RESUMEN
Until recently, two major types of colorectal epithelial polyps were distinguished: the adenoma and the hyperplastic polyp. While adenomas - because of their cytological atypia - were recognized as precursor lesions for colorectal carcinoma, hyperplastic polyps were perceived as harmless lesions without any potential for malignant progression, mainly because hyperplastic polyps lack cytological atypia. Meanwhile, it is evident that the lesions formerly classified as hyperplastic represent a heterogeneous group of polyps, some of which exhibit a significant risk of neoplastic progression. These lesions show characteristic epigenetic alterations not commonly seen in colorectal adenomas and progress to colorectal carcinoma via the so-called serrated pathway (CIMP pathway). This group of polyps is comprised not only of hyperplastic polyps, but also of sessile serrated adenomas (SSA), traditional serrated adenomas (TSA) and mixed polyps, showing serrated and "classical" adenomatous features. In a consensus conference of the working group of gastroenterological pathology of the German Society of Pathology, standardization of nomenclature and diagnostic criteria as well as recommendations for clinical management of these serrated polyps were formulated and are presented herein.
Asunto(s)
Adenoma/patología , Pólipos del Colon/patología , Neoplasias Colorrectales/patología , Lesiones Precancerosas/patología , Adenoma/diagnóstico , Adenoma/genética , Adenoma/terapia , Apoptosis/genética , Biopsia , División Celular/genética , Transformación Celular Neoplásica/genética , Transformación Celular Neoplásica/patología , Pólipos del Colon/diagnóstico , Pólipos del Colon/genética , Pólipos del Colon/terapia , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/terapia , Islas de CpG/genética , Metilación de ADN/genética , Diagnóstico Diferencial , Epigénesis Genética/genética , Marcadores Genéticos/genética , Humanos , Hiperplasia , Mucosa Intestinal/patología , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/genética , Lesiones Precancerosas/terapia , Pronóstico , Terminología como AsuntoRESUMEN
INTRODUCTION: The histopathological work-up of colorectal cancer is of critical importance for prognosis and therapy. Therefore we retrospectively analyzed all colorectal carcinomas diagnosed at our institution from January 2002 through March 2003. METHODS: 735 of a total of 777 carcinomas could be followed up. These tumors comprised 74 polypectomy specimens, 32 transanal microscopic surgery specimens, 322 surgical resection specimens analyzed at our own institution (subgroup A) and 263 surgical resection specimens that had been worked up at other pathological institutions (subgroup B) after the diagnosis of carcinoma had been established in our own institution in biopsies. 44 tumors were not treated locally until the end of the study. Quantitative quality parameters were analyzed statistically using Fisher's exact test. RESULTS: Between subgroups A and B significant differences were found within 1. the proportion of specimens with less than 12 lymph nodes examined (11 vs. 25 %), 2. for the detection of an R1 situation despite macroscopic R0 resection (9 vs. 1 %), 3. the proportion of early colonic cancers (9 vs. 4 %), 4. of mucinous adenocarcinomas (19 vs. 4 %), 5. of lymphatic (48 vs. 23 %) and venous invasion (25 vs. 8 %), 6. the frequency of a macroscopic description of mesorectum quality (85 vs. 14 %). In 7 of 32 surgically treated patients with a high-risk carcinoma originally found within a polypectomy specimen, residual tumor was detected in the surgical resection specimen (at the polypectomy site and/or in regional lymph nodes). CONCLUSION: Due to retrospective analysis of colorectal cancer specimens we were able to identify potential for improvement of diagnostic quality. Furthermore our data underline the importance of an oncological resection, if a high risk carcinoma has been detected within a polypectomy specimen.
Asunto(s)
Biopsia/estadística & datos numéricos , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Garantía de la Calidad de Atención de Salud/métodos , Anciano , Femenino , Alemania/epidemiología , Humanos , Incidencia , Masculino , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
There are a number of difficulties regarding the diagnosis of Barrett's mucosa and the varying grades of neoplasia that may be associated with it. It was therefore the aim of a consensus conference of the "Working Group for Gastroenterological Pathology within the German Society of Pathology" to achieve standardization regarding the following issues: definition and diagnostic criteria for Barrett's mucosa and its discrimination from intestinal metaplasia of the cardia, diagnostic criteria for intraepithelial neoplasia, number of biopsies necessary to establish the diagnosis, significance of additional immunohistochemical and/or molecular biological methods as well as importance of a second opinion in the diagnosis of intraepithelial neoplasia.
