RESUMEN
This study aimed to examine the range of beige colored mucosa (BCM) in patients with esophageal eosinophilic infiltration (EEI) using narrow-band imaging (NBI). In this retrospective study, EEI was confirmed histologically in 12 consecutive patients from January 2014 to December 2017. The BCM tone on NBI without magnifying endoscopy was evaluated, and red, green, and blue (RGB) values of BCM and normal mucosa were measured. BCM was macroscopically classified into 2 groups (bright and dark) using cluster analysis. Histopathological analysis was performed in 1 patient who underwent biopsy for both normal mucosa and BCM. All 12 patients presented with BCM. Endoscopy revealed fixed rings, longitudinal furrows, mucosal edema, and exudate in 3, 12, 10, and 8 patients, respectively. Strictures were absent. Five patients had findings suggestive of gastroesophageal reflux disease. In the cluster analysis, 5 and 7 patients had bright and dark BCM, respectively. Consistent results were noted when we categorized patients according to their macroscopic characteristics. RGB values of the BCM and normal mucosa were measured-normal mucosa: R: 99.8 ± 16.5, G: 121.7 ± 23.1, and B: 93.4 ± 19.2; BCM: R: 152.0 ± 31.3, G: 123.9 ± 35.0, and B: 97.5 ± 29.5. BCM had significantly higher R values than normal mucosa (P = .0001). All parameters were significantly lower in the dark BCM group than in the bright BCM group (P < .001). Histopathological analysis revealed expansion of the epithelial intercellular space, eosinophilic infiltration, and basal cell hyperplasia at the BCM sites. BCM was observed in all cases of EEI. RGB values differed between bright and dark BCM. Assessing BCM tone using NBI is a potentially novel diagnostic method for EEI.
Asunto(s)
Eosinofilia , Esófago , Endoscopía Gastrointestinal , Eosinofilia/patología , Esófago/diagnóstico por imagen , Esófago/patología , Humanos , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/patología , Imagen de Banda Estrecha/métodos , Estudios RetrospectivosRESUMEN
BACKGROUND AND AIM: The majority of patients with eosinophilic esophagitis (EoE) are likely to have observable features under narrow-band imaging, namely beige mucosa. However, the histological features and clinical implications of beige mucosa have not been investigated. The aim of this study was to determine whether beige mucosa could serve as an endoscopic marker for predicting active inflammatory sites of EoE. METHODS: We retrospectively analyzed both the narrow-band images and biopsied specimens of 77 esophageal lesions from 35 consecutive patients with EoE. We divided these specimens into two groups: target biopsied specimens from beige mucosa (beige group) and specimens biopsied from non-beige mucosa (non-beige group). The number of eosinophils per high-powered field, thickness of the superficial differentiated cell layer, and depth of the hemoglobin component from the surface layer were compared between the two groups. RESULTS: Forty-four out of the 45 specimens were diagnosed as histological active lesions in the beige group. The sensitivity, specificity, and overall accuracy of beige mucosa in predicting EoE activity were 97.8%, 96.9%, and 97.8%, respectively. Compared with the non-beige group, specimens in the beige group had a significantly thinner superficial differentiated cell layer. CONCLUSIONS: Beige mucosa is associated with thinning of the normal superficial differentiated cell layer, and these histological changes in the active inflammatory sites of EoE could be recognized endoscopically as color differences. Beige mucosa may serve as an endoscopic indicator for predicting the histological activity of EoE.
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Esofagitis Eosinofílica , Dominio Catalítico , Enteritis , Eosinofilia , Esofagitis Eosinofílica/diagnóstico por imagen , Eosinófilos/patología , Gastritis , Humanos , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/patología , Estudios RetrospectivosRESUMEN
BACKGROUND AND AIM: The proper visibility of mucosa during esophagogastroduodenoscopy (EGD) is crucial for the detection of early upper gastrointestinal tract lesions. In contrast to colonoscopy, no validated scoring system for the assessment of upper gastrointestinal mucosal cleanliness has been developed so far. The aim of the study was to create and validate standardized grading system (POLPREP) to assess the mucosal cleanliness during EGD. METHODS: To assess the visibility of mucosa during EGD, 4-point scale was developed (0-3). Twelve operators assessed 18 images of esophagus, stomach, and duodenum twice (in 2 weeks interval). In validation round, the images and endoscopy reports of 443 EGDs performed in six centers were assessed. RESULTS: The inter-observer accordance of POLPREP was 0.8 (intra-class correlation coefficient; 0.79 consultants, 0.85 trainees). The intra-observer repeatability was 0.64 (Fleiss kappa value; 0.64 consultants, 0.64 trainees). The lesions detection rate was significantly higher in clean (scores 2 and 3; 19.7%) than in "unclean" segments (score 1; 7.7%, P = 0.049). Score 3 was associated with over three-fold higher lesion detection than score 1 (odds ratio 3.2, 95% confidence interval 1.1-9; P = 0.03). CONCLUSIONS: The proposed POLPREP scale allows for unified assessment of upper gastrointestinal tract mucosal cleanliness. The higher cleanliness scores are related with greater upper gastrointestinal pathologies detection.
