Results Of Pathological Diagnosis Research Articles

Laparoscopic Cholecystectomy for Biliary Dyskinesia: Does Ejection Fraction Predict Long-term Symptom Relief?

Introduction: Biliary dyskinesia (BD) is diagnosed in patients who present with biliary colic, reduced ejection fraction of the gallbladder on a cholescintigraphy study (HIDA) scan and absence of gallstones on ultrasound. Laparoscopic cholecystectomy (LC) still remains the treatment of choice for biliary dyskinesia. Very few studies have looked at long-term response or efficacy of LC based on severity of gallbladder hypo function on a HIDA scan. Aim: To determine if long term symptom relief post LC in patients with BD or chronic acalculous cholecystitis is predicted by severity of gallbladder dysfunction. Methods: This was a retrospective study conducted at West Virginia university between 2005 and 2013. There were a total of 2,350 patients who underwent a cholecystectomy (either open or laparoscopic). Of these patients, 1,955 underwent LC, out of which 226 patients had the clinical diagnosis of chronic alcalculous cholecystitis. Data collection included demographics, pre operative patient symptoms, results of imaging studies, pathologic diagnosis and early post-operative pain relief. Our inclusion criteria was age >18, lack of gallstones on right upper quadrant ultrasound, normal liver function tests, diagnosis of BD determined by HIDA scan ejection fraction less than 35% and finally a pathology report confirming the diagnosis of chronic acalculous cholecystitis. Any pre operative or post operative workup was also reviewed. Long term symptom relief data was obtained via telephone interview using modified Likert scale. Based on this scale, patients were classified as either responder or non-responders. Results: A total of 209 patients met the above inclusion criteria. The mean long-term follow-up was 6.1 years. In 94 patients who had EF<10%, 86 were responders and 8 were non responders (response rate 92%, odds ratio [OR] 17.2; p-value<0.000). In 102 patients who had EF 10-35%, 68 patients were responders while 34 were non responders (response rate 67%, OR 3.2; p-value 0.056). The rest of the 13 patients were part of the reference group with gallbladder ejection fraction >35% who still ended up undergoing LC given ongoing biliary symptoms. All of the non responders in the <10% group either had pre or post operative testing that revealed alternative diagnosis. Conclusion: Severity of gallbladder dysfunction predicts long term response to laparoscopic cholecystectomy in patients with gallbladder dysfunction. Further studies with a larger group of patients should be done to corroborate our study results.

Clinical analysis of orbital exenteration for orbital retinoblastoma

To analyze the reasons of orbital exenteration for orbital retinoblastoma (RB) patients. Retrospective case series study. Clinical records were reviewed retrospectively of 17 orbital RB patients who had undergone exenteration from November 1999 to November 2010 at Armed Police General Hospital. The clinical records included ophthalmic history, process of diagnosis and treatment, symptom and signs, surgical approach, pathological diagnosis and follow-up results. The reasons of orbital exenteration for orbital RB patients according to medical history, process of diagnosis and treatment were analyzed. The average age of patient was 3.2 years old. The ratio of male versus female was 1.1: 1. The common clinical findings were as following: 11 cases of orbital mass, 7 cases of exophthalmos, 6 cases with palpebral edema, 4 cases of conjunctival congestion and edema with conjunctival mass, and 2 cases with orbital pain. Reasons for orbital exenteration were as following: 7 patients who lost the opportunity of the treatment because of concernning about the cost of treatment and poor prognosis and caused worst outcome. Exenteration had to be done eventually. Five cases of orbital recurrence happened after enucleation. Three patients' Rb invaded into orbit after conservative treatment intravenous chemotherapy or radio therapy alone. Two cases were misdiagnosed and mishandled causing rapidly tumor spread into the orbit. The major reasons of orbital exenteration for orbital RB patients lies in the following: giving up treatment from patients, tumor recurrence in the orbit after enucleation, progressing of orbital RB after simple conservative treatment, misdiagnosis and mishandling to let RB invade into orbit rapidly.

