Histopathologic changes are not specific for diagnosis of gastric antral vascular ectasia (GAVE) syndrome - A review of the pathogenesis and a comparative image analysis morphometric study of GAVE syndrome and gastric hyperplastic polyps
cirrhosis; endoscopic laser therapy; gastroduodenal; GAVE syndrome; hyperplastic polyps; intussusception; Pathology; portal hypertensive gastropathy; portal-hypertension; prolapse; watermelon stomach
We studied the nonspecific nature of the histologic findings in the gastric antral vascular ectasia (GAVE) syndrome by using a morphometric comparison with common gastric lesions including hyperplastic polyps and gastritis. Five clinicopathologically confirmed cases of GAVE syndrome and 41 cases of gastric hyperplastic polyps were diagnosed during a 5-year interval at Summa Health Systems (Akron, Ohio). These cases, as well as 16 randomly selected cases of nonspecific gastritis and 9 normal gastric antral biopsy specimens, were evaluated. A semiquantitative comparison of the light microscopic findings believed to be essential in diagnosis of GAVE syndrome, including vascular hyperplasia, mucosal vascular ectasia, intravascular fibrin thrombi, and fibromuscular hyperplasia, was performed. Image analysis morphometric measures of the area ratio (vascular area/total biopsy area), mean vascular area, and number of ectatic vessels per square millimeter of tissue were performed on the CAS 200 Image Analyzer (Becton Dickinson, San Jose, Calif). By morphometric and statistical parametric analysis, several histopathologic variables, including area ratio, mean vascular area, mucosal vascular ectasia, and fibromuscular hyperplasia, did not confidently differentiate the histologic features of gastric hyperplastic polyp from those of GAVE syndrome, but did apparently differentiate GAVE syndrome from gastritis and normal gastric mucosa. The propensity of gastric hyperplastic polyps to undergo prolapse changes and prolapse as one proposed mechanism for development of the GAVE syndrome lesion probably accounts for this morphologic similarity. Specific diagnostic histopathologic changes probably do not exist for the GAVE syndrome.
Vesoulis Z; Naik N; Maseelall P
American Journal of Clinical Pathology
1998
1998-05
Journal Article
<a href="http://doi.org/10.1093/ajcp/109.5.558" target="_blank" rel="noreferrer noopener">10.1093/ajcp/109.5.558</a>
Liver Ultrasound Elastography: An Update To The World Federation For Ultrasound In Medicine And Biology Guidelines And Recommendations
Acoustic radiation; Acoustics; acting antiviral therapy; controlled attenuation parameter; Elastography; Elastography; Focal liver lesions; force impulse; hepatitis-c virus; hypertension; liver; Liver diseases; Liver fibrosis; Liver stiffness; noninvasive assessment; Nuclear Medicine & Medical Imaging; Portal; portal-hypertension; radiation force impulse; Radiology; Shear wave elastography; shear-wave; significant; stiffness measurement; Strain elastography; time tissue elastography; Transient elastography; Transient elastography; ultrasound; World Federation for Ultrasound in Medicine and Biology guidelines
Ferraioli G; Wong V W S; Castera L; Berzigotti A; Sporea L; Dietrich C F; Choi B I; Wilson S R; Kudo M; Barr R G
Ultrasound in Medicine and Biology
2018
2018-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.ultrasmedbio.2018.07.008" target="_blank" rel="noreferrer noopener">10.1016/j.ultrasmedbio.2018.07.008</a>
Ultrasound liver elastography beyond liver fibrosis assessment
Heart failure; children; guidelines; Liver stiffness; Shear wave elastography; transient elastography; consensus; portal-hypertension; heart; Budd Chiari syndrome; central venous-pressure; congestion; fontan circulation; Fontan circulation; Hepatic sinusoidal obstruction syndrome; Liver congestion; stiffness measurements; Valvular diseases; Liver congestion
Several guidelines have indicated that liver stiffness (LS) assessed by means of shear wave elastography (SWE) can safely replace liver biopsy in several clinical scenarios, particularly in patients with chronic viral hepatitis. However, an increase of LS may be due to some other clinical conditions not related to fibrosis, such as liver inflammation, acute hepatitis, obstructive cholestasis, liver congestion, infiltrative liver diseases. This review analyzes the role that SWE can play in cases of liver congestion due to right-sided heart failure, congenital heart diseases or valvular diseases. In patients with heart failure LS seems directly influenced by central venous pressure and can be used as a prognostic marker to predict cardiac events. The potential role of LS in evaluating liver disease beyond the stage of liver fibrosis has been investigated also in the hepatic sinusoidal obstruction syndrome (SOS) and in the Budd-Chiari syndrome. In the hepatic SOS, an increase of LS is observed some days before the clinical manifestations; therefore, it could allow an early diagnosis to timely start an effective treatment. Moreover, it has been reported that patients that were successfully treated showed a LS decrease, that reached pre-transplantation value within two to four weeks. It has been reported that, in patients with Budd-Chiari syndrome, LS values can be used to monitor short and long-term outcome after angioplasty.