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Neoplasias Gastrointestinales , Tracto Gastrointestinal Superior , Endoscopía del Sistema Digestivo , Neoplasias Gastrointestinales/diagnóstico por imagen , Humanos , Membrana Mucosa/diagnóstico por imagen , Variaciones Dependientes del Observador , Tracto Gastrointestinal Superior/diagnóstico por imagenRESUMEN
Cancer patients undergoing therapeutic radiation routinely develop injury of the adjacent gastrointestinal (GI) tract mucosa due to treatment. To reduce radiation dose to critical GI structures including the rectum and oral mucosa, 3D-printed GI radioprotective devices composed of high-Z materials are generated from patient CT scans. In a radiation proctitis rat model, a significant reduction in crypt injury is demonstrated with the device compared to without (p < 0.0087). Optimal device placement for radiation attenuation is further confirmed in a swine model. Dosimetric modeling in oral cavity cancer patients demonstrates a 30% radiation dose reduction to the normal buccal mucosa and a 15.2% dose reduction in the rectum for prostate cancer patients with the radioprotectant material in place compared to without. Finally, it is found that the rectal radioprotectant device is more cost-effective compared to a hydrogel rectal spacer. Taken together, these data suggest that personalized radioprotectant devices may be used to reduce GI tissue injury in cancer patients undergoing therapeutic radiation.
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Tracto Gastrointestinal/efectos de la radiación , Neoplasias de la Boca/radioterapia , Impresión Tridimensional , Traumatismos por Radiación/prevención & control , Protección Radiológica/instrumentación , Protección Radiológica/métodos , Animales , Modelos Animales de Enfermedad , Tracto Gastrointestinal/diagnóstico por imagen , Humanos , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/efectos de la radiación , Órganos en Riesgo , Ratas , Ratas Sprague-Dawley , Porcinos , Tomografía Computarizada por Rayos XRESUMEN
We present the case of a 79-year-old male, who was initially treated for mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) of the right eyelid, and later for disease relapse in the stomach. During follow up, he was noted to have developed left arm nodules just medial to the proximal biceps muscle, which were found to be multiply enlarged lymph nodes on subsequent ultrasound imaging. Excisional biopsy of these nodes revealed MALT lymphoma. He was initially referred for consideration of radiation, but a restaging F-18 fluorodeoxyglucose positron emission tomography integrated with computed tomography (F-18 FDG PET/CT) further identified a focus of suspicious uptake in left calf, which was later also biopsy proven to be MALT lymphoma. His disease was upstaged as the result of this later finding, and the overall recommendation for treatment changed to favor systemic treatment with Rituximab.
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Tejido Linfoide/patología , Linfoma de Células B de la Zona Marginal/patología , Membrana Mucosa/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Anciano , Fluorodesoxiglucosa F18 , Humanos , Tejido Linfoide/diagnóstico por imagen , Linfoma de Células B de la Zona Marginal/diagnóstico por imagen , Masculino , Membrana Mucosa/diagnóstico por imagen , Estadificación de Neoplasias , Espera VigilanteRESUMEN
BACKGROUND: In clinical applications, mucosal healing is a therapeutic goal in patients with ulcerative colitis (UC). Endoscopic remission is associated with lower rates of colectomy, relapse, hospitalization, and colorectal cancer. Differentiation of mucosal inflammatory status depends on the experience and subjective judgments of clinical physicians. We developed a computer-aided diagnostic system using deep learning and machine learning (DLML-CAD) to accurately diagnose mucosal healing in UC patients. METHODS: We selected 856 endoscopic colon images from 54 UC patients (643 images with endoscopic score 0-1 and 213 with score 2-3) from the endoscopic image database at Tri-Service General Hospital, Taiwan. Endoscopic grading using the Mayo endoscopic subscore (MES 0-3) was performed by two reviewers. A pretrained neural network extracted image features, which were used to train three different classifiers-deep neural network (DNN), support vector machine (SVM), and k-nearest neighbor (k-NN) network. RESULTS: DNN classified MES 0 to 1, representing mucosal healing, vs MES 2 to 3 images with 93.8% accuracy (sensitivity 84.6%, specificity 96.9%); SVM had 94.1% accuracy (sensitivity 89.2%, specificity 95.8%); and k-NN had 93.4% accuracy (sensitivity 86.2%, specificity 95.8%). Combined, ensemble learning achieved 94.5% accuracy (sensitivity 89.2%, specificity 96.3%). The system further differentiated between MES 0, representing complete mucosal healing, and MES 1 images with 89.1% accuracy (sensitivity 82.3%, specificity 92.2%). CONCLUSION: Our DLML-CAD diagnosis achieved 94.5% accuracy for endoscopic mucosal healing and 89.0% accuracy for complete mucosal healing. This system can provide clinical physicians with an accurate auxiliary diagnosis in treating UC.
