Morphologic Clues Identify Muscularis Propria at Colonic Biopsy and Warn of Potential Perforation

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
Hafsah Arain ◽  
Mark Wu
Keyword(s):  
Muscularis Propria ◽  
Normal Mucosa ◽  
Nuclear Density ◽  
Muscularis Mucosa ◽  
Colonic Tissue ◽  
Control Tissue ◽  
Colonic Biopsy ◽  
Increased Risk ◽  
Maximal Thickness ◽  
Colonic Biopsies

Abstract Objectives Perforation is currently believed to be a rare but potentially serious complication of colonic biopsies performed with cold forceps. Most reported cases have occurred in the setting of colitis. The presence of muscularis propria in specimens from colonic biopsies might portend increased risk of perforation. However, identifying muscularis propria at time of biopsy is difficult for many reasons, including histologic overlap with muscularis mucosa. Incidental muscularis propria obtained in this manner has yet to be studied. We hypothesized that differences in nuclear density could distinguish muscularis propria from muscularis mucosa. Methods We retrospectively reviewed 3 specimens from colonic biopsies performed with cold forceps for which muscularis propria was presumed to be visualized based on the presence of smooth muscle with lower nuclear density compared to areas known to be muscularis mucosa. All patients were adults clinically suspected to have colitis. These specimens were then compared to a full-thickness section from normal colonic tissue obtained via colectomy that served as control to confirm whether nuclear density or other features could distinguish muscularis propria from muscularis mucosa. Results Muscularis propria in the control tissue had lower nuclear density, more cytoplasmic pallor, greater maximal thickness, and smoother texture than the corresponding muscularis mucosa in the control tissue. The constellation of these features was consistently seen in all three specimens obtained via biopsy and therefore confirmed the presence of muscularis propria in all three specimens, although all patients lacked perforation clinically. Surprisingly, all three specimens had histologically normal mucosa. Conclusion We showed that several morphologic features, including low nuclear density, identify muscularis propria at time of colonic biopsy and alert endoscopists to the possibility of perforation, and we showed that muscularis propria can accompany normal mucosa obtained via biopsy with cold forceps. Additional studies are necessary to further validate these findings.

scholarly journals A case of planar-type GIST of the sigmoid colon showing diverticular structure with perforation

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Yuka Shintaku ◽  
Yuya Asano ◽  
Takahiro Watanabe ◽  
Takako Kihara ◽  
Eri Ishikawa ◽  
...  
Keyword(s):  
Sigmoid Colon ◽  
Mutational Analysis ◽  
Muscularis Propria ◽  
Normal Mucosa ◽  
Sudden Onset ◽  
Surrounding Tissue ◽  
Spindle Cells ◽  
Japanese Male ◽  
Old Japanese ◽  
Exon 11

Abstract Background Gastrointestinal stromal tumors (GISTs) generally form well-defined mass lesions. However, some cases of the flatly distributed and muscularis propria-replacing GISTs have been reported so far. We experienced an additional case of planar-type GIST of the sigmoid colon accompanied by a diverticulum with perforation. Case presentation A 68-year-old Japanese male with sudden onset of abdominal pain was clinically diagnosed with gastrointestinal perforation, and an emergency abdominal operation was performed. A diverticulum with rupture was found in the sigmoid colon, but no apparent tumor was observed. Histological examination revealed bland spindle cells flatly proliferating and diffusely replacing the muscularis propria at the diverticular structure. The spindle cells were positive for KIT, DOG1, and CD34. Mutational analysis of the c-kit gene revealed that the lesion had a heterozygous deletion of 2 amino acids at codons 557 and 558 of exon 11. The mutation was not observed in the normal mucosa of the surrounding tissue. Conclusion We diagnosed this case as an unusual planar-type GIST. Some similar cases have been reported in the sigmoid colon and other sites. We discuss the mechanism of development of the planar-type GISTs associated with the diverticulum.

Constitutive expression of MMP9 in intestinal epithelium worsens murine acute colitis and is associated with increased levels of proinflammatory cytokine Kc

2013 ◽  
Vol 304 (9) ◽  
pp. G793-G803 ◽  
Author(s):  
Hongchun Liu ◽  
Neal R. Patel ◽  
Lewins Walter ◽  
Sarah Ingersoll ◽  
Shanthi V. Sitaraman ◽  
...  
Keyword(s):  
Intestinal Epithelium ◽  
Proinflammatory Cytokine ◽  
Constitutive Expression ◽  
Clinical Score ◽  
Underlying Mechanism ◽  
Chronic Inflammatory Disease ◽  
Simultaneous Increase ◽  
Colonic Tissue ◽  
Acute Colitis ◽  
Increased Risk

Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, is a chronic inflammatory disease associated with an increased risk for colon cancer. Matrix metalloproteinases (MMPs) are the predominant proteinases expressed in the gut mucosa during active IBD. Our laboratory has previously demonstrated that epithelial-derived MMP9 is absent in normal colonic tissue but is upregulated during IBD. In this study MMP9 transgenic mice (Tg-villin-MMP9) are generated specifically to overexpress MMP9 in intestinal epithelium to examine the role and underlying mechanism by which it modulates the pathogenesis of acute colitis. Dextran sodium sulfate (3% DSS)- and Salmonella typhimurium (S.T.)-induced colitis models were used to study gut inflammation in Tg-villin-MMP9 and wild-type littermates (WT). Colonic tissue was analyzed via Western blot, histology, myeloperoxidase (MPO) assay, and quantitative PCR. Tg-villin-MMP9 mice expressed significantly increased MMP9 mRNA and protein expression at basal level. There was a significant decrease in the goblet cells, but a significant increase in proliferation and apoptosis were observed among Tg-villin-MMP9 mice compared with WT mice. There was also a significant increase in the proinflammatory chemokine Kc among Tg-villin-MMP9 compared with WT mice. Tg-villin-MMP9 exhibited a severe inflammatory response than WT mice in both DSS- and S.T.-induced colitis models as evident by greater weight loss and higher clinical score, histological score, and MPO activity, which correlated with relative levels of Kc mRNA. MMP9 expressed by intestinal epithelial cells mediates inflammation in colitis with simultaneous increase in proinflammatory cytokine Kc.

scholarly journals cagA positive and negative Helicobacter pyloristrains are simultaneously present in the stomach of most patients with non-ulcer dyspepsia: relevance to histological damage

Gut ◽  
1998 ◽  
Vol 42 (6) ◽  
pp. 772-778 ◽  
Author(s):  
N Figura ◽  
C Vindigni ◽  
A Covacci ◽  
L Presenti ◽  
D Burroni ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Intestinal Metaplasia ◽  
Normal Mucosa ◽  
Mucosal Damage ◽  
Gastric Mucosal Damage ◽  
Glandular Cell ◽  
Increased Risk ◽  
Molecular Masses ◽  
Non Ulcer Dyspepsia ◽  
H Pylori

Background/Aims—Infection with Helicobacter pylori strains harbouring the cagA gene (cagA+) is associated with an increased risk of developing peptic ulcer and gastric cancer. The aim of this study was to assess whether H pylori isolates with different cagA status were present in patients with non-ulcer dyspepsia, and whether a variable cagA status is relevant to histological gastric mucosal damage and glandular cell proliferation.Methods—Well separated H pyloricolonies (between 2 and 25) from primary plates, per gastric area, for each of 19 patients with non-ulcer dyspepsia were examined forcagA by hybridisation. Western blotting was used to examine both representative colonies for CagA expression and the patients’ sera for antibody response to CagA. Glandular gastric cell proliferation was assessed immunohistochemically.Results—Of the 747 colonies examined, 45.3% werecagA+. All colonies from four patients werecagA+, and all colonies from two patients werecagA−. In 13 patients (68%) both cagA+ andcagA− colonies were found. CagA expression of isolates corresponded to their cagA status. H pyloristrains with different CagA molecular masses were present in three patients. Results based on all 19 patients studied showed that the prevalence of cagA+ colonies in areas with mucosal atrophy associated or not with intestinal metaplasia (67.9%) was significantly higher than in normal mucosa (44.7%) and mucosa from patients with chronic gastritis (44.0%) (p< 0.001). High levels of cell proliferation were associated with histological atrophy with or without intestinal metaplasia, but not with the possession of cagA by organisms colonising the same mucosal sites.Conclusions—Most patients with non-ulcer dyspepsia are infected by both cagA+ and cagA−H pylori colonies. The cagA status of infecting organisms may play a role in the development of atrophy and intestinal metaplasia.

Advanced Esophageal Cancer in Patients who Underwent Radiofrequency Ablation for Barrett Esophagus with High-Grade Dysplasia

2013 ◽  
Vol 8 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Min P. Kim ◽  
Kendra N. Brown ◽  
Mary R. Schwartz ◽  
Shanda H. Blackmon
Keyword(s):  
Esophageal Cancer ◽  
Radiofrequency Ablation ◽  
Delayed Diagnosis ◽  
Muscularis Propria ◽  
Normal Mucosa ◽  
Endoscopic Biopsy ◽  
High Grade Dysplasia ◽  
Barrett Esophagus ◽  
Resected Specimen ◽  
High Grade