Asunto(s)
Esófago de Barrett/patología , Neoplasias Esofágicas/patología , Esófago de Barrett/complicaciones , Neoplasias Esofágicas/etiología , HumanosRESUMEN
In almost all eradication regimens, which contain antibiotics and bismuth derivatives, the administration of acid suppressing drugs for 4-6 weeks is recommended for healing of duodenal ulcer. The aim of this multicenter double blind study is to elucidate the effect of two classic antibiotics tetracycline (CAS 60-54-8) and metronidazole (CAS 443-48-1) alone or combined with ranitidine (CAS 66357-35-5) on the healing of duodenal ulcer and eradication of Helicobacter Pylori. Patients with duodenal ulcer were randomized to two treatment groups: group A received either ranitidine 4 x 150 mg or tetracycline 4 x 500 mg or metronidazole 3 x 250 mg for 2 weeks. Group B received 4 x placebo + tetracycline and metronidazole as in group A for 2 weeks. A final endoscopy was performed after 8 weeks. Four biopsy specimens were obtained from the antrum (two) and corpus (two) for both urease test and hematoxylin stain for detection of H. pylori. Out of 201 patients entering the study 156 completed the study (78 in A and 78 in B). The healing rate of duodenal ulcer was 98.7% in group A and 97.5 in group B. The eradication rate was only 33.3% in group B but 64% in group A (p < 0.001), when additionally ranitidine was given. The present study shows that treatment with the two antibiotics tetracycline and metronidazole alone results in a very low H. pylori eradication, but almost complete healing of duodenal ulcer after 8 weeks. Prolonged administration of antisecretory drugs in eradication regimens containing two antibiotics is not necessary for duodenal ulcer healing. However, the addition of H2-receptor antagonists or proton pump inhibitors to antibiotics increases the eradication rate.
Asunto(s)
Antibacterianos/uso terapéutico , Antiulcerosos/uso terapéutico , Úlcera Duodenal/tratamiento farmacológico , Úlcera Duodenal/microbiología , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Metronidazol/uso terapéutico , Ranitidina/uso terapéutico , Tetraciclina/uso terapéutico , Antibacterianos/efectos adversos , Antiulcerosos/efectos adversos , Combinación de Medicamentos , Femenino , Infecciones por Helicobacter/microbiología , Humanos , Masculino , Metronidazol/efectos adversos , Persona de Mediana Edad , Ranitidina/efectos adversos , Tetraciclina/efectos adversos , Factores de Tiempo , Ureasa/metabolismoRESUMEN
Colonic biopsies of 283 patients with Crohn's disease (CD), ulcerative colitis (UC), infectious colitis (IC) lymphocytic colitis (LC) and controls for patients with either CD or UC, matched for age and sex, were evaluated with respect to the number of intraepithelial lymphocytes (IEL) and PCNA (cyclin) positive crypt epithelia. The IEL count of patients with LC differed significantly from all other patient groups, indicating that this condition bears no relation to the other diseases. Our patients with histologic diagnosis of LC had no uniform clinical presentation and the significance of this characteristic increase in IEL is unclear. The mean value of PCNA positive crypt epithelia in the lower crypt half was significantly higher in UC patients than in CD patients. PCNA counts in patients with IC or LC were not different from values in UC patients. PCNA counts in CD patients overlapped frequently with those in UC patients. This parameter thus fails to distinguish between CD and UC in individual patients and, though not investigated by us, is unlikely to be effective in the differential diagnosis in patients with a provisional diagnosis of indeterminate colitis.
Asunto(s)
Colitis Ulcerosa/diagnóstico , Colon/patología , Enfermedad de Crohn/diagnóstico , Linfocitos/patología , Antígeno Nuclear de Célula en Proliferación/análisis , Adulto , Biopsia , Colitis/diagnóstico , Colon/química , Diagnóstico Diferencial , Femenino , Humanos , Técnicas para Inmunoenzimas , Mucosa Intestinal/química , Mucosa Intestinal/patología , MasculinoRESUMEN
A membrane-associated 120 kDa protein of Helicobacter pylori with known species-specificity was isolated and used in an enzyme immunoassay (EIA) for the detection of Helicobacter pylori-specific IgG antibodies in patient sera. The EIA was compared with two other methods used for serodiagnosis of Helicobacter pylori infections: an EIA using sonicated whole Helicobacter pylori cell antigen and Western immunoblot. In a prospective study 127 unselected patients (76 patients with antrum gastritis, 51 patients without gastritis) who underwent gastroscopy were studied histologically and serologically. The EIA using the purified 120 kDa protein had the highest specificity (92%) compared with the EIA using a whole cell sonicate of a single Helicobacter pylori strain as antigen (60.7%) and the immunoblot (90.2%). The sensitivity was 96%, 100% and 92%, respectively. Sera of three control patients reacted strongly in all three methods, indicating possible Helicobacter pylori infection with negative histological findings. The EIA using the 120 kDa protein as antigen was shown to be a specific and sensitive technique for the serodiagnosis of Helicobacter pylori infections.