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Colitis Ulcerosa , Aprendizaje Profundo , Endoscopía , Membrana Mucosa/lesiones , Cicatrización de Heridas , Humanos , Membrana Mucosa/diagnóstico por imagen , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , TaiwánRESUMEN
OBJECTIVES: To explore the alterations in maxillary sinus mucosal thickening after extracting teeth with severe periodontal disease using cone-beam computed tomography (CBCT). METHODS: 30 patients with severe periodontal disease of maxillary posterior teeth that needed to be extracted and who were radiographically diagnosed with mucosal thickening (MT) in the maxillary sinus participated in the study. CBCT scans were taken before tooth extraction and 2-29 months after tooth extraction. The postextraction follow-up time was divided into two groups: group 1 (<4 months) and group 2 (≥4 months). Dimensions of maxillary sinus MT, including the MT zone length (SL) and the maximum thickness of the MT zone (ST), were evaluated preextraction and postextraction; the residual ridge height (RRH) was evaluated at the sites of extracted and nonextracted teeth. RESULT: Of the 24 patients with unilateral tooth extraction, there was a statistically significant difference in MT between the extraction and nonextraction sides (p < 0.05). The RRH at the site of the extracted teeth was significantly lower than that of the nonextracted teeth (p < 0.05). MT decreased significantly after tooth extraction on the extraction side but not on the nonextraction side. There was no significant difference between group 1 and group 2 regarding the reduction in mucosal thickness over time. CONCLUSIONS: Severe periodontitis can cause MT in the maxillary sinus. The RRH was lower at the sites of extracted teeth. MT reduced quickly by a thorough debridement after tooth extraction in 4 months. MT will not decrease further over time.
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Tomografía Computarizada de Haz Cónico , Seno Maxilar/diagnóstico por imagen , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/patología , Enfermedades Periodontales/diagnóstico por imagen , Extracción Dental , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
Imaging the Eustachian tube is challenging because of its complex anatomy and limited accessibility. This study fabricated a fiber-based optical coherence tomography (OCT) catheter and investigated its potential for assessing the Eustachian tube anatomy. A customized OCT system and an imaging catheter, termed the Eustachian OCT, were developed for visualizing the Eustachian tube. Three male swine cadaver heads were used to study OCT image acquisition and for subsequent histologic correlation. The imaging catheter was introduced through the nasopharyngeal opening and reached toward the middle ear. The OCT images were acquired from the superior to the nasopharyngeal opening before and after Eustachian tube balloon dilatation. The histological anatomy of the Eustachian tube was compared with corresponding OCT images, The new, Eustachian OCT catheter was successfully inserted in the tubal lumen without damage. Cross-sectional images of the tube were successfully obtained, and the margins of the anatomical structures including cartilage, mucosa lining, and fat could be successfully delineated. After balloon dilatation, the expansion of the cross-sectional area could be identified from the OCT images. Using the OCT technique to assess the Eustachian tube anatomy was shown to be feasible, and the fabricated OCT image catheter was determined to be suitable for Eustachian tube assessment.
