156 results on '"Misdraji J"'
Search Results
2. Prevalence and outcome of non-alcoholic fatty liver disease in adolescents and young adults undergoing weight loss surgery
- Author
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Corey, K. E., Stanley, T. L., Misdraji, J., Scirica, C., Pratt, J., Hoppin, A., and Misra, M.
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- 2014
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3. Disseminated Mycobacterium kansasii infection with hepatic abscesses in a renal transplant recipient
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Kaur, P., Fishman, J. A., Misdraji, J., Varma, M. C., and Kotton, C. N.
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- 2011
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4. 2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of Antibody-Mediated Rejection
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Demetris, A.J., Bellamy, C., Hübscher, S.G., O’Leary, J., Randhawa, P.S., Feng, S., Neil, D., Colvin, R.B., McCaughan, G., Fung, J.J., Del Bello, A., Reinholt, F.P., Haga, H., Adeyi, O., Czaja, A.J., Schiano, T., Fiel, M.I., Smith, M.L., Sebagh, M., Tanigawa, R.Y., Yilmaz, F., Alexander, G., Baiocchi, L., Balasubramanian, M., Batal, I., Bhan, A.K., Bucuvalas, J., Cerski, C.T.S., Charlotte, F., de Vera, M.E., ElMonayeri, M., Fontes, P., Furth, E.E., Gouw, A.S.H., Hafezi-Bakhtiari, S., Hart, J., Honsova, E., Ismail, W., Itoh, T., Jhala, N.C., Khettry, U., Klintmalm, G.B., Knechtle, S., Koshiba, T., Kozlowski, T., Lassman, C.R., Lerut, J., Levitsky, J., Licini, L., Liotta, R., Mazariegos, G., Minervini, M.I., Misdraji, J., Mohanakumar, T., Mölne, J., Nasser, I., Neuberger, J., O’Neil, M., Pappo, O., Petrovic, L., Ruiz, P., Sağol, ö., Sanchez Fueyo, A., Sasatomi, E., Shaked, A., Shiller, M., Shimizu, T., Sis, B., Sonzogni, A., Stevenson, H.L., Thung, S.N., Tisone, G., Tsamandas, A.C., Wernerson, A., Wu, T., Zeevi, A., and Zen, Y.
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- 2016
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5. 2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of Antibody-Mediated Rejection.
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UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Demetris, A J, Bellamy, C, Hübscher, S G, O'Leary, J, Randhawa, P S, Feng, S, Neil, D, Colvin, R B, McCaughan, G, Fung, J J, Del Bello, A, Reinholt, F P, Haga, H, Adeyi, O, Czaja, A J, Schiano, T, Fiel, M I, Smith, M L, Sebagh, M, Tanigawa, R Y, Yilmaz, F, Alexander, G, Baiocchi, L, Balasubramanian, M, Batal, I, Bhan, A K, Bucuvalas, J, Cerski, C T S, Charlotte, F, de Vera, M E, ElMonayeri, M, Fontes, P, Furth, E E, Gouw, A S H, Hafezi-Bakhtiari, S, Hart, J, Honsova, E, Ismail, W, Itoh, T, Jhala, N C, Khettry, U, Klintmalm, G B, Knechtle, S, Koshiba, T, Kozlowski, T, Lassman, C R, Lerut, Jan, Levitsky, J, Licini, L, Liotta, R, Mazariegos, G, Minervini, M I, Misdraji, J, Mohanakumar, T, Mölne, J, Nasser, I, Neuberger, J, O'Neil, M, Pappo, O, Petrovic, L, Ruiz, P, Sağol, Ö, Sanchez Fueyo, A, Sasatomi, E, Shaked, A, Shiller, M, Shimizu, T, Sis, B, Sonzogni, A, Stevenson, H L, Thung, S N, Tisone, G, Tsamandas, A C, Wernerson, A, Wu, T, Zeevi, A, Zen, Y, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Demetris, A J, Bellamy, C, Hübscher, S G, O'Leary, J, Randhawa, P S, Feng, S, Neil, D, Colvin, R B, McCaughan, G, Fung, J J, Del Bello, A, Reinholt, F P, Haga, H, Adeyi, O, Czaja, A J, Schiano, T, Fiel, M I, Smith, M L, Sebagh, M, Tanigawa, R Y, Yilmaz, F, Alexander, G, Baiocchi, L, Balasubramanian, M, Batal, I, Bhan, A K, Bucuvalas, J, Cerski, C T S, Charlotte, F, de Vera, M E, ElMonayeri, M, Fontes, P, Furth, E E, Gouw, A S H, Hafezi-Bakhtiari, S, Hart, J, Honsova, E, Ismail, W, Itoh, T, Jhala, N C, Khettry, U, Klintmalm, G B, Knechtle, S, Koshiba, T, Kozlowski, T, Lassman, C R, Lerut, Jan, Levitsky, J, Licini, L, Liotta, R, Mazariegos, G, Minervini, M I, Misdraji, J, Mohanakumar, T, Mölne, J, Nasser, I, Neuberger, J, O'Neil, M, Pappo, O, Petrovic, L, Ruiz, P, Sağol, Ö, Sanchez Fueyo, A, Sasatomi, E, Shaked, A, Shiller, M, Shimizu, T, Sis, B, Sonzogni, A, Stevenson, H L, Thung, S N, Tisone, G, Tsamandas, A C, Wernerson, A, Wu, T, Zeevi, A, and Zen, Y
- Abstract
The Banff Working Group on Liver Allograft Pathology reviewed and discussed literature evidence regarding antibody-mediated liver allograft rejection at the 11th (Paris, France, June 5-10, 2011), 12th (Comandatuba, Brazil, August 19-23, 2013), and 13th (Vancouver, British Columbia, Canada, October 5-10, 2015) meetings of the Banff Conference on Allograft Pathology. Discussion continued online. The primary goal was to introduce guidelines and consensus criteria for the diagnosis of liver allograft antibody-mediated rejection and provide a comprehensive update of all Banff Schema recommendations. Included are new recommendations for complement component 4d tissue staining and interpretation, staging liver allograft fibrosis, and findings related to immunosuppression minimization. In an effort to create a single reference document, previous unchanged criteria are also included.
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- 2016
6. Case records of the Massachusetts General Hospital. Case 3-2006. A 63-year-old woman with jaundice and a pancreatic mass
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Schapiro, R. H., Maher, Michael M., and Misdraji, J.
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Fine-needle ,Cholestasis ,Pancreatic mass ,Jaundice ,Tuberculosis ,Mycobacterium tuberculosis ,Extrahepatic ,Pancreas ,Pancreatic diseases ,Tomography ,Cholangiography ,Spleen - Published
- 2006
7. Inhibitory receptor expression and phenotype of virus-specific T cells are linked to tissue localization and HCV control
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Kroy, DC, primary, Ciuffreda, D, additional, Cooperrider, J, additional, Tomlinson, M, additional, Hauck, GD, additional, Aneja, J, additional, Berger, CT, additional, Tanabe, K, additional, Elias, N, additional, Freeman, G, additional, De Kruyff, R, additional, Misdraji, J, additional, Kim, AY, additional, and Lauer, GM, additional
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- 2013
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8. De Novo Autoimmune Hepatitis during Immune Reconstitution in an HIV-Infected Patient Receiving Highly Active Antiretroviral Therapy
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O'Leary, J. G., primary, Zachary, K., additional, Misdraji, J., additional, and Chung, R. T., additional
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- 2008
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9. Epithelial neoplasms and other epithelial lesions of the appendix (excluding carcinoid tumours)
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Misdraji, J., primary
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- 2005
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10. An improved method of surgical pathology testing for onychomycosis.