Asunto(s)
Anticuerpos Antibacterianos/análisis , Proteínas Bacterianas/inmunología , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/inmunología , Inmunoglobulina G/análisis , Adulto , Anciano , Anciano de 80 o más Años , Proteínas Bacterianas/aislamiento & purificación , Cromatografía en Gel , Humanos , Técnicas para Inmunoenzimas , Persona de Mediana Edad , Peso Molecular , Pruebas SerológicasRESUMEN
A simple and rapid method for the extraction, reverse transcription and PCR amplification of RNA from formalin-fixed, paraffin-embedded tissue is described. The procedure can be completed within 24 hours. In a first application of this method we detect human albumin mRNA in liver tissue, demonstrating the feasibility to retrospectively analyze gene expression and RNA viruses in fixed tissue.
Asunto(s)
Fijadores , Formaldehído , Hígado/química , Parafina , ARN Mensajero/análisis , Albúminas/genética , Biopsia con Aguja , ADN/biosíntesis , Expresión Génica , Humanos , Intrones , Reacción en Cadena de la Polimerasa , Empalme del ARN , Virus ARN/genética , ADN Polimerasa Dirigida por ARN/genética , ADN Polimerasa Dirigida por ARN/aislamiento & purificación , Sensibilidad y EspecificidadRESUMEN
The prevalence of Campylobacter pylori infection as detected by histology was studied in 5 predefined groups of patients. The associated histologic and endoscopic findings were registered. Validity of CLO-test was tested against the histologic detection. The following groups of patients were studied: A) Non-ulcer dyspepsia (defined by one or all of three symptoms: heartburn, nausea/inappetence, halitosis/belching) B) control group (no specific symptoms, no ulcer, no history of gastric surgery) C) Duodenal ulcer D) Gastric ulcer E) Billroth I or II resection of the stomach. 200 patients were recruited for group A-C, in group D 134 patients and in group E 113 patients were studied. A mean prevalence of 60% was observed. Prevalence was highest in patients with duodenal ulcer (86%). In group D a prevalence of 65%, in A and E a prevalence of 54%, and in B of 40% were seen. The overall test sensitivity of the CLO-test compared against the histologic detection rate was 75%, the specificity 81%. Sensitivity was reduced in group A (69%) and E (53%) and in patients with inactive chronic gastritis (67%). In all groups patients with active forms of gastritis showed the highest prevalence of C. pylori infection. The specificity of the CLO-test was reduced in patients with duodenal ulcer (46%) and gastric ulcer (48%). Decreased specificity observed after therapy with histamin receptor (H2) blockers may explain this finding. The relationship of C. pylori infection with active types of gastritis or gastro-duodenal ulcer hints at a causal relation but is no definite proof of its etiologic role. The validity of the CLO-test seems questionable in patients with gastroduodenal ulcer or operated stomach.
Asunto(s)
Infecciones por Campylobacter/complicaciones , Gastritis/complicaciones , Juego de Reactivos para Diagnóstico , Antiácidos/farmacología , Antieméticos/farmacología , Infecciones por Campylobacter/epidemiología , Infecciones por Campylobacter/patología , Estudios de Cohortes , Estudios de Evaluación como Asunto , Femenino , Gastritis/tratamiento farmacológico , Gastritis/patología , Antagonistas de los Receptores H2 de la Histamina/farmacología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Sensibilidad y EspecificidadRESUMEN
Since the fate and significance of gastric mucosal dysplasia is still largely unknown we have started a follow-up study for patients with dysplasia in the years 1986 and 1987. In this paper the short term results are reported. Dysplasia grade II was found in 2% of all patients and dysplasia grade III in 0.5%. The following results suggest a close-possibly sequential relationship of dysplasia and gastric cancer: dysplasia and gastric cancer are preferentially located in distal parts of the stomach; sex distribution of dysplasia and gastric cancer (especially intestinal type) are similar; considering the mean age of patients with dysplasia or gastric cancer we have observed that patients with dysplasia II were younger than patients with dysplasia III and both were younger than patients with gastric cancer of the intestinal type; during the short term follow-up (12-24 months) 4-8% of patients with dysplasia II and 18-20% of patients with dysplasia III showed a progression; of 26 carcinomas detected by follow-up of patients with dysplasia III 10 were early gastric cancer, 11 resectable with curative intent, 2 were metastatic and 3 without sufficient information for staging. We conclude therefore that gastric dysplasia is probably a true precancerous lesion that helps to identify high risk patients and thus contributes to the objective of an early diagnosis of gastric cancer.
