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Journal of clinical pathology [journal]
- Thank you to our reviewers 2014. [Journal Article]
- J Clin Pathol 2015 Jan; 68(1):91-2.
- Microscopic colitis occurring in association with hyperplastic polyps and tubulovillous adenomas: observations in 10 cases. [Letter]
- J Clin Pathol 2014 Oct; 67(10):919-20.
- The surgeon’s perspective on oesophageal disease, and what it means to pathologists. [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):913-8.
GERD and its potential complications of Barrett’s oesophagus and oesophageal adenocarcinoma are now the most important disease processes for oesophageal surgeons. A major impact on this disease will likely come from the development of cost-effective screening and diagnostic modalities which identify patients who are at risk for developing oesophageal cancer. The surgical approach to Barrett’s oesophagus and oesophageal adenocarcinoma will continue to evolve in response to advances in ablative therapy and ER. The role of the pathologist, with expertise in the diagnosis of Barrett’s oesophagus, will become more prominent as we better define the histological predictors of oesophageal adenocarcinoma. A collaborative effort between pathologists and surgeons is essential in determining the timing and best approach for interventional therapy.
- Message in a bottle: decoding medication injury patterns in the gastrointestinal tract. [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):903-12.
Medication injury in the gastrointestinal tract (GIT) is a rapidly evolving topic. Increasing endoscopy together with an ageing population, polypharmacy, and a burgeoning drug industry offer heightened opportunities to observe the unintended side effects of therapeutic ingestants. In this review, we emphasise the most commonly encountered medication injuries involving the GIT, as well as emerging agents and mimics. While topics are organised by organ system, the reader should keep in mind that injury patterns are generally not site-specific. As such, awareness of these major morphologic patterns can be translated to multiple tissue sites to more broadly facilitate the diagnostic process.
- Non-adenomatous forms of gastro-oesophageal epithelial dysplasia: an under-recognised entity? [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):898-902.
Foveolar dysplasia is an uncommon form of dysplasia that is encountered in the stomach and oesophagus in the context of Barrett’s oesophagus. Glands displaying foveolar dysplasia also show architectural abnormalities that are similar to those encountered in adenomatous dysplasia. However, from a cytological point of view, foveolar dysplasia glands are lined by low-cuboidal to columnar epithelium, the cytoplasm is often clear with round-to-oval nuclei. Nuclear stratification as seen in adenomatous dysplasia is not common, although there is loss of nuclear polarity, pleomorphism and mitotic activity. It is important to distinguish low-grade foveolar dysplasia from regenerative change.
- Cronkhite–Canada syndrome six decades on: the many faces of an enigmatic disease. [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):891-7.
Cronkhite–Canada syndrome is a rare gastro-enterocolopathy of uncertain aetiology first described almost 60 years ago. It is characterised by diffuse gastrointestinal polyposis sparing only the oesophagus, ectodermal abnormalities and an unpredictable but often fatal clinical course. The disease may demonstrate extremely diverse clinical and endoscopic features, which often leads to a delay in diagnosis. A high index of suspicion and recognition of the characteristic histological findings frequently facilitate a correct diagnosis, but the distribution of the gastrointestinal pathology and its microscopic features may be atypical. The pathologist thus requires a thorough knowledge of both the typical and many atypical faces of this disease, for which various documented therapies often still prove ineffective. Close correlation with clinical findings, including any pertinent ectodermal abnormalities, and careful examination of biopsies derived from polypoid and endoscopically spared mucosa will ensure a timely and correct diagnosis in patients with this enigmatic syndrome.
- Some observations on pyloric gland adenoma: an uncommon and long ignored entity! [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):883-90.
Pyloric gland adenomas (PGAs) are uncommon to rare and are found mostly in the stomach but in a number of other anatomical sites as well. They were recognized years ago by European and Japanese colleagues whereas North American pathologists learned to diagnose them more recently. They are associated with conditions that result in pyloric metaplasia, the prototype of which is autoimmune gastritis. Since the latter is more common in women and men, gastric PGA has a striking female predominance. There appear to be differences in the distribution of PGA in various populations. Herein we review PGA and note similarities and differences in their distribution in our institutions in Germany and the U.S.A. and review their morphological appearance, immunolabelling profile, and preliminary genetic data on these unusual lesions.
- Precursor neoplastic lesions of the biliary tract. [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):875-82.
Recently, the precursor neoplastic lesions of the bile duct tract have been classified using the same criteria used to classify the preinvasive lesions of the pancreas. Flat dysplasia and dysplastic mass-forming lesions of the bile duct system are considered precursor lesions of the adenocarcinomas and are frequently associated with invasive adenocarcinoma of the bile duct tract. The incidence and the histopathology of these dysplastic lesions are variable in different geographical areas. The prognosis of non-invasive dysplastic mass-forming lesions is very good if compared with lesions associated with adenocarcinoma and with conventional adenocarcinoma of the bile tract. Here, the main features of these lesions will be reviewed.
- Pathology of serrated colorectal lesions. [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):865-74.
The concept of serrated colorectal neoplasia has become recognised as a key process in the development of colorectal cancer (CRC) and an important alternative pathway to malignancy compared with the long established ‘adenoma-carcinoma’ sequence. Increasing recognition of the morphological spectrum of serrated lesions has occurred in parallel with elucidation of the distinct molecular genetic characteristics of progression from normal mucosa, via the ‘serrated pathway’, to CRC. Some of these lesions can be difficult to identify at colonoscopy. Challenges for pathologists include the requirement for accurate recognition of the forms of serrated lesions that are associated with a significant risk of malignant progression and therefore the need for widely disseminated reproducible criteria for their diagnosis. Alongside this process, pathologists and endoscopists need to formulate clear guidelines for the management of patients with these lesions, particularly with respect to the optimal follow-up intervals. This review provides practical guidance for the recognition of these lesions by pathologists, a discussion of ‘serrated adenocarcinoma’ and an insight into the distinct molecular genetic alterations that are seen in this spectrum of lesions in comparison to those that characterise the classic ‘adenoma-carcinoma’ sequence.
- Predictive markers of radiotherapy-induced rectal cancer regression. [Journal Article]
- J Clin Pathol 2014 Oct; 67(10):859-64.
Patients with locally advanced rectal cancer receive preoperative radiotherapy to reduce the probability of recurrence and to possibly improve overall survival. However, this appears dependent on the extent of histological tumour regression seen in the resected bowel, which can be highly variable between individuals. No predictive marker that can stratify patient management in this regard is currently available. Experimental data implicates a variety of factors that are involved in the DNA damage response following radiation injury, tumour tissue oxygenation, autoimmune antitumour response triggered by radiotherapy and in the pathogenesis of colorectal cancer, as potential indicators of radiation sensitivity. These details are presented in this review, which may serve as targets for clinical validation studies aiming to find predictors of radiotherapy response in rectal cancer.