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Nazarian RM, Due B, Deshpande A, Duncan LM, and Misdraji J
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- 2012
11. Appendiceal mucinous neoplasms: controversial issues.
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Misdraji J
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- 2010
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12. Eosinophilic esophagitis in children: a pathologic or clinicopathologic diagnosis?
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Brigger MT, Misdraji J, Hardy SC, and Hartnick CJ
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- 2009
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13. Longitudinal clinical evaluation of a novel antibody cocktail for detection of high-grade squamous intraepithelial lesions on cervical cytology specimens.
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Tambouret RH, Misdraji J, and Wilbur DC
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- 2008
14. Case records of the Massachusetts General Hospital. Case 33-2006. A 43-year-old man with diabetes, hypogonadism, cirrhosis, arthralgias, and fatigue.
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Chung RT, Misdraji J, Sahani DV, Chung, Raymond T, Misdraji, Joseph, and Sahani, Dushyant V
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- 2006
15. Protocol for the examination of specimens from patients with invasive carcinomas of the appendix.
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Misdraji J, Oliva E, Goldblum JR, Lauwers GY, Compton CC, and College of American Pathologists. Cancer Committee
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- 2006
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16. Cytologic findings in granular cell tumors, with emphasis on the diagnosis of malignant granular cell tumor by fine-needle aspiration biopsy.
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Wieczorek, Tad J., Krane, Jeffrey F., Domanski, Henryk A., Åkerman, Måns, Carlén, Birgitta, Misdraji, Joseph, Granter, Scott R., Wieczorek, T J, Krane, J F, Domanski, H A, Akerman, M, Carlén, B, Misdraji, J, and Granter, S R
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- 2001
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17. Laser-induced hyperthermia in rat prostate cancer: role of site of tumor implantation
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Lein, M., Koenig, F., Misdraji, J., McDougal, W. S., Jung, K., Loening, S. A., Hasan, T., and Ortel, B.
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- 2000
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18. Case records of the Massachusetts General Hospital. Case 39-2010. A 19-year-old woman with nausea, jaundice, and pruritus.
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Friedman LS, Gee MS, Misdraji J, Friedman, Lawrence S, Gee, Michael S, and Misdraji, Joseph
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- 2010
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19. Case records of the Massachusetts General Hospital. Case 3-2006. A 63-year-old woman with jaundice and a pancreatic mass.
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Schapiro RH, Maher MM, Misdraji J, Schapiro, Robert H, Maher, Michael M, and Misdraji, Joseph
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- 2006
20. Case records of the Massachusetts General Hospital. Case 25-2005. A 40-year-old man with prolonged fever and weight loss.
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Kasper DL, Sahani D, Misdraji J, Kasper, Dennis L, Sahani, Dushyant, and Misdraji, Joseph
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- 2005
21. Case records of the Massachusetts General Hospital. Case 21-2012. A 27-year-old man with fatigue, weakness, weight loss, and decreased libido.
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Hunt DP, Becker AE, Guimaraes AR, Stemmer-Rachamimov A, Misdraji J, Hunt, Daniel P, Becker, Anne E, Guimaraes, Alexander R, Stemmer-Rachamimov, Anat, and Misdraji, Joseph
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- 2012
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22. Case records of the Massachusetts General Hospital. Case 5-2012. A 39-year-old man with a recent diagnosis of HIV infection and acute psychosis.
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Freudenreich O, Basgoz N, Fernandez-Robles C, Larvie M, Misdraji J, Freudenreich, Oliver, Basgoz, Nesli, Fernandez-Robles, Carlos, Larvie, Mykol, and Misdraji, Joseph
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- 2012
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23. Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations.
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Wilbur DC, Madi K, Colvin RB, Duncan LM, Faquin WC, Ferry JA, Frosch MP, Houser SL, Kradin RL, Lauwers GY, Louis DN, Mark EJ, Mino-Kenudson M, Misdraji J, Nielsen GP, Pitman MB, Rosenberg AE, Smith RN, Sohani AR, and Stone JR
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- 2009
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24. Case records of the Massachusetts General Hospital. Case 9-2009. An 81-year-old man with massive rectal bleeding.
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Forcione DG, Alam HB, Kalva SP, Misdraji J, Forcione, David G, Alam, Hasan B, Kalva, Sanjeeva P, and Misdraji, Joseph
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- 2009
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25. Case records of the Massachusetts General Hospital. Case 38-2008. A 58-year-old man with hemophilia, hepatocellular carcinoma, and intractable bleeding.
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Dzik WH, Laposata M, Hertl M, Sandberg WS, Chatterji M, Misdraji J, Dzik, Walter H, Laposata, Michael, Hertl, Martin, Sandberg, Warren S, Chatterji, Manjil, and Misdraji, Joseph
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- 2008
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26. Case records of the Massachusetts General Hospital. Case 15-2006. A 46-year-old woman with sudden onset of abdominal distention.
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Chung RT, Iafrate AJ, Amrein PC, Sahani DV, Misdraji J, Chung, Raymond T, Iafrate, A John, Amrein, Philip C, Sahani, Dushyant V, and Misdraji, Joseph
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- 2006
27. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-2004. A 48-year-old man with recurrent gastrointestinal bleeding.
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Keroack MD, Peralta R, Abramson SD, Misdraji J, Keroack, Myles D, Peralta, Ruben, Abramson, Simeon D, and Misdraji, Joseph
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- 2004
28. Erythrophagocytosis is not a reproducible finding in liver biopsies, and is not associated with clinical diagnosis of hemophagocytic lymphohistiocytosis.
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Desai N, Kudose S, Remotti HE, Del Portillo A, Fazlollahi L, Lee MJ, Xiong Y, Moreira RK, Salomao M, Fiel MI, Gonzalez RS, Misdraji J, Gill RM, Hart J, Kleiner DE, Drebber U, Bellizzi AM, and Lagana SM
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- Humans, Acute Disease, Biopsy, Lymphohistiocytosis, Hemophagocytic diagnosis, Lymphohistiocytosis, Hemophagocytic complications, Lymphohistiocytosis, Hemophagocytic pathology, Hepatitis
- Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare disease with high mortality. Liver involvement is common (based on elevated liver function tests) with most patients demonstrating acute hepatitis. Liver biopsies are frequently obtained in the setting of suspected HLH for the purpose of identification of erythrophagocytosis, and if present, this finding is thought to suggest or support the diagnosis of HLH. However, there are problems with this approach; in particular, we do not know whether this finding is reproducible or whether it is specific to HLH. Therefore, we conducted a multi-institutional study in which experienced liver pathologists reviewed images taken from liver biopsies from patients with normal liver, acute hepatitis, possible HLH, and clinical HLH to determine if there was agreement about the presence or absence of erythrophagocytosis, and to ascertain whether the finding corresponds to a clinical diagnosis of HLH. Twelve liver pathologists reviewed 141 images in isolation (i.e., no clinical information or diagnosis provided). These came from 32 patients (five normal, 17 acute hepatitis, six HLH, four possible HLH). The pathologists classified each image as negative, equivocal, or positive for erythrophagocytosis. Kappa was .08 (no agreement) for case-level and 0.1 for image-level (1.4% agreement, based on two images which were universally considered negative). There was no difference in the proportion of pathologists who diagnosed erythrophagocytosis among those with different diagnoses at case or image-level (p = 0.82 and p = 0.82, respectively). Thus, erythrophagocytosis is an entirely unreliable histologic parameter in liver, as it is irreproducible and not demonstrably associated with a clinical disease (namely, HLH). Unless and until more reliable guidelines can be established, pathologists should refrain from commenting on the presence or absence of erythrophagocytosis in liver biopsy., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2024
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29. Inflammatory Pseudotumor of the Liver.