Asunto(s)
Mucosa Gástrica/patología , Lesiones Precancerosas/patología , Gastropatías/patología , Neoplasias Gástricas/patología , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Gastropatías/epidemiología , Neoplasias Gástricas/epidemiologíaRESUMEN
64 diffuse pleural mesotheliomas diagnosed between 1964 and January 1985 at the Institute of Pathology of the University of Freiburg were analyzed. Since 1980 an increase from one case to 10 cases per year has been observed. The tumor was 3 to 4 times more frequent in men than in women. The age distribution showed a peak between the age of 50 and 60. In 26 cases evidence of exposure to asbestos was detected. In one patient radiotherapy of Hodgkin's disease may have been of etiological significance. The median survival time was 13 months. The five-year survival rate was only 4%. Histologic reevaluation was only possible in cases diagnosed after 1975. Of 43 cases thus evaluated 26 were pure mesothelial, 15 biphasic and 2 of the spindle-cell subtype. A median survival time of 23 months for pure mesothelial mesothelioma in comparison to 13 months for the biphasic mesothelioma indicated a better prognosis for pure mesothelial mesothelioma. Although no other primary tumors were detected, in 10 cases the differential diagnosis of adenocarcinoma had to be considered, and in 3 cases tumors of non-epithelial origin had to be excluded. 35 of 43 mesothelioma were CEA-negative, 38 out of 43 cytokeratin-positive, and 33 out of 43 were EMA-positive. Factor-VIII-related antigen was not demonstrated. 12 of 43 mesotheliomas showed PAS-positive staining, 29 of 43 were stained with Alcian blue. 7 of these 29 showed a positive digestion with hyaluronidase. Although CEA may not be negative in every mesothelioma, this marker seems to be a valid tool for the differential diagnosis of adenocarcinoma. In order to safeguard against a mistaken diagnosis of pleural mesothelioma, the exclusion of other tumors is always indispensable.
Asunto(s)
Mesotelioma/patología , Neoplasias Pleurales/patología , Adulto , Factores de Edad , Anciano , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Mesotelioma/epidemiología , Persona de Mediana Edad , Neoplasias Pleurales/epidemiología , Coloración y Etiquetado , Análisis de SupervivenciaRESUMEN
Cytologic evaluation of aspirates obtained by ultrasonically guided puncture of circumscribed lesions leads to the diagnosis of a malignant lesion when tumor cells are detected. In the absence of tumor cells, it remains uncertain whether the focus had been biopsied correctly, since the histologic diagnosis of a benign focal lesion can only occasionally be made by means of cytologic smears. Cases are presented showing circumscribed lesions of the liver. With a cut-biopsy fine needle, small cylinders of tissue were obtained under ultrasonic guidance and examined after histologic preparation. In each case, a benign focal lesion could be diagnosed, proving that the observed lesion had been correctly biopsied.
Asunto(s)
Hepatopatías/diagnóstico , Adulto , Biopsia con Aguja , Femenino , Humanos , Hepatopatías/patología , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
A 39-year-old woman was evaluated for acute midepigastric pain. The patient was never severely ill; her only medication was an oral contraceptive (OC) which she took regularly over the last 12 years. Abdominal ultrasonography and computed tomography revealed bleeding into a liver tumor. At laparoscopy, 3 adenomas of the liver were detected. Bleeding was restricted to 1 tumor and did not require surgical intervention. OC medication was discontinued, and the patient was followed over more than 3 years. The patient was doing very well; ultrasonographically, the liver tumors became gradually smaller.
