scholarly journals New Kids on the Block: A Review of the Latest Iatrogenic Foreign Materials Seen in Gastrointestinal Specimens

2021 ◽  
Author(s):  
Dipti M. Karamchandani ◽  
Hazed Hammad ◽  
Runjan Chetty ◽  
Christina A. Arnold
Keyword(s):  
Clinical History ◽  
Novel Agents ◽  
Correct Identification ◽  
Sodium Polystyrene Sulfonate ◽  
Diagnostic Dilemma ◽  
Bile Acid Sequestrants ◽  
Clinical Scenarios ◽  
Foreign Materials ◽  
Published Research ◽  
Histopathologic Findings

Context.— With the increasing development and use of iatrogenic agents, pathologists are encountering more novel foreign materials in retrieved gastrointestinal specimens. These colorful and unusual-appearing foreign materials can pose a diagnostic dilemma to those unaware of their morphology, especially if the relevant clinical history is lacking. Objective.— To discuss the histopathologic features, clinical scenarios and significance, and differential diagnosis of relatively recently described, yet quickly expanding, family of iatrogenic agents that can present as foreign materials in gastrointestinal specimens—pharmaceutical fillers (crospovidone and microcrystalline cellulose), submucosal lifting agents (Eleview and ORISE), lanthanum carbonate, hydrophilic polymers, OsmoPrep, yttrium 90 microspheres (SIR-Sphere and TheraSphere), and resins (sodium polystyrene sulfonate, sevelamer, and bile acid sequestrants). Data sources.— We collate the findings of published literature, including recently published research papers and authors' personal experiences from clinical sign-out and consult cases. Conclusions.— Correct identification of these iatrogenic agents is important because the presence of some novel agents can explain the histopathologic findings seen in the background specimen, and specific novel agents can serve as diagnostic clues to prompt the pathologist to consider other important and related diagnoses. Awareness of even biologically inert agents is important for accurate diagnosis and to avoid unnecessary and expensive diagnostic studies.

The Italian External Quality Assessment (EQA) program on urinary sediment by microscopy examination: a 20 years journey

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Sandra Secchiero ◽  
Giovanni B. Fogazzi ◽  
Fabio Manoni ◽  
MariaGrazia Epifani ◽  
Mario Plebani
Keyword(s):  
Quality Assessment ◽  
External Quality Assessment ◽  
Clinical History ◽  
Correct Identification ◽  
Acute Glomerulonephritis ◽  
External Quality ◽  
Urinary Sediment ◽  
Clinical Associations ◽  
Microscopy Examination ◽  
Clinical Cases

AbstractObjectivesIn spite of the introduction of automated systems for urinary sediment analysis, microscopy examination remains the gold standard, and it is more than ever important to perform it with a good and reliable quality. External Quality Assessment (EQA) programs on urinary sediment are rare. The present paper provides an analysis of results from 2001 to date of the EQA Italian program which involves today 230 laboratories.MethodsThe program includes four surveys per year. Participants are asked the identification and clinical associations of urinary sediment particles, shown as phase contrast microscopy images in the website of the Center of Biomedical Research (CRB) (2 surveys), and the diagnosis of clinical cases presented by both images and a short clinical history (2 surveys). The results of each survey are then scored and commented. In 20 years, 298 images were presented: 90 cells (9 types), 23 lipids (5 types), 87 casts (21 types), 53 crystals (14 types), 22 microorganisms (5 types), and 23 contaminants (9 types). Moreover, 27 clinical cases, covering a wide spectrum of conditions with different degrees of complexity, were presented to participants.ResultsIdentification: among urinary particle categories, the correct identification rate (obtained for each particle from the sum of correct + partially correct answers) was very high for micro-organisms (mean ± SD: 96.2 ± 3.5%), high for lipids (88.0 ± 11.8%) and crystals (87.0 ± 16.5%) followed, in decreasing order, by cells (82.1 ± 15.9%), casts (81.8 ± 14.8%), and contaminants (76.7 ± 22.1%). Clinical associations (n=67): the rate of correct answers was 93.5 ± 5.7% ranging from 75.0 to 100% for all but one clinical association (i.e., acute glomerulonephritis: 55.4%). Clinical cases: throughout surveys, due to the overall rate of particle misidentification, only 59.8 ± 17.1%, (range 32.5–88.7%) of participants achieved access to clinical diagnosis. Of these, 88.7 ± 10.6% (range 59.9–99.3%) were able to indicate the correct diagnosis.ConclusionsOur program can be used as a tool to improve the identification of urine particles and the knowledge of their clinical meaning and to encourage specialists of laboratory medicine to correlate urinary findings with other laboratory data and the clinical history, an aspect that improves the value of the day by day work.