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Wang D and Misdraji J
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- Humans, Granuloma, Plasma Cell diagnosis, Granuloma, Plasma Cell pathology, Carcinoma, Hepatocellular diagnosis, Hodgkin Disease, Liver Neoplasms diagnosis
- Abstract
Hepatic inflammatory pseudotumor (IPT) describes a mass lesion composed of fibroblasts or myofibroblasts with a dense inflammatory infiltrate comprising lymphocyte, plasma cells, and histiocytes. These lesions are presumed to be an exuberant response to an infectious organism, although in most cases the causative agent is unknown. In specific circumstances, pathologists should consider ancillary techniques to exclude specific infections, such as mycobacteria, Candida, or syphilis. IgG4-related disease may cause a plasma-cell rich IPT. Finally, true neoplasms can mimic IPTs and must be excluded with appropriate ancillary studies, including inflammatory myofibroblastic tumor, follicular dendritic cell tumor, inflammatory angiomyolipoma, Hodgkin lymphoma, and inflammatory hepatocellular carcinoma., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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30. Can MRI features predict clinically relevant hepatocellular carcinoma genetic subtypes?
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Liu X, Guo Y, Zhao L, Misdraji J, Kapur T, Abrams TA, and Shyn PB
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- Humans, Retrospective Studies, Contrast Media, Magnetic Resonance Imaging methods, Sensitivity and Specificity, Gadolinium DTPA, Carcinoma, Hepatocellular diagnostic imaging, Carcinoma, Hepatocellular genetics, Carcinoma, Hepatocellular pathology, Liver Neoplasms diagnostic imaging, Liver Neoplasms genetics, Liver Neoplasms pathology
- Abstract
Purpose: Recent studies in cancer genomics have revealed core drivers for hepatocellular carcinoma (HCC) pathogenesis. We aim to study whether MRI features can serve as non-invasive markers for the prediction of common genetic subtypes of HCC., Methods: Sequencing of 447 cancer-implicated genes was performed on 43 pathology proven HCC from 42 patients, who underwent contrast-enhanced MRI followed by biopsy or resection. MRI features were retrospectively evaluated including tumor size, infiltrative tumor margin, diffusion restriction, arterial phase hyperenhancement, non-peripheral washout, enhancing capsule, peritumoral enhancement, tumor in vein, fat in mass, blood products in mass, cirrhosis and tumor heterogeneity. Fisher's exact test was used to correlate genetic subtypes with imaging features. Prediction performance using correlated MRI features for genetic subtype and inter-reader agreement were assessed., Results: The two most prevalent genetic mutations were TP53 (13/43, 30%) and CTNNB1 (17/43, 40%). Tumors with TP53 mutation more often demonstrated an infiltrative tumor margin on MRI (p = 0.01); inter-reader agreement was almost perfect (kappa = 0.95). The CTNNB1 mutation was associated with peritumoral enhancement on MRI (p = 0.04), inter-reader agreement was substantial (kappa = 0.74). The MRI feature of an infiltrative tumor margin correlated with the TP53 mutation with accuracy, sensitivity, and specificity of 74.4%, 61.5% and 80.0%, respectively. Peritumoral enhancement correlated with the CTNNB1 mutation with accuracy, sensitivity, and specificity of 69.8%, 47.0% and 84.6%, respectively., Conclusion: An infiltrative tumor margin on MRI correlated with TP53 mutation and peritumoral enhancement correlated with CTNNB1 mutation in HCC. Absence of these MRI features are potential negative predictors of the respective HCC genetic subtypes that have implications for prognosis and treatment response., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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31. Cytomegalovirus Hepatitis in Allograft Livers May Show Histologic Features of Acute Cellular Rejection.
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Shih AR, Naini BV, Westerhoff M, Alpert L, Masia R, and Misdraji J
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- Humans, Middle Aged, Cytomegalovirus, Retrospective Studies, Graft Rejection diagnosis, Antiviral Agents therapeutic use, Allografts, Liver Transplantation adverse effects, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections drug therapy, Hepatitis diagnosis, Hepatitis complications, Hepatitis drug therapy
- Abstract
Context.—: Cytomegalovirus (CMV) hepatitis in allograft livers is an important infectious complication, with histology that historically has been described to overlap with that of acute cellular rejection (ACR), a diagnosis that compels a different treatment regimen., Objective.—: To update the clinicopathologic features of CMV hepatitis and explore its clinical and histologic relationship with ACR., Design.—: A retrospective analysis of 26 patients with a diagnosis of CMV hepatitis across 4 institutions was performed, including clinical, histologic, and immunohistochemical features., Results.—: Patients were predominantly CMV donor positive/recipient negative (D+/R-; n = 9 of 15) and received a diagnosis of CMV hepatitis at a mean age of 52 years (SD, 17 years), at a mean interval of 184 days (SD, 165 days) from transplantation. Mean CMV viral load at diagnosis was 241 000 IU/mL (SD, 516 000 IU/mL), and liver biochemical enzymes were elevated (mean alanine aminotransferase, 212 U/L [SD, 180 U/L]; mean aspartate aminotransferase, 188 U/L [SD, 151 U/L]; mean alkaline phosphatase, 222 U/L [SD, 153 U/L]). Ten cases did not show histologic features of ACR, and 16 cases demonstrated features of ACR (including marked bile duct injury and endotheliitis). Viral cytopathic change was found in all cases. All patients were treated with a combination of antiviral therapy and CMV intravenous immunoglobulin, with near resolution of biochemical enzymes in all patients with undetectable serum CMV viral titers., Conclusions.—: CMV hepatitis and ACR are complex processes with interlinking mechanisms that are important to distinguish. A subset of transplantation patients with CMV hepatitis show histologic changes that mimic ACR but were treated successfully with antiviral therapy alone., (© 2023 College of American Pathologists.)
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- 2023
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32. Resection of NAFLD/NASH-related Hepatocellular Carcinoma (HCC): Clinical Features and Outcomes Compared with HCC Due to Other Etiologies.
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Pal Chaudhary S, Reyes S, Chase ML, Govindan A, Zhao L, Luther J, Bhan I, Bethea E, Franses JW, Paige Walsh E, Anne Dageford L, Kimura S, Elias N, Yeh H, Markman J, Bozorgzadeh A, Tanabe K, Ferrone C, Zhu AX, Andersson K, Thiim M, Antonio Catalano O, Kambadakone A, Vagefi PA, Qadan M, Pratt D, Hashemi N, Corey KE, Misdraji J, Goyal L, and Clark JW
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- Humans, Female, Retrospective Studies, Liver Cirrhosis pathology, Carcinoma, Hepatocellular pathology, Non-alcoholic Fatty Liver Disease complications, Non-alcoholic Fatty Liver Disease surgery, Liver Neoplasms pathology
- Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies., Methods: Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients., Results: Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant., Conclusions: Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs., (© The Author(s) 2023. Published by Oxford University Press.)
