Lung biopsy with guillotine cutting needle and biopsy forceps though transdiaphragmatic thoracoscopy in dogs with pulmonary alterations

ABSTRACT: Lung diseases are common in small animal clinical routine. Diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides a precise diagnosis. Thus thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared with thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy with a the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of Universidade Federal do Rio Grande do Sul (UFRGS), were assessed. Inclusion criteria were presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of FAVET/UFRGS. Surgical time was recorded from first incision to wound closure and surgical complications were reported. The dogs were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedure in any patient. Thoracoscopic assisted biopsy using guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.

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Unusual Imaging Features of Dentigerous Cyst: A Case Report

Dentistry Journal ◽

10.3390/dj7030076 ◽

2019 ◽

Vol 7 (3) ◽

pp. 76 ◽

Cited By ~ 1

Author(s):

Carla Patrícia Martinelli-Kläy ◽

Celso Ricardo Martinelli ◽

Celso Martinelli ◽

Henrique Roberto Macedo ◽

Tommaso Lombardi

Keyword(s):

Attenuation Coefficient ◽

Panoramic Radiography ◽

Histopathological Examination ◽

Dentigerous Cyst ◽

Radiographic Feature ◽

Histopathological Analysis ◽

Imaging Features ◽

Impacted Tooth ◽

Second Molar ◽

Dentigerous Cysts

Dentigerous cysts (DC) are cystic lesions radiographically represented by a well-defined unilocular radiolucent area involving an impacted tooth crown. We present an unusual radiographic feature of dentigerous cyst related to the impacted mandibular right second molar, in a 16-year-old patient, which suggested an ameloblastoma or odontogenic keratocyst (OKC) because of its multilocular appearance seen on the panoramic radiography. A multi-slice computed tomography (MSCT), however, revealed a unilocular lesion without septations, with an attenuation coefficient from 3.9 to 22.9 HU suggesting a cystic lesion. Due to its extension, a marsupialization was performed together with the histopathological analysis of the fragment removed which suggested a dentigerous cyst. Nine months later, the lesion was reduced in size and then totally excised. The impacted mandibular right second molar was also extracted. Histopathological examination confirmed the diagnosis of a dentigerous cyst. One year later, the panoramic radiography showed a complete mandible bone healing. Large dentigerous cysts can sometimes suggest other more aggressive pathologies. Precise diagnosis is important to avoid mistakes since DC, OKC and ameloblastoma require different treatments. Histological examination is, therefore, essential to establish a definitive diagnosis. In our case, MSCT and the tissue attenuation coefficient analysis contributed to guide the diagnosis and management of the dentigerous cyst.

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Histomorphological spectrum of Leiomyoma – a one year retrospective study

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v16i1.37609 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Reetu Sharma Baral ◽

Oshan Shrestha

Keyword(s):

Histopathological Examination ◽

Abdominal Mass ◽

Degenerative Change ◽

Lower Abdominal Pain ◽

College Teaching ◽

The Body ◽

Histopathological Analysis ◽

Pathology Laboratory ◽

Gynecology And Obstetrics ◽

One Year

Aims: To analyze the histomorphology of leiomyoma in specimens received in Pathology. Methods: This is a retrospective descriptive study of histopathology database of histomorphologic spectrum of leiomyoma at Pathology Laboratory of Nobel Medical College Teaching Hospital, Biratnagar, Nepal from April 2020 to April 2021. Data for the leiomyoma were analyzed descriptively. Ethical approval was obtained from the Institutional review committee. Results: A total of 1705 histopathology specimens were received in one year from April 2020 to April 2021 out of which 620 (37%) were from the Department of Gynecology and Obstetrics for histopathological analysis of various specimens. Total of 106 specimens of hysterectomy and myomectomy were included. Maximum number of leiomyoma was seen in the body 48 (45%) followed by fundus 34 (32%) and one from the lateral wall of the vagina 1 (0.9%). Mean age was 42 (24-70) years. Maximum size was 35 cm and minimum was 0.5 cm in diameter. Out of the rare ones one case of STUMP, Lipoleiomyoma and Mitotically active leiomyoma each were seen. Degenerative change was in 40 cases with hyaline type as the commonest one (33%); 61% were intramural; and 12% were multiple. Presentation was lower abdominal pain and abnormal uterine bleeding in 39.6%. Conclusions: Cases of leiomyoma may present with abdominal mass, pain and bleeding but the degenerative changes and malignant transformation can't be identified without histopathological examination.