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Cateterismo/métodos , Endoscopía/métodos , Trompa Auditiva/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Tejido Adiposo/citología , Tejido Adiposo/diagnóstico por imagen , Animales , Cartílago/citología , Cartílago/diagnóstico por imagen , Cateterismo/instrumentación , Dilatación , Endoscopía/instrumentación , Trompa Auditiva/anatomía & histología , Trompa Auditiva/citología , Masculino , Membrana Mucosa/citología , Membrana Mucosa/diagnóstico por imagen , Nasofaringe/citología , Nasofaringe/diagnóstico por imagen , Porcinos , Tomografía de Coherencia Óptica/instrumentaciónRESUMEN
OBJECTIVES/HYPOTHESIS: Identifying distinctive features of the vocal fold (VF) during development could have significant clinical implications for treating voice disorders. This study investigates the structural organization of the VF microanatomy across gender and age groups using optical coherence tomography (OCT). STUDY DESIGN: Prospective clinical trial. MATERIALS AND METHODS: In vivo OCT images were acquired from 97 patients (58 males and 39 females) aged between 6 weeks and 27 years. All patients showed no signs of vocal fold pathology on endoscopy. Morphological features were extracted from OCT images and statistically compared between age groups. This study was performed at Massachusetts Eye and Ear between 2017 and 2019. RESULTS: All OCT acquisitions show a stratified microanatomy across age groups, even in newborns suggesting the presence of a superficial lamina propria (SLP) at birth. Furthermore, the optical scattering in the VF lamina propria changes according to age, suggesting subepithelial maturation. Although the epithelium thickness was relatively constant across age groups, the SLP showed a significant linear relationship between age and thickness (P = .016). Furthermore, a significant difference (P = .002) in SLP thickness was found between young adult males and females. The overall thickness of the entire mucosa did not change significantly with age. CONCLUSION: OCT is a noninvasive imaging modality capable of providing quantitative morphological features to describe the VF development. A stratified structure can be observed in OCT from newborns to young adults. Further investigations could combine OCT, acoustic measurements, and molecular sensitive techniques to provide a complete interpretation of the VF development. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E2558-E2565, 2021.
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Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/crecimiento & desarrollo , Tomografía de Coherencia Óptica , Pliegues Vocales/diagnóstico por imagen , Pliegues Vocales/crecimiento & desarrollo , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios ProspectivosRESUMEN
BACKGROUND: Ultrasound has demonstrated a high accuracy in the prenatal diagnosis of placenta accreta spectrum. However, it is not known whether ultrasound findings can pinpoint the depths of villous invasion, recommend surgical strategies, and predict clinical outcomes. OBJECTIVE: We described an ultrasound descriptor for the placenta accreta spectrum and investigated whether it can predict the severity of villous invasion and clinical outcomes. STUDY DESIGN: The patients with placenta accreta spectrum in this retrospective cross-sectional study were diagnosed and managed in our hospital from 2002 to 2017. The placenta, with overlying myometrium and bladder, was mapped with color Doppler sonography while the patient's bladder was full. A "rail sign" was defined as 2 parallel neovascularizations depicted by color Doppler sonography over the uterovesical junction and bladder mucosa, with interconnecting bridging vessels perpendicular to both. The patients received serial ultrasound examinations and surgery at our hospital. An unpaired t test and Pearson chi-square test compared the pathology subtypes, surgical strategies, and clinical outcomes in patients with or without a rail sign. RESULTS: We enrolled 133 consecutive cases of placenta accreta spectrum confirmed either by surgical inspection or pathology examination. Patients with a rail sign had a significantly higher risk of an abnormally invasive placenta (placenta increta or placenta percreta) than those patients without a rail sign (83.3% [60 of 72] vs 27.9% [17 of 61]; odds ratio, 12.94; P<.001). In addition, patients with a rail sign had a higher probability of perioperative approaches, including preoperative vascular control (58.3% [42 of 72] vs 21.3% [13 of 61]; odds ratio, 5.17; P<.001) and uterine artery embolization (34.7% [25 of 72] vs 11.5% [7 of 61]; odds ratio, 4.1; P=.0002]. Furthermore, patients with a rail sign carried a higher risk of adverse clinical outcomes than patients without a rail sign, such as blood transfusion (80.6% [58 of 72] vs 36.1% [22 of 61]; odds ratio, 7.34; P<.001], admission to the intensive care unit (33.3% [24 of 72] vs 16.4% [10 of 61]; odds ratio, 2.55; P=.026), hysterectomy (75% [54 of 72] vs 24.6% [15 of 61]; odds ratio, 9.2; P<.001), and bladder invasion (16.7% [12 of 72] vs 4.9% [3 of 61]; odds ratio, 3.86; P=.033). Notably, the negative predictive value of bladder invasion was 95.1%, indicating a high confidence to reject bladder invasion while the rail sign was negative. When the rail sign was used as a screening test, the positive likelihood ratio of predicting deep villous invasion was 3.64 and correlated with an increased probability of 20% to 25%. Patients with a rail sign also had a greater blood loss (2944±2748 mL vs 1530±1895 mL; P<.001) and a longer hospital stay (11.9±10.9 days vs 8.6±7.1 days; P=.036) than patients without a rail sign. CONCLUSION: A "rail sign" depicted by color Doppler sonography correlates with deeper villous invasion, additional perioperative approaches, and more adverse outcomes.
