Posters & Abstracts

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The following posters were authored by the pathologists who work with Miraca Life Sciences and presented at the annual scientific meeting of the American College of Gastroenterology in 2012.


The following posters were authored by the pathologists who work with Miraca Life Sciences and presented at the annual scientific meeting of the American College of Gastroenterology 2011.

  • Advanced Adenoma and Colorectal Cancer Shared Corresponding and Dynamic Distribution Patterns
  • Dynamic Shift in the Distribution of Colorectal Cancer
  • Helicobacter pylori Gastritis is Inversely Correlated to Dysplasia in Patients with Barrett’s Esophagus
  • Intestinal Spirochetosis in the United States: A Clinicopathologic Study of Colonic Biopsy
  • Reactive Gastropathy: A Patho-epidemiologic Panorama in the United States
  • Clinical and Pathologic Characteristics of Patients with a Diagnosis of Intestinal Metaplasia in Biopsies of the Gastroesophageal Junction
  • Autoimmune Enteropathy in Adults: A Clinicopathologic Study of Four Patients
  • Herpes Esophagitis: A Clinicopathologic Study of Esophageal Specimens
  • Signet-Ring Carcinoma in Gastric Biopsies: Do Pathologists Worry Too Much?
  • Diagnostic Yield of the Colonic Biopsy in the Investigation of Diarrhea
  • Seasonal Patterns in Eosinophilic Esophagitis: An Analysis by Month of Diagnosis and Month of Birth
  • Metastatic Breast Carcinoma to the Colon Mimicking Microscopic Colitis
  • Amoebic Colitis in the United States: A Patho-epidemiologic Study of Colonic Biopsy Specimens
  • High Prevalence of Celiac Disease in Women with Young Onset Collagenous Colitis
  • Gastric Clear Cell Carcinoid Tumor in Patient with Von Hippel-Lindau Disease

The following presentations and posters were authored by the pathologists who work with Miraca Life Sciences and presented at Digestive Disease Week (DDW) 2011.

High Yield of Lynch Syndrome Screening in Pre-Cancerous Colorectal Polyps: A Study of 898 Patients

Lynch Syndrome research presented at DDW 2001 by Mark Redston, MD and Richard Lash, MD, found that the prevalence of LS among patients with newly diagnosed HGD adenomas in the community practice setting is similar to CRC patients in the same population (3.0% vs. 3.6%). In addition, the prevalence of LS is highest in HGD adenoma patients under age 50, however, more than 50% are older than age 50. Almost 50% of newly diagnosed HGD adenoma patients with probable LS do not meet family or personal history criteria for HNPCC.

These results suggest there is value to routinely screen for LS in patients with HGD adenomas and provide a novel approach for detection of LS prior to the development of cancer.


Size-specific prevalence of colorectal adenomas with high grade dysplasia: results from a nationally representative sample with implications for CT colonography practice

The aim of this cross-sectional study was to estimate size-specific prevalence of high grade dysplasia among adenomas identified from a nationally representative sample of colorectal specimens.


Differences in the Prevalence of Eosinophilic Esophagitis Among United States Climate Zones

Eosinophilic esophagitis (EoE) is a clinicopathologic condition characterized by dysphagia, and marked eosinophilic infiltrates in the esophageal mucosa. Although the etiology is unknown, leading hypotheses involve exposure to airborne or ingested antigens.

Previous studies have shown geographic variations in the numbers of constitutive eosinophils in the gastrointestinal mucosa and geographic variation in the prevalence of eczema among children in the U.S. We hypothesized that geographic and climatic factors, which are critical determinants of regional flora and environmental antigens, influence the epidemiology of EoE. This study was designed to determine the prevalence of esophageal eosinophilia in different U.S. climate zones.


Sporadic Duodenal Adenomas are Associated with a Significant Risk for Colorectal Adenomas

Sporadic duodenal adenomas (DA) are relatively rare lesions with a prevalence of approximately 0.4% and a reported association with colorectal adenomas. With small numbers available for study in existing series, potential associations may escape detection. The purpose of this study was to evaluate the demographic, clinical, endoscopic, and histopathologic characteristics in a large series of patients with adenomatous lesions of the duodenum and concurrent biopsies of the colon.


Biopsy Practice Patterns and Diagnostic Yield in Cases of Suspected Eosinophilic Esophagitis in the United States

For patients suspected of having eosinophilic esophagitis (EoE), published consensus recommendations suggest how esophageal biopsy specimens should be obtained. The 2007 American Gastroenterological Association Institute guidelines for EoE diagnostic testing and biopsy procurement suggest that multiple biopsy specimens should be obtained from different esophageal locations along the length of the esophagus. The aim of this study was to examine current biopsy practice patterns in suspected EoE cases in the United States, and to determine the relationship between number and location of biopsy sites and the histopathologic diagnosis of EoE.