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A Case of Incidentally Detected Bladder Lipoma and a Review of the Literature

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666210712122127 ◽

2021 ◽

Vol 17 ◽

Author(s):

Emre Emekli ◽

Elif Gündoğdu

Keyword(s):

Histopathological Examination ◽

Adrenal Adenoma ◽

Bladder Wall ◽

Benign Tumors ◽

Imaging Features ◽

Multiplanar Reconstructions ◽

Clinical Presentations ◽

Pelvic Lipomatosis ◽

One Year

Background: Lipomas are benign fatty tumors made of fat tissue. Bladder lipomas are extremely rare. For this reason, it is necessary to be aware of the imaging features when incidentally detected in imaging. Case Report: In the abdominal computed tomography (CT) performed as part of the follow-up examination of a 43-year-old patient, who had undergone surgery for adrenal adenoma five years earlier, a 14x9x8 mm smoothly marginated, ovoid-shaped, hypodense mass lesion with a homogeneous internal structure was detected in the anterior bladder wall. The pre-contrast density of the lesion was measured as -105 HU. The magnetic resonance imaging performed one year after the CT examination revealed a 14x9x8 intramural mass in the bladder wall, showing protrusion toward the lumen. The group was observed to be markedly hypointense on fat-suppressed T1 and T2-weighted images and considered consistent with a bladder lipoma. Discussion: Bladder lipomas are benign lesions that can vary in clinical presentations but usually cause hematuria. The differential diagnosis of bladder lipomas includes other mesenchymal rare benign tumors that can arise from the urinary bladder submucosal layer, including leiomyoma, hemangioma, plasmacytoma, fibroma, and neurofibroma, in imaging bladder lipomas present as homogeneous lesions containing macroscopic fat. Only the liposarcoma and pelvic lipomatosis could also show similar features. The less differentiated liposarcomas tend to present more heterogeneous enhancement, irregular-shaped margins, and infiltrative behavior. Also, appropriate multiplanar reconstructions may allow the radiologist to determine it is an extravesical pelvic lipomatosis. Conclusion: Using CT and MRI, these lesions rich in adipose tissue can be distinguished from other lesions, and their diagnosis can be made to a great extent. However, a histopathological examination is required for a definitive diagnosis.

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Doughnut bother! Histopathological examination of anastomotic doughnuts following colorectal anastomosis does not change patient management

Surgical and Experimental Pathology ◽

10.1186/s42047-019-0054-7 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Steven Dixon ◽

Hannah Barrow ◽

Jane Hughes

Keyword(s):