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- 2023
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33. COVID-19: gastrointestinal and hepatobiliary manifestations.
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Shih AR and Misdraji J
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- Humans, SARS-CoV-2, Post-Acute COVID-19 Syndrome, Gastrointestinal Tract, COVID-19 complications, Gastrointestinal Diseases diagnosis, Gastrointestinal Diseases etiology
- Abstract
SARS-CoV-2 is the viral agent of COVID-19, a pandemic that surfaced in 2019. Although predominantly a respiratory ailment, patients with COVID-19 can have gastrointestinal (GI) and hepatobiliary manifestations. These manifestations are often mild and transient, but they can be severe and consequential. In the GI tract, ischemic enterocolitis is the most common and significant consequence of COVID-19. In the liver, the reported pathologic findings may often be related to consequences of severe systemic viral infection, but reports of hepatitis presumed to be due to SARS-CoV-2 suggest that direct viral infection of the liver may be a rare complication of COVID-19. In both the GI tract and liver, lingering symptoms of GI or hepatic injury after resolution of pulmonary infection may be part of the evolving spectrum of long COVID., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2023
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34. High-Grade Appendiceal Mucinous Neoplasm: Clinicopathologic Findings in 35 Cases.
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Gonzalez RS, Carr NJ, Liao H, Pai RK, Agostini-Vulaj D, and Misdraji J
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- Humans, Retrospective Studies, Neoplasm Recurrence, Local, Pseudomyxoma Peritonei pathology, Peritoneal Neoplasms pathology, Appendiceal Neoplasms pathology
- Abstract
Context.—: High-grade appendiceal mucinous neoplasm (HAMN) is a relatively recently introduced term describing a rare epithelial neoplasm of the appendix that demonstrates pushing-type invasion but high-grade cytologic atypia. It remains understudied., Objective.—: To describe clinicopathologic features of HAMNs., Design.—: We identified 35 HAMNs in a multi-institutional retrospective study. Clinical and histologic features were reviewed in all cases, as well as molecular features in 8 cases., Results.—: Patients were 57 years of age on average and most commonly presented with abdominal/pelvic pain. Histologically, 57% of the tumors showed widespread high-grade features. Architectural patterns in high-grade areas included flat, undulating, or villous growth, and occasionally micropapillary, cribriform, or multilayered growth. Thirteen cases had intact serosa, and the remaining 22 perforated the serosa, including 7 with peritoneal acellular mucin beyond appendiceal serosa and 10 with grade 2 pseudomyxoma peritonei. Molecular abnormalities included KRAS mutations in 7 cases and TP53 mutations in 4. No tumor confined to the appendix recurred. Two patients without pseudomyxoma peritonei at initial presentation developed pseudomyxoma on follow-up. Among 11 patients who presented with pseudomyxoma peritonei, 5 died of disease and 3 were alive with disease at last follow-up., Conclusions.—: HAMNs have a similar presentation to low-grade appendiceal mucinous neoplasm, and similar stage-based prognosis. When they spread to the peritoneum, they typically produce grade 2 pseudomyxoma peritonei, which may be associated with a worse prognosis than classical grade 1 pseudomyxoma peritonei., (© 2022 College of American Pathologists.)
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- 2022
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35. Implementation and Clinical Adoption of Precision Oncology Workflows Across a Healthcare Network.
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Dias-Santagata D, Heist RS, Bard AZ, da Silva AFL, Dagogo-Jack I, Nardi V, Ritterhouse LL, Spring LM, Jessop N, Farahani AA, Mino-Kenudson M, Allen J, Goyal L, Parikh A, Misdraji J, Shankar G, Jordan JT, Martinez-Lage M, Frosch M, Graubert T, Fathi AT, Hobbs GS, Hasserjian RP, Raje N, Abramson J, Schwartz JH, Sullivan RJ, Miller D, Hoang MP, Isakoff S, Ly A, Bouberhan S, Watkins J, Oliva E, Wirth L, Sadow PM, Faquin W, Cote GM, Hung YP, Gao X, Wu CL, Garg S, Rivera M, Le LP, John Iafrate A, Juric D, Hochberg EP, Clark J, Bardia A, and Lennerz JK
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- Humans, Precision Medicine methods, Workflow, Medical Oncology methods, Delivery of Health Care, Neoplasms diagnosis, Neoplasms genetics, Neoplasms therapy
- Abstract
Background: Precision oncology relies on molecular diagnostics, and the value-proposition of modern healthcare networks promises a higher standard of care across partner sites. We present the results of a clinical pilot to standardize precision oncology workflows., Methods: Workflows are defined as the development, roll-out, and updating of disease-specific molecular order sets. We tracked the timeline, composition, and effort of consensus meetings to define the combination of molecular tests. To assess clinical impact, we examined order set adoption over a two-year period (before and after roll-out) across all gastrointestinal and hepatopancreatobiliary (GI) malignancies, and by provider location within the network., Results: Development of 12 disease center-specific order sets took ~9 months, and the average number of tests per indication changed from 2.9 to 2.8 (P = .74). After roll-out, we identified significant increases in requests for GI patients (17%; P < .001), compliance with testing recommendations (9%; P < .001), and the fraction of "abnormal" results (6%; P < .001). Of 1088 GI patients, only 3 received targeted agents based on findings derived from non-recommended orders (1 before and 2 after roll-out); indicating that our practice did not negatively affect patient treatments. Preliminary analysis showed 99% compliance by providers in network sites, confirming the adoption of the order sets across the network., Conclusion: Our study details the effort of establishing precision oncology workflows, the adoption pattern, and the absence of harm from the reduction of non-recommended orders. Establishing a modifiable communication tool for molecular testing is an essential component to optimize patient care via precision oncology., (© The Author(s) 2022. Published by Oxford University Press.)
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- 2022
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36. Persistent Cholestatic Injury and Secondary Sclerosing Cholangitis in COVID-19 Patients.
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Shih AR, Hatipoglu D, Wilechansky R, Goiffon R, Deshpande V, Misdraji J, and Chung RT
- Subjects
- Alkaline Phosphatase, Humans, RNA, COVID-19 complications, Cholangitis, Sclerosing complications, Cholangitis, Sclerosing diagnosis, Cholestasis complications, Cholestasis pathology
- Abstract
Context.—: COVID-19 has been associated with liver injury, and a small subset of patients recovering from severe disease have shown persistent markedly elevated liver biochemistries for months after infection., Objective.—: To characterize persistent biliary injury after COVID-19., Design.—: A search of the pathology archives identified 7 post-COVID-19 patients with persistent biliary injury, and the clinical, radiologic, and pathologic features were assessed., Results.—: All patients in this cohort presented with respiratory symptoms and had a complicated clinical course with acute elevation of liver biochemistries. Alkaline phosphatase (ALP) was markedly and persistently elevated after discharge (median peak ALP, 1498 IU/L, at a median of 84 days from diagnosis). Magnetic resonance cholangiopancreatography showed 3 patients with irregularity, stricturing, and dilatation of intrahepatic ducts; no radiographic abnormalities were identified in the remaining 4 patients. Liver biopsies showed mild portal changes with features of cholestatic injury in 4 patients (bile duct injury and canalicular cholestasis) and marked biliary obstruction in 2 patients (profound cholestasis, ductular reaction, and bile infarcts), but no SARS-CoV-2 RNA was identified on in situ hybridization. On follow-up, most patients had minimal intervention and showed marked improvement of liver biochemistries but with mild persistent elevation of ALP., Conclusions.—: A subset of critically ill COVID-19 patients demonstrates marked and persistent cholestatic injury, with radiographic and histologic evidence of secondary sclerosing cholangitis, suggesting that cholestatic liver disease and secondary sclerosing cholangitis may be long-term sequelae of COVID-19 acute illness as a longstanding manifestation of critical illness.
