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Diagnostic value of duodenal bulb biopsy in patients with celiac disease
PATHOLOGY UPDATE 2009 ABSTRACT PUBLICATION
DIAGNOSTIC VALUE OF DUODENAL BULB BIOPSY IN PATIENTS WITH CELIAC DISEASE K K Prasad, B R Thapa, A K Sharma, C K Nain, K Singh Department of Superspeciality of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (UT), India Aims: Multiple endoscopic biopsies from the descending duodenum are usually recognised as the standardised method for the evaluation of mucosal changes in celiac disease. Generally, the duodenal bulb is not considered a useful site for biopsies, due to some difficulties in histological evaluation. We wanted to verify if duodenal bulb histology established a correct diagnosis of celiac disease. Methods: Fifty-two consecutive children with suspicion of celiac disease and positive anti-tissue transglutaminase (tTG) antibodies were enrolled in a prospective fashion. During upper gastrointestinal (GI) endoscopy, two of four biopsies each were taken from descending duodenum distal to the papilla of Vater (D2) and duodenal bulb (B). The histological lesions were classified according to the modified Oberhuber classification by a single pathologist who was blinded to the site of biopsy. Results: A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anaemia 40/52 (76.9%) and failure to thrive 32/52 (61.5%). All had type 3 lesion (a) mild, (b) moderate, or (c) severe in at least one site. There were 45/52 (86.5%) CD patients with lesions of identical type (2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared to the duodenal bulb. Conclusions: The biopsies from the duodenal bulb and second part of the duodenum in celiac disease can be equally representative of the underlying disease. The diagnosis of celiac disease can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum.
LASER-INDUCED FLOURESCENCE (LIF) SPECTRA OF NORMAL, BENIGN AND MALIGNANT BREAST TISSUE Lakshmi Rao, Murli Krishna, V B Kartha, M V P Choudary, K Kalyan Kumar, Jacob Kurien Centre for Laser Spectroscopy, Manipal Life Sciences Center, Department of Pathology, Department of Surgical Oncology, Department of General Surgery, Kasturba Medical College, Manipal University, India Aims: (1) To demonstrate the efficacy of laser-induced fluorescence spectroscopy (LIF) in the discrimination of normal, benign and malignant breast tissue using histopathology as gold standard.(2) To develop a fibre optic probe using the data from the above mentioned method to diagnose breast malignancy in vivo. Methods: Twenty-nine normal, 20 benign and 27 malignant specimens were excited at three to four sites by laser radiation at 325 nm after mounting on quartz plate. Results: Emission spectral profiles of malignant, benign and normal tissue were as follows: Malignant tissue and benign tumours had higher intensity of collagen peak as compared to normal tissue. Higher content of total NAD(P)H, and bound NAD(P)H was seen in malignant tissue.
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Lower total NAD(P)H and increased free NAD(P)H was seen in benign tumours. Sharper 390 nm and weaker 460 nm peaks were characteristically seen in benign tissue. Discussion: Endogenous fluorophores such as collagen/elastin and NAD(P)H cause autoflourescence. Intensities and ratios were assessed by spectra deconvolution. The increase in NAD(P)H concentration is due to shift of metabolism from aerobic to anaerobic and increase in mitochondrial metabolism. Increased bound NAD(P)H in malignancy may be due to increased binding by overexpressed proteins secreted by tumour cells. References: Gupta PK, Majumder SK, Uppal A. Breast cancer diagnosis using N2 laser excited autofluorescence spectroscopy. Lasers Surg Med 1997; 21: 41722. Jakubowski DB, Cerussi AE, Bevilacqua F, et al. Monitoring neoadjuvant chemotherapy in breast cancer using quantitative diffuse optical spectroscopy: a case study. J Biomed Opt 2004; 9: 2308.