Patient Management ◽

Residual Disease ◽

Histopathological Examination ◽

Colorectal Anastomosis ◽

Complete Response ◽

Patient Treatment ◽

Histopathological Analysis ◽

Retrospective Case ◽

Female Ratio ◽

Stapling Device

Abstract Introduction The use of a circular stapling device to create an anastomosis following colonic or rectal resection is common practice in the United Kingdom. Histopathological analysis of the anastomotic doughnuts produced takes time and resources, but does it ever change patient management? The aim of this study was to review the examination of doughnuts and whether patient treatment was altered by the findings. Method A retrospective case note review of all cases involving anastomotic doughnuts in a single trust between December 2010 and January 2018, was performed. Results There were 435 cases identified, male to female ratio was 2.0:1, age range 20–86 years and a median age of 66 years. 376 Doughnut samples were received by the pathology department (86.4%) and 354 were examined (81.4%). The disease processes involved were adenocarcinoma (n = 352, 80.9%), diverticular disease (n = 47, 10.8%), no residual disease/complete response (n = 22, 5.1%), adenoma (n = 7, 1.6%), mucinous (n = 5, 1.1%), Crohn’s disease (n = 1, 0.2%) and neuroendocrine (n = 1, 0.2%). Benign adenomatous change was identified in 4 cases (0.9%). No doughnuts examined contained dysplastic or malignant changes. Conclusion The histological examination of anastomotic doughnuts is extremely unlikely to identify malignant change and subsequently does not change patient management. Pathology departments could save time and resources by not routinely examining doughnuts.

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Histology of Mice (Mus Musculus) Liver Tissue Fixed with Carnoy's Solution With Variation of 4 Hours, 8 Hours and 12 Hours

Jaringan Laboratorium Medis ◽

10.31983/jlm.v3i1.7920 ◽

2021 ◽

Vol 3 (1) ◽

pp. 38-43

Author(s):

Arin Dwi Afrida ◽

Djoko Priyatno

Keyword(s):

Mus Musculus ◽

Liver Tissue ◽

Histopathological Examination ◽

Observational Research ◽

Cell Nuclei ◽

Pathology Laboratory ◽

Descriptive Research ◽

Carnoy’S Solution ◽

Time Variations ◽

Examination Process

Histopathological examination is a routine examination process for each tissue in the anatomic pathology laboratory. The stages in making histology preparations are fixation stages. The type of solution that can be used as a fixative solution other than 10% NBF is Carnoy's solution. Carnoy's solution is a fixative solution with a relatively fast fixation process of about 1-4 hours. The advantages of Carnoy's solution can lyse erythrocytes and dissolve lipids, have the ability to maintain cell nuclei, and retain glycogen. The purpose of this study was to determine the histology of the liver tissue preparations of mice (Mus Musculus) which were fixed using Carnoy's solution with time variations of 4 hours, 8 hours, and 12 hours. This is an observational research with descriptive research design criteria. The results of the histology of the liver tissue preparations of mice (Mus Musculus) which were fixed using the 10% NBF solution group obtained 100% good preparations. In the Carnoy solution group with a time of 4 hours, it gave 2.2% results of poor preparations and 97.78% of good preparations. While the treatment group with Carnoy's solution with a time of 8 hours obtained as many as 11.11% of preparations that were not good and 88.89% of good preparations. and in the Carnoy solution group with a time of 12 hours, there were 44.44% of the poor preparations and 55.56% of the good preparations.

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Bullous Pemphigoid in a Dog

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.106575 ◽

2021 ◽

Vol 49 ◽

Author(s):

Suélen Dalegrave ◽

Denner Francisco Tomadon Fiorin ◽

Eduarda Gabriela Mansour ◽

Monica Regina De Matos ◽

Renato Herdina Erdmann ◽

...

Keyword(s):

