Histopathologic correlation of endoscopic ultrasound findings of chronic pancreatitis in human autopsies.

OBJECTIVES: To provide histologic correlation of endoscopic ultrasound (EUS) findings believed to represent chronic pancreatitis (CP). METHODS: Eighteen postmortem pancreatic specimens in patients dying of all causes were examined in vitro by EUS for features of CP: (1) echogenic foci, (2) hypoechoic foci, (3) echogenic main pancreatic duct (MPD), (4) accentuated lobular pattern, (5) cysts, (6) irregular MPD, (7) dilated MPD, (8) side branch dilation, and (9) calculi. The pancreata were then examined by 2 pathologists (blinded to the EUS/clinical findings) for histopathologic features of CP. RESULTS: Six specimens were autolyzed, and in 1 specimen, MPD could not be seen by EUS. In the other 11 patients, 10 had evidence of CP by EUS (> or =3 features) and by histopathologic examination (> or =2 features). One patient did not have CP by both EUS and histologic examination. CONCLUSIONS: Endoscopic ultrasound accurately detected CP, when compared with histopathologic examination. The presence of 3 or more features of CP correlates with the histologic diagnosis of CP, however, up to 3 features are frequently present in elderly patients dying of all causes. Future studies should address the clinical relevance and the specificity of EUS findings of CP in the older population.

Choice of first intervention is related to outcomes in the management of empyema.

BACKGROUND: The study determined whether the first procedure; simple drainage (tube thoracostomy, pigtail catheter) or operation (video-assisted thoracic surgery [VATS], thoracotomy) was related to outcomes in the management of empyema. METHODS: Data were collected from 104 consecutive patients with empyema. Primary outcomes were additional procedures and death. Predictor variables included age, delay, Karnofsky performance status (KPS), Charlson comorbidity index (CCI), serum albumin, malignancy, Acute Physiology and Chronic Health Evaluation II score, loculations on computed tomography scan, empyema stage, and first procedure choice. RESULTS: Advanced empyema (> or = stage IIA) was present in 84% of patients. Overall treatment success rates (no death, no additional drainage procedures) among evaluable patients for pigtail drainage, tube thoracostomy, VATS, and thoracotomy were 40% (4 of 10), 38% (14 of 37), 81% (13 of 16), and 89% (32 of 36), respectively. Five patients underwent miscellaneous procedures. Univariate variables associated with hospital death included KPS, CCI, and drainage as the first procedure. In multivariate analyses, KPS (coefficient, -0.06, p = 0.002) and failure of the first procedure (odds ratio [OR], 6.76; 95% confidence interval [CI], 1.45 to 31.4, p = .01) were independent predictors of death. Simple drainage as the first procedure was a strong, independent predictor of failure of the first procedure (OR, 11.1; 95% CI, 3.51 to 34.9; p = .00004). CONCLUSIONS: The choice of the first procedure is critical in the outcome for treatment of empyema, even with adjustment for confounding variables. VATS or thoracotomy as initial therapy for advanced empyema is associated with better outcomes.

Gene expression profiles from needle biopsies provide useful signatures of non-small cell lung carcinomas.

Gene expression profiles from DNA microarrays can provide molecular signatures that improve tumor classification, prognosis, and treatment options. While much of this work has focused on isolation of RNA from the resected tumor, fewer studies have utilized RNA from fine needle aspirates (FNA). In this pilot study we examined whether the gene signatures obtained from FNA samples would correlate with signatures taken from the resected tumor. Based on NSCLC gene expression profiles obtained from eleven sets of FNA and tumor samples we obtained a high concordance of FNA profiles matching their matched tumor sample. These results suggest that FNA samples may provide informative gene expression signatures regarding the potential aggressiveness of non-small-cell lung carcinomas.

Positron emission tomography in well differentiated fetal adenocarcinoma of the lung.

A 47-year-old woman with a 20 pack-year history of cigarette smoking presented with a chest x-ray demonstrating a left upper lobe lung density. Computed tomography of the chest showed a 3-cm lobulated mass in the apical left upper lobe. The lesion demonstrated intense focal uptake on FDG-PET scanning. The patient underwent left upper lobectomy. Pathology demonstrated the histologic and immunohistochemical findings of a well differentiated fetal adenocarcinoma (WDFA). The intense FDG-PET uptake and abundant glycogen stores associated with WDFA may be the result of its embryonic derivation and differential expression of glucose transporter proteins.