LIPOMA OF UNUSUAL SITES DIAGNOSED BY FINE NEEDLE ASPIRATION BIOPSY CYTOLOGY (FNABC): A CASE REPORT Annette L Salillas1,2, Fay Candice S Sun2, Allan P Magpayo2, Renelson L Esguerra1, Peter S. Aznar1 1 Department of Pathology, Matias H. Aznar Memorial College of Medicine, Cebu City, Philippines; 2 Department of Pathology, Governor Celestino Gallares Memorial Medical Center, Bohol, Philippines Aim: The role of the fine needle aspiration (FNA) technique in the diagnosis of common tumours in an uncommon location was emphasised. Methods: Pathological files of 67 cases of soft tissue tumours diagnosed by FNABC and confirmed by histopathological technique from Governor Celestino Gallares Memorial Hospital, Bohol, Philippines, were reviewed. Results: A 12-year-old male had a slow growing 8.0 6.5 cm mass on the left knee. Leg X-ray revealed an eccentric medullary expansile mass involving the fibula. A 52-year-old female had a slow growing 3.0 1.5 cm mass on the left side of the tongue. FNAs of the two cases showed cellular findings consistent with lipoma. Definitive diagnoses of lipoma of the leg and tongue were made with histopathological examination. Discussion: Lipoma is the most common benign tumour of the body occurring in sites where fat is present. Intraosseous and tongue lipomas where fat is absent are rare. Of thirty-one of the 67 soft tissue tumours diagnosed as lipomas, only two were found in the aforementioned unusual sites, thus were the first cases diagnosed by FNABC in this medical center.
BURULI ULCER (SKIN INFECTION WITH M. ULCERANS ): A CASE REPORT AND REVIEW OF LITERATURE Touraj Taheri, Sujatha Fernando Department of Anatomical Pathology, Central West Pathology Service, Orange, New South Wales, Australia Buruli (Bairnsdale) ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans, the third most common mycobacterial pathogen of humans, after M. tuberculosis and
DIAGNOSTIC VALUE OF DUODENAL BULB BIOPSY IN PATIENTS WITH CELIAC DISEASE K K Prasad, B R Thapa, A K Sharma, C K Nain, K Singh Department of Superspeciality of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh (UT), India Aims: Multiple endoscopic biopsies from the descending duodenum are usually recognised as the standardised method for the evaluation of mucosal changes in celiac disease. Generally, the duodenal bulb is not considered a useful site for biopsies, due to some difficulties in histological evaluation. We wanted to verify if duodenal bulb histology established a correct diagnosis of celiac disease. Methods: Fifty-two consecutive children with suspicion of celiac disease and positive anti-tissue transglutaminase (tTG) antibodies were enrolled in a prospective fashion. During upper gastrointestinal (GI) endoscopy, two of four biopsies each were taken from descending duodenum distal to the papilla of Vater (D2) and duodenal bulb (B). The histological lesions were classified according to the modified Oberhuber classification by a single pathologist who was blinded to the site of biopsy. Results: A total of 52 children had a final diagnosis of CD. The main presenting symptoms were diarrhea 43/52 (82.7%), anaemia 40/52 (76.9%) and failure to thrive 32/52 (61.5%). All had type 3 lesion (a) mild, (b) moderate, or (c) severe in at least one site. There were 45/52 (86.5%) CD patients with lesions of identical type (2 or 3) in both biopsy sites. The number of intraepithelial lymphocytes was not significantly different in the descending part of the duodenum as compared to the duodenal bulb. Conclusions: The biopsies from the duodenal bulb and second part of the duodenum in celiac disease can be equally representative of the underlying disease. The diagnosis of celiac disease can reliably be made even if biopsies are taken from the duodenal bulb rather than distal duodenum or jejunum.
