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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.

A subepithelial lesion (SEL) is an area of an abnormal tissue of non-epithelial origin. It is a broad-based convex into an intestinal lumen or exterior, covered by normal-appearing mucosa. This pathology is rather infrequent, most commonly identified incidentally during upper endoscopy. Only in rare cases does this method, via biopsy, yield a precise evaluation of SEL aetiology - most often it fails. If such is a case, other diagnostic methods are to be applied: endoscopic ultrasound (EUS) primarily, radiological imaging and different types of biopsy, if necessary. SEL aetiology proves to be divergent. It comprises benign SELs, mesenchymal neoplasms with a malignant risk and malignant SELs. Therefore, an accurate analysis of the afore-mentioned SELs in view of subsequent methodology of their diagnostics, treatment and control is vital. The sources of reference suggest a number of algorithms and recommendations for SEL diagnostics and treatment, though the proof level of these commonly appear to be low. This naturally causes discussion on what the most efficient diagnoses are, how to differentiate them, how to perform biopsies and what optimal plan of treatment and control is to be recommended. The objective of this study is to improve the efficacy of endoscopic and endoscopic ultrasound (EUS) features, to identify new differential diagnoses of SELs and to specify the most precise prognostic gastrointestinal stromal tumour (GIST) index. On the basis of our findings and the score set, we have created a unique scoring system of GISTs and leiomyomas, which has suggested a cut-off value of a subepithelial lesion index and could be handy in the process of an efficient diagnosis of GIST specificity. We also applied renewed deep biopsy based on our methodology, as well as established the criteria that could result in its diagnostic efficacy. We have also clarified the possibility to evaluate the malignancy risk of GISTs. On the basis of our study results, we have created an original algorithm for SEL diagnostics and treatment. Having unified the management principles of this pathology, we will be able to further carry out scientific research and suggest novel and error-free recommendations.

Recommendation:Transfer of synovial aspirate in blood culture bottles, obtaining deep biopsy of tissues and bone, obtaining multiple samples, increasing incubation period of cultures, and the use of molecular techniques for culture negative cases are some of the strategies that can help improve the ability to isolate the causative organism(s) in infections of foot and ankle.Level of Evidence:Moderate.Delegate Vote:Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

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 To investigate the effect of the nursing measures on endoscopic ultrasonography (EUS) for deep gastric biopsy, in order to improve the success rate and safety of biopsy. Methods 48 patients that have underwent ordinary gastroscopy more than once. At foreign hospital and the pathological results are negative, underwent endoscopic ultrasonography deep biopsy for diagnosis in our hospital. We retrospectively analysis and summarise the importance of the preoperative perfect preparation, the high quality of nursing in operation, postoperative close observation and nursing, and every step in operation. Results 48 cases were diagnosed by endoscopic ultrasonography. The procedure was smooth in 46 cases, 2 patients reacted with nausea and coughing. After examination, 19 patients complained of pharynx discomfort, and 1 cases had a small amount of bleeding after the operation and recovered after treatment. Conclusions Focusing on every step and details and high-quality nursing can effectively relieve pain and improve patient compliance during ultrasonic endoscopic gastric for deep biopsy; Effective coordination of medical and nursing care can improve the positive diagnosis rate and safety of biopsy. Ensuring successful operation.

The authors describe the case of a 23-year-old woman who was referred to the rheumatologist due to symmetrical and progressive stiffness, induration, and swelling of arms and thighs at the 12th week of her first gestation. The characteristic clinical aspect of ‘peau d’orange’, associated to the histopathologic results of the deep biopsy of the skin confirmed the diagnosis of eosinophilic fasciitis. Treatment with oral prednisone, at an initial dose of 1 mg/kg/day, was effective and rapidly tapered to 10 mg/day till the birth of a healthy newborn. A literature review showed only one previous description of pregnancy and eosinophilic fasciitis.

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.

Verrucous hemangioma (VH) is a rare, congenital and localized vascular malformation, which usually presents as warty, bluish, vascular papules, plaques, or nodules, mainly on the lower extremities. Linear presentation of the disease is rare. A deep biopsy is necessary to confirm the clinical diagnosis by histopathological examination, with dermoscopy acting as a useful tool for evaluating the precise vascular structure. Here, we report on a 13-year-old female child with linear VH presenting over her foot since infancy and dermoscopic findings of VH along with the clinical-pathologic features.

