Comparison of endoscopic brush cytology with biopsy for detection of Helicobacter pylori in patients with gastroduodenal diseases

Upper GI endoscopy was performed in 50 adult patients attending the gastroenterology OPD with gastroduodenal diseases. Gastric antral mucosal brushings were taken for cytological evaluation and urea broth test followed by antral biopsy. The slides prepared were stained with Wright Giemsa (WG), Hema toxylin & Eosin (H&E) and Papanicolaou (Pap). Brush Cytology Smears were compared with biopsy sections for detection of Helicobacter pylori and the staining techniques were evaluated to see which stain was easiest to perform and interpret on routine basis. H&E stained sections were examined for histomorphological parameters associated with H. pylori infection. Brush cytology was rapid and simple with observed sensitivity of 90% and specificity of 100%. On evaluating the various stains, M.B. and W.G. were found to the rapid and easy to perform and the bacteria stood out very well against the background. Of the histomorphological parameters studied, presence of actively and lymphoid aggregates and absence of intestinal metaplasia correlated positively with the presence of the bacteria. Cytological brushing urea broth test was not very sensitive (55.2%) and specific (51%) for detection of the bacteria.     

Helicobacter pylori in gastroduodenal diseases

OBJECTIVE: To determine the prevalence and disease association of Helicobacter pylori (H. pylori) in dyspeptic patients in southwest Nigeria. Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-lfe, Nigeria. METHODS: Consecutive dyspeptic patients for upper gastrointestinal endoscopy from January 1996 to March 1997 were investigated for H. pylori in gastric biopsy by histopathology and culture. Patients without gastroduodenal ulcerations or neoplastic lesions constituted the nonulcer dyspeptic (NUD) group. RESULTS: 138 (92 males, 46 females) patients aged 4.5-85 years [mean (7) = 45+/-SD 17.8 years] who had upper gastrointestinal endoscopy were analyzed for presence of H. pylori. Eighty-three had histopathology alone, while 55 others had both histology and culture. Endoscopic diagnosis included duodenal ulcer (DU) (n=35, 23%); gastric ulcer (n=4, 3%); gastric cancer (n=14, 9%); NUD, including gastritis (n=49, 32%); duodenitis (n=47, 31%); and normal (n=16, 11%). Overall, H. pylori was positive in 107 of 138 (77.5%) patients. There was a significant association of H. pylori with DU and NUD (p<0.000). Three-quarters of cases of normal endoscopy harbored H. pylori. The finding of 80% and 85% H. pylori in gastritis and duodenitis, respectively, was of interest. CONCLUSIONS: These findings suggest that DU and NUD were the main clinical expressions of H. pylori infection in southwest Nigerian dyspeptic patients similar to what is found in developed nations. Of note is the high incidence of H. pylori in endoscopically normal patients.     

Identification of Campylobacter pylori by endoscopic brush cytology

To investigate the value of Papanicolaou-stained endoscopic brush samples in the diagnosis of Campylobacter pylori infection of the upper gastrointestinal tract, 138 brush and biopsy samples from the esophagus, stomach, and duodenum, taken concomitantly, were reviewed retrospectively. In 35 cases, Campylobacter-like organisms (CLOs) were found in both cytology and biopsy samples. In 15 cases, CLOs were seen in biopsy material only, and in 8 cases, CLOs were found in cytology material only. CLOs were found in 49% of the gastric specimens and 33% of the Barrett's esophagus specimens by histologic or cytologic examination or by both methods. CLOs were found by at least one method in 64% of the gastric samples with active gastritis 40% with borderline gastritis, 15% without gastritis, and in 64% with adenocarcinoma. Cytologic examination of endoscopic brush samples is a valuable technique for the diagnosis of gastric Campylobacter infections and can be performed easily in cytopathology laboratories.     

