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Shanying Liao,1 Chao Liu,2 Beibei Wang,1 Linlin Huang,1 Zhongwen Zheng,1 Jin Kang3 1Department of Gastroenterology and Hepatology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of China; 2Department of Pathology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of China; 3Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of ChinaCorrespondence: Shanying Liao, Department of Gastroenterology and Hepatology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510080, People’s Republic of China, Email liaoshanying@gdph.org.cnObjective: This study was designed to investigate the clinical, pathological, endoscopic, and imaging characteristics of gastrointestinal metastasis in patients with lung cancer.Methods: The clinical data of 20 patients with primary lung cancer with gastrointestinal metastasis.Results: This study included sixteen men and four women, ranging in age from 31 to 75 years. The time interval from the diagnosis of lung cancer to the detection of gastrointestinal metastasis ranged from 13 to 142 months. The most common sites of metastasis were the small intestine (eight cases), colon (four cases), and upper gastrointestinal tract (eight cases). The major symptoms included obstruction, perforation, abdominal pain, abdominal distension, anorexia, and anemia. The predominant pathological type was poorly differentiated adenocarcinoma (seventeen cases). A single ulcer was mostly seen on endoscopy, and some cases showed a slight depression of the intestinal wall. The CT and PET-CT scan revealed bowel wall thickening, intraluminal polypoid masses, and intestinal perforation.Conclusion: Gastrointestinal metastasis of lung cancer is mainly observed in the small intestine, colon, and stomach, and is often detected when severe complications such as gastrointestinal obstruction and perforation occurred. Regular evaluation of gastrointestinal conditions during lung cancer diagnosis and treatment is recommended to improve the diagnostic accuracy and prevent misdiagnosis.Keywords: lung cancer, gastrointestinal tract, metastasis, endoscopic biopsy

In this paper we summarize the results of a retrospective investigation of tumor budding in endoscopic preoperative biopsies in patients with colorectal adenocarcinoma (CRC). The aim of this study was to assess the peritumoral budding evaluation interpretability, based on endoscopic colorectal biopsies in left and right sided colorectal carcinoma and some of the factors that influence it. A group of 100 patients, with preoperative endoscopic biopsies was selected and the tumor buds were counted on H&E stained slides, according to contemporary clinical recommendations. In the studied patient group, budding was identified in a total of 13 patients (13% of the studied cases). The primary localization of the tumor in the left or right colon was not associated with the reporting of budding in endoscopic biopsies of colorectal carcinoma. No budding was observed in highly differentiated tumors, and the presence of budding was reported less frequently in poorly differentiated tumors compared to moderately differentiated ones. Budding was accessible for evaluation in nearly 1/10 of the small biopsies from CRC. Artifacts from the sample management as well as factors related to the tumor characteristics predetermined the possibility for evaluation of tumor budding on small biopsies.

To assess the efficacy and surgical outcomes of the simultaneous single-trajectory endoscopic biopsy and third ventriculostomy (ETV) in pineal region tumors. A systematic review and meta-analysis adhering to Cochrane Standards and PRISMA framework were conducted. PubMed, Embase, and Web Of Science databases were searched until December 2023. Outcomes included rate of histopathologic diagnosis success, ETV success, complications, required VPS, and mortality. Seventeen studies (N = 388) met inclusion criteria. Histopathologic diagnosis success rate was 90% for general population (95% CI: 86%–95%; I2 = 42%) and 94% for pediatric patients (95% CI: 89%–98%; I2 = 19%). ETV Success rate was 93% (95% CI: 88%–97%; I2 = 60%). An estimated risk of postoperative ETV complications was found to be 16% for the general population (95% CI: 5%–28%; I2 = 90%) and 5% for pediatric patients (95% CI: 0%–13%; I2 = 51%). The risk of requiring VPS was estimated as 2% (95% CI: 0%–4%; I2 = 39%) and for the pediatric population it was 7% (95% CI: 0%–16%; I2 = 69%). Mortality risk was found to be 1% (95% CI: 0%–3%; I2 = 0%). Simultaneous endoscopic biopsy and ETV demonstrated high diagnostic and therapeutic success rates. The procedure's safety profile, with low mortality and complications, supports its role in treating hydrocephalus associated to pineal region tumors. Subgroup analyses revealed higher diagnostic success rates and required VPS in the pediatric population, whilst it had lower complication rates. [ABSTRACT FROM AUTHOR]

Primary effusion lymphoma and its tissue-based subtype extracavitary/solid variant was first described in human immunodeficiency virus (HIV)-seropositive patients. We report the case of a 50-year-old HIV-seronegative male patient who presented with icterus and cholestasis. Computed tomography revealed a 80 × 56 mm abdominal mass. Fine-needle aspiration biopsy was performed from the celiac lymph nodes and pancreatic head, under endoscopic ultrasonography guidance. A duodenal endoscopic biopsy was taken from the infiltration area, and a core biopsy was performed for the portal hilar mass. All biopsies showed similar cytohistopathological features. LCA-positive lymphoid neoplasia had a plasmacytoid/anaplastic morphology and null cell phenotype. HHV-8 and Epstein-Barr virus-encoded small RNAs (EBER) were diffuse positive. The patient, who did not have an effusion, was diagnosed with an extracavitary/solid variant of primary effusion lymphoma. Virus-associated lymphoproliferative disorders should be considered in the differential diagnosis of patients without a history of immunosuppression or HIV infection.

Background: The length of conventional single-use cholangioscopes poses a challenge for percutaneous or laparoscopic approaches for direct visualization of the biliary tract. The aim of this retrospective observational clinical study was to assess the use of a dedicated percutaneous short single-operator cholangioscope (PSSOC) for diagnosis and treatment of benign or malignant biliary diseases. Methods: Retrospective analysis of a prospectively maintained database including all consecutive patients undergoing percutaneous transhepatic cholangioscopy with the PSSOC between 06/2021 and 01/2023. Results: Forty patients were included (22F/18 M, age 58.7 ± 16.7 years). The diagnostic and therapeutic management plan was based on procedural findings. Indications were bile duct obstruction associated with complex anatomy (n = 13), choledocholithiasis (n = 11), suspected malignant stenosis of the biliary tract (n = 11), biliary stent placement (n = 2) and removal (n = 1), and failed endoscopic retrograde cholangiopancreatography (n = 2). The cholangioscopies were diagnostic (n = 5), therapeutic (n = 20) or both simultaneously (n = 15). The most frequent procedures were electrohydraulic lithotripsy (n = 25) and biopsy sampling (n = 12). Complications occurred in 7 cases (17.5%), including cholangitis (n = 4, B2), pleural perforation (n = 1, B2), portal bleeding (n = 1, B3), and Tako-Tsubo syndrome (n = 1, B3), classified according to the Society of Interventional Radiology classification. Intraprocedural visual diagnosis was confirmed by the histopathologic result in 11/12 patients in which biopsies were performed (91.7%). PSSOC was relevant to avoid surgery in 2 patients (5%) with indeterminate strictures, allowing to rule out malignancy and treat the lithiasis. Conclusions: Direct visualization of the biliary tract enabled targeted biopsies for histopathological diagnosis. The visual and histopathological diagnoses were concordant in all but one case. Percutaneous cholangioscopy with a dedicated PSSOC allows to optimize identification and treatment of complex biliary disease including biliary lithiasis while assessing bile duct patency. The clinical use of the novel PSSOC system was safe and effective and could prevent surgical exploration in select patients. [ABSTRACT FROM AUTHOR]