scholarly journals Pneumatosis Intestinalis: A Case Report and Approach to Management

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Sean Donovan ◽  
Joseph Cernigliaro ◽  
Nancy Dawson
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Bowel Wall ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Pneumatosis Intestinalis ◽  
Rapid Evaluation ◽  
Thought Process ◽  
Diagnostic Dilemma ◽  
Clinical Scenarios

Pneumatosis intestinalis (PI), defined as gas within the bowel wall, is an uncommon radiographic sign which can represent a wide spectrum of diseases and a variety of underlying diagnoses. Because its etiology can vary greatly, management of PI ranges from surgical intervention to outpatient observation (see, Greenstein et al. (2007), Morris et al. (2008), and Peter et al. (2003)). Since PI is infrequently encountered, clinicians may be unfamiliar with its diagnosis and management; this unfamiliarity, combined with the potential necessity for urgent intervention, may place the clinician confronted with PI in a precarious medical scenario. We present a case of pneumatosis intestinalis in a patient who posed a particularly challenging diagnostic dilemma for the primary team. Furthermore, we explore the differential diagnosis prior to revealing the intervention offered to our patient; our concise yet inclusive differential and thought process for rapid evaluation may be of benefit to clinicians presented with similar clinical scenarios.

scholarly journals Petroleum jelly-induced penile paraffinoma with inguinal

2013 ◽  
Vol 6 (4) ◽  
pp. 137 ◽  
Author(s):  
István Sejben ◽  
András Rácz ◽  
Mihály Svébis ◽  
Márta Patyi ◽  
Gábor Cserni
Keyword(s):  
Inguinal Hernia ◽  
Histopathological Examination ◽  
Granulomatous Inflammation ◽  
Mineral Oil ◽  
Petroleum Jelly ◽  
Diagnostic Dilemma ◽  
Incarcerated Inguinal Hernia ◽  
Patient’S History ◽  
Histopathologic Findings ◽  
Clinical Characteristic

Chronic granulomatous inflammation may develop after injectingforeign oily substances into the penis. The disorder affects mainlythe site of administration, but regional lymphadenopathy or evensystemic disease can occur. We present a 39-year-old man withpetroleum jelly-induced penile lesion and unilateral inguinal lymphadenitis mimicking incarcerated inguinal hernia. At hernioplasty no hernial sac was found, but enlarged lymph nodes suspicious for malignancy were identified. The histopathologic findings of these nodes were consistent with mineral oil granuloma. Paraffinoma of the male genitalia can cause various clinical features posing a differential diagnostic dilemma. Regional lymphadenitis may be the main clinical characteristic. Patient’s history, physical and histopathological examination are required to establish the diagnosis.

scholarly journals Expert consensus on management of dermatophytosis in elderly patients, patients with comorbidities, and immunocompromised status: an Indian perspective

2020 ◽  
Vol 7 (1) ◽  
pp. 141
Author(s):  
Jayakar Thomas ◽  
Anchala Parthasaradhi ◽  
A. K. Bajaj ◽  
Mukesh Girdhar ◽  
Asok Ghoshal ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Treatment Plan ◽  
Sequential Therapy ◽  
Clinical History ◽  
Antifungal Drugs ◽  
Special Populations ◽  
Comorbid Conditions ◽  
Specific Patient ◽  
Regular Treatment ◽  
Clinical Scenarios

<p class="abstract">Dermatophytosis is a common fungal infection of skin contributing to increasing disease burden worldwide. Increasing age, presence of comorbid conditions and immunity have a profound impact on the manifestation of dermatophyte infections. Treatment of dermatophytosis includes monotherapy, combination therapy, or sequential therapy of antifungal drugs. However, specific patient populations such as the elderly, people with comorbid conditions, immunocompromised patients, etc. are subjected to inappropriate adverse events due to highly interacting host and drug factors. Thus, the management of dermatophytosis in special populations is a challenge, and it demands a change in the regular treatment plan. A group of Indian experts reviewed the evidence available on different antifungal agents for the management of dermatophytosis and provided their expert opinion on safe and effective management of the condition in special clinical scenarios. This article summarizes the consensus clinical viewpoint of the entire expert panel for a choice of the antifungal drug, factors to be assessed, and treatment considerations in special populations with dermatophytosis. The panel emphasized that complete knowledge of patient's clinical history, presence of comorbid conditions, and pharmacokinetic and pharmacodynamic characteristics of antifungal agents and associated potential drug interactions are essential for the successful management of dermatophytosis in these patients. Also, regular monitoring of drug toxicity is important during antifungal therapy in special population.</p>

scholarly journals Brain and spine melanotic schwannoma: A rare occurrence and diagnostic dilemma