Bullous Pemphigoid ◽

Plasma Cells ◽

Histopathological Examination ◽

Clinical Signs ◽

Clinical Manifestations ◽

Punch Biopsy ◽

Mucous Membrane Pemphigoid ◽

Histopathological Analysis ◽

Biopsy Material ◽

Clinicopathological Findings

Background: In dogs, bullous pemphigoid (BP) is a subepithelial autoimmune disease, a rare dermatopathy in the clinical routine. BP is characterized by formation of vesicles and subepidermal blisters that result from dissolution of the dermal-epithelial junction. Clinical signs of BP usually include severe dermatological alterations with a variable prognosis. The aim of this work is to report a case of BP in a dog to contribute information for diagnosis, and to present clinical and pathological aspects that emerge during development of BP.Case: An adult male mongrel dog exhibited hyperemic, exudative, crusty lesions on the lip commissure and periocular areas. Results from laboratory tests were normal. Results from parasitological and mycological tests on skin scrapings were negative. Imprint cytology of the crusts revealed presence of gram-positive cocci bacteria. In the histopathological analysis of punch biopsy material, the epidermis was detached from the dermis, leading to formation of vesicles. There were inflammatory infiltrates containing neutrophils, eosinophils, and high amounts of fibrin, and areas of multifocal orthokeratotic hyperkeratosis. Multifocal infiltrates containing lymphocytes, histiocytes, and plasma cells were observed on the superficial portions of the dermis, which indicated a diagnosis of BP. After the definitive clinical diagnosis, the animal was treated with enrofloxacin (Baytril Flavour®; 5 mg/kg once a day for 10 days), and prednisolone (Prediderm®; 2 mg/kg once a day until further instructions). On the follow-up visit, 15 days later, the clinical picture had improved, and the lesions had decreased. Continuity of the treatment was prescribed, along with a gradual decrease in the corticoid dose. The dose of prednisolone was initially reduced to 1 mg/kg once a day, and later to 0.5 mg/kg until improvement of the clinical status of the patient. Remission of the lesions was observed 13 weeks later.Discussion: The diagnosis of BP was established after identification of the clinical cutaneous lesions and observation of microscopic findings on punch biopsy material obtained from the ocular and lip regions. BP does not exhibit breed or sex predisposition, and affects adult dogs. The clinical signs of BP are characteristic of autoimmune diseases that affect the dermoepidermal junction, and consist of erythematous, ulcerated, crusty, and painful lesions on the nose, dorsal area of the muzzle, and periorbital region. However, these lesions must be differentiated, by histological analysis, from several other conditions with a similar clinical presentation. Diseases that must be considered in the differential diagnosis comprise other variants of the pemphigus complex, lupus erythematosus, drug eruption, erythema multiforme, toxic epidermal necrolysis, epitheliotropic lymphoma, inherited bullous epidermolysis, mucous membrane pemphigoid, and lymphoreticular neoplasia. The clinicopathological findings indicated that the lesions were compatible with BP. The occurrence of necrotic and erythematous lesions is due to production of antibodies accompanied by a strong response of neutrophils, which results in loss of cell adhesion and epidermal necrosis. The presence of detachment of the epidermis from the dermis, inflammation in the superficial portion of the dermis, and infiltrates containing lymphocytes, histiocytes and plasma cells observed at the histopathological examination indicated the occurrence of BP. The skin histopathological examination warranted establishment of a diagnosis and therapeutic success. The lack of recurrence of clinical manifestations 43 weeks after the end of the glucocorticoid treatment demonstrated that the therapeutic approach and the cooperation of the owner are essential for success of the treatment.

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Abstract 147: Outcomes of the Stroke Thromboembolism Registry of Imaging and Pathology: A Multicenter International Study

Stroke ◽

10.1161/str.51.suppl_1.147 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Waleed Brinjikji ◽

Sean Fitzgerald ◽

David F Kallmes ◽

Kennith Layton ◽

Ricardo Hanel ◽

...

Keyword(s):