Endoscopic biopsy and cytology in the diagnosis of malignant gastric ulcers

Endoscopy significantly improves the diagnosis of tumors of the stomach; however, its value may be limited in differentiating benign from malignant gastric ulcers (MGUs). The accuracy of endoscopy was compared in 20 patients with MGU studied by endoscopy, biopsy, and cytology. Endoscopy correctly diagnosed 13 cases (65%), with endoscopic signs being benign or indeterminate in the remaining seven. However, all 20 MGUs were accurately diagnosed since biopsy and cytology increased the diagnostic accuracy of endoscopy in the remaining seven patients. The combination of biopsy and cytology yielded a positive diagnosis in 19 patients (95%); the remaining patient was operated on with only the endoscopic diagnosis of MGU. The complementarity of these three techniques was highlighted in five cases where only one of the procedures unequivocally diagnosed malignancy. It is concluded that biopsy and cytology are useful complementary techniques and should always be performed together in categorizing the nature of all gastric ulcers despite a benign macroscopic appearance at endoscopy.     

Epithelial repair versus carcinoma in esophageal brush cytology

The distinction between repair atypia and carcinoma in esophageal brushings is often difficult. To establish criteria for making this distinction, the cytologic smears from 121 consecutive esophageal brushings and the companion biopsies were reviewed. The most reliable criteria for malignancy included sharply angulated nuclear rims, a high nuclear/cytoplasmic ratio, and coarsely granular chromatin. Nuclei bearing these features were not numerous and had to be carefully sought. Nuclear pleomorphism was a more consistent feature, but it showed considerable overlap with epithelial repair. Cytologic features of multiple nucleoli, macronucleoli, and loss of polarity were common to both repair and carcinoma. Adherence to the criteria established in this study permits the distinction between repair atypia and carcinoma in almost all cases; however, there are lesions of the esophagus with such overlap between the features of repair and carcinoma that it may not be possible to reach a definitive diagnosis. Specific examples, with illustrations, are discussed as diagnostic guides.     

Metastatic metaplastic carcinoma of the breast: diagnosis by bronchial brush cytology

Metaplastic carcinoma of the female breast is an uncommon lesion that may metastasize to body sites. To our knowledge, this is the first reported case of pulmonary metastasis diagnosed on bronchial brush cytology. The patient presented with pulmonary symptomatology 1 yr and 3 mo after a left modified radical mastectomy for breast carcinoma. Bronchoscopic examination revealed an endobronchial lesion partially obstructing the bronchus intermedius. Bronchial brush cytology showed the presence of nonkeratinizing squamous tumor cells admixed with a few scattered clusters of tumor cells with glandular features. Histologic review of the original breast lesion showed a metaplastic carcinoma of the breast with a predominant squamous-cell component. Accurate knowledge of a patient's clinical history is necessary to differentiate a second primary lesion from a metastatic one, particularly when the original lesion is so uncommon.     

Association between Helicobacter pylori virulence factors and gastroduodenal diseases in Okinawa, Japan

The incidence of gastric cancer in Okinawa is lowest in Japan. Some previous reports using small number of strains suggested that the high prevalence of Helicobacter pylori with Western-type cagA in Okinawa compared to other areas in Japan might contribute to the low incidence of gastric cancer. It has still not been confirmed why the prevalence of Western-type cagA strains is high in Okinawa. We examined the association between the virulence factors of H. pylori and gastroduodenal diseases in Okinawa. The genotypes of cagA and vacA of 337 H. pylori strains were determined by PCR and gene sequencing. The genealogy of these Western-type cagA strains in Okinawa was analyzed by multilocus sequence typing (MLST). Overall, 86.4% of the strains possessed cagA: 70.3% were East-Asian type and 16.0% were Western type. After adjustment by age and sex, the presence of East-Asian-type cagA/vacA s1m1 genotypes was significantly associated with gastric cancer compared to gastritis (odds ratio = 6.68, 95% confidence interval = 1.73 to 25.8). The structure of Western-type CagA in Okinawa was different from that of typical Western-type CagA found in Western countries. Intriguingly, MLST analysis revealed that the majority of Western-type cagA strains formed individual clusters but not hpEurope. Overall, low prevalence of gastric cancer in Okinawa may result from the high prevalence of non-East-Asian-type cagA strains. The origin of Western-type cagA strains in Okinawa may be different from those of Western countries.     