2019 ◽  
Vol 32 (5) ◽  
pp. 335-343
Author(s):  
Ali Alamer ◽  
Donatella Tampieri
Keyword(s):  
Brain Lesion ◽  
Clinical History ◽  
Diagnostic Dilemma ◽  
Melanotic Schwannoma ◽  
Post Surgery ◽  
Imaging Characteristics ◽  
Mri Features ◽  
Operative Notes ◽  
The Brain

Purpose Melanotic schwannoma (MS) was formerly known as a rare variant of schwannoma. The behavior of MS is unpredictable, with a tendency for recurrence and metastasis. The purpose of this study was to illustrate the imaging characteristics of these rare and misdiagnosed tumors. The prognosis of MS is discussed, along with the importance of follow-up exams to assess for recurrence and metastasis. Furthermore, we compare our results with those previously published on MS in order to have a better understanding of this rare entity. Methods Three MS cases were encountered between 2008 and 2015 at our institute. All available data were reviewed, including the clinical history, imaging findings, operative notes, and the histopathology results. A follow-up magnetic resonance imaging (MRI) scan was also reviewed up to 23 months post surgery to assess for recurrence. Results Three cases of MS are included: one in the brain and two in the spine. The brain lesion was in the occipital region. The spine lesions were thoracic intramedullary and sacral intradural. All cases were hypointense on T2-weighted imaging. Gross total resection was achieved for all lesions without adjuvant therapy. To date, the brain lesion recurred 15 months after surgery. Conclusions MS is a rare and distinct entity rather than a variant of schwannoma, and it poses both diagnostic and management dilemmas. Although MS has characteristic MRI features, including T1 and T2 shortening, the preoperative diagnosis is always challenging. Accurate diagnosis is crucial for management planning, including long-term follow-up exams to assess for recurrence and metastasis.

Necrotizing Sialometaplasia: A Practical Approach to the Diagnosis

2009 ◽  
Vol 133 (5) ◽  
pp. 692-698 ◽  
Author(s):  
Diane L. Carlson
Keyword(s):  
Malignant Neoplasm ◽  
Clinical History ◽  
Myoepithelial Cells ◽  
Invasive Squamous Cell Carcinoma ◽  
Minor Salivary Glands ◽  
Diagnostic Dilemma ◽  
Ki 67 ◽  
Necrotizing Sialometaplasia ◽  
Hematoxylin Eosin ◽  
Diagnostic Pitfalls

Abstract Context.—Necrotizing sialometaplasia is a benign, self-limited lesion of both major and minor salivary glands, although more commonly the latter. It can represent a diagnostic dilemma and may be mistaken for a malignant neoplasm, such as mucoepidermoid carcinoma, as well as invasive squamous cell carcinoma. A major causal relationship has been ascribed to ischemia. Bulimia, an eating disorder with increasing prevalence in our society, may also be an underlying underreported cause. Objective.—To discuss the potential pathogenesis, diagnostic pitfalls, and the application of immunohistochemistry as an aid in the diagnosis of necrotizing sialometaplasia. Data Sources.—This report uses a previously published case history for illustrative purposes and a review of the current literature. Conclusions.—The diagnosis of necrotizing sialometaplasia may be difficult and is reliant upon a well-oriented biopsy section and a complete clinical history. Diagnosis may be further supplemented via immunohistochemistry, demonstrating focal to absent immunoreactivity for p53, low immunoreactivity for MIB1 (Ki-67), and the presence of 4A4/p63- and calponin-positive myoepithelial cells. Interpreted in context collectively, these findings may be helpful adjuncts in the diagnosis of necrotizing sialometaplasia; nonetheless, to date, hematoxylin-eosin staining remains the gold standard.

