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Hu X, Lucas E, Hammer S, Gopal P, Bhalla A, Panarelli N, Westerhoff M, Cheng J, Nalbantoglu I. H. pylori Pattern Gastritis with Negative Helicobacter Immunohistochemical Stain: Does A Specific Comment in Pathology Report Impact Clinical Management? Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
The clinical significance of H. pylori (HP) pattern of gastritis with a negative Helicobacter IHC stain on gastric biopsy is unclear. Some pathologists report this pattern in cases that are highly suggestive of HP infection with a comment raising the possibility of HP infection; however, the subsequent clinical management of these patients has not been well described.
Methods/Case Report
We conducted a retrospective comparison study of patients with gastric biopsy between 2016 and 2019. Group 1 included patients with chronic active or chronic inactive gastritis and negative HP IHC with a comment stating the gastritis pattern is suggestive of HP. Group 2 included patients with chronic active or chronic inactive gastritis and negative HP IHC with no comment about HP pattern.
Results (if a Case Study enter NA)
We identified 60 patients in Group 1 which were compared to 63 patients in Group 2. Group 1 more frequently had history of HP (48.3% vs. 29.1%, p<0.05). After diagnosis, Group 1 more frequently received treatment (51.7% vs. 20.6%, p<0.001). Of those who received treatment, Group 1 more frequently received HP treatment (triple or quadruple therapy; 21.7% vs. 1.6%, p<0.001). History of HP did not affect whether a patient was treated (p>0.05). Following post-biopsy HP treatment, more patients in Group 1 received fecal antigen test (23.7% vs. 5.5%, p<0.01). Age, gender, NSAID and PPI use did not differ between groups.
Conclusion
Adding the diagnostic comment raising the possibility of HP for patients with HP pattern gastritis with negative HP IHC changes clinical management and it is independent of patients’ prior HP history.
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Affiliation(s)
- X Hu
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - E Lucas
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - S Hammer
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - P Gopal
- Pathology, UT Southwestern Medical Center, Plano, Texas, UNITED STATES
| | - A Bhalla
- Pathology, Albert Einstein/Montefiore Medical Center, The Bronx, New York, UNITED STATES
| | - N Panarelli
- Pathology, Albert Einstein/Montefiore Medical Center, The Bronx, New York, UNITED STATES
| | - M Westerhoff
- Pathology, University of Michigan, Ann Arbor, Michigan, UNITED STATES
| | - J Cheng
- Pathology, University of Michigan, Ann Arbor, Michigan, UNITED STATES
| | - I Nalbantoglu
- Yale School of Medicine, New Haven, Connecticut, UNITED STATES
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Verma A, Nalbantoglu I, Barbieri A. Metastatic Neoplasms of the Large Bile Ducts- A Clinicopathological Study. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Biliary strictures are often considered malignant until proven otherwise. While the majority of malignant biliary strictures represent a primary neoplasm, secondary involvement by metastasis also rarely occurs. Primary cholangiocarcinoma and metastatic disease have different treatment considerations and likely different prognoses. The aim of this study is to look at the clinico-pathological characteristics of metastatic neoplasms of the bile duct.
Methods/Case Report
We retrospectively searched the pathology archives for biliary biopsies between 1991-2020. Patients with primary biliary, gallbladder, pancreatic, ampullary and hepatic malignancies and all cases of lymphoma were excluded from the study. A total of 20 cases were included.
Results (if a Case Study enter NA)
The median age of the patients was 63 years with a M:F ratio of 1.9:1. The biopsies were taken from the common bile duct (n=17), common hepatic duct (n=2) and left hepatic duct (n=1). 8 patients had synchronous and 12 had metachronous presentation. The overall median interval between the bile duct metastasis and primary was 18 months (Range: 0-100 months) for all patients and 33 months for metachronous cases. For 13 tumors, the primary site of origin was in the gastrointestinal tract (colon: 7; stomach: 4; anal canal: 1; gastro-esophageal junction: 1). Other primary sites included breast (3 cases), lung, endometrium and adrenal (1 each). One case presented with metastatic melanoma with an occult primary. Adenocarcinoma was the most common histological subtype seen in 17 cases. Other histological subtypes were squamous cell carcinoma, adrenocortical carcinoma and melanoma.
Conclusion
Secondary involvement of the bile duct by metastasis is rare. Most cases are metastasis from the lumenal gastrointestinal tract, with colon being the most common primary site. They are more likely to have a metachronous presentation with rare instances of bile duct metastasis as the first presentation. Awareness of secondary involvement of the biliary tree by metastasis is important as they can have prognostic and therapeutic significance.
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Affiliation(s)
- A Verma
- Pathology, Yale New Haven Hospital, New Haven, Connecticut, UNITED STATES
| | - I Nalbantoglu
- Pathology, Yale New Haven Hospital, New Haven, Connecticut, UNITED STATES
| | - A Barbieri
- Pathology, Yale New Haven Hospital, New Haven, Connecticut, UNITED STATES
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Saidi R, Ahad A, Talik J, Nalbantoglu I, Jacobs M. The Expression Of Interferon Receptor Alpha/Beta In Human Pancreatic Cancer In Nude Mice Is Essential For Tumor Response To Interferon Alpha Treatment. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Saidi R, Chang J, Brooks S, Nalbantoglu I, Adsay V, Jacobs M. Ischemic Preconditioning and Intermittent Clamping Increase the Tolerance of Fatty Liver to Hepatic Ischemia-Reperfusion Injury in the Rat. Transplant Proc 2007; 39:3010-4. [DOI: 10.1016/j.transproceed.2007.09.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 09/02/2007] [Indexed: 10/22/2022]
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