Prevalence and heterogeneity of Helicobacter pylori in gastric biopsies of patients with gastroduodenal diseases

Helicobacter pylori is a risk factor for development of peptic ulcers and adenocarcinoma of distal stomach. There are several highly specialized virulence factors, such as the production of sialic acid-specific hemagglutinins, cytotoxins and enzymes. This study was designed to study the in vivo prevalence of H. pylori in patients with gastroduodenal diseases, the in vivo correlation between H. pylori infection and blood group O, and the heterogeneity of H. pylori isolates in central Taiwan. We enrolled 776 symptomatic patients residing in the central Taiwan area. The age-specific in vivo prevalence of H. pylori in patients with gastroduodenal diseases increased from 11.1% in those between the ages of 1 to 20, 73.1% in those between the ages of 21 and 30, and to 79.8% in those between the ages of 51 and 60. In conclusion, H. pylori was present in 70% of biopsied specimens of symptomatic patients with gastroduodenal diseases and had the highest incidence (86%) in patients with peptic ulcers. The prevalence of H. pylori cag A expression positive strains in central Taiwan was 92.5%. This study has also demonstrated the high correlation between H. pylori and the blood group O-positive patients with gastroduodenal diseases. The prevalence of H. pylori infection in blood O-positive patients in central Taiwan was 86.4%.     

TNF基因多态性与胃十二指肠疾病幽门螺杆菌感染的相关性研究

目的：研究我国湖北汉族人群肿瘤坏死因子（Tumor Necrosis Factor,TNF）基因多态性与胃十二指肠疾病及幽门螺杆菌（Helicobacter Pylori,Hp）感染的关系,探讨宿主遗传因素对Hp感染在胃十二指肠疾病尤其是非贲门胃癌的作用.方法：采用病例对照研究和PCR-RFLP方法,检测210例胃十二指肠疾病患者（包括73例慢性胃炎、78例十二指肠溃疡及59例非贲门胃癌患者）和264例正常对照者的TNF-α 308、LT-α Nco Ⅰ、AspH Ⅰ双等位基因型分布.Hp感染检测血清Hp Ab-IgG.结果：胃十二指肠疾病患者的Hp阳性率90.5%,显著高于正常对照组62.1%（P＜0.000 1,Odds ratio=5.793,95%CI：3.431～9.780）.LT-α Nco Ⅰ A/G基因型在Hp阳性非贲门胃癌患者（64.0%）高于Hp阳性的正常对照组（46.0%）,差异有显著性意义（P=0.029 7,OR=2.026,95%CI：1.080～3.803）,该基因型与其他胃十二指肠疾病无相关性.TNF-α 308、LT-α AspH Ⅰ与Hp感染及胃十二指肠疾病亦无相关性.结论：LT-α Nco Ⅰ A/G基因型与中国湖北汉族人群非贲门胃癌Hp阳性相关.     

Histopathology of gastroduodenal inflammation: the impact of Helicobacter pylori

In this article the histological features of acute and chronic gastritis are reviewed. The histopathological gastric biopsy report can now encompass an aetiological, topographical (when antrum and corpus are sampled) and morphological comment on the gastric mucosa. The degree of detail included in the report (e.g. grading of the severity of inflammation, atrophy, density of Helicobacter pylori ) will vary according to local requirement. However, the distinct recognisable patterns of inflammation categorised in the Sydney system provide a common terminology for a succinct diagnosis. The overall condition of the patient's gastric mucosa assigns him/her to one of the H. pylori -positive or negative categories of chronic gastritis. This may not only have relevance to current clinical management, but may be a valuable record if the patient returns with dyspeptic symptoms in the future. For example, duodenal ulcers are unlikely to develop except in patients with antrum predominant H. pylori -associated gastritis. Knowledge of the natural history of different types of gastritis is rapidly evolving, and the biopsy provides a permanent 'snapshot' of the state of the gastric mucosa at the time of the endoscopy.     