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- 2022
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37. Hepatic histologic findings in a case of MEGDHEL syndrome due to SERAC1 deficiency.
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Yuen L, Sahai I, O'Grady L, Selig M, Walker MA, Shah U, and Misdraji J
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- Carboxylic Ester Hydrolases genetics, Child, Contracture, Female, Histiocytosis, Humans, Syndrome, Hearing Loss, Sensorineural diagnosis, Hearing Loss, Sensorineural genetics, Liver Diseases genetics, Metabolism, Inborn Errors genetics
- Abstract
MEGD(H)EL syndrome is a rare autosomal recessive disorder caused by mutations in SERAC1, a protein necessary for phosphatidylglycerol remodeling. It is characterized by 3-methylglutaconic aciduria, deafness-dystonia, (hepatopathy), encephalopathy, and Leigh-like syndrome, but has a wide spectrum of severity. Here, we present a case of a child with MEGD(H)EL syndrome with infantile hepatopathy, neurodevelopmental delays, characteristic biochemical abnormalities, and biallelic novel SERAC1 mutations: (1) deletion of (at least) exons 2-4, pathogenic; and (2) c.1601A>T (p.H534L), likely pathogenic. Her initial clinical presentation was notable for persistently elevated transaminases, speech delay, delayed motor milestones, and sensorineural hearing loss. However, her verbal and motor development has progressively improved and now, at 4 years of age, she has only speech and mild gross motor delays as compared to her unaffected peers and is exceeding clinical expectations. The histologic features of a liver biopsy are described, which has not previously been published in detail for this syndrome. Hepatocytes showed granular cytoplasm and fine intracytoplasmic lipid droplets. The ultrastructural findings included abnormal circular mitochondrial cristae. These findings are consistent with a mitochondrial disorder., (© 2022 Wiley Periodicals LLC.)
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- 2022
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38. A Novel Digital Algorithm for Identifying Liver Steatosis Using Smartphone-Captured Images.
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Xu K, Raigani S, Shih A, Baptista SG, Rosales I, Parry NM, Shroff SG, Misdraji J, Uygun K, Yeh H, Fairchild K, and Anne Dageforde L
- Abstract
Access to lifesaving liver transplantation is limited by a severe organ shortage. One factor contributing to the shortage is the high rate of discard in livers with histologic steatosis. Livers with <30% macrosteatosis are generally considered safe for transplant. However, histologic assessment of steatosis by a pathologist remains subjective and is often limited by image quality. Here, we address this bottleneck by creating an automated digital algorithm for calculating histologic steatosis using only images of liver biopsy histology obtained with a smartphone., Methods: Multiple images of frozen section liver histology slides were captured using a smartphone camera via the optical lens of a simple light microscope. Biopsy samples from 80 patients undergoing liver transplantation were included. An automated digital algorithm was designed to capture and count steatotic droplets in liver tissue while discounting areas of vascular lumen, white space, and processing artifacts. Pathologists of varying experience provided steatosis scores, and results were compared with the algorithm's assessment. Interobserver agreement between pathologists was also assessed., Results: Interobserver agreement between all pathologists was very low but increased with specialist training in liver pathology. A significant linear relationship was found between steatosis estimates of the algorithm compared with expert liver pathologists, though the latter had consistently higher estimates., Conclusions: This study demonstrates proof of the concept that smartphone-captured images can be used in conjunction with a digital algorithm to measure steatosis. Integration of this technology into the transplant workflow may significantly improve organ utilization rates., Competing Interests: K.U. has a financial interest in Sylvatica, a company focused on developing organ preservation technology. K.U.’s interests are managed by the Massachusetts General Hospital and Mass General Brigham in accordance with their conflict of interest policies., (Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)
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- 2022
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39. Liver stromal cells restrict macrophage maturation and stromal IL-6 limits the differentiation of cirrhosis-linked macrophages.
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Buonomo EL, Mei S, Guinn SR, Leo IR, Peluso MJ, Nolan MA, Schildberg FA, Zhao L, Lian C, Xu S, Misdraji J, Kharchenko PV, and Sharpe AH
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- Cell Differentiation, Humans, Liver Cirrhosis etiology, Macrophages pathology, Monocytes pathology, RNA, Stromal Cells pathology, Interleukin-6, Liver Diseases pathology
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Background & Aims: Myeloid cells are key regulators of cirrhosis, a major cause of mortality worldwide. Because stromal cells can modulate the functionality of myeloid cells in vitro, targeting stromal-myeloid interactions has become an attractive potential therapeutic strategy. We aimed to investigate how human liver stromal cells impact myeloid cell properties and to understand the utility of a stromal-myeloid coculture system to study these interactions in the context of cirrhosis., Methods: Single-cell RNA-sequencing analyses of non-cirrhotic (n = 7) and cirrhotic (n = 5) human liver tissue were correlated to the bulk RNA-sequencing results of in vitro cocultured human CD14
+ and primary liver stromal cells. Complimentary mechanistic experiments and flow cytometric analysis were performed on human liver stromal-myeloid coculture systems., Results: We found that stromal-myeloid coculture reduces the frequency CD14+ cell subsets transcriptionally similar to liver macrophages, showing that stromal cells inhibit the maturation of monocytes into macrophages. Stromal cells also influenced in vitro macrophage differentiation by skewing away from cirrhosis-linked CD9+ scar-associated macrophage-like cells and towards CD163+ Kupffer cell-like macrophages. We identify IL-6 production as a mechanism by which stromal cells limit CD9+ macrophage differentiation and find that local IL-6 levels are decreased in early-stage human liver disease compared to healthy liver tissue, suggesting a protective role for local IL-6 in the healthy liver., Conclusions: Our work reveals an unanticipated role for liver stromal cells in impeding the maturation and altering the differentiation of macrophages and should prompt investigations into the role of local IL-6 production in the pathogenesis of liver disease. These studies provide a framework for investigating macrophage-stromal interactions during cirrhosis., Lay Summary: The impact of human liver stromal cells on myeloid cell maturation and differentiation in liver disease is incompletely understood. In this study, we present a mechanistic analysis using a primary in vitro human liver stromal-myeloid coculture system that is translated to liver disease using single-cell RNA sequencing analysis of cirrhotic and non-cirrhotic human liver tissue. Our work supports a role for stromal cell contact in restricting macrophage maturation and for stromal-derived IL-6 in limiting the differentiation of a cirrhotic macrophage subset., Competing Interests: Conflicts of interest AS has patents/pending royalties on the PD-1 pathway from Roche and Novartis. AS is on advisory boards for Surface Oncology, SQZ Biotechnologies, Elpiscience, Selecta, Bicara and Monopteros. AS has received research funding from Novartis, Roche, UCB, Ipsen, Quark, Merck, AbbVie and Moderna. PK serves on the Scientific Advisory Board to Celsius Therapeutics Inc and Biomage Inc. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2022 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)- Published
- 2022
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40. Fundic gland polyps related to diverse aetiologies show subtle morphological differences: a multicentre retrospective study.