Background There is only few data available on the use of cryotechnique during medical thoracoscopy. Methods Medical thoracoscopy was performed in consecutive patients with pleural effusion. Prospectively, biopsies were taken by rigid forceps, flexible forceps and cryoprobe. Specimen size, depth and diagnostic yield were compared. Results 80 Patients were included. 408 biopsies were taken (205 rigid biopsies, 104 flexible biopsies, 99 cryobiopsies). Mean surface area of rigid biopsies was 22.6 ± 20.4 mm2 (flexible biopsies: 7.1 ± 9.3 mm2, cryobiopsies: 14.4 ± 12.8 mm2). Rigid biopsies were significantly larger than cryobiopsies (p

A 27-year-old immigrant sought care for inflammatory nodular swelling lesions over the right arm extending upto the neck with axillary and cervical fistulas lasting for six months (A). His medical history was marked by a long forest stay due to conflicts in his homeland (Mali). A deep biopsy was made for infectious and histopathological examinations. Cultures were negative. Microscopy on hematoxylin and eosin stained sections showed nodular abscesses organized around multilobated grains showing Splendore-Hoeppli Phenomenon (B). Special stains (Gram, Ziehl-Neelsen, Gomori Grocott) were positive. Thus, the histological diagnosis of actinomycetoma probably due to Nocardia was given. In addition, laboratory tests revealed an active hepatitis B infection. After consulting hepatologists, treatment with trimethoprim-sulfametoxazol was introduced, substituted by amoxicillin clavulanate for months with partial clinical response. The evolution was characterized by the reduction of right arm lesions but extension of the infection to the chest wall.

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.

This study measured the temperature in and around mandibular fractures in 20 anaesthetized patients. A fine calibrated thermocouple attached to a digital thermometer was used to measure temperature at the bone surface margin of a mandibular fracture and 5 and 10 mm from the fracture; within the fracture against the bone at 5, 7 and 10 mm depths and at the base of 7 mm deep biopsy cavities 5 and 10 mm distant from the fracture line immediately after biopsy, then 1 and 2 min later. On the surface the temperature was approximately 1 degrees C warmer than at the 5 and 10 mm sites distant from the fracture. Temperature reduced at the 1 and 2 min readings after the biopsy cavity cutting. This study confirmed that the surface temperature is lower than internal bone temperatures.

O mixofibrossarcoma, previamente conhecido como histiocitoma fibroso maligno, variante mixoide, é um tumor raro, de origem mesenquimal, composto por células fusiformes e estroma mixoide. Acomete mais idosos, envolvendo extremidades inferiores e estendendo-se, em sua maior parte, até a derme e o subcutâneo. Apresenta altas taxas de recorrência e para seu diagnóstico é fundamental a realização de uma biópsia profunda. Relataremos o caso de um mixofibrossarcoma de alto grau, caracterizado por lesão tumoral de crescimento rápido e pela presença de marcado pleomorfismo celular e componente mixoide em abundância Myxofibrosarcoma, previously known as malignant fibrous histiocytoma, myxoid variant, is a rare tumor of mesenchymal origin, composed of spindle cells and myxoid stroma. It mainly affects elderly people, involving the lower extremities and frequently extending to the dermis and subcutaneous tissue. The tumor presents high rates of recurrence, and a deep biopsy is required to obtain the correct diagnosis. We report a case of high-grade mixofibrossarcoma characterized by a rapidly growing tumor and the presence of marked cellular pleomorphism and an abundant myxoid matrix

Verrucous hemangioma represents a rare congenital vascular proliferation that may be mistaken for angiokeratoma. Histopathological examination of a deep biopsy is necessary to confirm the diagnosis of verrucous hemangioma based on its involvement of the deep dermis and subcutaneous tissue. We present two cases of verrucous hemangioma and discuss the clinicopathologic and immunohistochemical findings.