• Endoscopic extended transforaminal approaches are a useful tool for the resection of lesions of the III ventricle. • According to the approach route, there are different variations that can be used, being the transchoroidal the most used. • The medial subchoroid approach is a very safe alternative in patients with favorable venous anatomy. • The medial subchoroid approach allows for greater protection of the fornix. The extended transforaminal endoscopic approaches allows visualization and manipulation of the middle and posterior third of the III ventricle. In selected cases where the venous anatomy is favorable, the medial subchoroidal approach can be performed as an alternative to the classic transchoroidal approach (via trans -taenia fornicis) with increased protection over the fornix and without the need to sacrifice the septal vein. We present a 14-year-old male with history of Neurofibromatosis type 1 referred for two weeks of clinical evolution with headache, dizziness, gait instability and appearance of a right VI nerve palsy. Magnetic resonance imaging showed obstructive tri-ventricular hydrocephalus due to stenosis of the aqueduct of Sylvius with suspicion of an underlying tumor. An endoscopic surgical procedure was performed through a single approach with III cisternostomy and resection of the tissue that produced the stenosis. The anatomopathological diagnosis showed reactive glial tissue with no signs of malignancy. In conclusion, the medial subchoroidal approach is a plausible alternative in the endoscopic approach to the III ventricle structures in a safe and comfortable manner. [ABSTRACT FROM AUTHOR]

Aim: Our retrospective study was designed to explore the potential link between Helicobacter pylori (H. pylori) infection and the occurrence of colorectal cancer (CRC), gastric atrophy, and intestinal metaplasia. Material and Methods: We assembled two groups of 150 patients each, categorized based on their endoscopic biopsy results for H. pylori - one group testing positive (study group), the other negative (control group). All subjects underwent upper and lower gastrointestinal endoscopies, and we assessed their endoscopic gastric biopsy results as well as any indications of colorectal malignancies. Results: Our investigation established a noteworthy association between the presence of H. pylori infection and the incidences of CRC, gastric atrophy, and intestinal metaplasia (p<0.05). Our data suggests that individuals testing positive for H. pylori faced a 64% greater likelihood of developing CRC compared to those who tested negative. Among patients diagnosed with gastric atrophy, a remarkable 73.9% tested positive for H. pylori. Similarly, 78.9% of patients with intestinal metaplasia were also H. pylori positive. Conclusion: Our results underscore a meaningful correlation between H. pylori infection and a heightened incidence of CRC, gastric atrophy, and intestinal metaplasia. Further, prospective studies will be instrumental in deciphering the underlying causative mechanisms and assessing the feasibility of H. pylori eradication as a preventive measure against these conditions. [ABSTRACT FROM AUTHOR]

Aim: Histopathological examination has an important place in the evaluation of parameters that are important in the prognosis of gastric tumors. In addition to the prognostic data included in the guidelines, other observed findings that may be important for the tumor behavior are also evaluated in the histopathological examination. Mast cells, which are among the elements of the immune system, are among these findings. In this study, it is aimed to compare the endoscopic biopsy materials and resection materials, which have the potential to be used for the evaluation of mast cells. Material and Method: Nineteen gastric tumor cases with endoscopic biopsy and resection material belonging to the same patient were included in the study. Toludine blue histochemistry was applied to the sections obtained from the paraffin blocks of the preparations representing the tumor. In the light microscopic evaluation, the area with the highest concentration of mast cells was selected at 100× magnification, and then 100 cells were counted inside and around the tumor at 400× magnification. Mast cells staining positively with toludine blue were noted in these 100 cells. Mann-Whitney-U was used in the analysis of the significance of mast cell number between groups, and Pearson’s test was used in the correlation between groups. Results: In the endoscopic biopsy material, the mean number of mast cells inside the tumor (MCIT) was 1.32±2.65, the mean number of mast cells around the tumor (MCAT) was 1.0±1.76; in the resection materials, the average number of MCIT was calculated as 4.84±4.86, and the average number of MCAT was calculated as 5.63±6.99. A statistically significant difference was observed between the number of MCIT (p=0.001) and the number of MCAT (p=0.000) between endoscopic biopsies and resection materials in the analyzes. When all the materials were included in analysis, it was determined that the number of MCIT and the number of MCAT showed a positive correlation. However, when endoscopic biopsies and resection materials were compared, it was noted that there was no correlation in terms of MCIT or MCAT. Conclusion: Mast cells, which are an important element of the immune response, are evaluated with different aspects in gastric cancers as in various tumors. Considering the importance of tumor and tumor microenvironment analysis as well as the results of the presented study, it is thought that mast cells, which have the potential to be an important marker in gastric tumors in the future, should be evaluated in the resection material, and endoscopic material evaluations do not reflect the real picture. [ABSTRACT FROM AUTHOR]

Microsatellite instability (MSI) is a negative predictive factor for neoadjuvant chemotherapy in resectable oesogastric adenocarcinoma and a crucial determinant for immunotherapy. We aimed to evaluate reliability of dMMR/MSI status screening performed on preoperative endoscopic biopsies. Paired pathological samples from biopsies and surgical specimen of oesogastric adenocarcinoma were retrospectively collected between 2009 and 2019. We compared dMMR status obtained by immunohistochemistry (IHC) and MSI status by PCR. dMMR/MSI status on surgical specimen was considered as reference. PCR and IHC were conclusive on biopsies respectively for 53 (96.4%) and 47 (85.5%) of the 55 patients enrolled. IHC was not contributive for 1 surgical specimen. A third reading of IHC was carried out for 3 biopsies. MSI status was observed in 7 (12.5%) surgical specimens. When analyses were contributive, sensitivity and specificity of biopsies for dMMR/MSI were respectively 85% and 98% for PCR vs. 86% and 98% for IHC. Concordance rate between biopsies and surgical specimen was 96.2% for PCR and 97.8% for IHC. Endoscopic biopsies are a suitable source of tissue for dMMR/MSI status determination in oesogastric adenocarcinoma which should be routinely performed at diagnosis to better adapt neoadjuvant treatment. By comparison of dMMR phenotype obtained by immunohistochemistry and MSI status by PCR between match-paired samples of oesogastric cancer's endoscopic biopsies and surgical specimen, we observed that biopsies are a suitable source of tissue for dMMR/MSI status determination. [ABSTRACT FROM AUTHOR]

Objective: To establish an in vitro study model of gastric cancer, gastric cancer organoid culture system, by biopsy under gastroscope, and to explore and analyze the related factors affecting the success rate of culture, to provide a better in vitro model for the study of gastric cancer. Methods: Twenty-six patients with advanced gastric cancer were collected. Organoids were cultured by biopsy under gastroscope. Paraffin sections were made and HE staining was used to compare the consistency of gastroscopic pathological morphology and organoids. To explore the influencing factors of cultivating gastric cancer organoids in combination with clinical data. Results: A total of 26 cases were collected by gastroscopy, and 12 cases of gastric cancer organoids were successfully cultured after identification, with a success rate of about 48%. Its histopathological morphology was highly consistent with that of gastric cancer. According to the pathological type, 21 cases were poorly differentiated adenocarcinoma and 12 cases were successful. Four cases of signet ring cell carcinoma failed. According to the location of the lesion, the success rate of sampling and culture of gastric antrum was significantly lower, which may be related to antral edema and anatomical characteristics of gastric antrum. Some of the failed cases are related to the quality of sampling, technique and contamination of tissue cells. Conclusions: We have successfully established gastric cancer organoids through endoscopic biopsy, and analyzed the factors affecting the success rate of culture from various angles, to improve and enhance the organoid culture technology and provide a better platform for tumor research. [ABSTRACT FROM AUTHOR]

Introduction: Because of limited anatomical space and certain unusual clinicopathological features, gastrointestinal tract lesions causes problem in their diagnosis, prognosis, and management. The primary objective of the study is to know the utility of endoscopic biopsy in diagnosing gastrointestinal lesions, and the secondary objective is to correlate the histopathological findings with the clinical symptoms and endoscopic appearance of the lesions. Materials and Methods: The present study is a simple retrospective observational study. Upper and lower gastrointestinal lesions in the form of ulcer, polyp, and growth were biopsied by biopsy forceps using flexible fiberoptic endoscopes. Only adequate biopsies were included in the study. The exact site of the biopsy with clinical data was provided by the endoscopist. Routine histopathological examination was done on the specimens submitted in 10% formalin. The use of special stains was done wherever needed. Results: A total of 100 cases were categorized as nonneoplastic and neoplastic. Friedman and Osborn classification was used for nonneoplastic lesions. The maximum number of cases was seen in 5th–6th decade with male predominance with equal distribution of cases as far as anatomical site is concerned. Conclusion: Targeted biopsies are possible with definitive diagnosis in 90% of cases with safe use of endoscopy. 17% of cases diagnosed on endoscopy were confirmed on histopathology. In 73% of cases, histopathology was essential for further subtyping. Histopathology was mandatory in 8% of the cases. Recommended combined use of endoscopy and histopathology can offer a definitive diagnosis in 98% of cases.