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Neovascularización Patológica/diagnóstico por imagen , Placenta Accreta/diagnóstico por imagen , Placenta/irrigación sanguínea , Placenta/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Transfusión Sanguínea/estadística & datos numéricos , Estudios Transversales , Femenino , Humanos , Histerectomía/estadística & datos numéricos , Unidades de Cuidados Intensivos , Membrana Mucosa/diagnóstico por imagen , Admisión del Paciente/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Vejiga Urinaria/diagnóstico por imagen , Embolización de la Arteria Uterina/estadística & datos numéricosRESUMEN
Identifying distinct normal extracellular matrix (ECM) features from pathology is of the upmost clinical importance for laryngeal diagnostics and therapy. Despite remarkable histological contributions, our understanding of the vocal fold (VF) physiology remains murky. The emerging field of non-invasive 3D optical imaging may be well-suited to unravel the complexity of the VF microanatomy. This study focused on characterizing the entire VF ECM in length and depth with optical imaging. A quantitative morphometric evaluation of the human vocal fold lamina propria using two-photon excitation fluorescence (TPEF), second harmonic generation (SHG), and optical coherence tomography (OCT) was investigated. Fibrillar morphological features, such as fiber diameter, orientation, anisotropy, waviness and second-order statistics features were evaluated and compared according to their spatial distribution. The evidence acquired in this study suggests that the VF ECM is not a strict discrete three-layer structure as traditionally described but instead a continuous assembly of different fibrillar arrangement anchored by predominant collagen transitions zones. We demonstrated that the ECM composition is distinct and markedly thinned in the anterior one-third of itself, which may play a role in the development of some laryngeal diseases. We further examined and extracted the relationship between OCT and multiphoton imaging, promoting correspondences that could lead to accurate 3D mapping of the VF architecture in real-time during phonosurgeries. As miniaturization of optical probes is consistently improving, a clinical translation of OCT imaging and multiphoton imaging, with valuable qualitative and quantitative features, may have significant implications for treating voice disorders.
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Matriz Extracelular/fisiología , Microscopía de Fluorescencia por Excitación Multifotónica , Tomografía de Coherencia Óptica , Pliegues Vocales/diagnóstico por imagen , Adulto , Colágeno/metabolismo , Femenino , Humanos , Laringe/anatomía & histología , Laringe/diagnóstico por imagen , Persona de Mediana Edad , Membrana Mucosa/diagnóstico por imagenRESUMEN
BACKGROUND: Radial endoscopic ultrasound (EUS) is typically used to estimate the depth of rectal polyp invasion, however, there are no data on linear EUS in this setting and its relative accuracy compared to radial EUS. METHODS: In this prospective cohort study, 89 patients with non-pedunculated rectal polyp who underwent linear EUS or radial EUS were prospectively enrolled. The invasion depth was measured for each polyp and categorized as mucosal to shallow submucosal(SMs) or deep submucosal(SMd) invasion. Invasion measurements were compared with the final diagnosis on histopathology. RESULTS: A total of 58 patients underwent radial EUS and 31 patients underwent linear EUS examination. There were 38 lesions correctly diagnosed in the radial EUS group and 29 correctly diagnosed lesions in the linear EUS group. The diagnostic accuracy of SMd invasion for linear EUS was significantly higher than radial EUS (0.936 vs. 0.655, p = 0.003). A significant difference was also noted for specificity between the two groups (0.963 vs. 0.659, p = 0.003). Univariate analysis showed radial EUS type (OR 0.131, 95% CI 0.028-0.606, p = 0.009) to be an independent predictor for incorrect diagnosis. The area under the receiver operating curve (ROC) was 0.856 and 0.651 for linear EUS and radial EUS, respectively. It was noted that four patients underwent unnecessary surgery for radial EUS while there were no such patients in the linear EUS group. CONCLUSIONS: Linear EUS was more accurate for determining SMd invasion and contributed to the selection of appropriate treatment modalities in patients with non-pedunculated rectal polyp.
