Subsequent Histologic Findings Research Articles

HPV-Independent Cervical Adenocarcinoma Discovered by Cytology-Based Screening: A case report of gastric type adenocarcinoma of the uterine cervix from cytopathology to histopathology

Abstract Introduction/Objective In recent years, the relative prevalence of adenocarcinoma has increased, comprising 20–25% of all cervical carcinomas in developed countries. Approximately 15% of cervical adenocarcinomas are unrelated to human papilloma virus (HPV) infection. With the shift toward HPV primary testing, an increased understanding of HPV-independent cervical adenocarcinomas becomes more important. Methods/Case Report This case report demonstrates a rare case of gastric-type adenocarcinoma (GAS) of the cervix discovered during a routine well-woman exam. Patient-reported episodes of vaginal spotting were noted prior to screening. HPV testing by PCR on the initial pap smear was negative. Cytology findings raised concerns about endocervical glandular cell abnormalities. Subsequent cervical biopsy revealed GAS, a finding supported by positive CK7, MUC5AC, CDX2, and aberrant (mutant) p53 expression by immunohistochemistry. HPV independence was further confirmed by negative results on mRNA ISH for high-risk HPV and HPV16/18. Results (if a Case Study enter NA) NA Conclusion Here we discuss the impact of cytology-based screening on HPV-independent cervical cancers, with focus on adenocarcinoma. While the move to primary HPV screening has been shown to be effective at identifying HPV-related neoplasms, it ineffectively addresses HPV-independent malignancies. In this particular population, cytology-based screening remains indispensable. The described case demonstrated subtle cytologic features consistent with endocervical glandular abnormality, ultimately correlating with subsequent histologic findings of HPV-independent GAS. Negative HPV results combined with subtle cytomorphologic changes displayed by some adenocarcinomas on PAP smear could present a significant diagnostic pitfall. Additionally, p16+ expression attributable to aberrant p53 pathways (rather than HPV) may further contribute to potential diagnostic errors. While further research into best practices for early detection of HPV-independent cervical neoplasias should be conducted, this team suggests both clinical survey and referral for cytologic screening following reports of abnormal vaginal bleeding and/or watery discharge and screener education focused on cervical GAS.

Computed tomography-guided transfacial buccal space core biopsy of deep head and neck space lesions: our experience

Deep head and neck space lesions can present a number of diagnostic challenges due to their deep anatomical position and difficult access for diagnostic tissue sampling. We describe a series of percutaneous ‘transfacial’ buccal space computed tomography (CT)-guided core biopsies of these lesions and subsequent histological findings. Six patients underwent CT-guided core biopsy of deep parotid, parapharyngeal, or masticator space lesions over a 30-month period. We describe our biopsy technique and correlate our histological findings with subsequent surgical resection where performed. Five of six of CT-guided biopsies obtained sufficient tissue for histological interpretation with varying findings, including salivary gland tumours and squamous cell carcinoma confirmed on subsequent resection. One patient was treated palliatively following core biopsy. No biopsy-related complications were observed. In our small series, percutaneous CT-guided transfacial biopsy via the buccal space has proved an excellent option for the minimally invasive tissue acquisition of deep head and neck space lesions.

Classification of renal tumour using convolutional neural networks to detect oncocytoma

