SP6.1.10 Can gallbladder polyp surveillance be justified? Experience of a large DGH

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nicholas Bradley ◽  
Michael Wilson ◽  
Christopher Shearer ◽  
Timothy Heron ◽  
Katie Robertson ◽  
...  
Keyword(s):  
Incidental Finding ◽  
Case Series ◽  
District General Hospital ◽  
Pathological Examination ◽  
Histopathological Analysis ◽  
Low Grade ◽  
Retrospective Case ◽  
Gallbladder Polyps ◽  
Abnormal Pathology ◽  
Gallbladder Malignancy

Abstract Aims Gallbladder polyps are typically an incidental finding on sonographic or pathological examination with an estimated prevalence of 0.3 – 9.5%. Their role as a precursor to gallbladder malignancy is disputed. The 2017 European Joint Society Guidelines (ESGAR/EAES/EFISDS/ESGE) aim to standardise management of gallbladder polyps detected prior to cholecystectomy. We aim to describe our experience in the management of gallbladder polyps in a district general hospital. Methods This single centre retrospective case series included consecutive cholecystectomies over an 8-year period, identified through pathology records. Medical records were interrogated to identify the presence of gallbladder polyps identified pre-operatively and at subsequent histopathological analysis. Results 3835 cases were included. Four cases (0.1%) had an adenocarcinoma identified; none of these had pre-operatively identified polyps. Two cases (0.05%) were found to have lesions with high-grade dysplasia, 1 of which had a 17mm polyp preoperatively. One case (0.03%) had cellular atypia, without a pre-operative polyp. Forty six cases (1.2%) were found to have low-grade dysplasia; 1 (2.2%) of these had adenomyomatosis pre-operatively but none had pre-operative polyps. Overall, 53 patients (1.4%) had abnormal pathology with only 1 (1.9%) of these having a pre-operative polyp identified. Conclusions Our results suggest that in the real-world setting, intensive surveillance of gallbladder polyps has limited utility in identifying cases of gallbladder malignancy. The burden on services produced by adherence to strict surveillance guidelines is difficult to justify and a less arduous approach is unlikely to significantly influence the management or outcome in patients with gallbladder malignancy.

scholarly journals Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1453
Author(s):  
Chiara Fabbroni ◽  
Giovanni Fucà ◽  
Francesca Ligorio ◽  
Elena Fumagalli ◽  
Marta Barisella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Case Series ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Well Differentiated ◽  
The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

Incidental mastoiditis on magnetic resonance imaging scans: clinical relevance and cost implications

2018 ◽  
Vol 132 (11) ◽  
pp. 1010-1012 ◽  
Author(s):  
Y Abbas ◽  
H S Yuen ◽  
A Trinidade ◽  
G Watters
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Incidental Finding ◽  
Case Series ◽  
Resonance Imaging ◽  
Retrospective Case ◽  
Reporting Practice ◽  
Significant Pathology ◽  
Cost Implications ◽  
Rule Out

AbstractObjectivesTo determine: (1) the incidence of incidental ‘mastoiditis’ reported on magnetic resonance imaging scans performed in patients with asymmetrical sensorineural hearing loss and/or unilateral tinnitus; (2) how many of those patients have actual otological pathology and/or require treatment; and (3) the financial implications of such a reporting practice.MethodRetrospective case series.ResultsBetween October 2015 and November 2016, 500 patients underwent magnetic resonance imaging of the internal auditory meatus to rule out cerebellopontine angle lesions. There was an incidental finding of increased mastoid signalling in 5.8 per cent (n= 29), of which 20.7 per cent (6 of 29) were reported as bilateral cases. The diagnosis of ‘mastoiditis’ was found in 39.7 per cent (29 of 73). None of these patients had any pathology identified clinically. Other significant pathology was identified in a further 8.8 per cent (n= 44).ConclusionThe diagnosis of mastoiditis is primarily clinical. An incidental finding of high signalling in the mastoid region on magnetic resonance imaging is highly unlikely to represent actual clinical disease. In patients who are scanned for other reasons and who do not complain of otological symptoms, such findings are unlikely to require otolaryngology input.

Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management

2011 ◽  
Vol 31 (6) ◽  
pp. E15 ◽  
Author(s):  
Anil K. Roy ◽  
Nicholas P. Slimack ◽  
Aruna Ganju
Keyword(s):  
Conservative Management ◽  
Incidental Finding ◽  
Imaging Techniques ◽  
Case Series ◽  
Neurological Dysfunction ◽  
Type I ◽  
Retrospective Case ◽  
Chiari Malformation Type I ◽  
Comprehensive Review ◽  
Idiopathic Syringomyelia

Object A syrinx is a fluid-filled cavity within the spinal cord that can be an incidental finding or it can be accompanied by symptoms of pain and temperature insensitivity. Although it is most commonly associated with Chiari malformation Type I, the advancement of imaging techniques has resulted in more incidental idiopathic syringes that are not associated with Chiari, tumor, trauma, or postinfectious causes. The authors present a comprehensive review and management strategies for the idiopathic variant of syringomyelia. Methods The authors retrospectively identified 8 idiopathic cases of syringomyelia at their institution during the last 6 years. A PubMed/Medline literature review yielded an additional 38 articles. Results Two of the authors' patients underwent surgical treatment that included a combination of laminectomy, lysis of adhesions, duraplasty, and syrinx fenestration. The remaining 6 patients were treated conservatively and had neurologically stable outcomes. Review of the literature suggests that an etiology-driven approach is essential in the diagnosis and management of syringomyelia, although conservative management suffices for most cases. In particular, it is important to look at disturbances in CSF flow, as well as structural abnormalities including arachnoid webs, cysts, scars, and a diminutive posterior fossa. Conclusions The precise etiology for idiopathic syringomyelia (IS) is still unclear, although conceptual advances have been made toward the overall understanding of the pathophysiology of IS. Various theories include the cerebellar piston theory, intramedullary pulse pressure theory, and increased spinal subarachnoid pressure. For most patients with IS, conservative management works well. Continued progression of symptoms, however, could be approached using decompressive strategies such as laminectomy, lysis of adhesions, and craniocervical decompression, depending on the level of pathology. Management for patients with progressive neurological dysfunction and the lack of flow disturbance is unclear, although syringosubarachnoid shunting can be considered.

Absent right superior caval vein in situs solitus

2015 ◽  
Vol 26 (2) ◽  
pp. 334-339 ◽  
Author(s):  
Rebekka Lytzen ◽  
Karin Sundberg ◽  
Niels Vejlstrup
Keyword(s):  
Incidental Finding ◽  
Clinical Manifestations ◽  
Case Series ◽  
Retrospective Case ◽  
Caval Vein ◽  
Cardinal Vein ◽  
Benign Condition ◽  
Superior Caval Vein ◽  
Case Series Study ◽  
The Right

AbstractIntroductionIn up to 0.07% of the general population, the right anterior cardinal vein obliterates and the left remains open, creating an absent right superior caval vein and a persistent left superior caval vein. Absent right superior caval vein is associated with additional congenital heart disease in about half the patients. We wished to study the consequences of absent right superior caval vein as an incidental finding on prenatal ultrasonic malformation screening.Material and methodsThis is a retrospective case series study of all foetuses diagnosed with absent right superior caval vein at the national referral hospital, Rigshospitalet, Denmark, from 2009 to 2012.ResultsIn total, five cases of absent right superior caval vein were reviewed. No significant associated cardiac, extra-cardiac, or genetic anomalies were found. Postnatal echocardiographies confirmed the diagnosis and there were no postnatal complications. All children were found to have healthy hearts at follow-up.ConclusionsIn all cases, the findings proved to be a benign condition with no clinical manifestations or complications. Although isolated absent right superior caval vein does not seem to affect the outcome, associated anomalies may be serious. Absent right superior caval vein should, therefore, prompt a search for additional malformations. Furthermore, the diagnosis of an isolated absent right superior caval vein is important, because knowledge of the anomaly can prevent future problems when invasive procedures are necessary.

scholarly journals Clinicopathological analysis of primary carcinoid tumour of the ovary arising in mature cystic teratomas

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110346
Author(s):  
Fengcai Yan ◽  
Quan Zhou ◽  
Yulin Lin ◽  
Chunkai Yu ◽  
Hong Chang ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Carcinoid Tumour ◽  
Mature Teratoma ◽  
Thyroid Tissue ◽  
Case Series ◽  
Cytokeratin 19 ◽  
Histopathological Analysis ◽  
Retrospective Case ◽  
Carcinoid Tumours ◽  
Thyroid Transcription Factor 1

Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. Methods This retrospective case series analysed the data from patients with primary ovarian carcinoid tumours arising in mature cystic teratomas. Results The study enrolled four patients. Histopathological analysis of the tumours identified the following subtypes: insular ( n = 1), trabecular ( n = 1) and strumal ( n = 2). All four primary ovarian carcinoid tumours originated from a mature teratoma. The morphology of the primary ovarian carcinoids was similar to other neuroendocrine tumours. Strumal carcinoids were composed of different proportions of thyroid tissue intimately admixed with carcinoid tumour. Tumour tissue was arranged in insular and/or trabecular patterns. The nucleus of tumour cells displayed exquisite chromatin without obvious mitotic figures. Tumour tissues were positively stained for neuroendocrine markers chromogranin A, synaptophysin and CD56 to varying degrees. Strumal carcinoid tumours were cytokeratin 19 positive and thyroid transcription factor 1 negative. No recurrence or metastasis occurred during follow-up (12–71 months). Conclusion Primary ovarian carcinoid tumours arising in mature cystic teratomas are rare. Diagnosis and differential diagnosis should be confirmed by clinical features, histopathological characteristics and specific immunophenotyping.

Primary acquired melanosis/melanoma: utility of conjunctival map biopsy

2020 ◽  
pp. bjophthalmol-2020-317772
Author(s):  
Hansell Soto ◽  
Randy C Bowen ◽  
Vishal Raval ◽  
Gabrielle Yeaney ◽  
Arun Singh
Keyword(s):  
Case Series ◽  
Treated Group ◽  
Low Grade ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Primary Acquired Melanosis ◽  
Diagnostic Biopsy ◽  
Severe Atypia ◽  
Grade 3

AimTo assess the role of map biopsy in patients with conjunctival primary acquired melanosis (PAM)/melanoma.MethodsRetrospective case series of 400 conjunctival biopsy samples of 51 unique patients in a tertiary referral centre.ResultsEach patient underwent one diagnostic biopsy and several additional map biopsies (range 2–7) providing a total of 400 samples for the analysis (55 diagnostic biopsies, 345 map biopsies). The median age was 63 years old (range 20–88) with women representing 67% of the cases. Histopathological findings were graded as negative for melanosis/normal (grade 0), melanosis without atypia (grade 1), melanosis with mild atypia (grade 2), melanosis with severe atypia (grade 3) or invasive melanoma (grade 4). Clinicopathologic concordance was observed in the majority of the map biopsies (313, 91%) (positive: clinical+/path+ (57,17%), negative: clinical−/path− (256, 74%)). Three discordant samples (clinical−/path+) represented PAM sine pigmento. The histopathological spectrum of atypia was absent (40, 73%) or limited (11, 20%) in the majority of cases with tendency to cluster as low-grade or high-grade atypia. Map biopsy led to the identification of six patients (11%) with severe atypia, requiring topical mitomycin (MMC). Similarly, in 29 cases, periodic observation without topical MMC was recommended. One case of invasive melanoma transformation occurred in the MMC-treated group.ConclusionsMap biopsy enhances overall assessment of the anatomic and pathologic extent, impacting use of adjuvant topical chemotherapy. In absence of map biopsy, it would be impossible to diagnose PAM sine pigmento. Additional corroborative work is needed to validate our observations.

Combined use of minimal access craniotomy, intraoperative magnetic resonance imaging, and awake functional mapping for the resection of gliomas in 61 patients

2020 ◽  
Vol 132 (1) ◽  
pp. 159-167 ◽  
Author(s):  
Benjamin B. Whiting ◽  
Bryan S. Lee ◽  
Vaidehi Mahadev ◽  
Hamid Borghei-Razavi ◽  
Sanchit Ahuja ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Mapping ◽  
Intraoperative Mri ◽  
Neurophysiological Monitoring ◽  
Low Grade ◽  
Minimal Access ◽  
Retrospective Case ◽  
Who Grade ◽  
Motor Mapping ◽  
Combined Use

