The differential diagnoses for severe enteropathy or severely damaged small intestinal mucosa.

Aim: The aim of this study was to explore the aetiology of severe duodenal mucosal abnormality in consecutive patients who underwent gastroscopy and duodenal biopsy over the past 10 years. Background: A range of differential diagnoses have been reported for severe duodenal architectural distortion. Methods: Clinical and laboratory data of all the patients with severe duodenal architectural distortion diagnosed at MidCentral District Health Board (DHB), New Zealand were collected and statistically analysed. Ninety-five percent confidence intervals (CI) are shown. Results: Between September 2009 and April 2019, 229 patients were diagnosed with severe enteropathy. The median patient age was 41 years (range 6-83 years). Two hundred and twenty-four of these patients (97.8%, 95.0-99.3%) were diagnosed with coeliac disease (CeD), with one of these patients having gluten induced T-cell lymphoma. From the remaining five patients, one had a diagnosis of tropical sprue and four did not have a clear aetiology. There were 180 patients from 191 (94.2%, 89.9-97.1%) with at least one positive coeliac marker, all with a diagnosis of CeD. Eleven patients (5.8% of 191, 2.9-10.1%) had negative markers for both tissue transglutaminase IgA (tTG-IgA) and IgA-endomysial antibodies (EMA-IgA) with six having a diagnosis of seronegative CeD. Conclusion: Although the spectrum of histological changes in CeD may range from normal to a flat mucosa, severe duodenal architectural distortion seems to occur mainly in CeD. Idiopathic enteropathy was recorded as the second but by far less frequent presentation of severe enteropathy. This study highlights that infection and other aetiologies are rarely implicated in severe enteropathy, with one case (0.4%) of refractory CeD/T-cell lymphoma.

Symptomatic giant gastric hyperplastic polyp: a case report.

Herein we describe a rare case of a 59-year-old male who was diagnosed with giant hyperplastic polyps after referring with symptoms of abdominal pain and vomiting, and associated red-flag symptoms of unintentional weight loss and early satiety.

Five-year follow-up after cervical cytology and histology discordance: A retrospective cohort study.

BACKGROUND: Cervical smear cytology and colposcopic biopsy histology are prone to error at both collection and interpretation stages, leading to a large number of discordant cases. AIMS: Investigation of five-year outcomes for women who have cervical cytology that is discordant and higher grade than histology results. MATERIALS AND METHODS: A retrospective cohort study was carried out for 111 women with cervical cytology discordant and higher grade than histology, after cytopathological review, over a three-year period. Five-year follow-up data were reviewed to identify the highest level of pathology seen within five years from the discordance. RESULTS: Women with atypical squamous cells with possible high-grade change (ASC-H) cytology and negative biopsy (n = 28) had a 46% chance of high-grade histological disease within 5 years; with cervical intraepithelial neoplasia grade 1 (CIN1) histology (n = 20), this was reduced to 30%. With high-grade cytology and negative histology (n = 23), 48% had high-grade disease within five years, including one case of invasive disease; with CIN1 histology 50% had high-grade disease within five years. CONCLUSIONS: This study demonstrates a 30-50% chance of high-grade disease within five years, in the setting of ASC-H or high-grade cytology with a negative or low-grade colposcopic biopsy. This highlights that in the setting of cytology and histology discordance, at least one of the tests indicating high-grade pathology warrants the need for treatment or close ongoing surveillance.

The prevalence of human papillomavirus in oropharyngeal cancer in a New Zealand population.

BACKGROUND: The incidence of oropharyngeal cancer (OPC) in New Zealand (NZ) has more than doubled over the last 14 years with 126 cases in 2010. Overseas studies have shown that human papillomavirus (HPV) plays a significant role in the development of these cancers. However, the role of HPV in OPC and the burden on the NZ health system is unclear. AIM: The aim of the study was to determine the prevalence and the genotypes of HPV associated with OPC in New Zealand. METHODS: In this study, 621 OPC were identified from cancer registry data from 1996-98, 2003-05, and 2010-12. Biopsies of 267 cases were then retrieved from laboratories throughout New Zealand. p16 immunohistochemistry and a human beta globin PCR were performed on all specimens. HPV genotyping was performed on all beta globin positive specimens using real-time PCR with melt analysis. RESULTS: Using a p16/PCR algorithm, 77.9% (95% CI: 71.1-83.5%) of cases were attributable to HPV. Of these, 98.5% were HPV 16 positive. There was also one case each of HPV 33 and 35. The percentage of HPV positive cases increased from 61.9% (95% CI: 40.9%- 79.2%) in 1996-98 to 87.5% (95% CI: 79.8%- 92.5%) in 2010-12. Results from the multivariable model, adjusted for sex and ethnicity found statistically significant associations between HPV positivity and timeframe (OR: 5.65, 95% CI: 2.60-12.30, 2010-12 vs 1996-98), and between HPV positivity and patient age (OR: 0.55, 95% CI: 0.33-0.99, ≥61 years vs ≤60 years). CONCLUSIONS: This data is consistent with data from other developed countries showing an increase in cases of HPV positive OPC in New Zealand, and the majority of cases being attributable to HPV 16. These results support the recent inclusion of males into the nationally funded immunization schedule for Gardasil® 9.

Immunohistochemical analysis of forensic evidence from a double homicide.

We report the use of immunohistochemical staining for analysis of forensic evidence from a double homicide. A 38-year-old woman and her 7-year-old daughter were murdered by multiple blows to the head and face with a tomahawk, resulting in multiple fragments of brain tissue scattered about the murder scene. The victims' husband and father was the main suspect, who maintained that he was out of town on business during the evening of the murders. However, a shirt taken from the suspect's car on the morning after the murders (secured by the police before the suspect visited the murder scene) was found to have two small stains. DNA analysis on the stains showed the presence of the deceased wife's DNA, and immunohistochemical stains on shirt fragments conclusively documented the presence of deep central nervous system tissue, providing the critical piece of evidence needed to arrest and prosecute the suspect. This report demonstrates that shirt or similar cloth fragments can be processed into paraffin blocks and subsequently immunostained to search for and classify types of tissue fragments that may be present on the fabric.