Abstract Background The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus. Methods We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope. Results In the three patients, ventriculostomy and endoscopic biopsies were conducted. There was no death or morbidity throughout the 45-min procedure. All of the patients’ histological findings were confirmed. Germinoma was diagnosed in two patients who recieved postoperative radiotherapy, and the third patient diagnosed with a pineocytoma. Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery. Conclusion Biportal endoscopic approach enables better visual control of both procedures. Furthermore, it allows the surgeon to safely pass the ventriculoscope via the foramen of monro, even if it is narrow. Moreover, during endoscopic tumor biopsy and third ventriculostomy, the intracranial pressure can be smoothly managed using the outlet tubes accessible. This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients.

Background: The goal of this study is to show the feasibility and benefits of using the simultaneous biportal endoscopic procedure to treat pineal tumors in patients with obstructive hydrocephalus. Methods: We retrospectively reviewed three patients with pineal tumors and acute obstructive hydrocephalus who were treated in one session with a frameless stereotactic guided simultaneous biportal endoscopic third ventriculostomy and endoscopic tumor biopsy performed through two separate ports using one rigid ventriculoscope. Results: In the three patients, ventriculostomy and endoscopic biopsies were conducted. There was no death or morbidity throughout the 45-min procedure. All of the patients' histological findings were confirmed. Germinoma was diagnosed in two patients who recieved postoperative radiotherapy, and the third patient diagnosed with a pineocytoma. Magnetic resonance imaging with flow-sensitive sequences was used to confirm ventriculostomy patency in all patients 6 months after the surgery. Conclusion: Biportal endoscopic approach enables better visual control of both procedures. Furthermore, it allows the surgeon to safely pass the ventriculoscope via the foramen of monro, even if it is narrow. Moreover, during endoscopic tumor biopsy and third ventriculostomy, the intracranial pressure can be smoothly managed using the outlet tubes accessible. This treatment may be an alternative to traditional uniportal endoscopic operations in certain patients. [ABSTRACT FROM AUTHOR]

Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare glioneuronal neoplasm newly included in the 2016 World Health Organization Classification of Tumors of the Central Nervous System. Owing to the wide spectrum of its histopathological and radiological features, accurate diagnosis can be challenging. Recently, molecular testing including DNA methylation array has been introduced with the possibility of improving diagnostic accuracy and contributing to the subtyping especially for brain tumors with ambiguous histology. Two molecularly distinct subtypes of DLGNT have been reported: methylation class‐1 (MC‐1) with an indolent clinical course and MC‐2, the latter aggressive. Herein, we report a case of a 14‐year‐old girl with a conspicuous hypothalamic mass lesion and diffuse leptomeningeal enhancement on magnetic resonance imaging. Biopsy specimens obtained from the hypothalamic lesion endoscopically were mainly composed of oligodendrocyte‐like cells. However, it was difficult to make a definite diagnosis from these non‐specific histological findings. Thus, DNA methylation array analysis was performed additionally by using formalin‐fixed, paraffin‐embedded tissue, resulting in a diagnosis of "MC‐1 subtype of DLGNT" with a high calibrated score (0.99). Consequently, she was treated conservatively, with neither progression of the tumor nor aggravation of symptoms for the next 12 months. It was concluded that DNA methylation array analysis for DLGNT, a rare glioneuronal tumor, could be a powerful tool not only for accurate diagnosis but also decision‐making in selecting the best treatment. [ABSTRACT FROM AUTHOR]

There are only a few effective molecular targeted agents for advanced unresectable or recurrent advanced gastric cancer (AGC), which has a poor prognosis with a median survival time of less than 14 months. Focusing on phosphorylation signaling in cancer cells, we have been developing deep phosphoproteome analysis from minute endoscopic biopsy specimens frozen within 20 s of collection. Phosphoproteomic analysis of 127 fresh-frozen endoscopic biopsy samples from untreated patients with AGC revealed three subtypes reflecting different cellular signaling statuses. Subsequent serial biopsy analysis has revealed the dynamic mesenchymal transitions within cancer cells, along with the concomitant rewiring of the kinome network, ultimately resulting in the conversion to the epithelial-mesenchymal transition (EMT) subtype throughout treatment. We present our investigation of intracellular signaling related to the EMT in gastric cancer and propose therapeutic approaches targeting AXL. This study also provides a wealth of resources for the future development of treatments and biomarkers for AGC. [Display omitted] • Gastric cancer subtypes are defined based on phosphoproteomics of fresh-frozen biopsy samples • Dynamic EMT progression during standard treatment was revealed by serial biopsy analysis • A strong correlation between EMT and neutrophil level/NETosis status was observed • The clinical potentials of AXL inhibitors in late-stage gastric cancer patients are indicated Shoji et al. establish a phosphoproteome analysis for fresh-frozen biopsy specimens within 20 s of endoscopic collection to define subtypes of gastric cancer. Serial biopsy analysis reveals dynamic EMT progression during standard treatment and the clinical potentials of AXL inhibitors in patients with EMT-subtype late-stage gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Gastritis is a very common disorder that is widely distributed worldwide, representing one of the most prevalent pathological entities in gastroenterology and digestive endoscopy. This study aims to analyse the correlation between the endoscopic findings and the symptoms of gastritis. Upper gastro-intestinal (UGI) endoscopy is a widely used investigation for a variety of UGI symptoms namely dysphagia, dyspepsia, abdominal pain, etc., and when combined with biopsy, its diagnostic accuracy get increased manifold., Materials and Methods: This is a study with 70 patients with symptoms of gastritis underwent UGI endoscopy and biopsy included in study. Biopsy was taken from gastric/duodenal mucosa and was sent for histopathology examination. Data of patient's age, gender, food habits, oral hygiene, etc., were then taken into consideration and findings of UGI endoscopy were correlated with these data and also correlated with histopathological report., Results: Gastritis significantly affects the lifestyle of the majority of our participants as out of 70, 65 (95%) had gastritis in our study. Helicobacter pylori was present among 41.5 % of study participants. Other less common findings were esophagitis in 20 % and duodenitis in 7% of study participants. The mean age of participants were 46.76 ± 16.25 years., Conclusion: Histopathology plays a major role in diagnosing H. pylori infection. So, histological examination as an adjunct to UGI endoscopy should be considered as best diagnostic tool rather than UGI endoscopy alone or clinical examination or radiological examination alone. It helps to treat the gastritis patients by diagnosing the underlying cause and management accordingly., Competing Interests: Nil., (Copyright: © 2024 Journal of the West African College of Surgeons.)