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Kővári B, El Naili R, Pereira DV, Kumarasinghe P, De Boer WB, Jiang K, Pimiento JM, Fukuda M, Misdraji J, Kushima R, and Lauwers GY
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- Adenomatous Polyposis Coli classification, Adenomatous Polyposis Coli etiology, Adenomatous Polyposis Coli pathology, Adenomatous Polyps classification, Adenomatous Polyps etiology, Adenomatous Polyps pathology, Female, Gastric Mucosa pathology, Humans, Hyperplasia, Male, Parietal Cells, Gastric pathology, Polyps classification, Retrospective Studies, Stomach Neoplasms classification, Gastric Fundus pathology, Polyps etiology, Polyps pathology, Stomach Neoplasms etiology, Stomach Neoplasms pathology
- Abstract
Aims: Fundic gland polyps (FGPs) comprise 66% of all gastric polyps. Although they are usually non-syndromic, they may be associated with various syndromes, including familial adenomatous polyposis (FAP) or gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS). We aimed to evaluate how histological features relate to distinct FGP subtypes., Methods and Results: We performed a retrospective analysis of 118 FGPs from 109 patients for the architecture of fundic glands, microcyst lining, parietal cell hyperplasia and surface foveolar epithelial changes. Age, gender and history of FAP or GAPPS were collected. Based on combinations of histological features, three distinct patterns (A, B and C) of FGPs were delineated and correlated to the aetiologies. Non-syndromic FGPs were well-formed polyps composed of disordered fundic glands with intermediate-sized microcysts typically lined by a mixture of oxyntic and mucin-secreting cells (73%). Parietal cell hyperplasia (80%) and foveolar surface hyperplasia (78%) were common. FAP-associated cases demonstrated small microcysts that were predominantly lined by fundic epithelium (77%), with limited parietal cell hyperplasia (27%); foveolar hyperplasia was uncommon. GAPPS-related polyps were the largest, with prominent, mucin-secreting epithelium-lined microcysts (73%). Hyperproliferative aberrant pits were universally present, whereas parietal cell hyperplasia was uncommon. Pattern A was identified in most non-syndromic FGPs (74%) and in a minority of FAP-related FGPs (26%). The majority (82%) of FAP-related FGPs showed pattern B, but only 18% of non-syndromic FGPs did. Pattern C consisted exclusively of GAPPS-associated polyps., Conclusions: We conclude that, although FGPs share similar histomorphology, subtle differences exist between polyps of different aetiology. In the appropriate clinical setting, the recognition of these variations may help to consider syndromic aetiologies., (© 2022 John Wiley & Sons Ltd.)
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- 2022
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41. Hepatic Secondary Syphilis Can Cause a Variety of Histologic Patterns and May Be Negative for Treponeme Immunohistochemistry.
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Malvar G, Cardona D, Pezhouh MK, Adeyi OA, Chatterjee D, Deisch JK, Lamps LW, Misdraji J, Stueck AE, Voltaggio L, and Gonzalez RS
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- Adult, Female, Homosexuality, Male, Humans, Immunohistochemistry, Male, Middle Aged, Young Adult, Hepatitis, Phlebitis complications, Sexual and Gender Minorities, Syphilis diagnosis, Syphilis pathology
- Abstract
The rate of syphilis in the United States has been increasing steadily in the past decade, but it remains an uncommon diagnosis in tissue biopsies. Most of the pathology literature on hepatic syphilis consists of older series or case reports. This study aimed to systematically characterize the histologic spectrum of hepatic syphilis in a contemporary cohort. Clinicopathologic features of 14 hepatic syphilis cases between 2012 and 2018 were analyzed to characterize the broad spectrum of histologic changes. Thirteen patients were men (age range: 19 to 59 y); 6 had known human immunodeficiency virus, 7 were men known to have sex with men, and no patient had known prior syphilis. Hepatic syphilis was the primary clinical suspicion in only 1 patient. Common symptoms included jaundice, rash, and abdominal pain. Thirteen had elevated transaminases, and 12 had elevated alkaline phosphatase. Pathologic changes were grouped into 5 histologic patterns: biliary-pattern injury (n=5), acute hepatitis (n=4), autoimmune hepatitis-like (n=1), fibroinflammatory mass-forming lesion (n=2), and no particular pattern (n=2). Nearly all showed portal and lobular lymphocytes and plasma cells; 12 had prominent histiocytes/Kupffer cells, 9 had ductular reaction, and 7 had duct inflammation. Occasional focal findings included dropout (n=7), phlebitis (n=7), and loose granulomata (n=5). Treponeme immunohistochemistry was positive in 10 and negative in 4, though treatment was given before biopsy in 3 of those 4. Thirteen patients had rapid plasma reagin testing either before or after biopsy, with 1:64 or higher titer. All patients who received treatment recovered. Hepatic syphilis is rare but likely underrecognized. It exhibits a variety of histologic appearances and therefore should be considered in several hepatic differential diagnoses, especially in men who have sex with men. Kupffer cells, granulomata, and phlebitis may suggest the diagnosis regardless of predominant histologic pattern. Negative treponeme immunohistochemical staining does not exclude the diagnosis, including in untreated patients., Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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42. Next-generation sequencing in the evaluation of biliary strictures in patients with primary sclerosing cholangitis.
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Scheid JF, Rosenbaum MW, Przybyszewski EM, Krishnan K, Forcione DG, Iafrate AJ, Staller KD, Misdraji J, Lennerz JK, Pitman MB, and Pratt DS
- Subjects
- Bile Ducts, Intrahepatic pathology, Constriction, Pathologic diagnosis, Constriction, Pathologic genetics, High-Throughput Nucleotide Sequencing, Humans, In Situ Hybridization, Fluorescence, Prospective Studies, Bile Duct Neoplasms complications, Bile Duct Neoplasms diagnosis, Bile Duct Neoplasms genetics, Cholangiocarcinoma complications, Cholangiocarcinoma diagnosis, Cholangiocarcinoma genetics, Cholangitis, Sclerosing complications, Cholangitis, Sclerosing diagnosis, Cholangitis, Sclerosing genetics
- Abstract
Background: Primary sclerosing cholangitis (PSC) is a well-described risk factor for the development of cholangiocarcinoma (CCA). Early detection of CCA in these patients is of great importance because it expands options for therapeutic interventions, including liver transplantation. Current diagnostic tests for the evaluation of biliary strictures are limited to biliary brushing (BB) cytology and fluorescence in situ hybridization (FISH). Next-generation sequencing (NGS) has become an important diagnostic tool in oncology and may be a useful tool for diagnosing CCA on BBs. It is not clear how NGS performs when it is added to BB cytology and FISH in patients with PSC., Methods: This study reports the authors' experience with NGS performed as a prospective cotest with cytology and FISH on BBs obtained from 60 patients with PSC followed at Massachusetts General Hospital. A duct with malignancy was defined as a high-risk (HR) stricture with either high-grade dysplasia or CCA., Results: NGS was better than FISH and cytology in detecting HR strictures, which showed multiple genetic mutations in all cases. NGS provided specific mutational information, and NGS results were reproducible in longitudinal samples., Conclusions: Adding NGS to BB cytology and FISH in the evaluation of biliary strictures for patients with PSC may provide additional information that could help to inform clinical management., (© 2021 American Cancer Society.)