Objective We sought to evaluate clinicopathologic features of patients who underwent esophageal surgery after radiofrequency ablation (RFA) treatment using the HALO system for Barrett esophagus (BE) with high-grade dysplasia (HGD). Methods We evaluated patients from our hospital database who underwent esophagectomy from August 2006 to January 2012 after previously receiving RFA for BE. Information on demographics, time between RFA and surgery, indications for surgery, and final esophageal pathology was collected. Results In our study, we selected 102 patients who underwent esophagectomy. Five patients had a history of RFA for BE with HGD. Three patients were referred because of persistent HGD despite RFA, and all three patients had HGD in the esophagectomy specimen. Two patients presented with a benign diagnosis (esophageal perforation and leiomyoma), and both of these patients had pathologic stage T3N2M0 adenocarcinoma of the esophagus in the resected specimen. One of these patients had normal mucosa overlying carcinoma in the muscularis propria and adventitia. The patients with stage T3N2M0 cancer did not have pre-RFA endoscopic ultrasound, first treatment of RFA with HALO360, or surveillance endoscopic biopsy every 3 months. Conclusions Radiofrequency ablation for BE with HGD may mask underlying esophageal cancer. Patients who are counseled to undergo RFA for HGD should be aware that RFA could lead to delayed diagnosis and delayed treatment of invasive esophageal cancer without careful patient selection, appropriate RFA use, and close surveillance.

Analysis of Tumor Depth Invasion With Anti-Smoothelin Antibody in Equivocal Transurethral Resection of Urinary Bladder Tumor Surgical Specimens

2020 ◽  
pp. 106689692096776
Author(s):  
Ioana Maria Mihai ◽  
Gheorghe-Emilian Olteanu ◽  
Diana Herman ◽  
Denisa Anderco ◽  
Mihaela Iacob ◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Bladder Tumor ◽  
Bladder Wall ◽  
Muscularis Propria ◽  
Staining Intensity ◽  
Tumor Stage ◽  
Differential Staining ◽  
Muscularis Mucosa ◽  
Constant Intensity ◽  
The One

Objective To examine the expression and value of the smoothelin marker in control cases, to standardize the working method, and to analyze its application in pathologic staging process of problematic transurethral resection of bladder tumor (TURBT) cases. Material and Methods Immunohistochemical (IHC) staining was performed on tumor-free bladder wall sections, tumor-free large bowel sections, TURBTs with unequivocal tumor stage, and TURBTs with equivocal stage. The IHC staining of muscularis mucosa (MM), muscularis propria (MP), and blood vessels was evaluated semiquantitatively. Results Smoothelin IHC staining pattern ranged from negative (30% to 67% cases) to 2+ (0% to 15% cases) in MM and from 1+ (10% to 50% cases) to 3+ (9% to 48% cases) in MP. When compared on the same slide, the smoothelin expression of MP showed a stronger staining intensity than the one of the MM in all the analyzed cases. Blood vessel muscle cells stained in a constant intensity as the MM ( r = 0.9808; r = 0.9604). Smoothelin determined restaging of 33% of the problematic TURBT cases. Conclusion Smoothelin is an IHC marker that shows differential staining between coexistent MM and MP; however, variations in staining intensity and pattern may occur, aspects that can be influenced by different technique variables. We recommend using this marker as a diagnostic tool in problematic TURBT cases only when there is sufficient experience in control cases with this antibody.

Decreased apoptosis in normal mucosa is associated with increased risk of colorectal adenomas

2001 ◽  
Vol 120 (5) ◽  
pp. A662-A662
Author(s):  
T KEKU ◽  
C MARTIN ◽  
J GALANKO ◽  
A CONNELLY ◽  
J WOOSLEY ◽  
...  
Keyword(s):  
Normal Mucosa ◽  
Colorectal Adenomas ◽  
Increased Risk

Comparison between Stool Examination, Serology and Large Bowel Biopsy in Diagnosing Schistosoma Mansoni

1989 ◽  
Vol 19 (3) ◽  
pp. 132-134 ◽  
Author(s):  
Mohamed Ismail Yasawy ◽  
Abdel Rahman El Shiekh Mohamed ◽  
Mohamed Ali Al Karawi
Keyword(s):  
Schistosoma Mansoni ◽  
Large Bowel ◽  
Diagnostic Method ◽  
Stool Examination ◽  
Serological Tests ◽  
Colonic Biopsy ◽  
Number Of Patients ◽  
Gastrointestinal Problems ◽  
Colonic Biopsies ◽  
Hepatosplenic Schistosomiasis