PurposeTo investigate the ability of convolutional neural networks (CNNs) to facilitate differentiation of oncocytoma from renal cell carcinoma (RCC) using non-invasive imaging technology. MethodsData were collected from 369 patients between January 2015 and September 2018. True labelling of scans as benign or malignant was determined by subsequent histological findings post-surgery or ultrasound-guided percutaneous biopsy. The data included 20,000 2D CT images.Data were randomly divided into sets for training (70 %), validation (10 %) and independent testing (20 %, DataTest_1). A small dataset (DataTest_2) was used for additional validation of the training model. Data were divided into sets at the patient level, rather than by individual image. A modified version of the ResNet50V2 was used. Accuracy of detecting benign or malignant renal mass was evaluated by a 51 % majority vote of individual image classifications to determine the classification for each patient. ResultsTest results from DataTest_1 indicate an area under the curve (AUC) of 0.973 with 93.3 % accuracy and 93.5 % specificity. Results from DataTest_2 indicate an AUC of 0.946 with 90.0 % accuracy and 98.0 % specificity when evaluation is performed image by image.There is no case in which multiple false negative images originate from the same patient. When evaluated with 51 % majority of scans for each patient, the accuracy rises to 100 % and the incidence of false negatives falls to zero. ConclusionCNNs and deep learning technology can classify renal tumour masses as oncocytoma with high accuracy. This diagnostic method could prevent overtreatment for patients with renal masses.

Cytohistological discrepancies of cervico-vaginal smears and HPV status.

Discrepancies between abnormal cervical cytology or high-risk human papillomavirus (HR-HPV) status (cytolo-gy negative/HPV positive) and subsequent histological findings are a common occurrence. After using co-testing, the dis-crepancies between the HR-HPV status and cervical cytology have become an issue. In this study, we aimed to determine the characteristics of women with a discrepancy between histology and cytology/HR-HPV status, in terms of diagnosis, review and identification. A total of 52 women, patients of the University Hospital between 2013-2015, with cytohistologi-cal or HR-HPV status discrepancy were recruited for the study and retrospectively analyzed. The cytological samples were liquid-based Pap smears, classified according to the 2001 Bethesda system. The HR-HPV status was identified using the Hybrid Capture 2 HR-HPV DNA assay. The histological samples were obtained by cervical biopsy as well as large loop exci-sion of the transformation zone (LLETZ). A cytohistological discrepancy was demonstrated in patients with (-)cytology/HR-HPV(+), ASCUS, LSIL, ASC-H, HSIL, AGC-NOS: 17.3%, 23.07%, 26.9%, 9.5%, 17.3% and 5.7%, respectively. When the degree of atypia in cytology increases, the concurrency of cervical cytology with biopsy also increases. A positive HR-HPV co-test result (19/24, 79.1%) was observed in nearly all CIN2 ≥ (+) cases. Our study emphasizes the significance of HR-HPV testing to determine CIN2 ≥ (+) cases, even in the presence of a normal cytological result. In case of cytohistological or HR-HPV discrepancies, a careful review of the HR-HPV status and the degree of cytological atypia should be performed before further intervention.

PTU-018 The Emperor’s New Clothes: An Alternative Perspective on Colonoscopy

Introduction Following the quality improvement programme introduced to pave the way for the UK Bowel Cancer Screening Programme (BCSP), there was an improvement in caecal intubation rate from 76.9% in 1999 to 92.3% in 2011.1 90.2% suffered mild discomfort or less, although this was assessed and reported by the endoscopist. 53.6% of symptomatic patients had abnormal examinations but it was not clear how many of the pathologies identified were incidental findings. We aimed to determine the percentage of patients whose colonoscopy findings explained their symptoms (the diagnostic yield) and to compare endoscopist and patient assessment of colonoscopy tolerance. Methods Endoscopists and patients undergoing colonoscopy independently provided a Gloucester comfort score (GCS 1: comfortable; 5: severe discomfort). Endoscopic and subsequent histological findings were recorded. Results Symptomatic patients (n = 107; 46.7% male, mean age 55.0±1.6 yrs) were younger than BCSP patients (n = 46; 65.2% male, mean age 67.0±0.9; P Conclusion Almost half of patients having diagnostic colonoscopy reported moderate to severe discomfort, which was markedly underestimated by endoscopists. If the true diagnostic yield is only 17%, it would seem appropriate to offer patients a less invasive, better tolerated alternative as a first line test. Procedural tolerance was much better in the BCSP, where endoscopists were more accurate in grading patient discomfort, which may partly be explained by the male predominance. However, GCS 4–5 scores were still three times as common as reported in the national audit. Reference 1 Gavin DR, et al. Gut 2013;62:242–249. Disclosure of Interest None Declared

Histologic Findings and Inflammatory Reactions After Long-term Colonization of Helicobacter felis in C57BL/6 Mice.