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- 2022
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43. Hepatic vascular remodelling in a patient with dyskeratosis congenita.
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Boyraz B, Agarwal S, Pratt DS, Simoneau T, Bhan I, Markmann JF, and Misdraji J
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- Female, Hepatopulmonary Syndrome pathology, Humans, Liver pathology, Liver Transplantation, Young Adult, Dyskeratosis Congenita pathology, Hepatopulmonary Syndrome surgery, Liver blood supply, Vascular Remodeling physiology
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- 2022
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44. Clinicopathological findings in patients with COVID-19-associated ischaemic enterocolitis.
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Zhang ML, Jacobsen F, Pepe-Mooney BJ, Mino-Kenudson M, Deshpande V, Shih AR, Mattia AR, Goessling W, Hwabejire JO, Velmahos GC, and Misdraji J
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, SARS-CoV-2, COVID-19 complications, Colitis, Ischemic pathology, Colitis, Ischemic virology, Enterocolitis pathology, Enterocolitis virology
- Abstract
Aims: Coronavirus disease 2019 (COVID-19) has been recognised as a predominantly respiratory tract infection, but some patients manifest severe systemic symptoms/coagulation abnormalities. The aim of this study was to evaluate the impact of severe COVID-19 infection on the gastrointestinal tract., Methods and Results: We examined clinicopathological findings in 28 resected ischaemic bowels from 22 patients with severe COVID-19. Most patients required intubation preoperatively and presented with acute decompensation shortly before surgery. D-dimer levels were markedly elevated in all measured cases (mean, 5394 ng/ml). Histologically, 25 cases (19 patients) showed evidence of acute ischaemia with necrosis. In this group, the most characteristic finding was the presence of small vessel fibrin thrombi (24 of 25 cases, 96%), which were numerous in 64% of cases. Patients with COVID-19 were significantly more likely than a control cohort of 35 non-COVID-19-associated acute ischaemic bowels to show isolated small intestine involvement (32% versus 6%, P < 0.001), small vessel fibrin thrombi (100% versus 43%, P < 0.001), submucosal vessels with fibrinous degeneration and perivascular neutrophils (90% versus 54%, P < 0.001), fibrin strands within submucosal vessels (58% versus 20%, P = 0.007), and histological evidence of pneumatosis (74% versus 34%, P = 0.010). Three cases in this cohort had histopathological findings normally seen in the setting of chronic ischaemia, notably prominent fibroblastic proliferation affecting the outer layer of the muscularis propria., Conclusions: Herein, we describe the histopathological findings in COVID-19-associated ischaemic bowels and postulate a relationship with the hypercoagulable state seen in patients with severe COVID-19 infection. Additional experience with these cases may further elucidate specific features or mechanisms of COVID-19-associated ischaemic enterocolitis., (© 2021 John Wiley & Sons Ltd.)
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- 2021
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45. Bowel Ischemia in COVID-19 Infection: One-Year Surgical Experience.
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Hwabejire JO, Kaafarani HMA, Mashbari H, Misdraji J, Fagenholz PJ, Gartland RM, Abraczinskas DR, Mehta RS, Paranjape CN, Eng G, Saillant NN, Parks J, Fawley JA, Lee J, King DR, Mendoza AE, and Velmahos GC
- Subjects
- Female, Humans, Laparotomy, Male, Massachusetts, Middle Aged, SARS-CoV-2, COVID-19 complications, Intestinal Diseases surgery, Intestinal Diseases virology, Ischemia surgery, Ischemia virology
- Abstract
Background: COVID-19 is a deadly multisystemic disease, and bowel ischemia, the most consequential gastrointestinal manifestation, remains poorly described. Our goal is to describe our institution's surgical experience with management of bowel ischemia due to COVID-19 infection over a one-year period., Methods: All patients admitted to our institution between March 2020 and March 2021 for treatment of COVID-19 infection and who underwent exploratory laparotomy with intra-operative confirmation of bowel ischemia were included. Data from the medical records were analyzed., Results: Twenty patients were included. Eighty percent had a new or increasing vasopressor requirement, 70% had abdominal distension, and 50% had increased gastric residuals. Intra-operatively, ischemia affected the large bowel in 80% of cases, the small bowel in 60%, and both in 40%. Sixty five percent had an initial damage control laparotomy. Most of the resected bowel specimens had a characteristic appearance at the time of surgery, with a yellow discoloration, small areas of antimesenteric necrosis, and very sharp borders. Histologically, the bowel specimens frequently have fibrin thrombi in the small submucosal and mucosal blood vessels in areas of mucosal necrosis. Overall mortality in this cohort was 33%. Forty percent of patients had a thromboembolic complication overall with 88% of these developing a thromboembolic phenomenon despite being on prophylactic pre-operative anticoagulation., Conclusion: Bowel ischemia is a potentially lethal complication of COVID-19 infection with typical gross and histologic characteristics. Suspicious clinical features that should trigger surgical evaluation include a new or increasing vasopressor requirement, abdominal distension, and intolerance of gastric feeds.
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- 2021
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46. Case 25-2021: A 48-Year-Old Man with Fatigue and Leg Swelling.
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Moore AB, Wing JR, Goiffon RJ, Leaf RK, Tsao L, and Misdraji J
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- Cardiomyopathies etiology, Diabetes Mellitus etiology, Diagnosis, Differential, Edema etiology, Fatal Outcome, Fatigue etiology, Hemochromatosis complications, Hemochromatosis drug therapy, Hemochromatosis genetics, Humans, Iron metabolism, Iron Chelating Agents therapeutic use, Leg, Male, Middle Aged, Transferrin metabolism, Hemochromatosis diagnosis, Iron blood
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- 2021
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47. Liver biopsy findings in patients on immune checkpoint inhibitors.
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Cohen JV, Dougan M, Zubiri L, Reynolds KL, Sullivan RJ, and Misdraji J
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- Adult, Aged, Aged, 80 and over, Biopsy, Chemical and Drug Induced Liver Injury etiology, Female, Humans, Male, Middle Aged, Retrospective Studies, Antineoplastic Agents adverse effects, Chemical and Drug Induced Liver Injury pathology, Immune Checkpoint Inhibitors adverse effects, Liver drug effects, Neoplasms drug therapy
- Abstract
Immune checkpoint inhibitors (ICI) can induce a durable response against a wide range of malignancies but cause immune related adverse events. The purpose of this study was to evaluate whether the pattern of inflammation in a liver biopsy in patients on ICIs is likely to be related to ICIs or other causes, and whether the pattern correlates with LFT abnormalities, imaging findings, and responsiveness to steroids. Cancer patients on ICIs who underwent liver biopsy were identified. Clinical data were obtained from electronic records. Liver biopsies were recorded as hepatitic, cholangitic, mixed, steatotic, or as mild nonspecific changes. In total, 28 liver biopsies had a predominantly hepatitic pattern of inflammation, including 11 biopsies with granulomas and 10 with endothelialitis. Eight biopsies had a mixed hepatocytic and cholangitic pattern of injury, including 6 with granulomas and 4 with endothelialitis. Sixteen patients had a predominantly cholangitic pattern, with portal-based inflammation. Three patients had a pattern resembling fatty liver, and five had mild nonspecific changes. The three most common histologic patterns correlated with the pattern of LFT abnormalities. The majority of patients with a cholangitic pattern had competing causes for elevated LFTs, including disease progression or concomitant chemotherapy. The cholangitic pattern was more likely to have bile duct dilatation or narrowing on liver imaging. The pattern of inflammation, degree of lobular injury, or presence of granulomas or endothelialitis did not predict response to steroids or the need for secondary immunosuppression. In this retrospective study, the pattern of inflammation did not predict the need for steroids, the length of time that steroids is required, or the need for secondary immunosuppression. A cholangitic pattern was seen when the pattern of LFTs was cholestatic, and was associated with imaging abnormalities of the bile duct, but a similar pattern was seen in bile duct obstruction and other drug reactions.
