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Gastrointestinal (GI) pathology has become a vast and complicated subject, and it is appropriate that this Annual Review Issue (ARI) is restricted to the upper gastrointestinal tract. For a tubular organ some 24 cm long in the adult, the number of different inflammatory pathologies afflicting the oesophagus is relatively restricted but these authors describe, with aplomb, more recently recognised diseases and concepts. Infective pathology is always important in the GI tract and Nicole Panarelli, from New York City, has produced an excellent review of those infective pathologies that particularly afflict this area. [Extracted from the article]

Summary: The aim of this study was to ascertain the level of concordance among gastrointestinal pathologists for regression grading in rectal cancers treated with neoadjuvant chemoradiation. Seventeen gastrointestinal pathologists participated using the Mandard, Dworak, and modified rectal cancer regression grading systems to grade 10 representative slides that were selected from 10 cases of rectal cancer treated with long-course neoadjuvant chemoradiation. The slides were scanned with a whole-slide scanner generating dynamic digitized images. The results showed very little concordance across the 3 grading systems, with κ values of 0.28, 0.35, and 0.38 for the Mandard, Dworak, and modified rectal cancer regression grading systems, respectively. In only 1 of 10 study cases was there unanimous grading concordance using the modified rectal cancer regression grading system. It was felt that these systems lacked precision and clarity for reproducible, accurate regression grading. The study concluded that there was a need for a simple, reproducible regression grading system with clear criteria, a cumulative or composite score taking into account all sections of the tumor bed that is sampled rather than the worst section (highest grade), and there should be a uniform method of sampling of these specimens. [ABSTRACT FROM AUTHOR]

Shelley-Fraser G, Borley N R, Warren B F & Shepherd N A (2012) Histopathology 60, 1034-1044 The connective tissue changes of Crohn's disease Although the inflammatory pathology of Crohn's disease is manifestly its most important attribute, the connective tissue changes are important in the genesis of the more chronic features of the disease, and yet these have received little attention from clinicians, pathologists, and scientists. Fat-wrapping appears to be pathognomonic of Crohn's disease, and is an important marker of disease for surgeons. There is evidence of a complex interplay between the effector inflammatory cells of Crohn's disease and adipocytes, hyperplasia of which results in fat-wrapping. Pathologically, this is exhibited in the close relationship between the transmural inflammation that is so characteristic of Crohn's disease and fat-wrapping. Fibrosis and muscularization are also important components of the chronic changes of intestinal Crohn's disease. Neuronal and vascular changes make up the remaining connective tissue changes: these constitute a distinctive feature, and are even specific for Crohn's disease. For pathologists, the combination of these connective changes will allow a diagnosis of chronic 'burnt-out' Crohn's disease, even in the absence of its highly characteristic inflammatory features. The connective tissue changes of Crohn's disease form an important part of its long-term pathology. They deserve more attention from clinicians, diagnostic pathologists and researchers alike. [ABSTRACT FROM AUTHOR]

Shetty S, Anjarwalla S M, Gupta J, Foy C J W, Shaw I S, Valori R M & Shepherd N A (2011) Histopathology 59, 850-856 Focal active colitis: a prospective study of clinicopathological correlations in 90 patients Aims: Considerable controversy exists about the clinical implication of a diagnosis of focal active colitis (FAC). The aim of this study was to assess clinicopathological correlations of FAC in 90 adults, representing the largest and only prospective series of FAC. Methods and results: Patients were assessed by comprehensive clinical follow-up and questionnaires. Fifteen histopathological features were scored and correlated with clinical outcome. In 24% of patients drugs, especially NSAIDs, were implicated. Infection was a probable cause in 19%. In 14 patients (15.6%), predominantly women, a diagnosis of chronic inflammatory bowel disease was ultimately made. Most were Crohn's disease, but this is the first study in which FAC has presaged an ultimate diagnosis of ulcerative colitis in adults (in two patients). A specific subtype of FAC, termed basal FAC, was significantly associated with drugs. These excepted, this study has found no histopathological parameters of FAC, such as amount, location and/or distribution, to correlate with clinical outcome or allowed selection of those patients more likely to show subsequent evidence of chronic inflammatory bowel disease. Conclusion: This study has provided powerful information on the implication of a diagnosis of FAC. In a small but not inconsiderable case number, the ultimate diagnosis will be chronic inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Mitchard J R, Love S B, Baxter K J & Shepherd N A (2010) Histopathology, 671-679 The importance of circumferential resection margin involvement in predicting locoregional recurrence and death from rectal cancer is well known. However, it is well accepted that cases of rectal carcinoma recur when this surgical margin is not compromised. The aim of this study was to analyse the influence of peritoneal involvement, among other clinicopathological variables, on locoregional recurrence and overall prognosis in an unselected prospective series of rectal cancer resections. This unselected prospective study assessed 331 rectal carcinoma cases from a colorectal cancer study that recruited more than 1000 cases. Meticulous pathological examination was performed by one pathologist, with particular attention paid to the peritoneal surface. All clinicopathological variables were entered into a database with comprehensive clinical follow-up. Peritoneal involvement was a significant factor in prognosis on univariate analysis but not on multivariate analysis. However, in analysing the causes of locoregional recurrence specifically, it may have been a factor in causing this in up to half the cases. This study adds to the small amount of literature data on the potential importance of peritoneal involvement in predicting locoregional recurrence and overall prognosis, especially in upper rectal cancer. [ABSTRACT FROM AUTHOR]