Background and Objective: Dyspepsia is one of the most common complaints encountered in the general outpatient and gastroenterology clinics in Nigeria. Histopathological assessment of endoscopic gastric mucosa biopsy is crucial to delineate the exact cause of dyspepsia to guide patients’ management. This study aimed to determine and document the histopathological basis of dyspepsia among dyspeptic patients at our facility. Material sand Methods: This was a three year descriptive retrospective study and the materials consisted of all gastric endoscopic biopsies taken from clinically diagnosed dyspeptic patients sent to the Department of Histopathology of the Federal Medical Centre, Owerri, Nigeria. Results: The biopsies were from 64 (53.2%) male patients and 56 (46.8%) female patients, giving a male to female ratio of 1.14:1. The age range of the patients was 28-82 years with a mean of 56 years at presentation. Helicobacter Pylori (H. Pylori) bacilli were identified in the samples of 42 (35%) patients but absent in samples of 78 (65%) patients. The histopathological pattern of the aetiological basis of dyspepsia in this study consisted of gastritis (96, 80%), functional (17, 14.2%), adenocarcinoma (4, 3.3%) and polyps (3, 2.5%). H. Pylori bacilli were seen only in patients with gastritis (42/96, 43.8%), and it affected 19 (45.2%) male patients and 23 (54.8%) female patients. Chronic active H. Pylori associated gastritis (24, 25%) was the most common form of gastritis seen during the study period. Conclusion: The main organic cause of dyspepsia in our setting was chronic gastric followed in the distant by gastric adenocarcinoma and polyp. Dyspepsia and H. Pylori associated gastritis did not show a significant gender predilection.

Acinar cell carcinoma is an uncommon tumour, representing only 1% to 2% of all exocrine pancreatic tumours. Pancreatic-type acinar cell carcinoma can occur in other organs, including the stomach, but it is extraordinarily rare. We report a case of a 51-year-old woman with a pancreatic-type pure acinar carcinoma of the stomach coexisting with a large cell B lymphoma synchronously, and a literature review of gastric carcinomas with pancreatic cell differentiation. At present there is a preoperative underdiagnosis of these tumours that could be minimized by including this entity in the differential diagnosis of gastric cancer and by performing immunohistochemical analysis with neuroendocrine markers and exocrine pancreatic enzymes. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to compare the efficacy of feline mesenchymal stem cells (fMSC) with prednisolone as a treatment for inflammatory bowel disease (IBD) in cats. Methods: Cats with chronic enteropathy that failed a 2-week diet trial and were not found to have significant concurrent disease were eligible for the study. If endoscopic biopsies confirmed a histopathologic diagnosis of IBD, the cat was randomly assigned to either the fMSC or prednisolone groups. Owners were blinded to the grouping. Stem cell treatment consisted of two intravenous injections of 2 × 106 cells/kg of freshly cultured allogeneic stem cells separated by 2 weeks. Prednisolone treatment was 1–2 mg/kg PO q24h, tapered according to clinical response. Owners were asked to make no changes (eg, diet and other medications) for the first 2 months, at which time they either continued to the 6-month recheck with no changes, or 'failed' treatment and owners were unblinded and changes made as necessary. Results: Six prednisolone and six fMSC treatment cats completed the study. All six prednisolone group cats were spayed females with a mean age of 8.3 years (range 2–14), a mean body weight of 3.6 kg (range 2.5–4.8) and a mean pretreatment Feline Chronic Enteropathy Activity Index (FCEAI) score of 3.6 (range 2–6). The six stem cell cats included three spayed females and three castrated males, and had a mean age of 8.0 years (range 4.5–13), a mean body weight of 4.9 kg (range 4.0–5.9) and a mean pretreatment FCEAI score of 3.7 (range 2–5). One cat in each group failed at the 2-month recheck. At the 6-month recheck, the mean FCEAI score for the prednisolone group was 3.7 (range 0.5–9) and 0.75 (range 0–1.5) for the fMSC group. Conclusions and relevance: These results suggest that this specific fMSC protocol appears to be as effective in the treatment of feline IBD as a standard course of prednisolone therapy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic accuracy of C-14 Urea Breath Test for detection of helicobacter pylori infection in patients with gastritis. Study Design: Cross-sectional validation study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, from Feb to Aug 2016. Methodology: After fulfilling inclusion and exclusion criteria, 110 patients of both genders, aged between 18-50 years, were enrolled. Prior written informed consent was obtained from each patient. First, they were assessed by C-14 Urea Breath Test, followed by endoscopic biopsy and histopathology. Results of C-14 Urea Breath Test were compared to histopathology diagnosis which was taken as gold standard. Results: Patients’ ages ranged from 18-50 years with a mean ± SD of 37.45 ± 10.21 years. Seventy four (67.3%) of them were males and 36 (32.7%) were females. Sixty four (58.2%) patients were suspected of helicobacter pylori on C-14 Urea breath test. However, histopathology of endoscopic biopsy confirmed helicobacter pylori in 66 (60%) patients yielding 64 true positive, 44 true negative and 2 false negative cases. Calculated sensitivity was 96.97%, specificity 100% and accuracy was 98.18% for C-14 Urea Breath Test with negative and positive predictive values of 95.65% and 100% respectively. Conclusion: C-14 Urea Breath Test is highly accurate, sensitive and specific test for detection of helicobacter pylori infection, irrespective of patient’s age and gender.

Eosinophilic gastroenteritis (EGE) is a digestive disorder in children and adults that is characterised by eosinophilic infiltration in the stomach and intestine. Depending on the dominant layer of infiltration, this disorder is classified into three types, namely, mucosal, muscularis, and subserosa. Subserosa clinical presentation usually begins with ascites and is sometimes associated with symptoms of intestinal obstruction. Ascites is characterised by marked eosinophilia in ascitic fluid. EGE with ascites simulating appendicitis and peritonitis is rare in paediatric patients. This publication aims to report a case series of EGE with clinical features, treatment responses, and a review of the current strategies in the management of eosinophilic ascites.

Introduction: No standard method has been defined to evaluate the therapeutic response of esophageal cancer to neoadjuvant chemoradiotherapy (CRT). This study aimed to determine the predictive value of endoscopic evaluation and biopsy after CRT in predicting the complete pathological response to neoadjuvant CRT in patients with esophageal squamous cell carcinoma (SCC). Materials and Method: This prospective, descriptive study was conducted on patients with stage II and III esophageal SCC who could undergo esophagectomy. Patients underwent neoadjuvant CRT. Four to six weeks after the end of treatment, re-endoscopy was performed and a biopsy was taken in the presence of a tumor lesion. In the absence of a tumor lesion, the marked site of the esophagus was removed as a blind biopsy. Gastrologist observations during endoscopy and the result of the pathological examination of an endoscopic biopsy were recorded. The patient underwent esophagectomy. The pathology obtained from endoscopic biopsy was compared with the pathology response obtained from esophagectomy. Results: Sixty-nine patients were included in the study, of which 32 underwent esophagectomy. In an endoscopic examination after CRT, 28 patients had macroscopic tumor remnants and 4 patients did not. Pathological examination of the samples obtained from endoscopy showed no tumor remnants in 10 patients (31.3%), and in 22 patients (68.7%), living tumor remnants were seen in the biopsy specimen. Pathologic evaluation of the samples obtained by surgical resection showed that in 13 patients, there were no viable carcinomas in the esophagus or lymph nodes removed, and the rate of pathologic complete response was 40.6. Sensitivity, specificity, positive predictive, and negative predictive values of endoscopic observations were 94.7, 23, 64.2, and 75%, respectively. Preoperative biopsy sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 68.4, 30.7, 59, and 40%, respectively. Conclusion: Considering the negative and positive predictive values of endoscopic observations and biopsy after neoadjuvant CRT, it seems that these two methods alone are not suitable for assessing the pathologic complete response after neoadjuvant treatment. [ABSTRACT FROM AUTHOR]

