Adequacy of percutaneous non-targeted liver biopsy under real-time ultrasound guidance when comparing the Biopince™ and Achieve™ biopsy needle.

OBJECTIVE: The purpose of this study was to compare the adequacy rates of percutaneous liver biopsies, in parenchymal liver disease, using the BiopinceTM (Argon Medical, Texas, TX, ) 16G and AchieveTM (Carefusion, Illinois, IL, USA) 18G biopsy needles in relation to the Royal College of Pathologists guidelines and to assess risk of complications. METHODS: Data for all percutaneous non-targeted "medical" liver biopsies using the Biopince 16G and Achieve 18G biopsy needles were collected retrospectively over a 2-year period. Total biopsy core length and number of portal tracts was recorded along with adequacy of biopsy as assessed according to Royal College of Pathologists criteria. RESULTS: In total, 194 percutaneous liver biopsies met the inclusion criteria; 53 using the Biopince needle and 141 using the Achieve needle. The mean total core length was 23 mm (SD 4.1) and 20 mm (SD 6.8) for the Biopince and Achieve needles, respectively (p = 0.0005). The mean number of portal tracts was 11 (SD 4.2) and 7 (SD 3.4) for the Biopince and Achieve needles, respectively (p < 0.0001). An adequate biopsy was obtained in 15 (31.3%) and 1 (1.3%) case using the Biopince and Achieve needles, respectively (p < 0.001). Compromised biopsies were obtained in 32 (66.7%) and 39 (50.6%) cases using the Biopince and Achieve needles, respectively. Inadequate biopsies were obtained in 1 (2%) and 37 (48.1%) cases using the Biopince and Achieve needles, respectively. CONCLUSION: The Biopince 16G needle, when compared with the Achieve 18G needle, acquires a significantly greater total core length and number of portal tracts with significantly improved adequacy rates. There were no major complications associated with its use. Advances in knowledge: The Biopince 16G needle achieves significantly better specimen adequacy, when compared with the Achieve 18G needle and with no added major complications associated with its use.

Dysplasia in Barrett's oesophagus: p53 immunostaining is more reproducible than haematoxylin and eosin diagnosis and improves overall reliability, while grading is poorly reproducible.

AIMS: p53 immunostaining in Barrett's oesophagus (BO) has been shown to be predictive of progression, but data regarding its generalizability to routine practice are lacking. This study compared the reliability of p53 and dysplasia interpretation and grading. METHODS AND RESULTS: Seventy-two cases encompassing the full spectrum of BO were circulated to 10 pathologists from four institutions after a brief training session in p53 interpretation. Each pathologist classified cases on haematoxylin and eosin (H&E) alone using the Vienna classification and assessed the p53 staining using a qualitative system. Agreement was assessed using kappa statistics. For the four-tier Vienna system, the average unweighted kappa was 0.30. Weighted kappa values varied from 0.27 to 0.69 with an average of 0.47. When grouped into definite dysplasia versus no definite dysplasia the average kappa was 0.55, but the kappa for low-grade dysplasia (LGD) versus high-grade dysplasia (HGD) was only 0.31. For p53, using the three recognized patterns, the unweighted kappa was 0.6 (confidence interval 0.58-0.63). When cases were evaluated with both H&E and p53 the average kappa was 0.61 for definite dysplasia versus the rest. CONCLUSIONS: p53 immunohistochemistry interpretation is more reliable than dysplasia diagnosis, even with limited training. As it is predictive of prognosis and improves diagnostic reproducibility, it is suitable for routine use by pathologists as an adjunct to dysplasia diagnosis. The distinction of LGD versus HGD was poor. This study supports simplifying dysplasia diagnosis into 'present', 'indefinite' or 'absent', and the use of p53 as an ancillary marker in difficult cases. This should help to prevent overdiagnosis of dysplasia and inappropriate treatment.

Endometriosis presenting as an acute groin swelling: a case report.

INTRODUCTION: Many conditions present as groin swellings, in both the elective and emergency setting. The management of these conditions varies widely, thus a prompt and accurate diagnosis is important. CASE PRESENTATION: A 27 year old female presented with an acute painful swelling in her right groin. A preliminary diagnosis of an incarcerated femoral hernia led to urgent surgical exploration. Histology of the excised tissue showed appearances consistent with endometriosis. CONCLUSION: Endometriosis is an unusual cause of an acute groin mass, which should be considered as a differential diagnosis in women of childbearing age.