Aims: A survey was conducted into the routine use of special stains on gastrointestinal (GI) biopsy specimens in histopathology departments within the National Health Service. The aim was to compare the sole use of haematoxylin and eosin (H&E) staining with the use of H&E and special stains, according to the biopsy site. Methods and results: One hundred and sixty-seven histopathology departments in the UK were contacted using an e-mail questionnaire. Valid return rate was 55%. Sixty-eight percent of departments employ H&E only for oesophageal biopsy specimens. Gastric specimens are stained using only H&E in 47% of departments and 53% use H&E combined with special stains. Duodenal, small and large bowel biopsy specimens are mostly stained with H&E. Conclusions: The results show that the routine use of special stains in GI pathology in the UK is highly variable, especially for oesophageal and gastric biopsy specimens. The literature indicates that special stains in GI specimens can enhance sensitivity and specificity for the detection of pathological abnormalities, especially metaplasia and infections. The diversity of staining practice highlights the need to provide robust and evidence-based guidelines for the routine use of special stains to ensure universal best practice. [ABSTRACT FROM AUTHOR]

Aims: To assess observer agreement in the diagnosis of colorectal serrated polyps, in particular, serrated adenomas and admixed polyps (i.e. ‘polyps with admixed hyperplastic and adenomatous glands’). Methods and results: Sixty cases of large bowel polyps were assessed by four specialist gastrointestinal histopathologists and allocated into one of five categories: serrated adenoma, hyperplastic polyp, conventional adenoma, admixed polyp, and other polyps with serration. Complete agreement amongst all four assessors was seen with only two-fifths of the cases. The overall κ value for all the assessors distinguishing between all five categories was 0.49. The κ values for diagnosing serrated adenoma versus all other polyps, and admixed polyp versus all other polyps were 0.38 and 0.3, respectively. Conclusions: Specialist gastrointestinal histopathologists show only moderate concordance when distinguishing between serrated colorectal polyps. There is only fair interobserver agreement in the diagnosis of serrated adenomas and admixed polyps of the large bowel. [ABSTRACT FROM AUTHOR]

Aims: To examine the natural history of columnar-lined oesophagus with routinely diagnosed low-grade dysplasia and ascertain the risk of oesophageal adenocarcinoma development. Methods and results: A multicentre retrospective cohort study of 283 patients with low-grade dysplasia. Follow-up data were obtained from examination of hospital records. One hundred and forty-four patients had biopsies prior to low-grade dysplasia diagnosis and 217 had follow-up biopsies after index low-grade dysplasia diagnosis. In these patients the incidence of high-grade dysplasia and adenocarcinoma combined was 4.6% per annum and of adenocarcinoma alone was 2.7% per annum. At most recent follow-up, 43 (19.8%) had persistent low-grade dysplasia, 37 (17.1%) had changes indefinite for dysplasia and 108 (49.8%) had non-dysplastic columnar-lined oesophagus. When prevalent cases were excluded (those occurring within 1 year of index low-grade dysplasia diagnosis), the annual incidence of high-grade dysplasia and adenocarcinoma combined was 2.2% and of adenocarcinoma alone was 1.4%. The relative risk for adenocarcinoma development in low-grade dysplasia compared with non-dysplastic columnar-lined oesophagus was 2.871 ( P = 0.002). Conclusions: Low-grade dysplasia has a threefold increased risk of progression to cancer compared with non-dysplastic epithelium, but in the majority of patients dysplasia is not subsequently detected. [ABSTRACT FROM AUTHOR]

Abstract: Fine-needle aspiration (FNA) cytology is an inexpensive, effective and (generally) safe procedure for diagnostic sampling of superficial masses. In the UK, it has attained central importance in the management of palpable lesions of the breast and thyroid gland. The use of image guidance means that aspiration of impalpable and deep-seated lesions is routine in radiological practice in the UK. The aim of the FNA procedure is to collect sufficient representative material from the lesion to enable a cytological diagnosis—i.e. based on the appearance of dispersed individual cells and cell groups—to be made. As well as its role in the primary diagnosis of tumours, FNA cytology in very useful in the staging of malignant tumours. For example, endoscopic ultrasound-guided FNA of a paraoesophageal lymph node can detect metastatic oesophageal carcinoma. Another useful role for FNA is in diagnosing recurrence of malignancy, particularly lymphoma. Clinical FNA procedures are described and potential causes of an inadequate—i.e. non-diagnostic—aspirate are discussed. Various modalities of image guidance are discussed and methods of slide preparation compared. The role of special techniques such as immunocytochemistry and fluorescence in situ hybridization is illustrated by means of diagnostic scenarios. The uses and limitations of FNA cytology of the breast, thyroid, lymph nodes and salivary glands are discussed. [Copyright &y& Elsevier]