Background:The Helicobacter felis (H. felis) mouse model has been developed for the research regarding pathogenesis of chronic gastritis and gastric cancer. The aim of this study was to investigate long-term H. felis colonization in the stomachs of C57BL/6 mice and subsequent histologic findings and inflammatory reactions including pro-inflammatory cytokines.Methods:Twenty-three female C57BL/6 mice at 4 weeks of age were gavaged with H. felis, and 13 control mice served as vehicle only. The mice were sacrificed at 4, 24, and 52 weeks after inoculation. The infection status and degree of inflammation were determined by culture and histopathology. The level of gastric mucosal myeloperoxidase (MPO), tumor necrosis factor alpha (TNF-α), and interleukin-1beta (IL-1β) were measured by ELISA.Results:The overall infection rate was 100%, as determined by the culture and histology. At 4, 24, and 52 weeks, the neutrophil and monocyte scores were significantly higher in infected mice than in control mice. At 24 weeks after inoculation, most of the infected mice showed mucosal atrophy with or without metaplasia, and a few showed focal dysplasia. Adenocarcinoma was observed in one mouse at 52 week post-infection. Gastric mucosal MPO and IL-1β levels were significantly higher in infected mice than those in control mice at 24 and 52 weeks. However, the expression of gastric mucosal TNF-α was not significantly different between the infected and control mice at any time-point.Conclusions:Long-term H. felis-infection in C57BL/6 mice provoked a severe inflammatory reaction and it progressed into atrophy, metaplasia, dysplasia and cancer. IL-1β might play an important role in the inflammatory response of mice to Helicobacter species.

Cytologic Findings with Histologic Correlation in 43 Cases of Mammary Intraductal Adenocarcinoma Diagnosed by Aspiration Biopsy

To review the cytologic and subsequent histologic findings in intraductal mammary adenocarcinoma (ductal adenocarcinoma in situ) (DCIS) to evaluate the role of aspiration biopsy (AB) in identifying and grading the disease. AB smears and tissue sections from 43 women with pure DCIS who underwent preoperative AB were reviewed. Smears were assessed for cellularity, cellular arrangement (including dissociation, nuclear size and pleomorphism), and presence of nucleoli and necrosis. Of the 43 cases, 22 were high grade (HG) DCIS, 7 cases were intermediate grade (IG), and 14 cases were low grade (LG). Cytologic findings of HG DCIS was as follows: high cellularity (22/22), clusters of pleomorphic cells with large nuclei and increased nuclear/cytoplasmic ratios (22/22), single cells (20/22), prominent nucleoli (22/22) and necrosis (diffuse in 15/22, focal in 7/22). All LG cases had moderately to highly cellular smears with cohesive, 3-dimensional sheets of uniform, small cells with inconspicuous nucleoli arranged around a central lumen, forming "punched-out" spaces. Single cells were prominent in 2 of 14 cases. IG DCIS showed intermediate features between LG and HG DCIS: 3-dimensional sheets with punched-out spaces, abundant single cells, moderate pleomorphism and focal necrosis. HG DCIS is easily identifiable on AB smears; however, distinction from invasive carcinoma may not be possible. The cytologic diagnosis of LG DCIS is difficult, and 50% of our cases were called atypical on AB. Recognition of cohesive cellular arrangements with crowding and punched-out spaces is crucial as single cells and prominent atypia are often lacking.

Hepatitis B immune globulin for life versus limited use: I favor limited duration of therapy.