OBJECTIVECurrent management of gliomas involves a multidisciplinary approach, including a combination of maximal safe resection, radiotherapy, and chemotherapy. The use of intraoperative MRI (iMRI) helps to maximize extent of resection (EOR), and use of awake functional mapping supports preservation of eloquent areas of the brain. This study reports on the combined use of these surgical adjuncts.METHODSThe authors performed a retrospective review of patients with gliomas who underwent minimal access craniotomy in their iMRI suite (IMRIS) with awake functional mapping between 2010 and 2017. Patient demographics, tumor characteristics, intraoperative and postoperative adverse events, and treatment details were obtained. Volumetric analysis of preoperative tumor volume as well as intraoperative and postoperative residual volumes was performed.RESULTSA total of 61 patients requiring 62 tumor resections met the inclusion criteria. Of the tumors resected, 45.9% were WHO grade I or II and 54.1% were WHO grade III or IV. Intraoperative neurophysiological monitoring modalities included speech alone in 23 cases (37.1%), motor alone in 24 (38.7%), and both speech and motor in 15 (24.2%). Intraoperative MRI demonstrated residual tumor in 48 cases (77.4%), 41 (85.4%) of whom underwent further resection. Median EOR on iMRI and postoperative MRI was 86.0% and 98.5%, respectively, with a mean difference of 10% and a median difference of 10.5% (p < 0.001). Seventeen of 62 cases achieved an increased EOR > 15% related to use of iMRI. Seventeen (60.7%) of 28 low-grade gliomas and 10 (30.3%) of 33 high-grade gliomas achieved complete resection. Significant intraoperative events included at least temporary new or worsened speech alteration in 7 of 38 cases who underwent speech mapping (18.4%), new or worsened weakness in 7 of 39 cases who underwent motor mapping (18.0%), numbness in 2 cases (3.2%), agitation in 2 (3.2%), and seizures in 2 (3.2%). Among the patients with new intraoperative deficits, 2 had residual speech difficulty, and 2 had weakness postoperatively, which improved to baseline strength by 6 months.CONCLUSIONSIn this retrospective case series, the combined use of iMRI and awake functional mapping was demonstrated to be safe and feasible. This combined approach allows one to achieve the dual goals of maximal tumor removal and minimal functional consequences in patients undergoing glioma resection.

scholarly journals Critical Care Admissions following Total Laryngectomy: Is It Time to Change Our Practice?

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Hussein Walijee ◽  
Alexandria Morgan ◽  
Bethan Gibson ◽  
Sandeep Berry ◽  
Ali Jaffery
Keyword(s):  
Critical Care ◽  
Total Laryngectomy ◽  
Average Length ◽  
Case Series ◽  
Limited Resource ◽  
District General Hospital ◽  
Close Monitoring ◽  
Retrospective Case ◽  
Potential Cost ◽  
Average Length Of Stay

Critical Care Unit (CCU) beds are a limited resource and in increasing demand. Studies have shown that complex head and neck patients can be safely managed on a ward setting given the appropriate staffing and support. This retrospective case series aims to quantify the CCU care received by patients following total laryngectomy (TL) at a District General Hospital (DGH) and compare patient outcomes in an attempt to inform current practice. Data relating to TL were collected over a 5-year period from 1st January 2010 to 31st December 2015. A total of 22 patients were included. All patients were admitted to CCU postoperatively for an average length of stay of 25.5 hours. 95% of these patients were admitted to CCU for the purpose of close monitoring only, not requiring any active treatment prior to discharge to the ward. 73% of total complications were encountered after the first 24 hours postoperatively at which point patients had been stepped down to ward care. Avoiding the use of CCU beds and instead providing the appropriate level of care on the ward would result in a potential cost saving of approximately £8,000 with no influence on patient morbidity and mortality.

scholarly journals Beware of the Migrating Chest Pain and Widened Mediastinum: Case Series on Aortic Dissection

2002 ◽  
Vol 9 (2) ◽  
pp. 95-101
Author(s):  
CH Chung ◽  
KK Lai
Keyword(s):  
Pericardial Effusion ◽  
Aortic Dissection ◽  
Case Series ◽  
District General Hospital ◽  
X Rays ◽  
Case Review ◽  
Retrospective Case ◽  
Superior Mediastinum ◽  
Presenting Symptoms ◽  
Life Threatening