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- 2021
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48. Successful Treatment of Refractory Autoimmune Enteropathy With Ustekinumab.
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Scheid JF, Misdraji J, Nath BJ, and Yarze JC
- Abstract
Autoimmune enteropathy (AIE) is a rare autoimmune disorder that has been described both in pediatric and adult patients and usually causes intractable watery diarrhea. The management of AIE is not standardized because the disease shows variable response to different immunosuppressive regimens including corticosteroids, azathioprine, cyclophosphamide, 6-mercaptopurine, tacrolimus, cyclosporine-A, infliximab, vedolizumab, and abatacept. We present a patient with adult-onset AIE and intractable high-volume diarrhea resulting in numerous hospitalizations and temporary parenteral nutrition, who is now successfully maintained on ustekinumab. Therefore, ustekinumab should be considered for further evaluation as a therapeutic option in cases of refractory AIE., (© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)
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- 2021
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49. Morphologic and molecular analysis of early-onset gastric cancer.
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Setia N, Wang CX, Lager A, Maron S, Shroff S, Arndt N, Peterson B, Kupfer SS, Ma C, Misdraji J, Catenacci D, and Hart J
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- Adolescent, Adult, Female, Humans, Male, Middle Aged, Stomach Neoplasms pathology, Young Adult, Early Detection of Cancer methods, Genetic Predisposition to Disease genetics
- Abstract
Background: Evidence suggests that early-onset gastric cancers are distinct from traditional gastric cancers; however, detailed genomic and morphologic characterization of these cancers has not been performed., Methods: Genomic analysis was performed for 81 patients with gastric cancer who were 50 years old or younger; pathology slides were available for 53 of these patients, and they were re-reviewed to perform a morphologic-molecular correlation analysis. The results were compared with corresponding cBioPortal data and The Cancer Genome Atlas (TCGA) analysis, which represent traditional gastric cancers. The TP53 molecular signature was established to determine the pattern of somatic mutational damage. Variants of potential germline origin were also identified from next-generation sequencing data., Results: A higher rate of CDH1 mutations (22.2% of early-onset gastric cancers vs 11.4% of traditional gastric cancers; P = .0042) but a similar rate of TP53 mutations (63% of early-onset gastric cancers vs 56.6% of traditional gastric cancers; P = .2674) were seen in early-onset cancers in comparison with traditional gastric cancers. The diffuse/mixed types correlated with the TCGA genomically stable type, and the remaining Lauren types correlated with the TCGA chromosomal instability type. Diffuse and indeterminate histologic types (overall survival, 26.25 months for the intestinal type, 20.5 months for the mixed type, 12.62 months for the diffuse type, and 9 months for the indeterminate type; P = .027) and the presence of a CDH1 gene mutation (overall survival, 9 months for mutant CDH1 and 22 months for wild-type CDH1; P = .013) significantly correlated with worse survival. The TP53 gene frequently showed transition mutations (65.5%) involving the CpG sites (49%). Variants of potential germline origin were seen in high-penetrance genes (CDH1 and APC) and moderate-penetrance genes (ATM, NBN, and MUTYH) in 9.9% of cancers., Conclusions: Early-onset gastric cancer has distinct genomic alterations, such as CDH1 mutations, but shares with traditional gastric cancers a high frequency of TP53 mutations and the TP53 mutagenic signature. Diffuse and indeterminate histologic types and the presence of a CDH1 mutation are associated with worse overall survival. Endogenous factors leading to cytosine deamination and potential germline alterations in moderate-penetrance cancer susceptibility genes may be implicated in the pathogenesis of these cancers., (© 2020 American Cancer Society.)
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- 2021
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50. Abdominal Imaging Findings in COVID-19: Preliminary Observations.
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Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, Catalano O, Gee MS, Hahn PF, Harisinghani M, Kilcoyne A, Lee SI, Mojtahed A, Pandharipande PV, Pierce TT, Rosman DA, Saini S, Samir AE, Simeone JF, Gervais DA, Velmahos G, Misdraji J, and Kambadakone A
- Subjects
- Abdomen pathology, Abdomen surgery, Abdomen virology, Adolescent, Adult, Aged, Aged, 80 and over, Betacoronavirus isolation & purification, COVID-19, Coronavirus Infections complications, Coronavirus Infections pathology, Female, Gastrointestinal Diseases pathology, Gastrointestinal Diseases surgery, Humans, Laparotomy, Male, Middle Aged, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral pathology, Retrospective Studies, SARS-CoV-2, Young Adult, Abdomen diagnostic imaging, Coronavirus Infections diagnostic imaging, Gastrointestinal Diseases diagnostic imaging, Gastrointestinal Diseases virology, Pneumonia, Viral diagnostic imaging
- Abstract
Background Angiotensin-converting enzyme 2, a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury. Purpose To report abdominal imaging findings in patients with coronavirus disease 2019. Materials and Methods In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from March 27 to April 10, 2020, who tested positive for SARS-CoV-2 were included. Abdominal imaging studies performed in these patients were reviewed, and salient findings were recorded. Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results A total of 412 patients (average age, 57 years; range, 18 to >90 years; 241 men, 171 women) were evaluated. A total of 224 abdominal imaging studies were performed (radiography, n = 137; US, n = 44; CT, n = 42; MRI, n = 1) in 134 patients (33%). Abdominal imaging was associated with age (odds ratio [OR], 1.03 per year of increase; P = .001) and intensive care unit (ICU) admission (OR, 17.3; P < .001). Bowel-wall abnormalities were seen on 31% of CT images (13 of 42) and were associated with ICU admission (OR, 15.5; P = .01). Bowel findings included pneumatosis or portal venous gas, seen on 20% of CT images obtained in patients in the ICU (four of 20). Surgical correlation ( n = 4) revealed unusual yellow discoloration of the bowel ( n = 3) and bowel infarction ( n = 2). Pathologic findings revealed ischemic enteritis with patchy necrosis and fibrin thrombi in arterioles ( n = 2). Right upper quadrant US examinations were mostly performed because of liver laboratory findings (87%, 32 of 37), and 54% (20 of 37) revealed a dilated sludge-filled gallbladder, suggestive of bile stasis. Patients with a cholecystostomy tube placed ( n = 4) had negative bacterial cultures. Conclusion Bowel abnormalities and gallbladder bile stasis were common findings on abdominal images of patients with coronavirus disease 2019. Patients who underwent laparotomy often had ischemia, possibly due to small-vessel thrombosis. © RSNA, 2020.
- Published
- 2020
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