A proposal for a CT driven classification of left colon acute diverticulitis

Background. As the malignant potential of sessile serrated lesions/polyps (SSL/Ps) and traditional serrated adenomas (TSAs) has been clearly demonstrated, it is important that serrated polyps are identified and correctly classified histologically. Aim. Our aim was to characterize the clinicopathological features of a series of SSL/Ps & TSAs, to assess the accuracy of the pathological diagnosis, the incidence, and the rate of dysplasia in SSL/Ps & TSAs. Methods. We identified all colorectal serrated polyps between 01/01/2004 and 31/05/2016, by searching the laboratory information system for all cases assigned a “serrated adenoma” SNOMED code. All available and suitable slides were reviewed by one pathologist, who was blinded to the original diagnosis and the site of the polyp. Subsequently discordant cases, SSL/Ps with dysplasia, and all TSAs were reviewed by a second pathologist. Results. Over a 149-month period, 759 “serrated adenoma” polyps were identified, with 664 (from 523 patients) available for review. 41.1% were reviewed by both pathologists; 15.1% (100/664) were reclassified, with the majority being changed from SSL/P to hyperplastic polyp (HYP) (66/664; 9.9%). 80.3% of these HYPs were located in the left colon, and the majority exhibited prolapse effect. There were 520 SSL/Ps (92.2%) & 40 TSAs (7.1%). The majority of SSL/Ps were in the right colon (86.7%) and were small (64.5% <1 cm), while most TSAs were in the left colon (85.7%) and were large (73.1%≥1 cm). 6.7% of SSL/Ps exhibited dysplasia, the majority of which were large (66.7%≥1 cm). Following consensus review, 13/520 (2.5%) SSL/Ps were downgraded from SSL/P with dysplasia to SSL/P without dysplasia. Detection of SSL/Ps peaked in the most recent years reviewed (87.5% reported between 2013 and 2016, inclusive), coinciding with the introduction of “BowelScreen” (the Irish FIT-based colorectal cancer screening programme). Conclusions. Awareness of, and adherence to, diagnostic criteria is essential for accurate classification of colorectal polyps.

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EP.FRI.1040 Management of Acute Colonic Diverticulitis According to The WSES (World Society of Emergency Surgery) Classification in a Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab312.150 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Lorraine Hickey ◽

Paul Goldsmith

Keyword(s):

Acute Diverticulitis ◽

White Cell Count ◽

Colonic Diverticulitis ◽

C Reactive Protein ◽

Single Centre ◽

Ct Guided ◽

Reactive Protein ◽

Tertiary Centre ◽

Acute Colonic Diverticulitis

Abstract Aims Debate remains regarding management of complicated diverticulitis. The WSES acute diverticulitis working group published in 2015 a CT-guided classification of left colon acute diverticulitis, divided into uncomplicated (Stage 0) and complicated (Stage 1a-4). Using this classification, we reviewed our management of CT-proven acute colonic diverticulitis. Methods A single-centre retrospective review of management of CT-proven acute colonic diverticulitis over 12 months based on the WSES classification. Results 24 males and 31 females presented (median age=56, IQR 45-68). Median white cell count=12 (IQR 10-16) and median C-reactive protein=88 (IQR 41-157). Based on CT, 25 (45.5%) patients =stage 0, 14 (25.5%) =stage 1a, 6 (11%) =stage 1b, 4 (7%) =stage 2a, 6 (11%) =stage 2b, and none staged 3/4. 15% (8/55) patients had an operation, remainder were conservatively managed. 2 patients had laparoscopic washout/drainage (stages 1b and 2b). 6 patients had Hartmanns (x1 stage 1a, x1 stage 1b, x4 stage 2b). Median length of stay=5 days (IQR 4-8). There was 1 related reattendance declining readmission (stage 1a managed conservatively) and 2 readmissions (1 stage 0 managed conservatively, other initially stage 1a managed conservatively but on readmission staged 2b proceeding to Hartmanns). 30-day mortality included 3 deaths (stages 1b/2a/2b all managed conservatively). Conclusions Hartmanns resection is advocated as treatment of choice for complicated acute diverticulitis, particularly for Stage 2b or above.

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Hinchey Classification of Acute Diverticulitis

10.1093/med/9780199384075.003.0048 ◽

2017 ◽

Author(s):

Michael P. Catanzaro ◽

Rachel J. Kwon

Keyword(s):

Evidence Based Medicine ◽

Paradigm Shift ◽

Acute Diverticulitis ◽

Scoring Systems ◽

Historical Study ◽

Evidence Based ◽

Hinchey Classification ◽

History Of ◽

Based Medicine

This chapter provides a summary of a landmark historical study in surgery: the Hinchey classification of acute diverticulitis. It describes the history of the disease, gives a summary of the study including study design and results, and relates the study to a modern-day principle of evidence-based medicine: validation of scoring systems. Hinchey’s classification of diverticulitis has become the most widespread system and while the Hinchey score may currently have less clinical relevance as it did in his time, its publication and eventual adoption marked a practice-changing paradigm shift in the way diverticulitis is viewed and managed today.

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Left colon acute diverticulitis: An update on diagnosis, treatment and prevention

International Journal of Surgery ◽

10.1016/j.ijsu.2014.12.012 ◽

2015 ◽

Vol 13 ◽

pp. 157-164 ◽

Cited By ~ 8

Author(s):

Walter Bugiantella ◽

Fabio Rondelli ◽

Maurizio Longaroni ◽

Enrico Mariani ◽

Alessandro Sanguinetti ◽

...