Ferraioli G; Barr RG
World Journal of Gastroenterology
2020
2020-06-28
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.3748/wjg.v26.i24.3413" target="_blank" rel="noreferrer noopener">10.3748/wjg.v26.i24.3413</a>
Pseudocirrhosis in Breast Cancer - Experience From an Academic Cancer Center.
breast cancer; CT; liver metastases; METASTASIS; hepatocellular failure; portal hypertension; pseudocirrhosis; CARCINOMA; CHEMOTHERAPY; CIRRHOSIS; LIVER-FAILURE; PORTAL-HYPERTENSION
Background: Pseudocirrhosis is characterized by radiological changes in the liver that resemble cirrhosis, but with more rapid onset and progression. Though reported most frequently in patients with metastatic breast cancer, little is known about its prognostic factors and impact on breast cancer outcomes.; Methods: In this observational study, we reviewed abdominal CT and/or MRI scan reports of all patients with invasive breast cancer diagnosed at our center, during a ten-year period, to identify patients with pseudocirrhosis. Exclusion criteria included lack of baseline imaging, pre-existing cirrhosis, hepatitis B or C, other chronic liver diseases, or heavy alcohol use. Routine descriptive statistical measures were used. Survival distributions were estimated using Kaplan-Meier method, and Cox regression was used for multivariate analysis. Two-tailed p < 0.05 was considered significant.; Results: Eighty-six patients were included - all were females, median age was 57.5 years, and 90% were Caucasian; 86% of primary tumors were hormone-receptor positive and 17% were HER2 positive. Most patients (98%) had metastatic disease with liver involvement (94%), and were heavily pre-treated - 97% with chemotherapy, 85% with hormonal therapy, and 19% with anti-HER2 agents. Median interval from breast cancer diagnosis to pseudocirrhosis was 75.4 months (IQR 35.2-115.3 months). Thirty-six percentage of patients had ≥1 signs of portal hypertension and 49% had ≥1 signs of hepatocellular failure. Pseudocirrhosis led to permanent discontinuation of chemotherapy, endocrine therapy, and all systemic therapies in 29%, 31%, and 20% patients, respectively. Median overall survival from diagnosis of pseudocirrhosis was 10.0 months (95%CI 5.2-14.8 months). On multivariate analysis, coagulopathy, hyperbilirubinemia, hypoalbuminemia, and cancer progression were independently predictive of mortality.; Conclusions: In this largest series, to date, of breast cancer with pseudocirrhosis, the latter was often complicated by portal hypertension and hepatocellular failure, and markedly impacted breast cancer management. Survival was shorter for patients who developed hepatocellular failure. (Copyright © 2021 Gopalakrishnan, Shajihan, Purysko and Abraham.)
Gopalakrishnan D; Shajihan A; Purysko AS; Abraham J
Frontiers in Oncology
2021
2021-07-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.3389/fonc.2021.679163" target="_blank" rel="noreferrer noopener">10.3389/fonc.2021.679163</a>