Asunto(s)
Anticoncepción , Anticonceptivos Femeninos , Anticonceptivos Orales , Sistema Digestivo , Enfermedad , Servicios de Planificación Familiar , Hemorragia , Neoplasias Hepáticas , Hígado , Dolor , Signos y Síntomas , Biología , Anticonceptivos , Neoplasias , FisiologíaAsunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Hígado/efectos de los fármacos , SRS-A , Animales , Bilis/análisis , Colestasis/metabolismo , Femenino , Macrófagos del Hígado/metabolismo , Hígado/citología , Hígado/metabolismo , Mastocitos/metabolismo , Ratones , Peso Molecular , SRS-A/análisis , SRS-A/biosíntesis , SRS-A/metabolismo , SRS-A/farmacologíaRESUMEN
Based on the histological picture of liver biopsies examined in the years 1981 and 1983, drug-induced liver injury has been suspected in 131 and 170 cases. In relation to the total number of the examined liver biopsies this accounted for 6 and 9.6%, respectively. In only 20 (i.e. 15%), respectively 17 (i.e. 10%) of the cases, a drug-induced injury could be clinically excluded. However, a drug-induced injury was doubtlessly secured in 21 (16%) and 28 (16.5%) of the cases. The histological phenotype seen in association with the incriminated drug is presented. In 90 (68.7%) and 125 (73.5%) of the cases it was neither possible to secure nor to exclude the drug as cause of this damage, either because in 32/72 cases the clinical work-up was incomplete or because the drug-induced damage was clinically suspected, but not sufficiently documented by follow-up examinations after drug-withdrawal.
Asunto(s)
Hepatopatías/patología , Adolescente , Adulto , Anciano , Biopsia , Enfermedad Hepática Inducida por Sustancias y Drogas , Femenino , Granuloma/patología , Hepatitis Alcohólica/patología , Hepatitis Crónica/patología , Humanos , Hepatopatías/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
Sonographically guided puncture of intra-abdominal and retro-peritoneal masses for cytological diagnostic is widely employed. However, processing of cytological material may result in artifacts and in the case of certain malignant tumours, of benign tumours or diffuse organ changes, cytology is only relatively reliable. Special experience on the part of the investigato is therefore required. Hence, in far-reaching therapeutic decisions such as operation, cytostatic therapy or radiotherapy, diagnosis based on histological findings is preferred. Preliminary experience with a new type of fine needle (Schneidbiopsiekanüle) suitable for obtaining histological material is presented.
Asunto(s)
Biopsia con Aguja/métodos , Neoplasias/patología , Ultrasonografía , Adulto , Biopsia con Aguja/instrumentación , Humanos , Neoplasias Hepáticas/patología , Metástasis Linfática/patología , Persona de Mediana Edad , Neoplasias Pancreáticas/patologíaRESUMEN
A study comparing the effects of diatrizoate, ioxitalamate, metrizamide, ioxaglate, and a 22% sorbitol on aortic endothelia of the rat was performed. In each case 1 ml of the respective solution was injected in a single dose into the aorta. Endothelial damage was seen after injection of metrizamide, diatrizoate, and ioxitalamate. After injection of ioxaglate or sorbitol, only minor endothelial changes were observed.
Asunto(s)
Aorta/efectos de los fármacos , Medios de Contraste/toxicidad , Yodobenzoatos/toxicidad , Ácidos Triyodobenzoicos/toxicidad , Animales , Aorta/ultraestructura , Diatrizoato/toxicidad , Ácido Yotalámico/análogos & derivados , Ácido Yotalámico/toxicidad , Ácido Yoxáglico , Masculino , Metrizamida/toxicidad , Microscopía Electrónica de Rastreo , Concentración Osmolar , RatasRESUMEN
The corn protein gluten causes the gluten-sensitive enteropathy in susceptible persons (HLA-antigens). The diagnosis is made on the basis of the morphological criteria of villous atrophy of the jejunal mucosa and the clinical observation that the malabsorption can be healed by a gluten-free diet. The disease, which occurs in children and adults, is a distinct entity. Life-long adherence to a gluten-free diet is difficult. Intentional or unintentional reintroduction of gluten often causes masked disease states. These are best classified on the basis of electron-microscopy study of the jejunal biopsy. We propose a new classification of the phases of remission. A group of diseases exist which are closely related to gluten-sensitive enteropathy. Frequently villous atrophy is detectable. However, the disease does not respond to a gluten-free diet. The pathophysiology of these diseases is at present unclear. Diseases involving autoimmune processes also appear to be associated with gluten-sensitive enteropathy. The common factor is probably an immuno-genetic defect. This is supported by the existence of common HLA-antigen constellations. Gluten has been characterised in vitro as a lectin with oligomannose specificity. This provides a new pathomechanism for the gluten induced enterocytic destruction.