An Immuno-Histochemical Assessment of Ki67, P53 Over-Expression in Helicobacter Pylori Positive Gastritis.

Background and Objective: Helicobacter pylori infection of the stomach is a common disease and the resulting changes from it are numerous and deserve to be in the focus of researchers' attention. The aim of this study is to assess the expression of mutant P53 protein and Ki-67 markers in patients with gastritis secondary to Helicobacter pylori.Methods: Thirty samples with positive Helicobacter pylori gastritis were included in a retrospective study in Mosul / Iraq. The histological parameters were assessed using the Sydney system, then the expression of Ki67 and P53 expression were studied by immunohistochemical methods. The significance level was appointed at (0.05).Results: Ki67 and P53 expression were found in 83.3% of the total cases. The study results show that 92% of positive Ki67, P53 cases had chronic inflammatory cell infiltration, polymorph nuclear cells infiltration, and atrophy. Whereas 96% of positive Ki67 cases had no metaplasia, 92% of the positive P53 cases had no metaplasia. The results also showed that only 16% of the positive Ki67 cases had dysplastic changes, and 24 % of the positive cases of P53 cases were showed dysplasia. moreover, whenever P53 was negative; there is neither metaplasia nor dysplasia in the tissue, this does not apply to Ki67 negative cases.Conclusions: Ki67, P53 expressions increase with chronicity of Helicobacter pylori-positive gastritis, P53 expression is amplified when atrophy is present in these samples

Evaluation of chronic gastritis with Helicobacter pylori using updated Sydney system

Background: Helicobacter pylori has been established as a major etiological factor in the pathogenesis of chronic gastritis. The aim of the study was to interpret the histopathological changes in chronic gastritis using updated Sydney system and the association with H. pylori infection.Methods: This was a 3 years study in which 62 gastric endoscopic mucosal biopsies taken from patients presenting with dyspepsia were included. Slides were stained with routine H and E and Giemsa for H. pylori detection in chronic gastritis cases. Grading of the variables were done with reference to Sydney system of classification.Results: Out of 62 gastric biopsy specimens, 55 cases (88.7%) were histopathological diagnosed as chronic gastritis. Among chronic gastritis, 21 (38%) cases showed H. pylori and majority of these being moderately (2+) positive. 27 (49%) cases showed neutrophilic activity with most of them showed mild (1+) activity. Chronic inflammation was seen 52 (94.5%) with majority of these graded as moderate (2+). Intestinal metaplasia was seen in 8 (14.5%) of cases with majority being mild (1+). Atrophy was seen only in 3 (5.4%) of cases with majority being mild (1+). Significant statistical association was found between H. pylori and neutrophilic activity (p<0.001).Conclusions: Histological evaluation of chronic gastritis using updated Sydney system of classification helps in detection of H. pylori infection and prevents further progression of the disease.

Ultrasound-Guided Fine-Needle Aspiration of Superficial Lymphadenopathy Performed by Interventional Pathologists: The Applicability of the Sydney System from 2 Years of Experience and 363 Cases

<b><i>Introduction:</i></b> The Sydney system proposal for the study and reporting of lymphadenopathy by fine-needle aspiration (FNA) constitutes one of the first attempts to standardize this procedure. Here, we review its applicability. <b><i>Materials and Methods:</i></b> A retrospective study in which all ultrasound-guided FNAs (USFNAs) of superficial lymphadenopathy (palpable or not) performed by interventional pathologists in 2 specialized hospital centers were quantified over 2 years. The procedure was systematized, and the diagnoses were reclassified according to the Sydney system categories. <b><i>Results:</i></b> We analyzed 363 USFNAs of lymphadenopathies. The distribution of cases by categories was as follows: insufficient (<i>n</i> = 13; 3.58%), benign (<i>n</i> = 208; 57.30%), atypia of uncertain significance (<i>n</i> = 7; 1.93%), suspicious (<i>n</i> = 21; 5.79), and malignant (<i>n</i> = 114; 31.40%). The risks of malignancy calculated for categories I, II, III, IV, and V were 27%, 3%, 50%, 100%, and 100%, respectively. <b><i>Conclusion:</i></b> The implementation of the Sydney system allows the systematization and standardization of the lymph node FNA methodology, with increased efficacy and efficiency. Assimilating the recommendations enables the qualification of the diagnostic procedure.

A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System

Fine-needle cytology (FNC) is a useful diagnostic tool in the first line evaluation of lymphadenopathy of unknown aetiology. Nevertheless, considering the large number of conditions presenting as lymphadenopathy, lymph node cytology represents a challenging scenario. Recently, an expert panel published the proposal of the Sydney system for performing classification and reporting of lymph node cytopathology; the aim of the present study was to evaluate the applicability of this system. Thus, 300 lymph node FNCs performed over 1 year were reviewed and categorized according to the Sydney system classification. Overall, n = 20 cases (6.7%) were categorized as L1-inadequate/non-diagnostic; n = 104 (34.7%) as benign (L2); n = 25 (8.3%) as atypical (L3); n = 13 (4.3%) as suspicious (L4), and n = 138 (46%) as malignant (L5). FNC diagnoses were correlated with histopathologic and clinical follow-up to assess the diagnostic accuracy and the risk of malignancy (ROM) for each diagnostic category. Statistical analysis showed the following results: sensitivity 98.47%, specificity 95.33%, positive predictive value 96.27%, negative predictive value 98.08%, and accuracy 97.06%. The ROM was 50% for the category L1, 1.92% for L2, 58.3% for L3, and 100% for L4 and L5. In conclusion, FNC coupled with ancillary techniques ensures satisfactory diagnostic accuracy and the implementation of the Sydney system may improve the practice of cytopathologists.

Clue of Diagnosis for Autoimmune Gastritis

<b><i>Background:</i></b> The diagnostic clues for autoimmune gastritis (AIG) can be classified into 2 categories: endoscopic findings and pathological diagnosis. We believe that research on the AIG detection rate by endoscopists could provide a better understanding of the diagnosis of AIG. This study aimed to clarify the ratio of the endoscopic and the pathological diagnoses of AIG. <b><i>Methods:</i></b> We retrospectively reviewed consecutive patients who underwent esophagogastroduodenoscopy (EGD). During their first EGD, the gastric mucosa with C2 atrophy or more was biopsied for pathological evaluation based on the updated Sydney system. A gastric biopsy was also performed after <i>Helicobacter pylori</i> eradication, obtaining specimens from at least 2 sites, the greater curvature of the corpus and the antrum. We enrolled patients who were positive for the anti-parietal cell antibody and were diagnosed with AIG, histologically and/or endoscopically. The detection rates of AIG were compared between endoscopic diagnosis and pathological diagnosis. <b><i>Results:</i></b> A total of 10,822 patients underwent EGD during the study period. Finally, 41 patients with AIG were enrolled, leading to an AIG prevalence of 0.38% in this study. As for the clue leading to AIG detection, 31.7% (13/41) were diagnosed through endoscopy (proximal-predominant atrophy), and 68.3% (28/41) were diagnosed pathologically. The AIG detection rate by endoscopists in the posteradication group was significantly lower than in <i>the H. pylori-negative</i> group (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> Endoscopists frequently overlooked AIG, especially in posteradication cases. Pathological assessment using the updated Sydney system after <i>H. pylori</i> eradication might be a promising strategy to detect AIG better.