Objective Aortic dissection is not a rare life-threatening emergency. Undiagnosed and untreated aortic dissection is associated with a high mortality. A review of cases in the hospital may provide a baseline picture to guide clinical decisions. Design Retrospective case review for a period of 3 years and 4 months. Setting District general hospital near the Hong Kong – Shenzhen ‘border’ with 24-hour Accident & Emergency service but without cardiothoracic surgical capability. Population All cases coded as ‘aortic dissection’ in the computerized ‘Clinical Management System’ of the hospital. Main outcome measures Date, sex, age, history of hypertension, presenting symptoms, pulse deficit, chest X-ray findings, pericardial effusion, A&E diagnosis, type of dissection and patient outcome. Results From August 1998 to November 2001, 26 cases of aortic dissection were identified. There were 19 males and 7 females. Age range was 26 to 90 years (mean 65.04 ± SD 15.04, median 66.50, mode 65). In the plain chest X-rays, widened superior mediastinum (>8 cm) was present in 19 patients (73.1%) and pleural effusion in three (11.5%). Pericardial effusion was found in six patients (23.1%). As regard to outcome, 11 were discharged home (42.3%), 14 were transferred to cardiothoracic surgical unit (where two subsequently died) and one died in the hospital. Conclusion The prevalence of aortic dissection may be more common than is generally appreciated by emergency physicians. Owing to its variable clinical presentations mimicking other diseases, the diagnosis of aortic dissection is easily missed. Higher clinical vigilance should be exercised for this potentially deadly condition.

scholarly journals Orbital solitary fibrous tumors: a multi-centered histopathological and immunohistochemical analysis with radiological description

2020 ◽  
Vol 40 (3) ◽  
pp. 227-233
Author(s):  
Hind Manaa Alkatan ◽  
Abrar K. Alsalamah ◽  
Abdulrahman Almizel ◽  
Khalid M. Alshomar ◽  
Azza MY Maktabi ◽  
...  
Keyword(s):  
Sample Size ◽  
Case Series ◽  
Adult Patients ◽  
Histopathological Analysis ◽  
Retrospective Case ◽  
Female Ratio ◽  
Male Predominance ◽  
Tissue Diagnosis ◽  
Solitary Fibrous Tumors ◽  
Rare Tumors

ABSTRACT BACKGROUND: Solitary fibrous tumors (SFT), formerly called hemangiopericytoma, are rare tumors derived from mesenchymal cells originally described in the pleura, but these tumors may affect extraserosal tissues including the lacrimal gland and orbit. OBJECTIVE: Conduct a multi-centered clinical, radiological and histopathological analysis of 17 orbital SFT cases. DESIGN: A retrospective case series. SETTING: Three eye centers in two countries. PATIENTS AND METHODS: The data collected from the charts of 17 adult patients presenting with tissue diagnosis of orbital hemangiopericytoma or SFT from January 2003 to December 2018 included demographics, clinical imaging and histopathological information including immunohistochemical (IHC) characteristics. MAIN OUTCOME MEASURES: The demographic characteristics, clinical presentation, and histopathological patterns or variants of SFT were analyzed. SAMPLE SIZE: 17 adult patients. RESULTS: Mean age was 45 years (range 23-80 years). Male to female ratio was 3:1. The right eye was affected in 12 (70.5%) patients. Commonest presentation was proptosis in 13/17 (76% of patients). Other symptoms were impaired motility (29%) and ptosis (11%). Lesions mostly affected the medial orbit (35%), then orbital apex in 11%. The histopathological classic pattern-less variant was the commonest. One case with aggressive behavior, multiple recurrences and atypical features was encountered. Immunohistochemical (IHC) markers used included CD34 expression in all cases, Bcl-2 expression in 10/11, CD99 in 9/9 and Vimentin in 4/4. STAT6 was used in 2 cases. CONCLUSIONS: SFTs are rare tumors affecting the orbit in both genders equally in their mid-forties, but showed male predominance in our analysis with a predominant classic histopathological pattern. Tissue diagnosis is essential and requires IHC studies for confirmation. LIMITATIONS: Sample size is relatively small owing to the rarity of this tumor in the orbit. CONFLICT OF INTEREST: None.

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