Abstract: Staging is the process that determines the spread of a malignant tumour, thereby providing prognostic information. It can be assessed by clinical, radiological and pathological means. Before accurate staging is undertaken, a diagnosis of cancer is required, which is usually made by histological examination of biopsy material; this may include imaging techniques to localize and sample the lesion. Once a diagnosis of malignancy is established, the extent of local invasion and the presence of distant metastases must be determined; this is usually undertaken using imaging methods. This contribution discusses the TNM system, staging of oesophageal and gastric carcinoma, staging of carcinoma of the small intestine, and staging of carcinoma of the anal region. [Copyright &y& Elsevier]

Barrett’s esophagus remains the most enigmatic of conditions. In Western communities, it has increased dramatically and its malignant complication, adenocarcinoma, is stated to be the cancer increasing the most in the Western world. Although this Western epidemic can be partly attributed to increasing reflux disease, there remain major controversies with regard to the pathogenesis, histogenesis, and even definitions of the disease. For pathologists, there are particular controversies as to the importance of the demonstration of “specialized” intestinal metaplasia and there have been many attempts to demonstrate a specific (and thus specialized) phenotype, compared with, say, intestinalization in the stomach. There has been much recent work on cytokeratin subsets and this shows some promise for differentiating the different types of intestinal metaplasia in this area. [ABSTRACT FROM AUTHOR]

This section comments on the article Bayesian Analysis of Stochastic Volatility Models, by Eric Jacquier, Nicholas G. Polson, and Peter E. Rossi, in the October 1994 issue of the Journal of Business & Economics Statistics. The contribution of Jacquier, Polson and Rossi (JPR) is to propose a Metropolis algorithm that overcomes the difficulty of not being able to easily bound p(x)/q(x). The JPR approach seems to be a more elegant solution than the one suggested by Shephard for this problem, and it may have considerable use outside the context proposed here. The authors wish to congratulate them on this idea and on generally helping to bring this type of methodology to the attention of econometricians. The comment will almost entirely deal with the smoothing issue, that is, estimating h given y. The authors challenge the very idea that Markov-chain Monte Carlo of unobserved component time series models should be carried out by cycling through the elements of h, drawing single elements at a time. It may be possible to wring out slightly better performance from the JPR algorithm by making it closer to a Gibbs algorithm, but that is not really tackling the reason why it is slow. To make orders of magnitude of gains, it is needed to avoid Gibbs sampling within blocks of highly correlated elements.

The article presents an obituary for Basil C. Morson, a British gastrointestinal pathologist.

The article presents a case study of a 62-year-old woman with diarrhoea and abdominal pain. It mentions that she had a history of renal transplantation secondary to reflux nephropathy and primary biliary cirrhosis and was diagnosed with pathognomonic of idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV). It mentions that the disease affected her terminal ileum which resulted into spontaneous perforation and deep ulceration.

An introduction to the journal is presented which discusses various papers published within the issue, including one on infective pathology of the intestine, one on drug-induced pathology of the intestines, and another on non-coeliac small intestinal inflammatory pathology.

A response from the authors of the article "How do we stage acellular mucin in lymph nodes of colorectal cancer specimens without neo-adjuvant therapy?" published in a 2016 issue of "Histopathology" is presented.

An obituary for Basil Morson, a surgeon and the president of professional organization British Society of Gastroenterology, is presented.

A letter to the editor is presented regarding the Pacinian corpuscle-like structures, tactoid bodies and tactile corpuscle-like structures which seemed to appear in the specimens of gastrointestinal biopsy as granulomata mimics which are located in the gastrointestinal mucosa.

An obituary for professor Jeremy Robin Jass is presented.

Reports on the monitoring of the long term effects of construction of the pelvic ileal reservoir. Alternative to permanent ileostomy and continent ileostomy in patients undergoing proctocolectomy for ulcerative colitis; Manifestation of pouchitis as a complication of the reservoir; Hypothesis of the pathogenesis of pouchitis.

Characterizes inflammatory and infectious diseases of the intestines. Changing patterns of inflammatory bowel disease; Macroscopic and microscopic features of inflammatory bowel disease; Conditions associated with intraepithelial lymphocytosis with normal small intestinal villous architecture; Surgery-related inflammation of the intestines.