Laparoscopic-assisted resection of a giant colonic diverticulum: a case report.

INTRODUCTION: Diverticular disease of the colon is a common benign condition. The majority of patients with diverticular disease are asymptomatic and are managed non-operatively, however complications such as perforation, bleeding, fistulation and stricture formation can necessitate surgical intervention. A giant colonic diverticulum is defined as a diverticulum larger than 4 cm in diameter. Despite the increasing incidence of colonic diverticular disease, giant colonic diverticula remain a rare clinical entity. CASE PRESENTATION: This is the first reported case of laparoscopic-assisted resection of a giant colonic diverticulum. We discuss the symptoms and signs of this rare complication of diverticular disease and suggest investigations and management. Reflecting on this case and those reported in the literature to date, we highlight potential diagnostic difficulties and consider the differential diagnosis of intra-abdominal gas-filled cysts. CONCLUSION: The presence of a giant colonic diverticulum carries substantial risk of complications. Diagnosis is based on history and examination supported by abdominal X-ray and computed tomography findings. In view of the chronic course of symptoms and potential for complications, elective surgical removal is recommended. Colonic resection is the treatment of choice for this condition and, where possible, should be performed laparoscopically.

Tumour Lysis Syndrome Occurring in a Patient with Metastatic Gastrointestinal Stromal Tumour Treated with Glivec (Imatinib Mesylate, Gleevec, STI571).

Tumour lysis syndrome (TLS) is a rare side effect of chemotherapy for solid tumours. It describes the metabolic derangements following rapid and extensive tumour cell death following a good response to chemotherapy. Symptoms are those of metabolic derangement and renal failure. Treatment involves rehydration and correction of metabolic abnormalities. TLS should be considered in high risk groups. We report a case of TLS in a patient with metastatic gastrointestinal stromal tumour treated with imatinib mesylate. To our knowledge, this is the first reported case.

Uterine innervation after hysterectomy for chronic pelvic pain with, and without, endometriosis.

OBJECTIVE: Chronic pelvic pain is associated with a wide range of clinical conditions that include endometriosis. The precise cause, mechanisms of pain, and natural history are imprecise. Patterns of uterine innervation have been studied after hysterectomy for chronic pelvic pain with and without endometriosis. STUDY DESIGN: Tissue blocks were taken from the lower one half of the uterus after hysterectomy for advanced endometriosis (n = 16 specimens; group 1) and for chronic pelvic pain without endometriosis (n = 15 specimens; group 2). The control group consisted of uteri that were removed for painless gynecologic conditions (n = 25 specimens; group 3). Tissue sections from the lower one half of the uterus were stained with anti-S100 to demonstrate patterns of innervation, and nerve fiber profiles were counted by standardized techniques; qualitative differences were also recorded. RESULTS: In uteri from women with advanced endometriosis, there were increased numbers of nerve fiber profiles compared with control specimens (group 1 vs group 3; P = .0013, Mann Whitney U test). There were also increased numbers of nerve fiber profiles in uteri that were associated with chronic pelvic pain without endometriosis (group 2 vs group 3; P = .04, Mann Whitney U test). There were no differences in nerve fiber count in uteri from groups 1 and 2 (P = .35, Mann Whitney U test). Comparing both groups of uteri with controls (groups 1 and 2 vs 3) demonstrated marked differences in nerve fiber counts (P = .002, Mann Whitney U test). Two distinctive patterns of reinnervation that were observed: disruption of nerve bundles (collateral sprouting with microneuroma formation) and ingrowth around blood vessels (perivascular nerve fiber proliferation). There were increased numbers of microneuromas (groups 1 and 2 vs 3; P = .001, chi-squared test with Yates correction) and perivascular nerve fiber proliferation (groups 1 and 2 vs 3; P = .008, chi-squared test with Yates correction) in the myometrium in chronic pelvic pain with, and without, endometriosis compared with the control group. CONCLUSION: Nerve fiber proliferation and other features of reinnervation have been observed in the isthmic regions of uteri that were removed at hysterectomy for chronic pelvic pain with and without endometriosis. There were no quantitative differences between the groups with chronic pelvic pain and endometriosis. These observations provide an alternative explanation for the source of pain and other clinical symptoms in these clinical settings.