Gastric Biopsies: The Gap between Evidence-Based Medicine and Daily Practice in the Management of Gastric Helicobacter pylori

BACKGROUND: Many consider histology to be the gold standard for Helicobacter pylori detection. Because the number and distribution of H pylori organisms vary, particularly in patients taking proton pump inhibitors (PPIs), the American Gastroenterological Association recommends discontinuing PPIs two weeks before endoscopy, and taking biopsies from both the body and antrum

Neuroendocrine Tumor (Carcinoid) of the Appendix With Mucocele

Acute right lower quadrant pain is a common emergency department presentation. Medical imaging has a main role to rule out appendicitis. Distinguishing between appendicitis and the other two major appendix pathologies, mucocele and carcinoid tumors, is not easy, but it is important for medical and surgical management planning. Appendix mobility is not usually assessed during sonography, but is it helpful? When comparing sonography and computerized tomography with histopathology findings to distinguish appendiceal pathologies, appendix mobility was found to be a key component. Appendix diameter, wall thickness, hyperemia, and surrounding echogenic fat are signs of an inflammatory process that will fix the appendix. Appendiceal carcinoids and mucoceles, on the other hand, will not initially have an inflammatory component for years, and thus patients present with only mild recurrent vague abdominal pain, normal blood work, and mild or borderline imaging findings. Sonography should be the first-choice medical imaging modality to rule out appendiceal pathologies because appendix mobility should be assessed and reported. </jats:p

Appendiceal Well-Differentiated Neuroendocrine Tumors: A Single-Center Experience and New Insights into the Effective Use of Immunohistochemistry

Background. Appendiceal well-differentiated neuroendocrine tumor is the most common histological type of appendiceal tumor. The majority of tumors are found incidentally at the tip of the appendix, with few exceptions. Due to its primarily indolent nature, this entity presents unique pathological challenges, particularly in the appropriate use of immunohistochemistry which this study aims to clarify. Patients and methods. Patients diagnosed at University Health Network (Canada) between 2005–2019 were selected and reviewed. Results. We identified 70 patients and sex distribution was female 60%; median age 36.5 years. Among them, 63 patients underwent appendectomy, and seven had initial right hemicolectomy for non-appendix lesions. Mean tumor size was 5.0 mm. Tumor extent was submucosa (15%); muscularis propria (34%); subserosa or mesoappendix (42%); visceral peritoneum (8%). All were clinically non-functional and negative for nodal and distant metastasis. Ninety percent of tumors were WHO Grade 1; 10% were WHO Grade 2. Immunohistochemically, an average of six stains were performed per patient. Nearly all tumors were positive for chromogranin A, synaptophysin, CAM5.2, and CDX2. MIB-1 staining was &lt; 3% in 58/63 tumors. Other immunohistochemical stainings performed were hormonal markers (serotonin, glucagon, pancreatic peptide, peptide YY). Subsequent right hemicolectomy was performed on five patients. All were followed up (median 4 years 8 months), and all were alive without recurrence except for one patient who died of another comorbidity. Conclusion. Tumors that are small, localized, and of low grade can be reasonably exempt from an extensive immunohistochemical panel in the absence of non-typical clinical and morphological features. </jats:p

Establishment of a remote diagnostic histopathology service using whole slide imaging (digital pathology)

BackgroundWhole slide imaging (WSI) has diverse applications in modern pathology practice, including providing histopathology services to remote locations.Materials and methodsUtilising an existing contractual partnership with a Northern Ontario group of hospitals, the feasibility of using WSI for primary diagnostic services from Toronto was explored by the dedicated working group. All aspects explored from information technology (IT), laboratory information system (LIS) integration, scanning needs, laboratory workflow and pathologist needs and training, were taken into account in the developing the rationale and business case.ResultsThe financial outlay for a scanner was $CA180K (approximately £105.6 k) after discounts. There were no human resource requirements as staff were reorganised to cater for slide scanning. Additional IT/LIS costs were not incurred as existing connectivity was adapted to allow two site groups (gastrointestinal and skin) to pilot this study. Scanned slides were available for pathologist review 24–96 hours sooner than glass slides; there was a 2-day improvement for final authorised cases, and per annum savings were:$CA26 000 (£15.2 k) in courier costs, $CA60 000 (£35.2 k) travel and$CA45 000 (£26.4 k) in accommodation, meals and car rental expense.ConclusionWSI is a viable solution to provide timely, high-quality and cost efficient histopathology services to underserviced, remote areas.</jats:sec