Inverse Correlation ◽

Categorical Variables ◽

Histopathological Analysis ◽

Large Artery ◽

Imaging Features ◽

Continuous Variables ◽

Imaging Findings ◽

Clinical Registry ◽

Stroke Etiology ◽

Platelet Content

Background: We performed a multicenter prospective clinical registry across 11 centers to study the association between histopathological characteristics of retrieved clots and imaging, stroke etiology and clinical outcomes. Materials and Methods: Following IRB approval at the 11 centers, patients were enrolled in the STRIP registry. All retrieved emboli were sent for histopathological analysis with H&E and MSB staining. Demographic variables, comorbidities, stroke etiology, imaging findings and procedural details were collected for each case. We studied the association between clot histopathology and imaging findings, stroke etiology and and revascularization outcomes. Student’s t-test was used for continuous variables and chi-squared testing for categorical variables. Results: To date, 1022 patients have been included. There was a significant correlation between platelet rich clots and the absence of hyperdensity on non-contrast CT [p=0.321, p=0.003) and a significant inverse correlation between the percentage of platelets and mean HU on NCCT (p=-0.243, p=0.025). The proportion of platelet-rich clots (55.0% versus 21.2%, p=0.005) and the percentage of platelet content (22.1% versus 13.9%, p=0.03) was significantly higher in patient with large artery atherosclerosis compared to those with a cardioembolic etiology. There was no correlation between RBC density, WBC density, fibrin density or platelet density and revascularization outcomes with stent-retrievers. However, we have found that with aspiration alone, patients with platelet rich clots are less likely to be fully revascularized (i.e. TICI 2c/3) than non-platelet rich clots (OR=0.36, 95%CI=0.12-0.81, P<.0001). Meanwhile, patients with RBC rich clots are more likely to be completely revascularized with aspiration alone than those with RBC poor clots (OR=2.71, 95%CI=1.25-3.24, P=0.02). Conclusions: Interim analysis of the STRIP registry suggests that the platelet content of a clot may be the most revealing factor in determining a clot’s etiology, imaging features and revascularization outcome. Platelet rich clots are less dense on NCCT, are associated with a large artery atherosclerosis source and are less likely to be completely revascularized with aspiration alone.

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Spectrum of histopathological lesions in the fallopian tubes

Journal of Pathology of Nepal ◽

10.3126/jpn.v3i5.7858 ◽

2013 ◽

Vol 3 (5) ◽

pp. 356-360 ◽

Cited By ~ 1

Author(s):

S Gon ◽

A Basu ◽

B Majumdar ◽

TK Das ◽

M Sengupta ◽

...

Keyword(s):

Genital Tract ◽

Histopathological Examination ◽

Female Genital Tract ◽

Secondary Malignancies ◽

Fallopian Tubes ◽

Serial Sections ◽

Pathology Laboratory ◽

Surgical Specimen ◽

Neoplastic Lesions ◽

Female Genital

Background: Fallopian tubes are common surgical specimen in the pathology laboratory; still there is a lack of data to describe the frequency of various histological fi ndings. The aim and objectives of this study was to describe the various histopathological fi ndings of fallopian tubes. Materials and Methods: Two thousand fi ve hundred and seventy fi ve cases where fallopian tubes were removed either separately or along with other female genital tract organs were studied retrospectively and their histopathological fi ndings documented. Results: Ectopic pregnancy comprised maximum number of cases closely followed by salpingitis. Primary neoplastic lesions were rare as compared to secondary malignancies. Serial sections of fallopian tube and sections from representative areas are essential for a pathologist so that the diagnosis of these pathological entities is not missed. Conclusion: Though the fallopian tubes remain unremarkable in majority of the surgical pathological specimens, it must be subjected for histopathological examination to demonstrate the pathological lesions. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 356-360 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7858

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Abdominal hysterectomy: analysis of clinico-histopathological correlation in Western Rajasthan, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170575 ◽

2017 ◽

Vol 6 (3) ◽

pp. 1012

Author(s):

Dinesh Pal Yadav ◽

Ramgopal Yadav ◽

Indra Bhati

Keyword(s):