Prevalence of Rectal Carcinoid Tumors among Outpatient Colonoscopy Patients and the Utility of Immunohistochemistry for Definitive Diagnosis

Rectal carcinoid tumors are rare (0.05% in the general population, SEER data) and are usually discovered incidentally in routine colonoscopy biopsies. Although immunohistochemistry with neuroendocrine markers synaptophysin and/or chromogranin is often used to confirm the diagnosis, its utility is not well established. The aims of this study were to (1) determine the prevalence of rectal carcinoid tumors in a large cohort of US outpatient colonoscopy patients and (2) evaluate whether the routine use of immunohistochemical stains is necessary for a definitive diagnosis.


A Descriptive Analysis of Colorectal Carcinoma in Patients with Ulcerative Colitis Seen Over a Three Year Period

Patients with longstanding and extensive ulcerative colitis (UC) are at increased risk for developing colorectal carcinoma (CRC). Recent epidemiologic studies have suggested an overall decrease in the incidence of CRC in individuals with UC but that men appear to have a higher risk of developing CRC. We reviewed a large nationwide pathology database to examine demographic, histologic and other features associated with CRC in individuals with UC.


Read posters from Miraca Life Sciences presentations at the 2010 Annual Meeting of the American College of Gastroenterology ("ACG 2010") held in San Antonio, TX, October 15-20, 2010. In total, we were awarded 17 accepted abstracts, three of which are ACG Presidential Poster Award recipients.

Incidental Strongyloidiasis in Colonic Biopsy Specimens

M.H. Saboorian, Guy M. Lindberg, Robert M. Genta, Miraca Life Sciences Research Institute, Irving, TX

Strongyloides stercoralis, a worldwide parasitic nematode, can persist indefinitely within a host, usually asymptomatic, through a mechanism known as autoinfection. Immunosuppression may cause rapid increases in the numbers of re-infecting larvae (hyperinfection), which can disseminate throughout the body, usually with a fatal outcome. The diagnosis is made by finding larvae in the stools, but in some patients larvae can be found incidentally in colonic biopsy specimens. The purpose of this study was to review all cases of strongyloidiasis detected in colonic biopsies in patients who had not been suspected of harboring a parasite.


Over 15,000 Sessile Serrated Polyps: Slow Progression to Low-Grade and High-Grade Dysplasia in a Large Nationwide Population.

Richard H. Lash and Robert M. Genta, Miraca Life Sciences Research Institute, Irving, TX

Sessile serrated polyps (or adenomas, SSAs) are recognized as precursors to microsatellite unstable adenocarcinomas. We have reported the prevalence of dysplasia and carcinoma arising in SSAs in a recently published article (Lash, Schuler, Genta, J Clin Pathol, 2010) that was accompanied by an editorial highlighting the confusion regarding classification and biology of these polyps.

In our original study we evaluated over 2,100 patients with SSAs. In the present study we have attempted to determine whether our results could be confirmed in the much larger population to which we now have access.


Prevalence and Clinical Correlations of Reactive Gastropathy in Children and Younger Adults

SD Melton and RM Genta, Miraca Life Sciences Research Institute, Irving, TX; Department of Pathology, Dallas VA Medical Center – UT Southwestern Medical Center, Dallas, Texas

Reactive (or chemical) gastropathy (RG), an entity characterized by foveolar hyperplasia, projections of smooth muscle fibers into the lamina propria, edema, and hyperemia. RG is most commonly seen in older adults and is believed to be associated with either medications (mostly NSAIDs) or bile reflux. However, RG is detected with increasing frequency in younger adults and even children, despite the apparent lack of obvious risk factors.


Primary Myeloid Sarcoma of the Colon in a 71 Year Old Male Presenting as a Nodule During Screening Colonoscopy

Jeremy S. Ditelberg MD, Ahmed Bedeir MD, Parag Patel DO, Miraca Life Sciences Research Institute, Newton, MA

Myeloid sarcoma (MS) is a solid tumor composed of myeloblasts occurring outside of the bone marrow. Also known as chloroma, extramedullary myeloid tumor or granulocytic sarcoma, it can occur in patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or myeloproliferative syndromes (MPS). In the setting of a MDS or MPS, the detection of a MS is evidence that the pre-malignant condition has transformed into an acute leukemia. Rarely, MS is diagnosed without a known pre-existing diagnosis of acute leukemia, MDS or MPS - this is referred to as primary MS. Because acute leukemia develops soon after the diagnosis of primary MS in almost all cases, primary MS is considered an initial manifestation of acute leukemia rather than a localized process. MS has been described in numerous organs and tissues, but most commonly involves the skin, bone and lymph nodes. Its occurrence in the colon is exceptionally rare.


Influence of Sampling Strategy and Utility of Rectal Biopsy in the Diagnosis of Collagenous and Lymphocytic Colitis.