Laparoscopic cholecystectomy for biliary dyskinesia: Which patients have long term benefit?

Biliary dyskinesia (BD) is described as biliary colic in the absence of gallstones. The diagnosis relies on imaging studies and decreased excretion of bile in response to cholecystokinin during quantitative cholescintigraphy. The purpose of this study was to evaluate the success of laparoscopic cholecystectomy (LC) for relieving symptoms in patients diagnosed with BD and correlate gallbladder ejection fraction (EF) with symptom relief. A retrospective review was performed at a single institution of all patients who underwent LC for BD from January 2005 through January 2012. The diagnosis of BD was determined by a normal gallbladder as viewed with ultrasonography and cholescintigraphy with a gallbladder EF less than or equal to 45%. Data collection included demographics, results of imaging studies, pathologic diagnosis, and early postoperative pain relief. Patients were contacted by phone after being discharged from the surgeon's care for evaluation of symptom relief. Data were analyzed with nonparametric statistical methods, including Mann-Whitney U test, receiver operator characteristic, Fisher exact test, and χ(2) test. All data are expressed as median and 25th and 75th percentile range. There were 126 patients who had a LC for BD during the study period. The median biliary EF was 20% (10-29%). The most common pathologic finding was chronic cholecystitis (n = 95; 75%). Median length of follow-up in the perioperative period was 11 days (8-17), during which time 98 patients (78%) had relief of symptoms. Phone interviews (n = 53; 42%) confirmed 66% (n = 35) of patients remained free of pain. There was no difference in the mean EF among those with resolution of pain 20% (10-29%) compared with patients with persistent pain 23% (11-29%), P = .62. Obese patients were more likely to have persistent symptoms in the perioperative period with a shift to lower body mass index at the time of the phone survey. Receiver operator characteristic characteristic for the association between scintigraphic EF and resolution of postoperative pain demonstrated no association, with the area under the curve equal to 0.47. The majority of patients in this series with BD had resolution of symptoms with LC. However, cholescintigraphy EF did not correlate with outcome. Further studies are needed to better identify patients diagnosed with BD who will benefit from LC.

Molecular pathological diagnosis for early esophageal cancer in Kazakh patients

Chromosome abnormalities in cancer cells occur early in carcinogenesis. We employed DNA probes for the detection of cancer cells in surgical specimens in Kazakh patients with suspected esophageal carcinoma, to analyze the application of this technique during the early diagnosis of esophageal cancer. Comparative analysis was used to compare the results of pathological diagnosis with the results of FISH. We performed esophagofiberscopic biopsy examinations in 50 Kazakh patients with suspected esophageal carcinoma, including 40 males and 10 females, with an average age of 56.8 years. The final diagnosis was esophageal squamous cell carcinoma in 47 patients, and adenocarcinoma, mucinous carcinoma and small cell carcinoma in one patient each. The pathological findings of the biopsy were positive in 45 cases, and false-negative in 5. The sensitivity and specificity of pathological diagnosis were 87.2 and 100%, respectively. Using FISH to examine the same tissues, we found that 48 cases showed aberrant copy numbers in either chromosome 3 or 17, and 2 cases were false-negative, with a sensitivity and specificity of 94.8 and 100%, respectively. The copy numbers of centromeres in chromosome 3 were significantly higher than the copy numbers of centromeres in chromosome 17 (P=0.0001). Compared with biopsy pathology, the FISH test was more sensitive. Being an objective and qualitative method, the technology of molecular pathological diagnosis may effectively increase the early diagnostic rate of esophageal cancer. In addition, the centromere probe in chromosome 3 may be the most sensitive probe for the diagnosis of esophageal cancer in Kazakh patients.

Experiences on the application of video-assisted mediastinoscopy for 40 patients with mediastinal lesions.