Keyword(s):

Acute Diverticulitis ◽

Left Colon ◽

Treatment And Prevention

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What radiologists should know about tomographic evaluation of acute diverticulitis of the colon

Radiologia Brasileira ◽

10.1590/0100-3984.2015.0227 ◽

2017 ◽

Vol 50 (2) ◽

pp. 126-131 ◽

Cited By ~ 9

Author(s):

Aline de Araújo Naves ◽

Giuseppe D'Ippolito ◽

Luis Ronan Marquez Ferreira Souza ◽

Sílvia Portela Borges ◽

Glênio Moraes Fernandes

Keyword(s):

Computed Tomography ◽

Intestinal Inflammation ◽

Acute Diverticulitis ◽

Differential Diagnoses ◽

Proper Treatment ◽

Common Indication ◽

Major Complications ◽

Pictorial Essay ◽

Indication For Treatment

Abstract Acute diverticulitis of the colon is a common indication for computed tomography, and its diagnosis and complications are essential to determining the proper treatment and establishing the prognosis. The adaptation of the surgical classification for computed tomography has allowed the extent of intestinal inflammation to be established, the computed tomography findings correlating with the indication for treatment. In addition, computed tomography has proven able to distinguish among the main differential diagnoses of diverticulitis. This pictorial essay aims to present the computed tomography technique, main radiological signs, major complications, and differential diagnoses, as well as to review the classification of acute diverticulitis.

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Note on the spectral classification of carbon stars in the photographic infrared region

Symposium - International Astronomical Union ◽

10.1017/s0074180900053080 ◽

1966 ◽

Vol 24 ◽

pp. 21-23

Author(s):

Y. Fujita

Keyword(s):

Infrared Region ◽

Spectral Classification ◽

Carbon Stars

We have investigated the spectrograms (dispersion: 8Å/mm) in the photographic infrared region fromλ7500 toλ9000 of some carbon stars obtained by the coudé spectrograph of the 74-inch reflector attached to the Okayama Astrophysical Observatory. The names of the stars investigated are listed in Table 1.

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Diagnostic Value of Electron Microscopy in Soft Tissue Tumors

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100068096 ◽

1970 ◽

Vol 28 ◽

pp. 220-221

Author(s):

Gerald Fine ◽

Azorides R. Morales

Keyword(s):

Cardiac Myxoma ◽

Osteogenic Sarcoma ◽

Diagnostic Value ◽

Soft Tissue Tumors ◽

Amelanotic Melanoma ◽

Growth Patterns ◽

Light Microscopic Level ◽

Mesenchymal Tumors ◽

Good Agreement

For years the separation of carcinoma and sarcoma and the subclassification of sarcomas has been based on the appearance of the tumor cells and their microscopic growth pattern and information derived from certain histochemical and special stains. Although this method of study has produced good agreement among pathologists in the separation of carcinoma from sarcoma, it has given less uniform results in the subclassification of sarcomas. There remain examples of neoplasms of different histogenesis, the classification of which is questionable because of similar cytologic and growth patterns at the light microscopic level; i.e. amelanotic melanoma versus carcinoma and occasionally sarcoma, sarcomas with an epithelial pattern of growth simulating carcinoma, histologically similar mesenchymal tumors of different histogenesis (histiocytoma versus rhabdomyosarcoma, lytic osteogenic sarcoma versus rhabdomyosarcoma), and myxomatous mesenchymal tumors of diverse histogenesis (myxoid rhabdo and liposarcomas, cardiac myxoma, myxoid neurofibroma, etc.)

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Ultrastructure of mesotheliomas

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100110775 ◽

1984 ◽

Vol 42 ◽

pp. 98-101

Author(s):

Irving Dardick

Keyword(s):

Electron Microscopy ◽

Latent Period ◽

Spindle Cell ◽

Spindle Cell Sarcoma ◽

Metastatic Adenocarcinoma ◽

Cell Sarcoma ◽

Cytological Features ◽

Industrial Use ◽

Degree Of Differentiation

With the extensive industrial use of asbestos in this century and the long latent period (20-50 years) between exposure and tumor presentation, the incidence of malignant mesothelioma is now increasing. Thus, surgical pathologists are more frequently faced with the dilemma of differentiating mesothelioma from metastatic adenocarcinoma and spindle-cell sarcoma involving serosal surfaces. Electron microscopy is amodality useful in clarifying this problem.In utilizing ultrastructural features in the diagnosis of mesothelioma, it is essential to appreciate that the classification of this tumor reflects a variety of morphologic forms of differing biologic behavior (Table 1). Furthermore, with the variable histology and degree of differentiation in mesotheliomas it might be expected that the ultrastructure of such tumors also reflects a range of cytological features. Such is the case.

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Interpreting HVEM of muscle-cell impulse networks

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010012103x ◽

1992 ◽

Vol 50 (1) ◽

pp. 126-127

Author(s):

Paul DeCosta ◽

Kyugon Cho ◽

Stephen Shemlon ◽

Heesung Jun ◽

Stanley M. Dunn

Keyword(s):

Structural Analysis ◽

Muscle Cell ◽

Electron Micrographs ◽

Relative Size ◽

Automatic Classification ◽

Nerve Fibers ◽

Analysis Algorithm ◽

Structural Networks

Introduction: The analysis and interpretation of electron micrographs of cells and tissues, often requires the accurate extraction of structural networks, which either provide immediate 2D or 3D information, or from which the desired information can be inferred. The images of these structures contain lines and/or curves whose orientation, lengths, and intersections characterize the overall network.Some examples exist of studies that have been done in the analysis of networks of natural structures. In, Sebok and Roemer determine the complexity of nerve structures in an EM formed slide. Here the number of nodes that exist in the image describes how dense nerve fibers are in a particular region of the skin. Hildith proposes a network structural analysis algorithm for the automatic classification of chromosome spreads (type, relative size and orientation).

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