Preoperative diagnosis of well‐differentiated neuroendocrine tumor in common hepatic duct by brush cytology: A case report

The biological behavior of neuroendocrine tumors (NETs) is heterogeneous and differs from that of cholangiocarcinoma, which is the most common malignant tumor of the biliary tree. However, the preoperative diagnosis of NET in the biliary tree is extremely difficult and to our knowledge, diagnosis by brush cytology has not previously been reported. Herein, we first reported a case of biliary NET preoperatively diagnosed by brush cytology in a 33‐year‐old female patient. Imaging study revealed a 2.6‐cm mass in the common hepatic duct. The brush cytology was characterized by loosely cohesive plasmacytoid tumor cells and scattered clusters of thin vascular septa. The tumor cells showed abundant cytoplasm and severe nuclear size variation but mitosis was not observed. Immunohistochemical staining of the cell block (CB) showed strong positivity for both synaptophysin and chromogranin A and a Ki‐67 labeling index of 3.5%. The surgically resected bile duct mass was pathologically confirmed as NET, G2 with lymphovascular and perineural invasion of the tumor cells. The patient showed no evidence of tumor recurrence 10 months after operation without adjuvant chemotherapy. Suspicion of this rare tumor and immunohistochemical staining of the CB are important for the preoperative diagnosis of NET in the biliary tree.     

Endometrial intraepithelial carcinoma diagnosed by brush cytology and P53 immunostaining,and confirmed by hysterectomy

Endometrial intraepithelial carcinoma (EIC) is associated with tumors of high nuclear grade and usually is seen in endometria without complex atypical hyperplasia. Tumor cells oftentimes show an accumulation of mutant p53 protein. This report describes a case of EIC detected by endometrial brush cytology and p53 immunostaining, and confirmed by hysterectomy. Diagn. Cytopathol. 1998;19:284–287. © 1998 Wiley-Liss, Inc.     

Lack of association between Helicobacter pylori infection with dupA-positive strains and gastroduodenal diseases in Brazilian patients

Duodenal ulcer-promoting gene (dupA) was recently described as a new putative Helicobacter pylori virulence marker associated with an increased risk for duodenal ulcer and reduced risk for gastric carcinoma in Japan and Korea. Since differences regarding the association among H. pylori markers and H. pylori-associated diseases have been demonstrated around the world, we evaluated the presence of the gene in 482 strains from Brazilian children (34 with duodenal ulcer and 97 with gastritis) and adults (126 with duodenal ulcer, 144 with gastritis and 81 with gastric carcinoma) by PCR using the described primers and an additional set of primers based on Brazilian strain sequences. The results were confirmed by sequencing. The presence of cagA was investigated by PCR and also included in the analysis. dupA was present in 445 (92.32%) and absent in 29 (6.02%) strains. All samples from children with and without duodenal ulcer were dupA-positive (p=1.0). No association was observed among the strains from adults with gastritis (92.36%), duodenal ulcer (87.30%, p=0.30) and gastric carcinoma (87.65%, p=0.31). Conversely, cagA-positve status remained independently associated with duodenal ulcer (children: odds ratios (OR)=5.58, 95% confidence intervals (CI)=1.67–18.50; adults: OR=3.33, 95% CI=2.14–5.19) and gastric carcinoma (OR=6.58, 95% CI=3.51–12.30) in multivariate analyses. The presence of dupA was significantly higher in strains from children than in those from adults (p=0.01). In conclusion, dupA is highly frequent and not associated with H. pylori-associated diseases in both Brazilian adults and children, which points to regional differences in the distribution of the gene.     