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Endosonografía , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/patología , Pólipos/diagnóstico por imagen , Neoplasias del Recto/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pólipos/diagnóstico , Estudios Prospectivos , Curva ROC , Neoplasias del Recto/diagnóstico , Factores de Riesgo , Adulto JovenRESUMEN
Full-field optical coherence tomography (FFOCT) is an imaging technique of biological tissue based on tissue light reflectance analysis. We evaluated the feasibility of imaging fresh digestive mucosal biopsies after a quick mounting procedure (5 min) using two distinct modalities of FFOCT. In static FFOCT mode, we gained high-resolution images of general gut tissue-specific architecture, such as oesophageal papillae, gastric pits, duodenal villi and colonic crypts. In dynamic FFOCT mode, we imaged individual epithelial cells of the mucosal lining with a cellular or subcellular resolution and identified cellular components of the lamina propria. FFOCT represents a promising dye-free imaging tool for on-site analysis of gut tissue remodelling.
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Tracto Gastrointestinal/diagnóstico por imagen , Tracto Gastrointestinal/patología , Tomografía de Coherencia Óptica , Biopsia , Endoscopía , Humanos , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/patologíaRESUMEN
BACKGROUND: Although few studies evaluated the significance of random biopsies under white light cystoscopy (WLC) in patients with non-muscle-invasive bladder cancer (NMIBC), the findings are controversial. AIM: This aim of this study was to evaluate what kind of preoperative covariates were useful as predictive factors in detecting carcinoma in situ (CIS) from normal-appearing mucosa using random bladder biopsies under WLC. METHODS AND RESULTS: A total of 229 patients with NMIBC underwent initial TUR followed by random biopsies under WLC at Red Cross Takayama Hospital between 2007 and 2016. These patients underwent TUR with complete resection of intravesical visible tumors followed by random biopsies of normal-appearing mucosa. In this study, random bladder biopsies of normal-appearing urothelial mucosa, excluding abnormal mucosa, were carried out with a cold punch in the selected intravesical sites. The covariates included age, gender, the urine cytology result, presence of an abnormal mucosa, number of tumors, size of the largest tumors, configuration of the tumor, and tumor type. Abnormal mucosa was defined as reddish or mossy areas at the time of TUR under WLC. The primary endpoint was to determine what kind of preoperative covariates were useful as predictive factors in detecting CIS from normal-appearing mucosa using random bladder biopsies under WLC. Finally, 212 patients were evaluated, and 67 patients (31.6%) were diagnosed with CIS from normal-appearing mucosa. In univariate analysis, positive urine cytology, abnormal mucosa, and the number of tumors were significantly associated with concomitant CIS. On multivariate analysis, positive urine cytology and abnormal mucosa were significantly associated with CIS. CONCLUSION: The patients who were diagnosed with positive urine cytology or abnormal mucosa by WLC are ideal candidates for TUR followed by random biopsy of normal-appearing mucosa.
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Carcinoma in Situ/diagnóstico , Cistectomía , Cistoscopía/estadística & datos numéricos , Neoplasias de la Vejiga Urinaria/diagnóstico , Anciano , Biopsia/métodos , Biopsia/estadística & datos numéricos , Carcinoma in Situ/patología , Carcinoma in Situ/cirugía , Cistoscopía/métodos , Estudios de Factibilidad , Femenino , Humanos , Luz , Masculino , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/patología , Membrana Mucosa/cirugía , Clasificación del Tumor , Recurrencia Local de Neoplasia , Periodo Preoperatorio , Pronóstico , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/patología , Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugía , Urotelio/diagnóstico por imagen , Urotelio/patología , Urotelio/cirugíaAsunto(s)
Comunicación Interdisciplinaria , Síndrome de Stevens-Johnson/diagnóstico , Telemedicina/economía , Transporte de Pacientes/economía , Triaje/métodos , Ahorro de Costo/estadística & datos numéricos , Análisis Costo-Beneficio/estadística & datos numéricos , Diagnóstico Diferencial , Humanos , Membrana Mucosa/diagnóstico por imagen , Transferencia de Pacientes/economía , Transferencia de Pacientes/normas , Transferencia de Pacientes/estadística & datos numéricos , Fotograbar , Valor Predictivo de las Pruebas , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Piel/diagnóstico por imagen , Síndrome de Stevens-Johnson/economía , Síndrome de Stevens-Johnson/terapia , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Transporte de Pacientes/estadística & datos numéricos , Triaje/normas , Triaje/estadística & datos numéricosRESUMEN
