dynamics against the background of conservative therapy

Introduction. Currently, eosinophilic esophagitis (EoE) is a big and urgent problem for modern pediatrics. Its pathogenesis is associated with the formation of stenoses and strictures of the esophagus during a long course of the disease without treatment, which leads to serious disorders in the nutrition of children. In widespread practice, X-ray contrast examination of the esophagus is used, however, it is also necessary to perform esophagogastroduodenoscopy (EGDS) with taking multiple biopsies with morphological examination to verify the diagnosis. Materials and methods. Boy Y. 12 years, was admitted in March 2021 with complaints of difficulty in swallowing solid food, as well as poor weight gain. From the anamnesis of the disease, it is known that the phenomena of dysphagia were noted from the preschool period. Symptoms have progressed over the past year. EGDS was performed. A biopsy was taken: 6 fragments of the esophagus, 2 fragments from each third. Results. Diagnosed with eosinophilic esophagitis, complicated by esophageal stenosis. Chronic gastritis, Helicobacter pylori-not associated, incomplete remission. Chronic duodenitis, incomplete remission. Protein-energy malnutrition, mild. Appropriate treatment was prescribed. An allergological examination of the child was carried out and recommendations for nutrition were given. Against the background of the therapy, the child’s condition with pronounced positive dynamics - the appetite improved, the phenomena of dysphagia were completely stopped. When the child was re-hospitalized a month later, there was an increase in body weight (900 g) and growth (3 cm). Conclusions. The high efficiency of complex conservative therapy has been shown. The prescribed conservative treatment made it possible to avoid dilatation and bougienage of the esophagus. In this case, all three components of EoE treatment were applied: elimination diet, proton pump inhibitors, and topical corticosteroids. In the future, it is necessary to observe the allergist, taking into account the data obtained on multiple sensitization with a decision on the question of further treatment.

Management of primary upper urinary tract carcinoma in situ diagnosed by ureteroscopic biopsy: Is bacillus Calmette-Guerin an alternative to nephroureterectomy?

BackgroundRadical nephroureterectomy (RNU) represents the gold standard treatment for upper tract urothelial carcinoma (UTUC); however, attempts have been made to treat upper urinary tract CIS (UT-CIS) conservatively. The aim of this study was to compare the outcome of patients with primary UT-CIS treated in our center by means of RNU vs. bacillus Calmette-Guérin (BCG) instillations. MethodsThis retrospective study included patients with diagnosis of primary UT-CIS between 1990 and 2018. All patients had histological confirmation of UT-CIS in the absence of other concomitant UTUC. Histological confirmation was obtained by ureteroscopy with multiple biopsies. Patients were treated with BCG instillations, RNU or distal ureterectomy. Clinicopathological features and outcomes were compared between RNU and BCG groups. ResultsA total of 28 patients and 29 renal units (RUs) were included. Sixteen (57.1%) patients (17 RUs) received BCG. BCG was administered via nephrostomy tube in 4 patients, with a single-J ureteral stent in 5, and using a Double-J stent in 7. Complete response and persistence or recurrence were detected in ten (58.8%) and seven (41.2%) RUs treated with BCG, respectively. Eight (27.6%) RUs underwent RNU, and 4 (13.8%) Rus distal ureterectomy. No differences were found in recurrence-free survival (p=0.841) and cancer-specific survival (p=0.77) between the RNU and BCG groups. ConclusionsAlthough RNU remains the gold standard treatment for UT-CIS, our results confirm that BCG instillations are also effective. Histological confirmation of UT-CIS is mandatory before any treatment.