Role of brush cytology in the diagnosis of Barrett's esophagus: an analysis of eight cases

Although debatable, role of cytology in diagnosing Barrett's esophagus has been stressed by some authors. Our brief report analyses the role of brush cytology (BC) in its diagnosis. Eight patients who presented with upper gastrointestinal (GI) manifestations and subsequently diagnosed to have Barrett's esophagus with or without adenocarcinoma on brush cytology (BC) or, endoscopic biopsy (EB) or, a combination of both the techniques were included in the study. In all the cases routine cytologic smears and histologic sections with relevant special stains (when essential) were studied. On cytology, the diagnosis of "Barrett's esophagus" was made when the esophageal brushings obtained from a region beyond 3 cm from the gastroesophageal junction showed closely intermingled clusters of squamous and columnar cells, or when there was evidence of intestinal metaplasia. Adenocarcinoma in Barrett's esophagus was diagnosed by the usual criteria for malignancy with features of adenocarcinoma. Cytologic diagnoses were correlated with the histologic diagnoses. Of the eight cases, seven had histopathologic correlation of which six had evidence of BE on BC; four had cytohistologic concordance, of which three cases revealed adenocarcinoma arising in BE. Two endoscopic biopsies were nonrepresentative. In one case, cytology missed Barrett's esophagus. For two cases in which cytology detected Barrett's mucosa, biopsies were nonrepresentative. Our study showed brush cytology (BC) to be a fairly reliable test for detecting Barrett's esophagus. Owing to its inherent advantage of sampling a wider and circumferential area, a technically well performed brushing procedure is likely to be more representative and superior than multiple endoscopic biopsies.     

Helicobacter (Campylobacter) pylori in gastric brushing cytology.

Helicobacter (formerly Campylobacter) pylori is frequently associated with chronic gastritis and peptic ulcer and has been implicated as an etiologic agent. Identification of H. pylori is important for specific treatment with antibiotics and bismuth compounds. We studied 27 patients who presented with symptoms of gastritis or peptic ulcer on whom paired gastric biopsies and gastric brushings for cytology had been performed. Biopsies were stained with H & E and Warthin-Starry or Giemsa for H. pylori. Previously, Papanicolaou-stained brushings were restained with Giemsa and reviewed blindly by two cytologists. Cytologic examination revealed the characteristic 1-3 mu curved or spiral gram-negative bacilli embedded in mucus in 12 of 27 (44%) of cases. Biopsies showed H. pylori in 13 of 27 (48%) of cases. Cytology and histology were concordant in 22 of 27 (81%) of cases. Three cases were positive on biopsy, negative on cytology; two of these were unsatisfactory cytology specimens. Two cases were positive on cytology, negative on biopsy, apparently sampling artifacts. Papanicolaou-stained slides were scored for several morphologic parameters; numbers of acute and chronic inflammatory cells and degree of cytologic atypia. None of these were predictive of the presence of H. pylori. We conclude that Giemsa-stained gastric brushings are a useful complement to gastric biopsies in establishing the diagnosis of H. pylori.     

Rapid and easy detection of Helicobacter pylori by in situ hybridization

Various in situ hybridization (ISH) methods have been used to identify Helicobacter pylori, a causative organism responsible for chronic gastritis and peptic ulcer disease, but they were hard to perform and time consuming. To detect H. pylori in a rapid and easily reproducible way, we developed synthetic biotinylated oligonucleotide probes which complement rRNA of H. pylori. Formalin-fixed and paraffin-embedded tissues from 50 gastric biopsy specimens were examined. Using a serologic test and histochemical stain (Warthin-Starry silver stain and/or Giemsa stain) as a standard, 40 of them were confirmed to be H. pylori-positive. Our ISH was quickly carried out within one hr and results were compared with those obtained from immunohistochemical stain. The ISH produced a positive reaction in 38 of 40 cases (95%). All H. pylori-negative cases failed to demonstrate a positive signal. The ISH has a sensitivity comparable to those of conventional histochemical and immunohistochemical stain, and has high specificity. In conclusion, ISH with a biotinylated oligonucleotide probe provides a useful diagnostic method for detecting H. pylori effectively in routinely processed tissue sections.     