Secondary Malignancies of the Bladder: Avoiding the Diagnostic Pitfall

2017 ◽  
Vol 26 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Alexander Feldman ◽  
Samuel Borak ◽  
Soroush Rais-Bahrami ◽  
Jennifer Gordetsky
Keyword(s):  
Metastatic Tumor ◽  
Clinical History ◽  
Prior History ◽  
Bladder Tumors ◽  
Diagnostic Dilemma ◽  
Secondary Tumors ◽  
Diagnostic Pitfall ◽  
Imaging Characteristics ◽  
History Of ◽  
Primary Bladder

Although rare, secondary tumors of the bladder can present a diagnostic dilemma to pathologists considering a differential diagnosis of primary bladder cancer. We investigated the clinicopathologic and imaging characteristics of metastatic tumors to the bladder. We retrospectively reviewed the surgical pathology databases from 2 sites from 2013 to 2016, identifying 66 cases of secondary bladder tumors. Clinical, pathologic, and imaging findings were reviewed. Mean age at diagnosis was 63 years (range = 25-87). Females had a significantly higher proportion (44/66, 66.7%) of secondary bladder tumors compared with males (22/66, 33.3%; P = .007). In total, 56/66 (84.8%) patients had a clinical history of an in situ or invasive malignancy in another organ, and 54/66 (81.8%) patients had imaging supporting a metastatic tumor. Only 2/66 (3.0%) patients had a prior history of urothelial carcinoma. In total, 4/66 (6.1%) cases (all females) were originally misdiagnosed as primary bladder malignancies and were corrected after clinicoradiologic correlation. Overall, colorectal origin was most common (15/66, 22.7%), followed by cervical and ovarian primaries (10/66, 15.2% each). Cervical and ovarian origins predominated in the female cohort (10/44, 22.7% each), followed by endometrial (8/44, 18.2%). Colorectal and prostate primaries were the most common among males (10/22, 45.5%, and 7/22, 31.8%, respectively). Secondary bladder tumors can mimic urothelial carcinomas. In our cohort, gynecological, colorectal, and prostatic origins were most common. Clinical history, imaging, and immunohistochemical studies can be useful in avoiding this diagnostic pitfall.

Primary Ewing's Sarcoma of the Mandibular Ramus: A Case Report

1980 ◽  
Vol 88 (3) ◽  
pp. 211-214 ◽  
Author(s):  
Diran O. Mikaelian ◽  
Stuart A. Scherr ◽  
Leopoldo E. Delucca
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Mandibular Ramus ◽  
Diagnostic Dilemma ◽  
Rare Finding ◽  
Diagnosis And Prognosis ◽  
Histopathologic Findings ◽  
Microscopic Findings

Primary Ewing's sarcoma of the mandible is an exceedingly rare finding in the practice of otolaryngology. A case of this neoplasm occurring as a parotid mass is presented. It represented a diagnostic dilemma because of its elusive histopathologic findings. The gross and clinical appearances, microscopic findings, differential diagnosis, and prognosis of this neoplasm are discussed.

scholarly journals A study of clinicopathologic spectrum of vesicobullous disorders

2017 ◽  
Vol 3 (3) ◽  
pp. 355
Author(s):  
Heena Mittal ◽  
Sukhjot Kaur ◽  
Bhavna Garg ◽  
Neena Sood ◽  
Sunil Kumar Gupta ◽  
...  
Keyword(s):  
Pemphigus Vulgaris ◽  
Clinical History ◽  
Final Diagnosis ◽  
Stevens Johnson Syndrome ◽  
Direct Immunofluorescence ◽  
Diagnostic Dilemma ◽  
Dermoepidermal Junction ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Detailed Clinical History

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Blistering diseases are alarming skin conditions. Autoimmune blistering diseases are a group of bullous disorders characterized by pathogenic antibodies directed at the target antigens in the epidermis or dermoepidermal junction.</span><span lang="EN-IN">The objectives were to study the spectrum of histopathological changes by light microscopy, to evaluate the pattern of direct immunofluorescence (DIF) and to correlate clinical, histopathological features and DIF findings of vesiculobullous lesions of the skin or/and mucosa.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The present study was carried out on 110 skin and/or mucosal biopsies with vesicobullous disorders from July 2013 to June 2016. Detailed clinical history, morphology of lesions, site of involvement and other findings were recorded as per proforma.<strong> </strong>These cases were analysed clinically, histopathologically and on immunofluorescence</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of the patients presented in the age group of 41-50 years (30.9%). The male: female ratio was 1:1.15. Pemphigus vulgaris was the most common vesiculobullous disorder constituting 48.2%, followed by Bullous Pemphigoid constituting 27.3%. Dermatitis herpetiformis constituted 8.3%; Pemphigus foliaceous 3.6%, varicella and Stevens Johnson Syndrome both were observed in 2.7% each. DIF was performed in 81 cases out of which only 72 cases (92.6%) showed positivity. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">DIF is a sensitive tool for distinguishing immune mediated bullous diseases from other vesiculobullous disorders especially in cases which pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on correlation of clinical, histopathological and immunoflourescence findings.</span></p><p class="abstract"> </p>

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