Clinical Diagnosis ◽

Histopathological Examination ◽

Abdominal Hysterectomy ◽

Major Surgery ◽

Clinical Impression ◽

Histopathological Analysis ◽

Age Group ◽

Histopathological Correlation ◽

Wide Range ◽

Gynecological Diseases

Background: Hysterectomy is the most common gynecological surgery done in the females worldwide as it provides definitive cure to a wide range of gynecological diseases, both benign and malignant. The indications to perform this major surgery should always be justified and the pathology should be proved histopathologically. Histopathological analysis and review is mandatory to evaluate the appropriateness of the hysterectomy.Methods: A retrospective, longitudinal study was conducted in the Department of Obstetrics and Gynecology, UMAID Hospital, Dr. S.N. M.C. Jodhpur (Raj.) during October 2014 to March 2015.Total 105 cases were studied during this period. The study included all women undergoing planned abdominal hysterectomy. Data was recorded on proformas, including demographic characteristics and clinical features. Hysterectomy specimens were saved in 10% formalin and sent to the Department of Pathology. Histopathology reports were analyzed and compared with the indications of surgery to draw various informative conclusions.Results: Of 105 cases, 55(52.38%) were in the age group of 41 – 50, which comprised the commonest age group undergoing the surgery. Maximum women (95%) those underwent hysterectomy were multiparous. Most common preoperatively clinical diagnosis was leiomyoma uterus which was diagnosed clinically and sonographically in 51(48.57%) cases. On Histopathological examination, the commonest pathology, similar to clinical impression, was found to be Leiomyoma at 50.48% (n = 53). Adenomyosis (21.90%) was detected as Second most common pathology. Histopathological confirmation of pre-operative diagnosis was 89% for malignancy, 96% for fibroids, 100% for adenomyosis, 100% for pelvic inflammatory disease.Conclusions: There was a high correlation when the clinical diagnosis was a fibroid, adenomyosis and ovarian mass. Every hysterectomy specimen should be subjected to histopathological examination because it is mandatory for conforming diagnosis and ensuring optimal management, in particular of malignant disease.

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Eosinophilic Granulomatosis with Polyangiitis: Diagnostic Dilemmas

Internal Medicine ◽

10.2478/inmed-2018-0007 ◽

2018 ◽

Vol 15 (1) ◽

pp. 63-68

Author(s):

Delia Tulbă ◽

Răzvan Adrian Ionescu ◽

Daniela Gologanu ◽

Marius Ioan Balea ◽

Simona Caraiola

Keyword(s):

Granulomatosis With Polyangiitis ◽

Histopathological Examination ◽

Systemic Vasculitis ◽

Transbronchial Biopsy ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Imaging Features ◽

Necrotizing Vasculitis ◽

Tissue Eosinophilia ◽

Lung Abnormalities ◽

Eosinophilic Granulomatosis

AbstractIntroduction. Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome, is a systemic vasculitis of the small vessels that often associates asthma and blood/tissue eosinophilia.Case presentation. A 58-year-old woman was admitted to our hospital for progressive exertional dyspnea. She had been diagnosed with asthma three years earlier. Recent multiple thoracic computed tomography scans displayed non-fixed interstitial lung abnormalities, whereas the infectious workup (HIV, parasites) was negative.On admission, the clinical examination noted prolonged expiratory phase. Paraclinical tests revealed biological inflammatory syndrome, eosinophilia, polyclonal hypergammaglobulinemia, elevated total IgE level, negative anti-neutrophil cytoplasmic antibodies and proteinuria of nephritic pattern.The pulmonary evaluation reconfirmed the obstructive ventilatory dysfunction and interstitial lung abnormalities - interlobular septal thickening and diffuse ground-glass opacification. The histopathological examination of a transbronchial biopsy specimen identified leukocytoclastic necrotizing vasculitis and tissue eosinophilia.Provided the clinical and paraclinical setting, specifically the asthma, blood and extravascular eosinophilia, paranasal sinus abnormalities, non-fixed pulmonary infiltrates and the histopathologically confirmed necrotizing vasculitis, the diagnosis of EGPA seemed appropriate.Conclusion. In the absence of diagnostic criteria, EGPA diagnosis is often challenging. Although certain clinical and imaging features could assist the diagnosis, biopsy remains the diagnostic gold standard.In the setting of lung involvement, open lung biopsy is usually required for EGPA histopathological proof, but few cases diagnosed by transbronchial biopsy have been reported. This method often identifies discrete, nonspecific lesions or an incomplete spectrum of pathognomonic abnormalities but has the advantage of minimal invasivity that justifies its use as an alternative diagnostic technique.

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