MYCOSIS FUNGOIDES (MF): THE MASTER OF MIMICRY

<h3>Introduction</h3> Mycosis fungoides (MF) is the most common form of primary cutaneous T-cell lymphomas, characterized by a long clinical course and malignant T-cell proliferation. The early stages of MF can mimic atopic dermatitis (AD), and psoriasis and thus, diagnosis can be challenging and oftentimes delayed. <h3>Case Description</h3> A 39-year-old African American female with developmental delay was referred for a mildly pruritic, generalized eczematous dermatitis, hyperkeratosis of the palms and soles, and contractures with fingernail clubbing. Skin biopsy two years prior was reportedly unremarkable. Treatment for an initial diagnosis of fungal dermatitis with mupirocin, clotrimazole, and lotrisone was started with regular debridement of the feet. Rheumatological workup was negative, including x-rays of the hands and chest. Clobetasol wraps provided short-term relief. Dupixent for AD was discussed but not started. A second skin biopsy ultimately revealed erythrodermic MF. Flow cytometry was compatible with Sezary syndrome and T-cell receptor gene rearrangement study was positive for monoclonal gene rearrangement. <h3>Discussion</h3> MF diagnosis is not easy, primarily due to the atypical clinical presentation of the disease at an early stage, and non-specific changes on histopathology. As such, multiple biopsies may be needed to make a diagnosis. This case highlights important points for the allergist. 1) Erythema in skin of color is hard to appreciate 2) MF can often look like AD and 3) Palmoplantar Keratoderma may be associated with MF.

A clinical-grade liquid biomarker detects neuroendocrine differentiation in prostate cancer.

BackgroundNeuroendocrine prostate cancer (NEPC) is an aggressive subtype, the presence of which changes the prognosis and management of metastatic prostate cancer.MethodsWe performed analytical validation of a Circulating Tumor Cell (CTC) multiplex RNA qPCR assay to identify the limit of quantification (LOQ) in cell lines, synthetic cDNA, and patient samples. We next profiled 116 longitudinal samples from a prospectively collected institutional cohort of 17 patients with metastatic prostate cancer (7 NEPC, 10 adenocarcinoma) as well as 265 samples from 139 patients enrolled in 3 adenocarcinoma phase II trials of androgen receptor signaling inhibitors (ARSIs). We assessed a NEPC liquid biomarker via the presence of neuroendocrine markers and the absence of androgen receptor (AR) target genes.ResultsUsing the analytical validation LOQ, liquid biomarker NEPC detection in the longitudinal cohort had a per-sample sensitivity of 51.35% and a specificity of 91.14%. However, when we incorporated the serial information from multiple liquid biopsies per patient, a unique aspect of this study, the per-patient predictions were 100% accurate, with a receiver-operating-curve (ROC) AUC of 1. In the adenocarcinoma ARSI trials, the presence of neuroendocrine markers, even while AR target gene expression was retained, was a strong negative prognostic factor.ConclusionOur analytically validated CTC biomarker can detect NEPC with high diagnostic accuracy when leveraging serial samples that are only feasible using liquid biopsies. Patients with expression of NE genes while retaining AR-target gene expression may indicate the transition to neuroendocrine differentiation, with clinical characteristics consistent with this phenotype.FundingNIH (DP2 OD030734, 1UH2CA260389, R01CA247479, and P30 CA014520), Department of Defense (PC190039 and PC200334), and Prostate Cancer Foundation (Movember Foundation - PCF Challenge Award).

118. Single-cell RNA sequencing and co-occurring cellular state analysis of high-grade serous ovarian cancer

High-grade serous carcinoma (HGSC) is the most lethal subtype of ovarian cancer, and a majority of patients are diagnosed at advanced stages. One standard-of-care is neoadjuvant chemotherapy followed by cytoreductive surgery, however up to 80% of HGSC patients develop recurrent disease. There exists a critical need to better understand the features of this tumor microenvironment that may highlight potential therapeutic targets, help stratify chemotherapy responders from non-responders, and uncover novel cell states that may serve as prognostic or predictive biomarkers. We obtained multiple biopsies from five patients with advanced-stage HGSC, both pre- and post-treatment, and analyzed these samples using single-cell RNAseq. We identified 20 distinct transcriptional clusters of cells, including a well-defined tumor subset enriched for EPCAM and KRT8. We annotated each cluster using known marker genes, and additionally validated these data through genome-wide copy number and developmental maturity analyses. We then performed transcriptome deconvolution to identify co-occurring transcriptional states using EcoTyper. We then performed bulk RNAseq on paired pre- and post-treatment tumor biopsies from 23 HGSC patients. Applying our fingerprints of ecotypes from the scRNA-seq data, we identified multiple distinct transcriptional states within the pre- and post-treatment HGSC tumor microenvironment, which were enriched for distinct co-occurring states comprised of multiple immunologic lineages, including CD4 T and NK cell states. We plan to validate these ecotypes using spatial transcriptomics and compare clinical outcomes across transcriptional states to determine the potential prognostic or predictive implications of our discoveries.