The initial enthusiasm for performing orthotopic liver transplantation (OLT) on patients with chronic hepatitis B virus (HBV) infectionwas tempered in the early 1990s by a high rate of recurrent infection, with the subsequent development of severe recurrent hepatitis frequently leading to loss of the allograft.1 In the absence of effective therapy, recurrent infection, defined as the appearance after OLT of detectable hepatitis B surface antigen (HBsAg) in serum, occurred in 70% to 90%2 of patients who were HBsAg positive preoperatively. Subsequent histological findings of hepatitis were seen in most patients, including the lesion termed fibrosing cholestatic hepatitis.3 This lesion is marked by overexpression of HBV proteins in hepatocytes, with cellular swelling and cholestasis, but only minimal inflammation. These observations suggested that HBV may be directly cytopathic in the post-OLT setting. Fortunately, most patients who clear HBsAg after OLT have a normal liver on histological studies and a benign clinical course.2 Patients at greatest risk for developing recurrent HBV infection are those with chronic HBV infection and, in particular, detectable HBV DNA or hepatitis B e antigen in serum before OLT.2,4 Patients at lower risk for reinfection include patients with acute HBV infection and those coinfected with hepatitis D virus, which appears to suppress HBV replication. A major breakthrough came when several studies showed that hepatitis B immune globulin (HGIg) administered intravenously in high doses during and after OLT could substantially reduce the risk for reinfection, leading to improved survival rates.2,5-8 Using HBIg alone to prevent recurrent HBV infection was most effective in those at lower risk for recurrent infection, i.e., patients with hepatitis D virus coinfection or acute hepatitis B or those who were HBV DNA negative in serum.2,5 However, intravenous administration of HBIg is costly, i.e., currently $74,320 for eight daily doses of HBIg during the first week post-OLT and monthly thereafter and approximately $45,000 per annum after year 1 (local data). When used alone, it may be required for life. Late breakthroughs also have occurred in patients who develop a variety of mutations in the HBV S gene.9 For these reasons, there is an extreme need for true antiviral agents that might inhibit viral replication and prevent HBV reinfection when used pre-OLT. Several nucleoside analogues have been shown to meet such criteria.8,10,11 The first such agent, lamivudine, has been shown to markedly decrease the rate of HBV reinfection after OLT, even when administered alone.10,12 Lamivudine is very well tolerated and much less expensive than HBIg. The major limitation to its use is the development of resistance through viral mutation at the YMDD locus of the polymerase molecule.10,13,14 Resistance develops in up to 30% of transplant recipients by 1 year. Moreover, severe recurrent disease has occurred in patients after the development of viral breakthrough.11,13 Because of the problem of viral mutation leading to viral escape with the use of both lamivudine and HBIg, many programs have combined the use of lamivudine with HBIg.7,15,16 Neither the optimal dosage and treatment interval nor the utility of measuring antibody to HBsAg titers to monitor therapy in this setting have been established. However, it appears that much lower doses of HBIg are required when combined with lamivudine, and the rate of acquired viral resistance is much lower. Several groups have published excellent results using relatively low-dose HBIg administered intramuscularly, which reduces both the cost and side effects of HBIg.With such regimens, the rate ofHBV infection is down to 5% or less.7,15 Newer agents with antiviral activity against HBV include adefovir and entecavir. These agents are attractive in that they have activity against the YMDD mutant variants of HBV.11,13 In the future, we likely will use combinations of antiviral agents with differing sites of action to prevent HBV reinfection after OLT. In this current era, a key question is whether one needs to continue HBIg therapy for life. As stated, the use of HBIg adds substantially to the cost of performing OLT on patients with hepatitis B and, when adminisFrom the Liver Transplantation Program, University of Minnesota, Minneapolis, MN. Address reprint requests to John R. Lake, MD, University of Minnesota, Department of Medicine, 420 Delaware St, Box 36, Minneapolis, MN 55455. Telephone: 612-625-0684; FAX: 612-625-5620; E-mail: lakex009@umn.edu Copyright © 2002 by the American Association for the Study of Liver Diseases 1527-6465/02/0810-1016$35.00/0 doi:10.1053/jlts.2002.35978