LASER-INDUCED FLOURESCENCE (LIF) SPECTRA OF NORMAL, BENIGN AND MALIGNANT BREAST TISSUE Lakshmi Rao, Murli Krishna, V B Kartha, M V P Choudary, K Kalyan Kumar, Jacob Kurien Centre for Laser Spectroscopy, Manipal Life Sciences Center, Department of Pathology, Department of Surgical Oncology, Department of General Surgery, Kasturba Medical College, Manipal University, India Aims: (1) To demonstrate the efficacy of laser-induced fluorescence spectroscopy (LIF) in the discrimination of normal, benign and malignant breast tissue using histopathology as gold standard.(2) To develop a fibre optic probe using the data from the above mentioned method to diagnose breast malignancy in vivo. Methods: Twenty-nine normal, 20 benign and 27 malignant specimens were excited at three to four sites by laser radiation at 325 nm after mounting on quartz plate. Results: Emission spectral profiles of malignant, benign and normal tissue were as follows: Malignant tissue and benign tumours had higher intensity of collagen peak as compared to normal tissue. Higher content of total NAD(P)H, and bound NAD(P)H was seen in malignant tissue.
81
Lower total NAD(P)H and increased free NAD(P)H was seen in benign tumours. Sharper 390 nm and weaker 460 nm peaks were characteristically seen in benign tissue. Discussion: Endogenous fluorophores such as collagen/elastin and NAD(P)H cause autoflourescence. Intensities and ratios were assessed by spectra deconvolution. The increase in NAD(P)H concentration is due to shift of metabolism from aerobic to anaerobic and increase in mitochondrial metabolism. Increased bound NAD(P)H in malignancy may be due to increased binding by overexpressed proteins secreted by tumour cells. References: Gupta PK, Majumder SK, Uppal A. Breast cancer diagnosis using N2 laser excited autofluorescence spectroscopy. Lasers Surg Med 1997; 21: 41722. Jakubowski DB, Cerussi AE, Bevilacqua F, et al. Monitoring neoadjuvant chemotherapy in breast cancer using quantitative diffuse optical spectroscopy: a case study. J Biomed Opt 2004; 9: 2308.
LIPOMA OF UNUSUAL SITES DIAGNOSED BY FINE NEEDLE ASPIRATION BIOPSY CYTOLOGY (FNABC): A CASE REPORT Annette L Salillas1,2, Fay Candice S Sun2, Allan P Magpayo2, Renelson L Esguerra1, Peter S. Aznar1 1 Department of Pathology, Matias H. Aznar Memorial College of Medicine, Cebu City, Philippines; 2 Department of Pathology, Governor Celestino Gallares Memorial Medical Center, Bohol, Philippines Aim: The role of the fine needle aspiration (FNA) technique in the diagnosis of common tumours in an uncommon location was emphasised. Methods: Pathological files of 67 cases of soft tissue tumours diagnosed by FNABC and confirmed by histopathological technique from Governor Celestino Gallares Memorial Hospital, Bohol, Philippines, were reviewed. Results: A 12-year-old male had a slow growing 8.0 6.5 cm mass on the left knee. Leg X-ray revealed an eccentric medullary expansile mass involving the fibula. A 52-year-old female had a slow growing 3.0 1.5 cm mass on the left side of the tongue. FNAs of the two cases showed cellular findings consistent with lipoma. Definitive diagnoses of lipoma of the leg and tongue were made with histopathological examination. Discussion: Lipoma is the most common benign tumour of the body occurring in sites where fat is present. Intraosseous and tongue lipomas where fat is absent are rare. Of thirty-one of the 67 soft tissue tumours diagnosed as lipomas, only two were found in the aforementioned unusual sites, thus were the first cases diagnosed by FNABC in this medical center.
BURULI ULCER (SKIN INFECTION WITH M. ULCERANS ): A CASE REPORT AND REVIEW OF LITERATURE Touraj Taheri, Sujatha Fernando Department of Anatomical Pathology, Central West Pathology Service, Orange, New South Wales, Australia Buruli (Bairnsdale) ulcer is an infectious disease involving the skin, caused by Mycobacterium ulcerans, the third most common mycobacterial pathogen of humans, after M. tuberculosis and