Introduction: In Bangladesh, laryngeal and hypopharyngeal cancers in 2018 were 3.3% and 4.7% of total cancer cases, 2.6% and 2% of total cancer deaths. Fiber optic laryngoscopy (FOL) has been established as a valuable tool for diagnosis in outpatient department (OPD) setting. The primary objective of this study was to see the distribution of laryngeal and hypopharyngeal cancers and secondary objective was to assess the role of Flexible Endoscopic Biopsy (FEB) in the diagnosis of laryngopharyngeal cancers. Methods: This descriptive cross-sectional study was performed from March 2020 to March 2021 at Mount Adora Hospital, Sylhet, Bangladesh. All suspected patients attending in this hospital for FOL and FEB were included in this study. Results: Total 300 patients of laryngopharyngeal growth were included in this study. The age of the patients ranged from 25 to 100 years with a mean age of 58.1 year (SD=11.8). Male: Female ratio was 4.8:1. Hypopharyngeal growth was most common (47.3%) followed by laryngeal (31.7%) and tongue base growth (21%). In laryngeal growth, supraglottic was more common (69.47%). In hypopharyngeal growth, pyriform fossa was the most common site (88.3%). Synchronous pathology was found in two patients (0.67%). FEB was obtained from 95% of cases. Histopathological examination showed 95.85% positive for malignancy. Sensitivity of FEB was 95.8%. All malignancies were squamous cell carcinoma (100%). Conclusion: Supraglottic region is the most common site for laryngeal cancers and pyriform sinus is the most common site for hypopharyngeal cancers. FEB is highly sensitive in acquiring a definite diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Small and large intestines are major portion of gastrointestinal tract. So many benign, malignant and congenital disorders arise from there. Benign causes, mainly include inflammatory and infectious disorders. Colon is the most common site for gastrointestinal neoplasia in western populations. Aim: To find out the pattern, frequency and site of non neoplastic lesions affecting intestine with intention that clinicians of this region can be responsive of its incidence. Materials and Methods: A prospective cross-sectional study was done at a quaternary care centre from June 2017-October 2019. Total 150 cases were studied, out of those 125 were benign and 25 were malignant cases. Patients of all ages were included with sign and symptoms of intestinal lesions. Results: Majority of specimens were bowel resection 130 (86.7%) and remaining were endoscopic biopsy 20 (13.3%). Majority of lesions were inflammatory lesions (73.34%) followed by malignant lesions (16.66%). Congenital and benign lesions were less common (6% and 4%). Non neoplastic lesions 125 (83.33%) were more common than neoplastic lesions 25 (16.67%). A 65.33% lesions were in small intestine and caecum and 34.67% were in colon and rectum. Non specific inflammation was most common type (47.90%). Hirsprung's Disease and Ulcerative Colitis lesions were least common (1.69% and 3.36%) in present study. Conclusion: Accurate macroscopic and microscopic examination of specimens which are associated with clinical data helps to reach at definite goal and can improve quality of life of the patient. [ABSTRACT FROM AUTHOR]

Introduction: There are several invasive and noninvasive techniques used to diagnose H. pylori infection, each having its advantages and disadvantages. Invasive methods require biopsy samples from the stomach and duodenum and can be tested by various methods such as histology, Rapid urease test (RUT), microbiological culture, and Polymerase chain reaction (PCR), whereas noninvasive tests including stool antigen test, serology, and urea breath test. Objective: To determine the diagnostic accuracy of the Helicobacter pylori fecal antigen test by taking endoscopic biopsy as the gold standard in dyspeptic patients. Materials & Methods: Descriptive, cross-sectional study was conducted from 30th April 2019 to 30th October 2019 in Gastroenterology Unit, Holy Family Hospital, Rawalpindi. A total of 85 patients irrespective of gender aged 18-65 years with symptoms of dyspepsia (epigastric pain, early satiety, postprandial fullness, nausea, or retching) were included. Patients having gall bladder or pancreatic diseases, celiac disease, diabetes mellitus, thyroid disease, ischemic heart disease, chronic liver diseases, HIV, malignancy, alcoholism, pylori infection or treatment, drug PPI or H2 receptors, and pregnant were excluded. H. Pylori on fecal antigen detection and endoscopic biopsy was noted. Results: Fecal antigen detection test found that 42 were True Positive and 04 were False Positive. Among 39, fecal antigen-negative patients, 04 (False Negative) had H. Pylori on endoscopic biopsy whereas 35 (True Negative) had no H. Pylori involvement on endoscopic biopsy (p=0.0001). Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of H. Pylori Fecal antigen detection taking endoscopic biopsy as the gold standard in dyspeptic patients was 91.30%, 89.74%, 91.30%, 89.74%, and 90.59% respectively. Conclusion: The study concluded that the diagnostic accuracy of Helicobacter pylori fecal antigen detection in dyspeptic patients is quite high. [ABSTRACT FROM AUTHOR]

Introduction:Roasted and spicy food (mainly hot pepper) consumption is very common in Southeastern Anatolia. Smoked and spicy diets and Helicobacter pylori (H. pylori) infection are known risk factors for gastric cancer. The aim of this study was to investigate the effects of eating habits on the gastric mucosa, to investigate the rate of H. pylori positivity, and to examine the association of these factors with histopathological features in this region.Methods:Histopathological findings in endoscopic biopsies of 943 consecutive patients were retrospectively evaluated.Results:More than half of the patients were female (54%; n=505), and the median age was 47±17.27 (range: 18-96). The most common non-gastritis histopathologic diagnosis was gastric carcinoma (2.5%; n=24), followed by polypoid lesions (1.6%; n=16). The vast majority of patients (92%) had chronic gastritis, and neutrophilic activity was present in 61% (n=537). The frequencies of atrophy, intestinal metaplasia, and regenerative mucosal changes were significantly correlated with the severity of neutrophilic activity (p

IntroductionNo standard method has been defined to evaluate the therapeutic response of esophageal cancer to neoadjuvant chemoradiotherapy (CRT). This study aimed to determine the predictive value of endoscopic evaluation and biopsy after CRT in predicting the complete pathological response to neoadjuvant CRT in patients with esophageal squamous cell carcinoma (SCC).Materials and MethodThis prospective, descriptive study was conducted on patients with stage II and III esophageal SCC who could undergo esophagectomy. Patients underwent neoadjuvant CRT. Four to six weeks after the end of treatment, re-endoscopy was performed and a biopsy was taken in the presence of a tumor lesion. In the absence of a tumor lesion, the marked site of the esophagus was removed as a blind biopsy. Gastrologist observations during endoscopy and the result of the pathological examination of an endoscopic biopsy were recorded. The patient underwent esophagectomy. The pathology obtained from endoscopic biopsy was compared with the pathology response obtained from esophagectomy.ResultsSixty-nine patients were included in the study, of which 32 underwent esophagectomy. In an endoscopic examination after CRT, 28 patients had macroscopic tumor remnants and 4 patients did not. Pathological examination of the samples obtained from endoscopy showed no tumor remnants in 10 patients (31.3%), and in 22 patients (68.7%), living tumor remnants were seen in the biopsy specimen. Pathologic evaluation of the samples obtained by surgical resection showed that in 13 patients, there were no viable carcinomas in the esophagus or lymph nodes removed, and the rate of pathologic complete response was 40.6. Sensitivity, specificity, positive predictive, and negative predictive values of endoscopic observations were 94.7, 23, 64.2, and 75%, respectively. Preoperative biopsy sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 68.4, 30.7, 59, and 40%, respectively.ConclusionConsidering the negative and positive predictive values of endoscopic observations and biopsy after neoadjuvant CRT, it seems that these two methods alone are not suitable for assessing the pathologic complete response after neoadjuvant treatment.