Phéochromocytome extrasurrénalien découvert en peropératoire

In this study, an uncommon case has been reported of an ectopic pheochromocytoma without the presence of any clinical symptoms. The radiological investigations showed a right retroperitoneal tumor without any kidney involvement. The diagnosis was established by biopsy and subsequent histological findings. In the course of surgery as the large tumor mass was being removed, tachycardia was observed which caused the resection to be performed as rapidly as possible. Once the tumor had been removed, bradycardia occurred, followed by cardiac arrest: although the latter was stabilized after cardiac massage, the patient died one hour after the operative field had been closed. In addition to this case report, the diagnosis, therapeutic strategy and prognosis regarding an ectopically located pheochromocytoma have been discussed.

Thyroid nodules with FNA cytology suspicious for follicular variant of papillary thyroid carcinoma: follow-up and management.

Thyroid nodules diagnosed as follicular neoplasm on fine-needle aspiration biopsy (FNAB) may represent hyperplastic/adenomatous nodules, follicular adenoma or carcinoma, and follicular variants of papillary thyroid carcinoma (FVPTC) on histologic follow-up. In our laboratory, we attempted to identify a subset of cases which showed cellular specimens with focal features (nuclear chromatin clearing, membrane thickening, and rare grooves) suspicious for the follicular variant of papillary thyroid carcinoma. These cases are reported as follicular-derived neoplasms with nuclear features suspicious for FVPTC to distinguish them from those diagnosed as follicular neoplasm. This study documents our experience with 52 cases so diagnosed and followed prospectively with histologic follow-up. A neoplastic nodule was confirmed in 45/52 cases (86%), of which 40 were malignant (77%). FVPTC was identified in 35/52 cases (67%). Four cases were usual papillary carcinoma, 3 were follicular adenoma, 2 were Hürthle-cell adenoma, and 1 was insular carcinoma. In 7 cases, the subsequent histologic findings were nonneoplastic (5 hyperplastic nodules and 2 colloid nodules). Our prospective study shows that in cellular smears from thyroid nodules, a careful search for the nuclear features of papillary carcinoma should be performed, and it is appropriate to diagnose cases as suspicious for FVPTC if the nuclear features of papillary carcinoma are focal. The surgical management of this group may include an intraoperative confirmation of cytologic diagnosis by scrape preparation and/or frozen section in order to avoid a second surgical intervention for completion thyroidectomy.

Clinical significance of an inconclusive cytopathologic diagnosis: a five-year experience at Duke University Medical Center. II. Analysis and follow-up of specimens from the respiratory tract.

As a follow-up of our initial report, we critically examined a selected number of cases from the respiratory tract with an original diagnosis of "atypical cells present suspicious for malignancy" in order to ascertain if any particular features of the specimen or the atypical cells were predictors of malignancy. From a total of 563 such cases, 31 were identified with subsequent histologic findings of a nonneoplastic pathologic process. An additional 45 cytologic cases were randomly selected to represent those with subsequent histologic findings confirming the suspicion of malignancy. All the cytologic specimens were examined without knowledge of the histologic follow-up results. Analysis of the cellular composition of the specimens identified no discernible difference between specimens from benign and malignant processes. Quantitative analysis of the atypical cells and qualitative assessment of the nuclear abnormalities revealed that marked nuclear hyperchromasia and a very high nuclear/cytoplasmic ratio were more likely to represent a malignant process. However, none of the parameters examined could consistently predict the presence or absence of malignancy. When a single cytologic specimen is inconclusive as to the presence or absence of malignancy, standard cytologic criteria cannot reliably predict a malignant process.

