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Inflammatory myofibroblastic tumors (IMTs) are particularly rare tumors that have been described in various anatomic locations, of which the urinary bladder is the most common. These benign tumors are amendable to conservative therapy but are notoriously difficult to diagnose given their mimicry of malignant sarcomas and sarcomatoid carcinomas, making an accurate diagnosis paramount to spare a patient radical and unnecessary treatment. We hereby present the case of a 37-year-old female patient who was diagnosed with an IMT of the urinary bladder during workup for painless gross hematuria. Patient was successfully managed with a laparoscopic partial cystectomy and is free of recurrence 5 years after surgery. IMTs are rare benign tumors that share the same clinical presentation as malignant bladder tumors. Deep biopsy and experienced pathologist are crucial in establishing diagnosis and avoiding patient radical treatment. This case is a classical demonstration of a remarkably rare tumor that was adequately managed with conservative therapy, achieving excellent clinical outcomes.

Background Conventionally, endoscopic ultrasound-guided fine-needle aspiration and biopsy (EUS-FNA)/EUS-FNB) has been used for tissue diagnosis of upper gastrointestinal (GI) subepithelial tumors (SETs). However, deep biopsy (DB) via endoscopic submucosal dissection (ESD) is emerging as an alternative technique, given the inadequate tissue sampling with EUS-FNA/EUS-FNB. Our aim was to conduct a systematic review and meta-analysis to report the overall diagnostic yield of DB via ESD for upper GI SETs. Methods PubMed, Cochrane Library and Web of Science databases were searched to identify studies (from commencement to Oct 2017) that reported the DB via ESD technique for diagnosis of upper GI SETs. The primary outcome of interest was the method's overall diagnostic yield and the secondary outcome was to the occurrence of complications. The meta-analysis was performed using the DerSimonian and Laird random-effects model. Results A total of 7 studies, comprising 209 patients with a mean age of 57.3 years, were included in the final meta-analysis. The overall pooled diagnostic yield of DB via ESD for upper GI SETs was 95% (95% confidence interval [CI] 84.91-99.98, I2=78.2%). Overall, pooled outcomes of major bleeding and perforation in our meta-analysis was noted in 0.07% (95%CI 0.00-2.32, I2=0%) and 0% (95%CI 0.00-1.70, I2=0%) respectively. Data regarding major bleeding and perforation rates were not reported in 2 studies. Substantial heterogeneity was observed in our meta-analysis. Conclusion DB via ESD is an effective and safe procedure for diagnosing upper GI SETs. Further multicenter randomized controlled trials are needed to validate these findings.

Introduction : Accurate diagnosis of subepithelial lesions (SELs) in the gastrointestinal tract depends on a variety of methods: endoscopy, endoscopic ultrasound and different types of biopsy. Making an error-free diagnosis is vital for the subsequent application of an appropriate treatment. Aim: To evaluate the efficacy of deep biopsy via the endoscopic submucosal dissection (ESD) technique for SELs in the upper gastrointestinal tract. Material and methods: It was a case series study. Deep biopsy via the ESD technique was completed in 38 patients between November 2012 and October 2014. Thirty-eight SELs in the upper gastrointestinal tract of varying size (very small ≤ 1 cm, small 1–2 cm and large ≥ 2 cm) by means of the ESD technique after an incision with an electrosurgical knife of the overlying layers and revealing a small part of the lesion were biopsied under direct endoscopic view. Results: Deep biopsy via the ESD technique was diagnostic in 28 of 38 patients (73.3%; 95% CI: 59.7–89.7%). The diagnostic yield for SELs with a clear endophytic shape increased to 91.3%. An evident endophytic appearance of a subepithelial lesion, the mean number of biopsied samples (6.65 ±1.36) and the total size in length of all samples per case (19.88 ±8.07 mm) were the main criteria influencing the positiveness of deep biopsy in the diagnostic group compared to the nondiagnostic one (p = 0.001; p = 0.025; p = 0.008). Conclusions : Deep biopsy via the ESD technique is an effective and safe method for the diagnosis of SELs especially with a clear endophytic appearance in a large number of biopsied samples.

Background and Objectives: The most accurate technology to detect and diagnose subepithelial tumors (SETs) is the endoscopic ultrasonography (EUS) combined with puncture techniques, such as the endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) or the endoscopic ultrasonography-guided fine-needle biopsy. Going further in the improvement of the results of tumor samples obtained endoscopically to diagnose the SETs, the canalization technique guided by miniprobes (MPs) to obtain biopsies of SET could be an alternative to EUS-FNA. The objective of this study is to analyze the results of samples obtained by this procedure. Materials and Methods: A multicenter, retrospective study of a review of a database of 32 consecutive patients with a SET in the digestive tract, from 2000 to 2015 was conducted. All patients underwent EUS-performed by MP, to define the size, internal echostructure, and layer of origin of tumor. Once the echostructure was defined, it proceeded to the canalization technique to arrive to the tumor tissue. Results: The average diameter of SETs in this series (32 patients) was about 21.6±11 mm (range: 5–41 mm). The diagnostic accuracy was 28/32, 87.50% (Confidence interval 95%: 76.04%–98.99%), and there were no major complications. All procedures were performed on outpatients, none of which required additional hospitalization. The 50% of patients were operated or endoscopically resected and in all cases, the previous pathological diagnosis was confirmed. Conclusions: This is a feasible, safe, and effective procedure that allows to access to inside of SET to obtain deep biopsies. Tumor samples obtained by deep biopsy, with prior performing of the canalization technique guided by MP, were sufficient for histopathological and immunohistochemical diagnosis and similar to those obtained with other known methods (FNA Trucut, ProCore®, etc.). However, more prospective comparative studies with a larger number of patients and different specialists carrying out the procedure to reach a higher statistical significance are necessary.