Introduction: Small and large intestines are major portion of gastrointestinal tract. So many benign, malignant and congenital disorders arise from there. Benign causes, mainly include inflammatory and infectious disorders. Colon is the most common site for gastrointestinal neoplasia in western populations. Aim: To find out the pattern, frequency and site of non neoplastic lesions affecting intestine with intention that clinicians of this region can be responsive of its incidence. Materials and Methods: A prospective cross-sectional study was done at a quaternary care centre from June 2017-October 2019. Total 150 cases were studied, out of those 125 were benign and 25 were malignant cases. Patients of all ages were included with sign and symptoms of intestinal lesions. Results: Majority of specimens were bowel resection 130 (86.7%) and remaining were endoscopic biopsy 20 (13.3%). Majority of lesions were inflammatory lesions (73.34%) followed by malignant lesions (16.66%). Congenital and benign lesions were less common (6% and 4%). Non neoplastic lesions 125 (83.33%) were more common than neoplastic lesions 25 (16.67%). A 65.33% lesions were in small intestine and caecum and 34.67% were in colon and rectum. Non specific inflammation was most common type (47.90%). Hirsprung’s Disease and Ulcerative Colitis lesions were least common (1.69% and 3.36%) in present study. Conclusion: Accurate macroscopic and microscopic examination of specimens which are associated with clinical data helps to reach at definite goal and can improve quality of life of the patient.

Background: The microtumor environment is an area where tumor cells are surrounded by several cells such as immune cells, stromal cells and endothelial cells as well as blood and lymphatic vessels. It is known that various cytokines and growth factors are released by various cells surrounding the tumor and affect the growth of tumor cells. Differences in chemical composition in the microtumor environment can be detected using spectrometry. The aim of this study was to examine the potential of scanning absorbance spectrometry in differentiating cells based on the chemical composition of endoscopic biopsies of colorectal cancer patients. Methods: An endoscopic biopsy of the patient from Cipto Mangunkusumo Hospital, Jakarta was collected and homogenized in phosphate buffer saline using TissueLyser. Scanning absorbance was performed using a UV-VIS spectrophotometer. The results of scanning absorbance were then processed using principal component analysis (PCA) in Orange Data-Mining version 3.28.0 software and the results were represented in a scatter plot diagram. Results: Based on the results of the analysis using PCA, three patients were identified in different quadrant regions, crc006 and crc011 obtained from patients with the differentiation status located close together while crc009 and undifferentiated were located far apart. Conclusion: This indicates the potential of scanning absorbance in differentiating the chemical composition of the tumor microenvironment from patient biopsies.

Endoscopic biopsies are occasionally taken from the minor duodenal papilla when abnormal appearance is encountered during esophagogastroduodenoscopy. Minor complications such as bleeding could occur after biopsy, however acute pancreatitis is a very rare complication after biopsy of the minor papilla. We report a case of severe acute necrotizing pancreatitis following biopsy of the minor papilla. [ABSTRACT FROM AUTHOR]

Objective: This study examined the reliability of the various parameters obtained in diagnostic ureteroscopy for upper-tract urothelial carcinoma (UTUC) in predicting the degree of differentiation in the final pathological report after radical nephroureterectomy (RNU). Methods: We conducted a retrospective review of patients undergoing RNU at a single tertiary hospital between 2000 and 2020. Only patients who underwent preoperative diagnostic ureteroscopy (URS) were included. The results of urine selective cytology, endoscopic appearance of the tumor, and biopsy taken during ureteroscopy were compared to the final pathological report. Results: In total, 111 patients underwent RNU. A preliminary URS was performed in 54. According to endoscopic appearance, 40% of the "solid"-looking tumors were high grade (HG), while 52% of those with a papillary appearance were low grade (LG). Positive cytology predicted HG tumors in 86% of cases. However, 42% of patients with negative cytology had HG disease. The biopsies acquired during URS showed that HG disease findings matched the final pathology in 75% of cases. However, 25% of patients noted as being HG, based on URS biopsies, were noted to have LG disease based on nephroureterectomy biopsies. Full analyses revealed that 40% of the cases diagnosed as LG based on the URS biopsies actually had HG disease. Conclusions: Direct tumor observation of papillary lesions, negative cytology, and biopsies indicating LG disease are of low predictive value for classifying the actual degree of tumor differentiation. No single test can accurately rule out HG disease. In light of the rising use of neo-adjuvant chemotherapy in UTUC, a reliable predictive model should be developed that accurately discriminates between HG and LG disease. [ABSTRACT FROM AUTHOR]

Previous studies showed that the yield of immunohistochemistry (IHC) staining on endoscopic biopsies may be as good as on surgically removed tissues. However, we noted that some patients showed inconsistent DNA mismatch repair protein (MMRP) stains between biopsies and surgical specimens. In this study, we aimed to investigate factors which are related to the consistence of MMRP evaluation between two pathologists or between different tissues. Two pathologists were asked to diagnose 4 MMRP, both on endoscopic biopsies and surgical materials, in 51 colorectal cancer (CRC) patients, using a single blind method. The consistence of two specimens and inter-observers’ variances across different pathologists were compared respectively and the factors related to this variability were analyzed. Among the 816 paired MMRP, 804 (98.5%) pairs showed concordant IHC stains between biopsies and surgical materials, the agreement was almost perfect for MSH6 and PMS2 (k = 0.85, 0.85 separately); 804 (98.5%) pairs showed concordant IHC stains between two pathologists, the inter-observer agreement was almost perfect for MSH6 and PMS2 (k =0.85, 0.88 separately). Clinical and pathological characteristics analysis showed that biopsy number and TNM stage were related to the variations. Inter-observers variations should be taken into account during MMRP testing in colorectal cancers. Generous endoscopic biopsies could improve the accuracy of endoscopic biopsy for MMRP detection which can be used histological tool in the evaluation of CRC and a promising new prognostic factor for these patients.

Background: Gastric intestinal metaplasia is seen chronic gastritis associated with Helicobacter pylori. The objective of this study was to determine the prevalence of subtypes of intestinal metaplasia and presence of Helicobacter pylori infection. Materials and Methods: This was a cross sectional study done at Kathmandu Medical College teaching Hospital in Pathology department from December 2018 to August 2019. The endoscopic biopsies were evaluated for intestinal metaplasia and Helicobacter pylori with the help of Hematoxylin and Eosin stains as well as Giemsa stain. Subtypes of intestinal metaplasia were classified with the help of periodic acid- Schiff/Alcian Blue stain combination and High Iron Diamine- Alcian Blue stain at pH 2.5. The relationship between Helicobacter pylori and subtypes of intestinal metaplasia were compared. Fisher’s exact test was used for statistical evaluation. A p value of ˂0.05 was considered as statistically significant. Results: The prevalence of intestinal metaplasia was found in 57 (12.2%) biopsies. Type I intestinal metaplasia was found in 23 (40.4%) biopsies, type II in 10 (17.5%) biopsies and type III in 24 (42.1%) biopsies. Helicobacter pylori was positive in 28(49.1%) and it was negative in 29(50.9%) biopsies. No statistical significant correlation was seen in the subtypes of intestinal metaplasia with Helicobacter pylori status (p˃0.05). Conclusion: Intestinal metaplasia is frequently observed in endoscopic biopsies, most common being type III subtype.

Peptic ulcer disease is common and can be diagnosed easily if the patient has an ulcer history or characteristic abdominal symptoms. On the other hand, it may take a long time for the patient to visit the hospital due to severe complications if the patient is old or insensitive to symptoms caused by peptic ulcers. In the present case, a 72-year-old female visited the hospital due to general weakness and inadequate oral intake, which started two weeks ago. Endoscopy and abdominal CT revealed huge gastric ulcer findings. Through a tissue examination by endoscopy, hepatic cells were identified, and the patient was diagnosed with peptic ulcer perforation to the liver and later received surgical treatment.

