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Objective: Indications for major pancreatic resections have been expanded to include complicated chronic pancreatitis (CP). We assessed clinical findings and outcomes and evaluated histology in patients who had major pancreatic resections for CP. We also determined if histologic findings were associated with persistent postoperative pain., Design: We reviewed charts and slides from 44 patients who underwent major pancreatic resections for CP between 1989 and 1999., Results: The etiology for disease included alcohol (n = 15), hereditary (n = 5), idiopathic (n = 6), pancreas divisum (n = 3), stricture (n = 2), trauma (n = 2), systemic lupus erythematosus (n = 1), and unknown (n = 10). Patients included 20 men and 24 women; ages ranged from 22 to 76 years. Perioperative mortality and morbidity were 0% and 4.5%, respectively. Persistent pain was present in 25 (57%) of the 44 patients, and pain was encountered more frequently in patients with alcoholic pancreatitis (67%) versus other etiologies (52%), and in those who underwent Whipple/Beger or total resections (68%) versus distal or subtotal pancreatectomy (42%). Metaplastic changes were present in 14 cases, and ductal atypia was seen in 9 cases. No malignancies were found. Acinar necrosis and acute inflammation were seen more often in patients with persistent pain than in those who were pain free (P =.081)., Conclusion: Major pancreatic resection for CP can be performed with low morbidity and mortality. This procedure relieves pain in nearly half the patients. There is a wide spectrum of histopathologic changes seen in CP, including ductal atypia and metaplastic changes. Acute exacerbations of CP identified histologically at the time of surgery and alcohol as etiology for CP may be associated more frequently with intractable pain.

Objective: The value of routine second opinion review of liver and gastrointestinal pathologic material was evaluated to determine whether there were discrepancies in diagnoses and if these discrepancies had an impact on treatment or prognosis., Materials and Methods: All gastrointestinal and hepatobiliary histopathology referral diagnoses made during a 1-year period for patients being treated at Ohio State University Medical Center were compared with the outside pathologic diagnosis. All major discrepant diagnoses were reviewed by at least 2 pathologists. Diagnoses were classified as no diagnostic disagreement, diagnostic disagreement, or no diagnostic disagreement but pertinent information missing or terminology unclear. Discrepant cases were also classified according to the clinical significance of the discrepancy., Results: Pathology reports from 194 hepatobiliary and gastrointestinal cases were reviewed. Of the hepatobiliary cases, 57 (64.8%) of 88 cases showed no discrepancies. Discrepancies were noted in 31 cases (35.2%), including missing information or unclear terminology in the diagnosis in 23 cases (26.1%) and diagnostic disagreement in 8 cases (9.1%). Of the cases with discrepancies, 6 (6.8%) were of major significance. Of the gastrointestinal cases, 87 (82.1%) of 106 cases showed no discrepancies. Discrepancies were noted in 19 cases (17.9%), including missing or unclear information in 3 cases (2.8%) and diagnostic disagreements in 16 cases (15.1%). The cases with discrepancies included 8 cases (7.5%) for which the change was of major clinical significance., Conclusions: Routine pathologic review of gastrointestinal and hepatobiliary cases revealed notable discrepancies in diagnoses. In 14 cases (7.2%), the change in diagnosis or additional information had a significant effect on the proper treatment or a significant prognostic implication. Routine review of all pertinent pathologic material should be performed on all patients being transferred to a second institution for treatment or second opinion.

Extranodal Hodgkin disease presenting as a primary localized neoplasm is uncommon, with rare case reports describing primary sites other than lymph nodes. The gastrointestinal tract is the most frequent site of involvement by extranodal Hodgkin disease, typically involving the stomach or small bowel. To date, we have been able to find only one fully documented case of Hodgkin disease of the sigmoid colon confirmed by immunohistochemical studies. We report a case of extranodal Hodgkin disease involving the transverse colon, presenting as inflammatory bowel disease and documented by light microscopic, immunohistochemical, cytogenetic, and molecular studies.

Smooth muscle tumors of the serosal membranes are extremely rare and have received little attention in the literature. To the best of our knowledge, only 1 published series of 5 pleural smooth muscle neoplasms has been published to date. We describe a primary pleural neoplasm with smooth muscle differentiation documented by light microscopy, immunohistochemistry, and electron microscopy. This tumor originated in the parietal pleura in a 32-year-old white man and was diagnosed incidentally by chest radiography; the diagnosis was confirmed by magnetic resonance imaging and biopsy. Four years later, the tumor was noted to have increased in size and disseminated into the chest wall as a separate circumscribed mass located in the pectoral muscle. Both masses were resected and diagnosed as smooth muscle tumors. We conclude that smooth muscle tumor of the pleura is a well-defined entity with a low, but definite malignant potential; therefore, we recommend complete resection and long-term follow-up for all patients.