Diagnosis of gastric adenoma versus early gastric cancer by Bromodeoxyuridine immunohistochemistry from gastric biopsy specimen

Differentiation between gastric adenomas and type IIa early gastric cancer by macroscopic and histologic examinations is often difficult. This study has shown that there are differences in the distribution of S-phase cells in these two types of tumour, and these differences can be exploited to differentiate between them. The distribution of S-phase cells was assessed by Bromodeoxyuridine (BrdU) immunohistochemistry using an in vitro BrdU-labelling method. Biopsy specimens were obtained from 27 lesions (12 adenomas and 15 type IIa early gastric cancers), and the distributions of BrdU-labelled cells in the tumour thickness as well as in the superficial layer of the tumour were determined. Significant difference was seen in the labelling of the two tumour types with regard to both these parameters. Using the criteria of BrdU immunohistochemisty, the accuracy of differentiation between gastric adenomas and cancers was 88.9%. Therefore, it is concluded in this study that in vitro BrdU labelling is a useful method of diagnosing gastric adenomas and cancers.     

Diagnosis of sarcoidosis by bronchial biopsy and transbronchial pulmonary biopsy

The presence of non-caseating epitheloid cell granulomas in biopsy material is still one of the most important factors in establishing the diagnosis of sarcoidosis. Since Carlens introduced mediastinoscopy as a diagnostic procedure in these cases the use of liver biopsy or bronchoscopic biopsy has decreased because of the better results obtained by mediastinoscopy. In 148 of 163 persons with sarcoidosis the diagnosis could be verified by the finding of epitheloid cell granuloma without central necrosis in biopsies taken from the lungs and/or bronchial wall. In 15 patients the diagnosis could not be confirmed by bronchological methods, but the presence of epitheloid cell granulomas was established by other biopsy procedures. The conclusions drawn from the observations are that the combination of bronchial and transbronchial biopsies during bronchoscopy with rigid instruments is a valuable technique for establishing the diagnosis of sarcoidosis and that bronchological methods could replace mediastinoscopy in most cases.     

Diagnosis of pulmonary amyloidosis by transbronchial biopsy

Previously reported cases of pulmonary parenchymal amyloidosis were diagnosed by open lung biopsy or postmortem examination. We describe 3 patients who were found to have amyloid deposits within the lung parenchyma by flexible fiberoptic bronchoscopy. In each case, the diagnosis was suspected when a waxy eosinophilic substance was observed within the alveolar walls of transbronchial biopsy specimens stained with hematoxylin-eosin. When stained with Congo red and examined under polarized light, this amorphous material exhibited the apple-green birefringence characteristic of amyloid fibrils. We suggest that a diagnosis of pulmonary amyloidosis can be made by transbronchial biopsy provided the appropriate histologic stains are employed. Special stains for amyloid should be obtained whenever histologic sections from transbronchial biopsy specimens reveal amorphous eosinophilic material within the alveolar septa or within the walls of small vessels.     

Diagnosis of Wegener's granulomatosis by transbronchial biopsy

We performed transbronchial biopsies in a patient with a large cavitary lung lesion and obtained tissue diagnostic of Wegener's granulomatosis. Fiberoptic bronchoscopic examination with transbronchial biopsy may be indicated as the first diagnostic test in the evaluation of patients with suspected Wegener's granulomatosis.     

盲式细针滑膜活检术的临床观察

目的 探讨盲式细针滑膜活检的最佳方法.方法 81例膝关节肿痛患者行盲式细针滑膜活检,其中20例类风湿关节炎(RA)患者术前超卢定位. 结果 所有患者均成功取出合格滑膜,活检成功率为(71±21)%,操作时间为(26±6)min,套针进针深度为(3.1±0.7)cm,合格滑膜面积为(1.8±0.8)mm2.其中RA患者活检成功率(80±6)%明显高于非RA患者(54±10)%,超声定位的活检成功率(85±5)%明显高于未经超声定位者(78±6)%.肉眼判断滑膜组织的阳件预测值为95.0%,阴性预测值为81.1%. 结论 盲式细针滑膜活检成功率高、安全,能获取足够滑膜,值得临床推广应用.     

放大内镜结合窄带成像技术指导活检对诊断早期胃癌的重要性

目的评估放大内镜结合窄带成像技术（ME—NBI）在胃黏膜病变靶向活检中的意义。方法前瞻性收集2011年5月至2013年5月经普通白光内镜检查发现胃部可疑早期病变并取得活检病理者纳入研究,进一步行ME-NBI检查并指导再次活检,所有患者接受内镜下治疗。以内镜切除病理结果为金标准,比较2次内镜活检病理的诊断准确度。结果研究纳入113例患者。白光内镜活检病理、ME-NBI靶向活检病理与最终病理相比,总体符合率由22．1％（25／113）提高到54．0％（61／113,P〈0．0001）。对早期胃癌和高级别上皮内瘤变的诊断,ME-NBI靶向病理与白光内镜活检病理的灵敏度分别为70．9％和37．9％（P〈0．0001）;特异度均为90．0％;准确度分别为72．6％和42．5％（P〈0．0001）;阳性预测值分别为98．6％和97．5％,阴性预测值分别为23．1％和12．3％,差异均无统计学意义（P均〉0．05）。ME—NBI靶向活检病理相对白光内镜活检病理的总体进展率为46．9％（53／113）。结论对于早期胃癌的诊断,ME-NBI靶向活检病理结果显著优于普通白光内镜,可为内镜切除治疗提供更好的依据。     

Occult gastric cancer with distant metastasis proven by random gastric biopsy

Krukenberg tumor, a rare metastatic ovarian tumor arising from gastrointestinal adenocarcinoma mainly, tends to occur in premenopausal females. Finding the origin of a Krukenberg tumor is crucial for determining prognosis. In Eastern countries, the most common origin of Krukenberg tumor is stomach cancer, which is generally diagnosed via endoscopic biopsy to investigate an abnormal mucosal lesion. Here, we describe a case of huge adnexal mass in a 33-year-old woman who presented with abdominal distension. Two independent endoscopic examinations performed by experts in two tertiary university hospitals revealed no abnormal mucosal lesion. The patient was diagnosed with a Krukenberg tumor according to findings from random endoscopic biopsies taken from normal-looking gastric mucosa in our hospital. It is very rare to be diagnosed via a random biopsy in cases where three well-trained endoscopists had not found any mucosal lesion previously. Thus, in this case, random biopsy was helpful in finding the origin of a Krukenberg tumor.