Objective This study examined the reliability of the various parameters obtained in diagnostic ureteroscopy for upper-tract urothelial carcinoma (UTUC) in predicting the degree of differentiation in the final pathological report after radical nephroureterectomy (RNU). Methods We conducted a retrospective review of patients undergoing RNU at a single tertiary hospital between 2000 and 2020. Only patients who underwent preoperative diagnostic ureteroscopy (URS) were included. The results of urine selective cytology, endoscopic appearance of the tumor, and biopsy taken during ureteroscopy were compared to the final pathological report. Results In total, 111 patients underwent RNU. A preliminary URS was performed in 54. According to endoscopic appearance, 40% of the “solid”-looking tumors were high grade (HG), while 52% of those with a papillary appearance were low grade (LG). Positive cytology predicted HG tumors in 86% of cases. However, 42% of patients with negative cytology had HG disease. The biopsies acquired during URS showed that HG disease findings matched the final pathology in 75% of cases. However, 25% of patients noted as being HG, based on URS biopsies, were noted to have LG disease based on nephroureterectomy biopsies. Full analyses revealed that 40% of the cases diagnosed as LG based on the URS biopsies actually had HG disease. Conclusions Direct tumor observation of papillary lesions, negative cytology, and biopsies indicating LG disease are of low predictive value for classifying the actual degree of tumor differentiation. No single test can accurately rule out HG disease. In light of the rising use of neo-adjuvant chemotherapy in UTUC, a reliable predictive model should be developed that accurately discriminates between HG and LG disease.

A three-year-four-month-old boy with primary disseminated medulloblastoma M3 stage and secondary occlusive hydrocephalus underwent an endoscopic triventriculocisternostomy (ETVC) and tumor biopsy, followed by ventriculoperitoneal shunt (VPS) placement due to ETVC failure. The treatment regimen, which included intensive induction chemotherapy, proton beam therapy (PBT), and maintenance chemotherapy, led to significant clinical improvement and a complete radiological response. Four years post-treatment, the child remains in remission, illustrating the effectiveness of a multimodal approach in managing complex cases of medulloblastoma in pediatric patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ashurov et al.)

Non-cutaneous squamous cell carcinoma (ncSCC) is a rare malignancy, especially involving the orbital and lacrimal apparatus. Hereby, we present a case of recurrence of squamous cell carcinoma (SCC) in the left orbit after excision of lacrimal sac SCC and radiotherapy. She presented with acute painful visual impairment with a frontal headache, with imaging showing medial extraconal and intraconal mass. After confirmation of SCC from the biopsy, modified enucleation was done. However, the patient had a recurrence of SCC, and further debulking was performed with palliative measures. Noteworthy, ncSCC is a rare malignancy with an aggressive nature. Orbital SCC has the worst prognosis compared to conjunctiva or lacrimal sac SCC. Surgery remained the mainstay for higher survival, but chemotherapy and radiotherapy were not associated with a better prognosis, yet there is a lack of data regarding recurrence and its management. In conclusion, ncSCC is a rare and challenging disease that requires timely intervention with multiple disciplinary care, especially when it is spread from the lacrimal sac to the orbital., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Teoh et al.)

Background: Head and neck squamous cell carcinoma (HNSCC) is heterogeneous in etiology, phenotype and biology. Patient-derived xenografts (PDX) maintain morphology and molecular profiling of the original tumors and have become a standard "Avatar" model for human cancer research. However, restricted availability of tumor samples hindered the widespread use of PDX. Most PDX-projects include only surgical specimens because reliable engraftment from biopsies is missing. Therefore, sample collection is limited and excludes recurrent and metastatic, non-resectable cancer from preclinical models as well as future personalized medicine. Methods: This study compares the PDX-take rate, -growth, histopathology, and molecular characteristics of endoscopic specimens with surgical specimens. HNSCC samples (n = 55) were collected ad hoc, fresh frozen and implanted into NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ mice. Results: Engraftment was successful in both sample types. However, engraftment rate was lower (21 vs. 52%) and growth delayed (11.2 vs. 6.7 weeks) for endoscopic biopsies. Following engraftment, growth kinetic was similar. Comparisons of primary tumors and corresponding PDX models confirmed preservation of histomorphology (HE histology) and molecular profile (Illumina Cancer Hotspot Panel) of the patients' tumors. Accompanying flow cytometry on primary tumor specimens revealed a heterogeneous tumor microenvironment among individual cases and identified M2-like macrophages as positive predictors for engraftment. Vice versa, a high PD-L1 expression (combined positive score on tumor/immune cells) predicted PDX rejection. Conclusion: Including biopsy samples from locally advanced or metastatic lesions from patients with non-surgical treatment strategies, increases the availability of PDX for basic and translational research. This facilitates (pre-) clinical studies for individual response prediction based on immunological biomarkers. [ABSTRACT FROM AUTHOR]

BackgroundP16 methylation is expected to be potential diagnostic and therapeutic targets for esophageal cancer (EC). The intratumoral heterogeneity (ITH) of EC has been mentioned but has not been quantitatively measured yet. We aimed to clarify the impact of ITH on pathological diagnosis and P16 methylation, and the concordance between endoscopic biopsy and the corresponding surgically resected tissue.MethodsWe designed a systematic sampling method (SSM) compared with a general sampling method (GSM) to obtain EC tumor tissue, tumor biopsy, and normal squamous epithelium biopsy. MethyLight assay was utilized to test P16 methylation. All specimens obtained by the SSM were pathologically diagnosed.ResultsA total of 81 cases were collected by the GSM, and 91.4% and 8.6% of them were esophageal squamous cell carcinomas (ESCCs) and esophageal adenocarcinomas (EADs), respectively. Nine SSM cases were 100.0% ESCCs. The positive rates of P16 methylation of the GSM tumor and normal tissues were 63.0% (51/81) and 32.1% (26/81), respectively. For SSM samples, tumor tissues were 100.0% (40/40) EC and 85.0% (34/40) P16 methylated; tumor biopsy was 64.4% (29/45) diagnosed of EC and 68.9% P16 methylated; the corresponding normal biopsies were 15.7% (8/51) dysplasia and 54.9% (28/51) P16 methylated. The concordance of pathological diagnosis and P16 methylation between tumor biopsy and the corresponding tumor tissue was 75.0% and 62.5%, respectively.ConclusionThe SSM we designed was efficient in measuring the ITH of EC. We found inadequate concordance between tumor biopsy and tissue in pathological diagnosis and P16 methylation.

Background: P16 methylation is expected to be potential diagnostic and therapeutic targets for esophageal cancer (EC). The intratumoral heterogeneity (ITH) of EC has been mentioned but has not been quantitatively measured yet. We aimed to clarify the impact of ITH on pathological diagnosis and P16 methylation, and the concordance between endoscopic biopsy and the corresponding surgically resected tissue. Methods: We designed a systematic sampling method (SSM) compared with a general sampling method (GSM) to obtain EC tumor tissue, tumor biopsy, and normal squamous epithelium biopsy. MethyLight assay was utilized to test P16 methylation. All specimens obtained by the SSM were pathologically diagnosed. Results: A total of 81 cases were collected by the GSM, and 91.4% and 8.6% of them were esophageal squamous cell carcinomas (ESCCs) and esophageal adenocarcinomas (EADs), respectively. Nine SSM cases were 100.0% ESCCs. The positive rates of P16 methylation of the GSM tumor and normal tissues were 63.0% (51/81) and 32.1% (26/81), respectively. For SSM samples, tumor tissues were 100.0% (40/40) EC and 85.0% (34/40) P16 methylated; tumor biopsy was 64.4% (29/45) diagnosed of EC and 68.9% P16 methylated; the corresponding normal biopsies were 15.7% (8/51) dysplasia and 54.9% (28/51) P16 methylated. The concordance of pathological diagnosis and P16 methylation between tumor biopsy and the corresponding tumor tissue was 75.0% and 62.5%, respectively. Conclusion: The SSM we designed was efficient in measuring the ITH of EC. We found inadequate concordance between tumor biopsy and tissue in pathological diagnosis and P16 methylation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic accuracy of C-14 Urea Breath Test for detection of helicobacter pylori infection in patients with gastritis. Study Design: Cross-sectional validation study. Place and Duration of Study: Nuclear Medical Centre, Armed Forces Institute of Pathology, from Feb to Aug 2016. Methodology: After fulfilling inclusion and exclusion criteria, 110 patients of both genders, aged between 18-50 years, were enrolled. Prior written informed consent was obtained from each patient. First, they were assessed by C-14 Urea Breath Test, followed by endoscopic biopsy and histopathology. Results of C-14 Urea Breath Test were compared to histopathology diagnosis which was taken as gold standard. Results: Patients' ages ranged from 18-50 years with a mean ± SD of 37.45 ± 10.21 years. Seventy four (67.3%) of them were males and 36 (32.7%) were females. Sixty four (58.2%) patients were suspected of helicobacter pylori on C-14 Urea breath test. However, histopathology of endoscopic biopsy confirmed helicobacter pylori in 66 (60%) patients yielding 64 true positive, 44 true negative and 2 false negative cases. Calculated sensitivity was 96.97%, specificity 100% and accuracy was 98.18% for C-14 Urea Breath Test with negative and positive predictive values of 95.65% and 100% respectively. Conclusion: C-14 Urea Breath Test is highly accurate, sensitive and specific test for detection of helicobacter pylori infection, irrespective of patient's age and gender. [ABSTRACT FROM AUTHOR]

