[Categorization of occult tumour cells in lymph nodes in patients with colon cancer not reliable enough]. / Indeling occulte tumorcellen in de lymfklieren bij patiënten met darmkanker onvoldoende betrouwbaar.

OBJECTIVE: To assess interobserver agreement between pathologists in judging photographs of lymph node preparations of occult tumour cells of patients with colon cancer. DESIGN: Descriptive and comparative study of interobserver variability. METHODS: All lymph nodes of 82 pN0 patients with colon cancer were analysed using three monoclonal antibodies against epithelial cells. Digital pictures of the 37 lesions detected were placed on a secured website. Forty pathologists selected at random were asked to examine the pictures and to categorize the lesions into 'micro metastases', 'isolated tumour cells' or something else. The degree of agreement was calculated by the Kendall W coefficient (with a range of 0.0-1.0). RESULTS: Thirty-five pathologists (88%) categorized the 37 lesions. Five lesions (14%) were categorized unanimously as micro metastases or isolated tumour cells. In 26 pictures (70%) the degree of agreement was poor to moderate. When the analysis was performed only on those diagnoses of which the pathologists were confident about their judgment, the percentage of lesions with good agreement rose to 49%. Differences in agreement were principally associated with multifocal lesions, clusters of tumour cells < 0.2 mm with proliferation characteristics in the parenchyma of the lymph node and lymphangio invasion. CONCLUSION: The differentiation between micro metastases and isolated tumour cells in lymph nodes of patients with colon cancer was not uniform. If this classification has clinical relevance to colon cancer then better definitions are needed.

Cardiac tamponade, an unusual and fatal complication of esophagus dilatation for benign stenosis: a case report.

INTRODUCTION: We present a patient with a fatal late esophago-pericardial fistula three months after dilatation for benign oesophagus stenosis CASE PRESENTATION: A 71-year-old caucasian male with a known benign esophagus stenosis was referred to the ICU. On arrival an asystole developed which proved to be due to a large pericardial effusion. Pericardial fluids were drained, but the patients' condition worsened and he died due to multiple organ failure. Postmortum investigation revealed an esophago-pericardial fistula. CONCLUSION: Causes of an acute tamponade should also be sought in semirecent events, such as manipulation to the oesophagus months before the acute critical illness.