Importance: Vulvar melanosis is a common pigmentary change that accounts for most pigmented vulvar lesions. It presents as single or multiple asymptomatic macules or patches of varying size and color that may be asymmetric with poorly defined borders. The differential diagnosis of melanocytic lesions includes melanoma, which creates anxiety for patients and the physicians who diagnose the condition and treat the patients. Objective: To evaluate the clinical and dermoscopic features of vulvar melanosis and their changes over time. Design, Setting, and Participants: In this cohort study, patients with vulvar melanosis were recruited and followed up in the Department of Dermatology, University of Florence, Florence, Italy, between January 1, 1998, and June 30, 2019. Data on patient characteristics and on both the clinical and dermoscopic features of the vulvar lesions were collected. Each lesion was photographed clinically and dermoscopically at initial evaluation and at annual follow-up visits. Main Outcomes and Measures: The clinical, dermoscopic, and histopathologic features of vulvar melanosis and their changes over time. Results: This cohort study included 129 women (mean age at diagnosis, 46 years [range, 19-83 years]) with vulvar melanosis. A total of 87 patients (67%) with vulvar melanotic lesions were premenopausal, and 84 patients (65%) had received some type of hormone therapy. The most frequent location for vulvar melanosis was the labia minora (55 [43%]), followed by the labia majora (33 [26%]). In 39 of 129 cases (30%), the lesions increased in size and changed color after initial evaluation but ultimately stabilized. No malignant evolution was documented in any patient during a median follow-up of 13 years (range, 5-20 years). Conclusions and Relevance: This study suggests that vulvar melanosis was a benign entity, and changes in lesions over time did not signify malignant transformation. An association between hormonal status and vulvar melanosis may be hypothesized.
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Dermoscopía , Melanosis/diagnóstico , Membrana Mucosa/diagnóstico por imagen , Vulva/diagnóstico por imagen , Enfermedades de la Vulva/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Color , Diagnóstico Diferencial , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Terapia de Reemplazo de Hormonas/efectos adversos , Terapia de Reemplazo de Hormonas/estadística & datos numéricos , Humanos , Italia , Melanoma/diagnóstico , Melanosis/etiología , Melanosis/patología , Persona de Mediana Edad , Membrana Mucosa/patología , Fotograbar , Estudios Retrospectivos , Vulva/patología , Enfermedades de la Vulva/etiología , Enfermedades de la Vulva/patología , Neoplasias de la Vulva/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: Heterotopic tissue can be found throughout the GI tract, most commonly being gastric tissue. The finding of ectopic salivary tissue located in the GI tract is an exceedingly rare finding. We present a case of an otherwise healthy 30-year-old male with rectal bleeding who underwent biopsy of a submucosal rectal lesion with pathologic findings of ectopic salivary gland tissue. CASE PRESENTATION: Our patient is a 30-year-old male who presented with rectal bleeding. During his workup, he underwent colonoscopy and subsequent endoscopic ultrasound after discovery of a submucosal mass in the rectum measuring approximately 2 × 1 cm. Biopsies were sent which returned showing ectopic salivary gland tissue superimposed on hyperplastic rectal mucosa. The patient's symptoms resolved and he has not had recurrence of bleeding. CONCLUSIONS: Ectopic salivary gland tissue is a rare pathological finding in the rectum. It can present as a symptomatic lesion or be found incidentally. There is no clear reason for its presence, but it is felt to be due to metaplasia, developmental anomalies, or idiopathic in nature. Treatment includes excision and monitoring.
Asunto(s)
Coristoma/diagnóstico , Coristoma/patología , Recto/patología , Glándulas Salivales/patología , Adulto , Biopsia , Endosonografía , Humanos , Masculino , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/patología , Recto/diagnóstico por imagen , Glándulas Salivales/diagnóstico por imagenRESUMEN
OBJECTIVE: A comprehensive CT algorithm in suspected ischemic stroke consists of a native CT scan, CT perfusion imaging of the brain and a CT angiography from the aortic arch to the vertex. Besides core findings of the brain and targeted vessels, various other findings may be identified. We analyzed a large patient sample and estimated the frequency of incidental findings (IFs) and whether these findings were correctly mentioned in the radiological reports. PATIENTS AND METHODS: In the time period between 01/16 and 02/19 the radiological database of one hospital containing 1625 patients admitted for stroke suspicion were retrospectively evaluated. In total 1175 patients with ischemic stroke CTs were included. IFs were classified according to Lumbreras et al. for their clinical relevance. The primary radiological report was used to classify, whether the finding was reported initially or not. RESULTS: Overall, 1988 IFs were identified in 1175 patients (mean 1.7 findings per patient). The most frequent finding were thyroid incidentalomas with n = 461 (23.2 % of all findings), followed by signs of mucosal swelling and/or opacification of the nasal sinus (n = 391, 19.7 %). Regarding clinical relevance, 181 findings were of major relevance (9.1 % of all findings), 902 were of moderate relevance (45.4 %) and 905 were of minor relevance (45.5 %). Overall, 772 findings (38.8 %) were not reported and 1216 (61.2 %) were sufficiently reported by the radiologist. CONCLUSION: The present study corroborates that incidental findings are frequent in patients undergoing ischemic stroke CT, which are about half of moderate and major relevance. About 40 % of these findings were not mentioned in the primary radiology report, including findings of high clinical relevance. The radiologist should be aware of these findings.
Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Cabeza/diagnóstico por imagen , Hallazgos Incidentales , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Cuello/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Incidencia , Masculino , Persona de Mediana Edad , Membrana Mucosa/diagnóstico por imagen , Senos Paranasales/diagnóstico por imagen , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/epidemiología , Adulto JovenRESUMEN
The aim of this study was to visualize the tumor propagation and surrounding mucosal field in radiography-based 3D model for advanced stage HNSCC and combine it with HPV genotyping and miRNA expression characterization of the visualized area. 25 patients with T1-3 clinical stage HNSCC were enrolled in mapping biopsy sampling. Biopsy samples were evaluated for HPV positivity and miR-21-5p, miR-143, miR-155, miR-221-5p expression in Digital Droplet PCR system. Significant miRNA expression differences of HPV positive tumor tissue biopsies were found for miR-21-5p, miR-143 and miR-221-5p compared to the HPV negative tumor biopsy series. Peritumoral mucosa showed patchy pattern alterations of miR-21-5p and miR-155 in HPV positive cases, while gradual change of miR-21-5p and miR-221-5p was seen in HPV negative tumors. In our study we found differences of the miRNA expression patterns among the HPV positive and negative tumorous tissues as well as the surrounding mucosal fields. The CT based 3D models of the cancer field and surrounding mucosal surface can be utilized to improve proper preoperative planning. Complex evaluation of HNSCC tissue organization field can elucidate the clinical and molecular differentiation of HPV positive and negative cases, and enhance effective organ saving therapeutic strategies.
Asunto(s)
Imagenología Tridimensional/métodos , MicroARNs/genética , Neoplasias de la Boca/patología , Membrana Mucosa/patología , Neoplasias Orofaríngeas/patología , Infecciones por Papillomavirus/complicaciones , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Biomarcadores de Tumor/genética , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/virología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Regulación Neoplásica de la Expresión Génica , Genómica/métodos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/diagnóstico por imagen , Neoplasias de la Boca/genética , Neoplasias de la Boca/virología , Membrana Mucosa/diagnóstico por imagen , Membrana Mucosa/metabolismo , Membrana Mucosa/virología , Neoplasias Orofaríngeas/diagnóstico por imagen , Neoplasias Orofaríngeas/genética , Neoplasias Orofaríngeas/virología , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/virología , Pronóstico , Tasa de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Reliable biomarkers are necessary for assessment of treatment responses. Acral and mucosal melanomas are commonly associated with copy number (CN) alterations rather than specific point mutations, with CN alterations inKIT, CDK4, and CCND1 occurring frequently. Cell-free DNA is released to peripheral blood by both normal and tumor cells, and therefore contains the same genetic alterations present in the source tumor. OBJECTIVE: To investigate the usefulness of detecting CN alterations in oncogenes in cell-free DNA for monitoring treatment response in acral and mucosal melanomas. METHODS: We isolated cell-free DNA from peripheral blood and assessed the CN alterations in the cell-free DNA. Using droplet digital PCR, we examined CN alterations ofKIT, CDK4, and CCND1 in tumors from 37 melanoma patients (acral, n = 27; mucosal, n = 10) and peripheral blood from 24 melanoma patients (acral, n = 17; mucosal, n = 7). RESULTS: CN gain was detected in at least one of the genes examined in 62.9 % (17/27) of acral melanomas and 70 % (7/10) of mucosal melanomas. CN gains were also detected in the plasma of some patients. Furthermore, plasma CN ratio was correlated with clinical condition. This correlation was especially clear in patients with high CN ratios in tumors and high tumor burdens. CONCLUSION: Plasma CN ratios may be useful for evaluating treatment responses in patients with acral and mucosal melanoma.