Introduction: Seeds may be found in gastrointestinal tissue samples, and their multifaceted appearance may be challenging. The aim is to report a rough incidence of pathology samples which show seeds, specify the most frequent sample types and show an iconography of the most commonly identified seeds.Materials and Methods: Between 2017 and 2020, all gastrointestinal pathology cases in which seeds/seed parts were found, were collected and seed type described by referencing a seed image library.Results: Fifty cases with complete seeds/seed parts were collected: 16 colonic resections for colorectal cancer and diverticulosis, 13 appendiceal resections for appendicitis, 1 gastric resection. Fifteen cases were found in polypectomy specimens and 5 cases in colorectal endoscopic biopsies. Most frequent seed types were tomato, kiwi, blueberry, and blackberry seeds.Conclusion: Seeds may be found in up to 4% of specimens; their recognition may be useful to exclude parasitic infections as well as in forensic sciences.

Introduction: Roasted and spicy food (mainly hot pepper) consumption is very common in Southeastern Anatolia. Smoked and spicy diets and Helicobacter pylori (H. pylori) infection are known risk factors for gastric cancer. The aim of this study was to investigate the effects of eating habits on the gastric mucosa, to investigate the rate of H. pylori positivity, and to examine the association of these factors with histopathological features in this region. Methods: Histopathological findings in endoscopic biopsies of 943 consecutive patients were retrospectively evaluated. Results: More than half of the patients were female (54%; n=505), and the median age was 47±17.27 (range: 18-96). The most common non-gastritis histopathologic diagnosis was gastric carcinoma (2.5%; n=24), followed by polypoid lesions (1.6%; n=16). The vast majority of patients (92%) had chronic gastritis, and neutrophilic activity was present in 61% (n=537). The frequencies of atrophy, intestinal metaplasia, and regenerative mucosal changes were significantly correlated with the severity of neutrophilic activity (p<0.05). Patients with atrophy and intestinal metaplasia were significantly older than those without atrophy and intestinal metaplasia (p<0.001; mean age: 47 and 46 vs 56 and 55, respectively). More than 50% were infected with H. pylori (57%; n=542), and H. pylori positivity was associated with the presence of chronic and chronic active gastritis, as well as lymphoid hyperplasia (p<0.001). In contrast, erosion, atrophy, and neuroendocrine cell hyperplasia were less common in patients with H. pylori gastritis (p<0.05). Conclusion: H. pylori infection and spicy food consumption are key risk factors for gastritis in Southeastern Anatolia. Prospective epidemiological studies are needed to better demonstrate the causal interaction between dietary factors and gastritis. [ABSTRACT FROM AUTHOR]

Objective: To correlate serum IgA anti-tissue transglutaminase antibody levels with the histopathological grades of celiac disease using Corazza grading system. Study Design: Descriptive Cross-sectional study. Place and Duration: At Al Nafees Medical College and Hospital Department of Pathology from April 6, 2015 to June 10, 2016. Methodology: From all the enrolled patients, based upon inclusion and exclusion criteria, endoscopic biopsies were processed routinely for histopathological analysis. Corazza Grading system was used for grading the morphological findings. Anti-Tissue transglutaminase (tTG) IgA antibodies were measured by the ELISA (Enzyme-Linked Immunosorbent Assay) method. Both biopsy data and serological marker were correlated. Results: 77 patients were included in this study, out of which 55 were diagnosed as celiac disease patients. Gender distribution included 38.9% males and 61.1% females. According to Corraza Grading System, there were 28.6% cases in Corraza 0 and 22% cases in Corraza A whereas Corraza B1 and B2 included 35% and 14.3% cases respectively. After correlation with anti-tTG IgA Ab titers, 27.2% patients had negative serology. Total 22% patients in Corraza A were serologically positive and had IgA tTG Ab titers between 11 to 100 units/ml whereas in Corazza B1, only 18% patients had titers greater than 100 units/ml and Corazza B2 almost all patients had titers greater than 100 units/ml. Conclusion: Corazza Grading System significantly correlates with anti-tissue transglutaminase IgA Antibody titers. [ABSTRACT FROM AUTHOR]

Intramural duodenal hematoma (IDH) is an extremely rare complication after endoscopic biopsy. It typically presents with symptoms due to duodenal obstruction, which include abdominal pain and bilious vomiting. The hematoma may also expand and cause ampullary compression leading to pancreatitis and cholestasis. Computed tomography scan and abdominal ultrasound are the most common diagnostic modalities. Treatment is usually conservative, with bowel rest, nasogastric suctioning and total parenteral nutrition. Refractory cases have been described, requiring endoscopic therapy or surgical drainage. We describe a 28-year-old healthy male who presented with acute abdominal pain a few hours after a routine esophagogastrodudenoscopy with biopsies was performed. Following an otherwise uneventful endoscopy, he developed a gastric outlet obstruction and pancreatitis secondary to an IDH. The patient was managed conservatively. Resolution of his gastric outlet obstruction occurred immediately after gentle passage of the endoscope through the narrowed duodenal lumen.

Objective ― HER-2/neu assay in gastric cancers is routinely evaluated by immunohistochemistry and fluorescent in situ hybridization methods because the monoclonal antibody trastuzumab developed against HER-2/neu give rise to significant improving on the survival. In the HER-2/neu evaluation, some problems related to the sampling process, analysis method, tumor biology and heterogeinity are encountered. Our aim in the present study was to analyze these evaluation problems on endoscopic biopsy samples and resection materials of our cases with gastric carcinoma. Material and Methods ― The study included 109 gastric cancer cases. The analyses were realized on the resection materials of the 109 cases and the endoscopic mucosa biopsies of 43 out of these 109 cases. Immunohistochemistry was applied on mucosa biopsies and, tumor sections of resections, while fluorescent in situ hybridization was performed on tumor sections of resections (21 cases). The assays results were compared with each other and clinicopathological parameters. Results ― Our rate of HER-2/neu positivity (IHC3+ and IHC2+/FISH+ cases) was 6.42%. The compatibility rate between the rates of overexpression and amplification in resections was 90.5% while the compatibility ratio between the overexpression rates of mucosa samples and resections was 95.4%. The false negativity rate on mucosa biopsies was detected as 4.65%. HER-2/neu status was not correlated with unfavorable clinicopatological features. Conclusion ― Our gene positivity rate was near the lower limit of the range reported in the literature. Our compatibility rate between the results of immunohistochemistry and fluorescent in situ hybridization was over 90%. However our false negativity rate in mucosa biopsy analysis was low according to the literature. In order to preclude false negativity arising from tumor heterogeinity, we think that immunohistochemistry should be applied on the whole section.