To evaluate the clinical experiences on the application of videoassisted mediastinoscopy for 40 patients with mediastinal lesions. Forty patients underwent video-assisted mediastinoscopy through neck-way surgery, including 17 cases with sole mediastinal nodule or mass, of which the pathologic diagnosis was warranted; 18 cases diagnosed as lung cancer with enlarged mediastinal lymph nodes, of which the clinical stage needed to be clarified; and 5 cases of mediastinal mass with miscellaneous clinical conditions. The results of mediastinoscopy biopsy and pathological diagnosis were analyzed. Satisfied tissue for detailed examination was obtained for all of the 40 cases who underwent mediastinoscopy. The successful rate for biopsy was 100%. The final pathologic diagnosis were 11 cases of lymph node metastasis from lung cancer, 4 cases of lymph node metastasis from unknown site, 9 cases of sarcoidosis, 6 cases of lymph node reactive hyperplasia, 4 cases of tuberculosis, 2 cases of lymphoma, 2 cases of mediastinal cyst, 1 case of retrosternal thyroid, 1 case of inflammatory granuloma. Two cases of postoperative hemorrhage related to surgery were successfully treated. Video-assisted mediastinoscopy is safe and useful. It's essential for the diagnosis of sole mediastinal mass, a good method to clarify the pathologic stage of patients with lung cancer, and the only way to get the pathologic diagnosis for some special mediastinal disease.

Validity of intraoperative pathological diagnosis of paratracheal lymph node as a strategy for selection of patients for cervical lymph node dissection during esophagectomy.

The aim of this paper is to examine whether intraoperative examination of paratracheal nodes can indicate cervical node dissection and whether this approach is valid. From 1988 to 1997, 76 patients with thoracic esophageal squamous cell carcinoma received esophagectomies with and without cervical lymph node (LN) dissection based on the results of intraoperative pathological diagnosis from selective checking of paratracheal LN. We retrospectively examined the outcomes for the patients and the micro metastasis in the dissected lymph node using cytokeratin staining. Three of the seven patients with cervical LN dissection were detected as having cervical LN metastasis by postoperative hematoxylin-eosin or cytokeratin staining. Five (7%) of the 69 patients without cervical LN dissection had cervical LN recurrence after the operation. Four of the seven patients who were diagnosed as having metastasis or micro metastasis in paratracheal LN by postoperative examination had cervical LN recurrence after the operation. In conclusion, the esophagectomy with and without cervical LN dissection for thoracic esophageal squamous cell carcinoma based on the results of intraoperative pathological diagnosis from selective checking of paratracheal LN was not fully acceptable. The reliability of intraoperative pathological diagnosis of selective checking may improve by increasing the number of checked LN and the detection of micro metastasis.

膀胱全層生検による浸潤性膀胱癌に対する Neoadjuvant 療法の評価

The most important information for treatment of bladder cancer is to know its exact staging. A whole layer needle biopsy technique has been developed for this purpose. Recently, neoadjuvant therapy has been used for invasive bladder cancer. Although down staging of bladder cancer after neoadjuvant therapy are evaluated by CT or ultrasound, these imaging are not reliable. We examined 11 invasive bladder cancer patients by whole layer needle biopsy pre and post neoadjuvant therapy. All cases were pT3-4 by pretreatment biopsy. After neoadjuvant therapy 4 were changed to pT0 by needle biopsy, other cases were no change or minimal change. In 4 changed to pT0, 3 were done total or partial cyctectomy and the results of pathological diagnosis of cystectomized specimens were also pT0. Another one case changed to pT0 is selected as candidate for bladder sparing and the patient is now in close surveillance. All 4 cases changed to pT0 were done combined treatment by chemo (internal iliac artery infusion) and radiotherapy. In remaining 7 cases, pathological staging of surgical or autopsy specimen agreed with that of whole layer needle biopsy. Whole layer needle biopsy showed no severe complication, except minor bleeding from the bladder wall. Tumor seeding into the needle tract was not observed up to present time. In conclusion, this biopsy system is useful for evaluation of the change of stage with chemotherapy and/or radiation therapy. By using this technique we can select the cases for candidate of bladder sparing.