喉頭の上皮性肥厚病変の臨床的及び組織学的検討

A clinical and histological study was conducted from 1971 to 1992 on 51 cases (44 males and 7 females) who, on their first visit to the clinics of Kitasato University Hospital or Kitasato Institute Medical Center Hospital, were diagnosed as having epithelial hyperplasia of the larynx. The patients were classified into three groups based on subsequent histological findings : 1. Hyperplasia with atypia (7 cases), 2. Hyperplasia without atypia (39 cases), and 3. Carcinoma (5 cases). As for incidence by age groupings, epithelial hyperplasia was seen most frequently in subjects in their fifties, followed by those in their forties and sixties thereafter. The chief complaints were hoarseness (in 46 out of 51), difficulty in expectrating sputum, throat discomfort and coughing. The lesion was most commonly observed in the anterior 1/3 of the vocal cord, although diffuse involvement of the vocal cord was not seldomly seen. There was no positive relationship between the frequency of recurrence after surgical removal of the lesion and the degree of atypism. Subepitherial inflammation was often observed similarly in the two groups of epitherial hyperplasia. In those cases who were diagnosed as having carcinoma, subepitherial inflammatory reaction was relatively severe.

MR imaging and spectroscopy for prognostic evaluation in soft-tissue sarcomas.

To enable prediction of tumor response to a particular treatment. The authors studied the value of hydrogen-1 T2 and phosphorus-31 magnetic resonance (MR) spectroscopic metabolic determinations as indicators of prognosis in 20 humans and 10 dogs with soft-tissue sarcomas. All patients underwent combined fractionated radiation therapy and hyperthermia. Surgical resection of the entire tumor in humans allowed comparison of pretherapy T2 and MR spectroscopic parameters with subsequent histologic findings. Long-term clinical follow-up (no surgical intervention) was available with the dogs and allowed comparison of pretherapy pH with the duration of local relapse-free survival. A relationship exists between pretherapy pH and T2 and ultimate tumor necrosis in humans and pretherapy pH and time elapsed until local failure in dogs. MR imaging and spectroscopy could be useful in the prognosis of patients with soft-tissue sarcomas before therapy is initiated.

Strip biopsy後5日目に大量消化管出血を呈し胃部分切除を要した胃腺腫の1例

A 58-year-old female was admitted diagnosed with gastric adenoma. Endoscopic findings revealed an adenoma with protruding lesion, approximately 15mm in length on the posterior wall of the gastric antrum. A EMR performed without abdominal pain or evidence of bleeding. A resected specimen was revealed Group III. Liquid antacid, thrombin, and ranitidine were prescribed with the patient initially responding well. However, five days after the EMR the patient experienced epigastric discomfort followed by massive tarry stool. Blood pressure indicated pronounced hemorrhagic shock with systoric pressure measuring 70mmHg. Emergency endoscopic hemostasis was performed using hemoclipping technique, however, aggrevated hemorrhaging resulted from the procedure. A partial gastrectomy was performed with subsequent histological findings revealing a bleeding ulcer (Ul II) .

ASPIRATION BIOPSY CYTOLOGY IN THE DIAGNOSIS OF BREAST DISEASE

From May 1983 to December 1991, aspiration biopsy cytology was performed in 983 breast tumors. Two hundred and sixty-two cases of them were able to gain subsequent histologic findings. In this study results of apiration cytology and false-negative cases were comparatively analyzed. There were 137 malignant and 125 benign cases. Aspiration cytology resulted in true-positive in 99 cases (72.3%), false-positive in 16 (11.7%), and fales-negative in 22 (16.0%). Of 22 false-negative cases which were malignant but were incorrectly determined as benign by aspiration cytology, reevaluation was performed on the same specimens. As a results, 13 cases were technically unsatisfactory becaused of a lack of cells be re-evaluated; 6 cases turned out malignant; and 3 cases were unable to diagnose as malignant because of poor volume of malignant cells and lack of atypia. These 3 cases might indicate a limit to aspiration biopsy cytology. The false-negative rate was high in small tumors less than 1cm in diameter and scirrhus carcinomas. Of 125 benign lesions, 2 were incorrectly diagnosed as malignant. Histologically one lesion was a fibroadenoma and the other, mastpathy.

