Mesenteric panniculitis: a paraneoplastic phenomenon?

BACKGROUND: Mesenteric panniculitis is an inflammatory condition of mesenteric adipose tissue with characteristic features on abdominal CT imaging. Although its cause is unknown, it has been associated with malignancy. OBJECTIVE: The aim of this study was to determine the prevalence of malignancy in patients identified as having mesenteric panniculitis on CT imaging and to identify demographic, clinical, and radiological features that may predict an unknown underlying malignancy. DESIGN: This study is a retrospective analysis of medical records and imaging. SETTING: This study was conducted at Christchurch Hospital, Canterbury District Health Board, New Zealand. PATIENTS: Individuals with mesenteric panniculitis on abdominal CT imaging performed between 2003 and 2010 were included. RESULTS: One hundred eighteen (92 male; median age, 61 years; range, 20-88 years) patients were identified with mesenteric panniculitis. Malignancy was identified in 45 patients (38%) (34 male). The most common malignancies were colorectal (14), lymphoma (13), and urogenital tract (7). Malignancies were diagnosed after the detection of mesenteric panniculitis in 13 patients. Univariate analysis of demographic, clinical, and radiological features revealed that lymph node size >12 mm (relative risk 4.5 (CI 1.4-14.6); p = 0.0266) and the absence of the fat ring sign (relative risk 0.6 (0.3-1.1); p = 0.047) were associated with the subsequent diagnosis of malignancy in patients with mesenteric panniculitis. LIMITATIONS: This review was limited by its retrospective nature and the small number of individuals with diagnosis of malignancy after the detection of mesenteric panniculitis. CONCLUSION: Mesenteric panniculitis is often associated with an underlying malignancy. In most cases, malignancy is diagnosed before mesenteric panniculitis. Lymph node size (>12 mm) and the absence of the fat ring sign were identified as predictors of subsequent diagnosis of malignancy in patients with mesenteric panniculitis. Identification of mesenteric panniculitis on imaging should prompt an awareness for possible malignancy in these patients.

Evaluation of the use of digital images for a national prostate core external quality assurance scheme.

AIMS: To evaluate the use of virtual images as an alternative to glass slides to expand the number of participants in the External Quality Assurance Scheme for prostatic biopsies. METHODS AND RESULTS: Benign and neoplastic cases, previously circulated as glass slides, were selected to include cases that had demonstrated a high level of agreement (n = 10) and a lesser degree of agreement (n = 10). Whole slide virtual images were circulated to 68 pathologists; 51 responses were returned. The levels of agreement for the primary diagnosis and for Gleason grading of cancers were analysed using kappa statistics. Responses for glass slides versus images were compared for the 24 pathologists for whom data were available. Levels of agreement for diagnostic categories using virtual slides were moderate to substantial, comparable to those found using glass slides. The level of agreement for Gleason grades 8-10 was substantial, but for lower grades was fair or moderate, poorer than for the glass slide circulation. CONCLUSIONS: Circulation of virtual images of biopsy material is a suitable alternative to glass slide-based schemes for the evaluation of diagnostic consistency. The majority of participants agreed that the ability to evaluate limited diagnostic material outweighed the disadvantages of a virtual system.

Comparison of duplex ultrasound with digital subtraction angiography in the assessment of infra-inguinal autologous vein bypass grafts.

BACKGROUND: Postoperative surveillance of infra-inguinal vein grafts has arisen because of the high incidence of vein graft stenoses, which frequently progress to vein graft occlusion. The use of duplex ultrasound as the primary imaging method for graft surveillance is well established. This study aims to compare the accuracy of duplex ultrasound with the reference standard of digital subtraction angiography in the assessment of infra-inguinal vein grafts. METHODS: Sixty patients underwent routine postoperative duplex ultrasound as part of the local graft surveillance programme. Angiography was subsequently carried out on 18 grafts. Each lower limb arterial tree was divided into three segments (native arteries proximal to the graft, the graft itself and native arteries distal to the graft) resulting in a total of 42 comparisons. Degree of diameter stenosis on ultrasound was compared with angiography findings to determine concordance. Agreement was also expressed as a kappa value. RESULTS: Overall accuracy of duplex ultrasound was 88% (37/42). A kappa value of 0.80 indicates good agreement. In three of the five discordant cases, ultrasound correctly identified a stenosis, but overestimated the degree of stenosis compared with angiography. In each of the remaining two discordant cases, ultrasound identified a focal stenosis that was not apparent on angiography. In both cases, the area of duplex described abnormality responded to balloon angioplasty. CONCLUSION: Duplex ultrasound as part of the local vein graft surveillance programme is a reliable and accurate method in the detection of failing grafts and in some instances may be more sensitive.

Histopathology training schools 4 years on.

The initial three pilot histopathology senior house officer schools have improved training efficiency and effectiveness. Additional schools have been established to develop a national network of histopathology training schools. Their success provides lessons for the organization and delivery of structured training in other medical specialties.

IT innovation in histopathology recruitment, training and research.

The introduction of national recruitment and cohort training in histopathology in England has produced significant challenges and highlighted opportunities for development. Innovative information technology solutions have been deployed to facilitate recruitment and enhance education provision and research.