幽门螺杆菌cagL基因缺失株的建立

目的:构建幽门螺杆菌Ⅳ型分泌系统cagL基因缺失株,为研究cagL基因的功能奠定基础。方法:利用同源重组原理,PCR扩增该基因编码区两侧序列,作为同源臂,构建出带卡那霉素抗性标志的载体,采用电穿孔法将其转化入受体菌中,并经PCR验证后获得了cagL基因缺失株;突变株和野生株分别与胃上皮细胞GES-1共培养后,检测其对CagA蛋白转运的影响。结果:构建cagL基因缺失的自杀质粒,并获得一株cagL基因缺失株;CagA转运实验表明,cagL基因缺失后,导致幽门螺杆菌CagA转运功能的丧失。结论:成功获得了幽门螺杆菌cagL基因缺失株,该基因参与CagA蛋白的转运,是该菌IV型分泌系统中重要组成成分之一。     

Detection of Helicobacter pylori in gastric mucosa of patients with gastroduodenal diseases by PCR-restriction analysis using the RNA polymerase gene (rpoB)

A novel PCR restriction analysis method using the RNA polymerase beta-subunit- coding gene (rpoB) was employed to both detect and identify Helicobacter pylori in biopsy specimens and culture isolates. The rpoB DNAs (458 bp) were specifically amplified by PCR with the Helicobacter-specific primers (HF and HR). Based on the determined rpoB sequences of the culture isolates, an H. pylori-specific restriction site, Tru9I, was found. H. pylori can be identified by observing two discernible DNA fragments (288 and 138 bp) after Tru9I digestion and agarose gel electrophoresis. The rpoB PCR and subsequent restriction analysis (PRA) enabled the specific detection and identification of H. pylori in biopsy specimens from patients with gastroduodenal diseases. The rpoB PRA conferred a compatible or a slightly higher positive rate (53.7%) than did the Campylobacter-like organism (CLO) test (50.4%) and glmM PCR (48.8%), suggesting that it is useful for diagnosing an H. pylori infection without culture in the clinical laboratory.     

细针吸取细胞学检查对乳腺良性病变的鉴别诊断

目的 :探讨鉴别纤维囊性乳腺病和乳腺纤维腺瘤细针吸取细胞学 (FNAC)的主要细胞形态学指标。方法 :运用Logistic多重回归模型的统计分析方法 ,对 2 2 4例有活检证实的乳腺FNAC的良性病变 (4 8例纤维囊性乳腺病和 176例纤维腺瘤 )的5 4个细胞学指标进行分析 ,指标的评价采用 0～ 3 的分级评价方式。结果 :研究发现 ,最有价值的鉴别指标是细胞量 (P =0 0 0 1) ,次要指标是背景的游离肌上皮细胞量 (P <0 0 5 )。组合细胞量 (2～ 3 )和背景的游离肌上皮细胞量 (2～ 3 )作为联合指标进行评价 ,可将纤维腺瘤的阳性预测价值提高至 93 5 %。结果发现 ,在乳腺FNAC检查中 ,分叶结节状的间质在纤维囊性乳腺病和乳腺纤维腺瘤中的发生率存在明显的差异性。结论 :在乳腺细针吸取细胞学的良性病变中 ,细胞量和背景的游离肌上皮细胞量是鉴别纤维囊性乳腺病和纤维腺瘤的最有价值的细胞形态学指标。分叶结节状的间质是管内型纤维腺瘤的间质的组织形态在FNAC中的表现 ,是诊断纤维腺瘤的特征性指标 ,对诊断纤维腺瘤有重要的意义     

Mixed hepatoblastoma diagnosed by fine-needle aspiration biopsy cytology: A case report

The cytologic features of a case of mixed hepatoblastoma diagnosed by fine-needle aspiration biopsy (FNAB) in a 2½-yr-old child are described. FNAB was carried out on a large, firm mass in the upper abdomen, without any complications. The characteristic cytologic features were clusters of polyhedral cells with mild anisonucleosis, and intracytoplasmic bile pigment. Focal areas of mesenchymal elements were seen. Immature hematopoietic cells were present. FNAB offers a safe and accurate method of diagnosis. Diagn. Cytopathol. 1998;19:306–308. © 1998 Wiley-Liss, Inc.