Adaptation to arterial wall hypoxia demonstrated in vivo with oxygen microcathodes

Iliofemoral arteries of 9 rabbits were balloon de-endothelialized resulting in subintimal thickening. Contrary to expectation, enzyme and lactate determinations did not indicate arterial wall hypoxia when compared with arteries of 10 control rabbits. The explanation came from in vivo measurement of oxygen tension profiles across the de-endothelialized and control femoral arteries and from the subsequent histological findings. They showed that the impaired oxygen supply of the de-endothelialized arteries with subintimal thickening was counteracted by a centripetal oxygenation of the arterial wall obviously induced by proliferation of newly formed nutrient vessels in the adventitia. Such adaptation is an important mechanism against hypoxia induced by arterial injury and may be an essential protective factor in atherogenesis.

Intraoral neurilemmoma (schwannoma): An unusual palatal swelling

A case of an uncommon intraoral tumor, the neurilemmoma, is reported. This tumor presented in an unusual way and exhibited clinical features that are classically associated with the pleomorphic adenoma. The subsequent histologic findings are presented, and an explanation for the clinical behavior of this lesion is suggested. The case for excision biopsy of palatal swellings is supported.

The pathogenesis of chronic inflammation in experimental antigen-induced arthritis. I. The role of antigen on the local immune response.

AbstractUsing the model described by Dumonde and Glynn in which a chronic synovitis is induced by the intraarticular injection of antigen in previously immunized rabbits, marked chronic local synthesis of immunoglobulin comparable to that of lymph nodes and spleen was found as long as 6 weeks after the arthritis was induced. Between 30 and 40% of this newly synthesized immunoglobulin was accounted for as specific antibody to the locally injected antigen. Very low levels of synthesis were found in the spleen, control synovia and regional lymph nodes not draining immunized sites. The circulating antibody levels at the time of induction showed a positive correlation (r = 0.66) with the severity of the subsequent histologic findings in the synovium. The fate of the intraarticular antigen was studied in arthritic and control animals. There was a selective local retention of antigen in animals previously immunized with the homologous antigen. The retained intraarticular antigen was eliminated very slowly, with a half‐life of over 20 days. These data indicate that the chronic synovial inflammatory response is associated with a chronic local immune response in which prolonged active synthesis of immunoglobulin and specific antibody directed against the locally retained inducing antigen takes place.

Gastroscopic and Histolosic Studies of the Stomach with Gastric and Extra-Gastric Disease During Life and at Autopsy

1. A study of 40 autopsy and gastroscopic biopsy cases is presented in an attempt to understand better, the underlying pathology existing in gastritis. li]2.|Histologie criteria for the “normal” stomach and grades of gastritis as agreed upon by our pathologists, and utilized in this study, are presented. li]3.|In 15 necropsy cases, the stomachs of adults and infants were fixed by immediate autopsy or intubation at death for the evaluation of so-called normals in extra-gastric disease. 6 of the 15 proved normal histologically, and three in adults from 26 to 43 years of age. li]4.|9 of this group showed gastritis, subacute or chronic, and again revealed that histologic chronic gastritis does not run parallel with clinical gastrointestinal symptoms. li]5.|Detailed data, with illustrative charts, on 25 cases, in which gastroscopic studies, followed shortly by biopsied specimens taken through the open tube gastroscope, were compared with subsequent histologic findings. In no case was operation or resection performed. li]6.(a)|Histologic diagnosis agrees with gastroscopic diagnosis on “normal” or gastritis stomachs in 52% of cases; (b) Histologic diagnosis disagrees with gastroscopic diagnosis on “normal” or gastritis stomachs in 24% of cases; (c) Histologic diagnosis gave questionable findings in 24% of cases diagnosed gastroscopically as gastritis or “normal.” li]7.(a)|The gastroscopic appearance of a severe gastritis is usually verified by the histologic examination; (b) The gastroscopic appearance of a mild or moderate degree of gastritis or normal stomach may be contradicted upon histological examination; (c) What appears to be a normal stomach gastroscopically —may be a gastritis, histologically, and vice versa, unless a marked, or Grade III to IV gastritis is seen gastroscopically.