AIM To report on a more accurate diagnostic possibility offered by endoscopic ultrasound-guided cutting of holes and deep biopsy (EUS-CHDB) for pathologic diagnosis of gastric infiltrative tumors and gastrointestinal submucosal tumors. METHODS Ten consecutive patients who were suspected of having gastric invasive tumors or gastrointestinal submucosal tumors underwent EUS-CHDB with a novel vertical diathermic loop. We reviewed their medical data and analysed the effectiveness and safety of this new method. The final diagnosis was based on the surgical pathology or clinical/imaging follow-up. RESULTS EUS-CHDB was performed successfully in all the ten patients. Neither severe haemorrhage nor perforation occurred in any patient. Among the ten patients, there were three cases of gastric linitis plastica, one case of gastric lymphoma, five cases of gastrointestinal stromal tumors (GISTs), and only one case of chronic non-atrophic gastritis. That is, nine (90%) of the cases treated by EUS-CHDB showed positive findings. CONCLUSION EUS-CHDB may be a technically feasible and safe option for patients with gastric infiltrative tumors or gastrointestinal submucosal tumors. EUS-CHDB may be used as a remedial or even preferred biopsy method for submucosal lesions.

Papillary adenoma of the nipple is a benign condition of the nipple that can be confused clinically with adenocarcinoma metastatic to the skin or Paget's disease. Deep biopsy of the nipple is necessary to make a histologic diagnosis. Complete excision of the nipple and the subareolar tissue is sufficient to effect a cure.

The general and radiologic features of neurogenic tumors of the stomach are reviewed in connection with 18 cases (16 benign and 2 malignant tumors). Such neurogenic tumors are rare in the stomach, representing less than 0.5% of all tumors. Solitary neurogenic tumors must be differentiated from those encountered during von Recklinghausen's disease. Radiological or endoscopic examination can generally determine the benign or malignant nature of solitary neurogenic tumors, which are essentially represented by schwannomas. Since these tumors are submucosal, a deep biopsy is imperative; furthermore, since such tumors are subject to hemorrhage, prior investigation by CT appears advisable to detect possible hypervascularization after injection of contrast material. For patients with von Recklinghausen's disease, a neurofibroma is usually diagnosed when faced with a digestive hemorrhage. Radiological exploration of the entire digestive tract appears essential to confirm the solitary nature of the gastric lesion and to be sure it is responsible for the clinical symptoms.

Verrucous carcinoma is a variant of squamous cell carcinoma that often presents as a large cauliflower-like lesion with localy destructive growth. A high index of suspicion on the part of the clinician and pathologist is needed for an accurate diagnosis since the pathologic findings may be benign on an individual cell basis or may even resemble those of a condyhloma. Deep biopsy that includes the base of the lesion is needed for accurate histologic diagnosis, and the pathologist should be aware of the aggressive nature of lesion. The treatment of choice is surgical, with wide local excision being sufficient in most cases. Radiotherapy often fails to eradicate the lesion and may even cause it to become more anaplastic.

A woman who received radiotherapy for a breast carcinoma developed symptomatic deep subcutaneous fibrosis 7 months after treatment. Deep biopsy confirmed the diagnosis. A good response to prednisone therapy was obtained in this patient. Long-term sequelae may include soft tissue sarcoma.

The appropriate interval between a colorectal biopsy and a barium enema is controversial. Superficial and deep biopsies, above and below the peritoneal reflection, were performed on 12 dogs. Six control dogs did not have a barium enema. Six study dogs had a barium enema at different postbiopsy time intervals: immediately, 3 days, and 6 days. After superficial biopsies, there was no barium extravasation in any study animal. Histological examination, 48 hr after enema, showed complete epithelialization of all superficial sites on both study and control dogs. When the barium enema was done after a deep biopsy, there was intramural extravasation of barium immediately after biopsy but not after 3 or 6 days. Focal ulcerations were seen microscopically at sites of deep biopsies when the barium enema was performed immediately and 3 days after the diagnostic procedure. All deep biopsy sites were reepithelialized in 6 days. There was no evidence of intraperitoneal or retroperitoneal perforation and no difference in healing of biopsy sites in subjects and control animals. This study in dogs suggests that a barium enema may be performed without hazard immediately after a superficial biopsy of nondiseased colon and 6 days after a deep biopsy.

A total of 150 colorectal biopsies were performed in 71 patients and correlated with the barium-enema examination (BE). The investigation was divided into two parts. In the first part, involving 19 patients, the depth of each biopsy specimen was determined histologically prior to BE and potential complications related to the biopsy-BE sequence were evaluated. In the second part, involving all 71 patients, the depth of biopsy specimens taken from various colon lesions was determined histologically without regard to the timing of BE. The results confirm previous in vitro findings in pigs and dogs, namely: (a) BE may be performed without delay following a superficial biopsy, but should not be performed until at least 6 days after a deep biopsy; (b) transcolonoscopic biopsies are likely to be superficial, while transproctoscopic biopsies have the potential to be deep; and (c) BE should be delayed at least 6 days following polypectomy or polyp biopsy performed with electrosurgery.

Chondrosarcoma of the larynx is a rare disease. The condition usually presents as a space-occupying lesion in the larynx. It is usually internal, but an external mass may be noted. Diagnosis demands a deep biopsy as the tumour is submucosal. Treatment is surgical, but the extent of this surgery is dependent upon the stage of the disease. The prognosis, in most cases, is usually very good. The literature relating to chondrosarcoma of the larynx is reviewed and salient features are presented. Added interest in this case is due to the long precedent history and the difficulty in obtaining a diagnosis.