This report evaluates the diagnostic method in 167 patients with colonic schistosomiasis. These patients formed a part of a large number of patients who had sigmoidoscopy or colonoscopy for various gastrointestinal problems. During sigmoidoscopy or colonoscopy examination, typical intestinal Schistosomia lesions could be seen and at the same time several biopsies could be taken. Stool examination showed Schistosoma mansoni ova in only 19 patients (11.37%) of the 167 patients whose colonic biopsies were positive for Schistosoma mansoni. Serological tests were carried out in 115 of these patients and 88 patients (52.69%) had a titre of 64 or more. This study shows that endoscopic colonic biopsy is a better method than stool examination and serological tests in the diagnosis of intestinal or hepatosplenic schistosomiasis.

scholarly journals An atypical type I gastric neuroendocrine tumor

2017 ◽  
Vol 55 (4) ◽  
pp. 253-256 ◽  
Author(s):  
Andrada-Viorela Gheorghe ◽  
Mihai Rimbas ◽  
Octav Ginghina ◽  
Andrada Spanu ◽  
Theodor Alexandru Voiosu
Keyword(s):  
Neuroendocrine Tumor ◽  
Neuroendocrine Tumors ◽  
Polypoid Lesion ◽  
Muscularis Propria ◽  
Distant Metastases ◽  
The Body ◽  
Gastric Body ◽  
Pathology Report ◽  
Type I ◽  
Muscularis Mucosa

AbstractBackground. Gastric neuroendocrine tumors (GI-NETs) are rare lesions, usually discovered incidentally during endoscopy. Based on their pathology, there are 4 types of GI-NETs. Type I are multiple small polypoid lesions with central ulceration located in the gastric body or the fundus, associated with atrophic gastritis usually noninvasive and very rarely metastatic. We report on a rare case of a gastric NET arising from the muscularis propria layer of the pyloric ring.Case report. We present the case of a 65-year old woman with a history of alcoholic cirrhosis, investigated for melena. Upper endoscopy revealed a 30 mm submucosal pedunculated polypoid lesion located on the pylorus protruding in the duodenum, with normal overlying mucosa, fundic gastric atrophy and multiple small polyps at this level, with no active bleeding. CT scan did not reveal any distant metastases. An ultrasound endoscopy was performed, and a round hypoechoic heterogeneous solitary mass, evolving from the pyloric muscle was described. Considering a 30-mm tumor evolving from the gastric muscle layer in the absence of local invasion and with no distant metastases we decided against an endoscopical resection and we referred the patient to surgery. A laparoscopic wedge resection was performed. The pathology report described a 30/25 mm welldifferentiated neuroendocrine tumor invasive in the muscularis mucosa (pT3).Conclusions. Usually, type I neuroendocrine tumors are located in the body or the fundus of the stomach without submucosal invasion. The interesting feature in our case was that the tumor originated from the pylorus, making it an atypical presentation for a neuroendocrine tumor.

scholarly journals Reliability of Endoscopic Ultrasound Using Miniprobes and Grayscale Histogram Analysis in Diagnosing Upper Gastrointestinal Subepithelial Lesions

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Samiullah Khan ◽  
Rui Zhang ◽  
Weili Fang ◽  
Tao Wang ◽  
Shu Li ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Endoscopic Ultrasound ◽  
Muscularis Propria ◽  
Histogram Analysis ◽  
Muscularis Mucosa ◽  
Stromal Tumors ◽  
Subepithelial Lesions ◽  
Upper Gastrointestinal ◽  
Diagnostic Consistency

Background. To assess the role of endoscopic ultrasound (EUS) in the diagnosis of upper gastrointestinal subepithelial lesions (SELs) and to investigate EUS combined with a grayscale histogram analysis for the differentiation of leiomyomas and gastrointestinal stromal tumors (GISTs). Methods. A retrospective study of 709 patients with upper gastrointestinal SELs was conducted by EUS before endoscopic resection. The EUS findings of SELs and pathological results after endoscopic resection were compared. The EUS images of SELs, particularly, leiomyoma and GIST, were further analyzed via a grayscale histogram to differentiate between the two tumors. Results. Of the 709 patients, 47 cases were pathologically undetermined. The diagnostic consistency of EUS with endoscopic resection was 88.2% (584/662), including 185 muscularis mucosa, 61 submucosa, and 338 muscularis propria, respectively. The diagnostic consistency of EUS with pathology was 80.1% (530/662). The gray value of GISTs was significantly higher than that of leiomyomas (58.9±8.3 vs. 39.5±5.9, t=57.0, P<0.0001). The standard deviation of leiomyomas was significantly lower than that of GISTs (20.6±7.0 vs. 39.8±9.3, t=23.7, P<0.0001). The grayscale histogram analysis of GISTs showed higher echo ultrasound, and the echo of leiomyoma was more uniform. Conclusion. EUS is the preferred procedure for the evaluation of upper gastrointestinal SELs. EUS combined with a grayscale histogram analysis is an effective method for the differentiation of leiomyomas and GISTs.

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