Purpose: Bipolar energy has recently been used for transurethral resection of bladder tumor (TURBT). Although this modality is thought to be safe, there are some controversies concerning the pathologic accuracy of the biopsy specimens. We compared clinical efficacy, safety, and pathologic characteristics of deep biopsy specimens between bipolar and monopolar devices. Materials and Methods: From January 2002 to June 2007, a total of 115 patients underwent TURBT with deep biopsy with the use of bipolar (bipolar group, n=64) or monopolar (monopolar group, n=51) devices. We retrospectively analyzed tumor size, tumor number, urine cytology, perioperative blood loss (postoperative changes in hemoglobin levels), complications, duration of catheterization, duration of hospitalization, pathologic stage, WHO grade, deep biopsy specimen thickness, and grade of thermal damage. Results: There were no statistical differences in tumor size, tumor number, urine cytology, complications, duration of hospitalization, pathologic stage, or WHO grade between the two groups. Postoperative changes in hemoglobin levels were significantly lower in the bipolar group (p=0.038), and the duration of catheterization was shorter in the bipolar group (p=0.026). The deep biopsy specimen thickness was significantly thinner in the bipolar group (2.25±0.94 mm vs. 3.02±1.39 mm, p＜0.05). The grade of thermal damage was not statistically different between the two groups (p=0.862). Conclusions: In terms of clinical efficacy and safety, bipolar TURBT is comparable to monopolar TURBT, having advantages in perioperative blood loss and duration of catheterization. In addition, pathologic changes in deep biopsy after bipolar and monopolar TURBT are similar. Bipolar TURBT can be properly used for bladder tumors without pathologic error.

A retrospective study was performed to determine the ploidy of superficial (above muscularis propria) and deep (below muscularis propria) biopsy specimens from the primary colorectal cancer of 88 patients with Dukes Stage C2 and D colorectal tumors. The ploidy of lymph node and liver metastases was compared with that of the superficial and deep specimen from the corresponding primary tumor. Among the tumors studied, 78% exhibited nondiploid stemlines. In 19% of the tumors, the ploidy of the superficial biopsy differed from that of the deep biopsy. Among these discordant tumors, all of the deep biopsy specimens corresponded in ploidy to the liver metastases, whereas most of the superficial specimens were similar in ploidy to the lymph node metastases. Our observations suggest that measurement of a single site may not be sufficient to detect nondiploid stemlines within a tumor. They also suggest that measurement of deeper parts of invasive tumors may be more reflective of the phenotype of distant metastases than measurement of superficial specimens.

Background The plexiform schwannoma, a peripheral nerve sheath tumor, is a very rare entity. But dermatologists should be familiar with since they may be the first who make diagnosis possible by taking a deep biopsy.

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 instrument is based upon a radiolucent ring fixed to the skull by four pins. This locks into a frame for CT scanning from which the x, y and z stereotactic coordinates are derived. The head ring may be locked into a compatible support on the operating table for biopsy. A similar support and localization system is used for rotational radiotherapy. With the current 14 MeV apparatus, fields as small as 2 cm in diameter are available with 90% dosage fall-off in the surrounding 1-cm shell.

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.

Summary Five patients are reported who had cutaneous tuberculosis of the nose. All of them had unusual clinical or histological features that led to a delay in establishing the diagnosis. The purpose of this paper is to highlight several of these features that would have enabled an earlier diagnosis to be made. The differential diagnosis of lesions occurring on the nose is discussed. The possible mechanisms by which certain diseases are localized to the nose, is explained. The importance of a deep biopsy to obtain representative histopathology is emphasized.

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.

We report a case of unusually large multiple penile horns following removal of condylomata acuminata. Penile horns can grow rapidly, although malignant degeneration is uncommon. Wide excision with deep biopsy of skin at the base of the lesion probably is appropriate treatment.

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.

• Verrucous carcinoma, a variant of squamous cell carcinoma, is recognized as a distinct clinicopathologic entity. It occurs principally in three anatomic sites: panoral, genitogluteal, and plantar. Two cases of plantar verrucous carcinoma treated by the Mohs' chemosurgery technique are reported, and the literature is reviewed. The clinical and pathologic appearance of these lesions make them recognizable in a patient with a persistent plantar lesion usually diagnosed as a wart but unresponsive to conventional therapy. The role of irradiation, a possible viral etiology of the tumor, and the necessity for a deep biopsy are discussed. Because these tumors are characterized by extensive local growth, Mohs' chemosurgery is proposed as the treatment of choice. In this way, total tumor ablation is obtained with maximum preservation of normal tissue structure and function. ( Arch Dermatol 116:794-797, 1980)