Jonathan N. Glickman, Miraca Life Sciences Research Institute, Irving, TX

Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic watery diarrheal disorders that most commonly affect middle aged to elderly adults. Since the colonic mucosa in each disorder appears endoscopically normal, the diagnosis rests upon characteristic histologic findings in mucosal biopsies. However, the histologic distinction between LC and CC, and between CC/LC and other types of colitis, can be challenging. Typically, multiple random colonic mucosal biopsies are taken for patients with suspected CC and LC, and the diagnosis is based upon cumulative evaluation of multiple fragments. However, the influence of biopsy sampling strategy on diagnostic accuracy for CC and LC is poorly understood, and the utility of rectal biopsies in evaluation of these disorders is not known.


Microscopic Colitis-Like Histologic Changes in Idiopathic Inflammatory Bowel Disease Patients: A Clinicopathologic Study Utilizing a National Pathology Database

Jonathan N. Glickman, Anuradha Singhal, Miraca Life Sciences Research Institute, Irving, TX

Collagenous colitis (CC) and lymphocytic colitis (LC), collectively termed microscopic colitis (MC), are chronic watery diarrheal disorders that most commonly affect middle aged to elderly adults. The diagnosis rests upon characteristic histologic findings in endoscopic mucosal biopsies, which also distinguish MC from idiopathic inflammatory bowel disease (IBD) [ulcerative colitis (UC) and Crohn’s disease (CD)]. MC and IBD have different treatments, natural histories, and need for endoscopic surveillance. However, the distinction between MC and IBD can be difficult at times since they can share some histologic features. It has also been speculated that these disorders may bear some relationship, at least in some individuals. The objective of this study was to characterize patients in whom these disorders present either synchronously or metachronously.


Malakoplakia

Guy M. Lindberg, Robert M. Genta, M.H. Saboorian, Miraca Life Sciences Research Institute, Irving, TX

Malakoplakia (MP) is a rare granulomatous condition thought to result from the insufficient killing of bacteria by macrophages; it is of uncertain clinical significance and can occur at any tissue site. It may be focal or widespread, involving multiple organs. Gastrointestinal MP has been described in association with a variety of conditions such as ulcerative colitis, diverticulitis, adenomatous polyps, and carcinoma. It has been reported


Laboratory Screening of Colorectal Cancer Patients in Routine Practice Identifies Probable Lynch Syndrome Patients at a High Frequency, Even Among Older Patients

Mark Redston and Richard Lash, Miraca Life Sciences Research Institute, Miraca Life Sciences, Newton, MA and Irving, TX

Lynch Syndrome (LS) is a clinically important colorectal and extracolonic cancer predisposition syndrome that may be underdiagnosed in the US. Recently, some experts and advisory groups have recommended routine screening of all newly diagnosed colorectal cancers (CRCs) in order to improve detection of this entity. We analyzed results of a laboratory screening program for LS to determine the prevalence, age distribution and family history characteristics of probable LS patients in a community practice setting.


Proton Pump Inhibitors and Lymphocytic Esophagitis : A Novel Association?

Salima Haque, Robert M. Genta, Miraca Life Sciences Research Institute, Irving, TX

Lymphocytic esophagitis was first described by Rubio et al. as an entity in 2006; however, in 2008 Purdy et al. reviewed 42 cases of lymphocytic esophagitis and dismissed it as a non-specific response of uncertain relevance. We recently reviewed the histopathology and clinical correlations of 42 patients with dense lymphocytic infiltrates in the esophageal mucosa and concluded that lymphocytic esophagitis is a specific type of inflammatory disorder of the esophagus.


Rare Presentation of Gastrointestinal Mantle Cell Lymphoma

Danielle Morris, Nicolas Sun, Shawn Kinsey, University of Texas Southwestern Medical Center Department of Pathology, Jackson Gastro Center LLC, Jackson, MI, Miraca Life Sciences Research Institute, Irving, TX

Colorectal lymphomas are rare accounting for <1% of colonic malignancies. The most common types are diffuse large B-cell lymphoma and marginal zone lymphoma. The incidence of colonic mantle cell lymphoma (MCL) is rising, likely due to increased screening. MCL is an aggressive disease with frequent extranodal involvement. Colonic involvement is a common manifestation, often presenting as multiple lymphomatous polyposis. Occasional cases of MCL presenting as a dominant ileocecal mass or concurrently with adenocarcinoma are described. A single case is reported of mantle cell detected in a tubular adenoma. However, this patient had concurrent colonic carcinoma. This is the first report of mantle cell lymphoma presenting asymptomatically in a tubular adenoma on a screening colonoscopy.


The Inlet Patch Revisited: A Clinicopathologic Study of 569 Patients with Heterotopic Gastric Mucosa in the Proximal Esophagus

Giovanni M. Luján, Robert M. Genta, Miraca Life Sciences Research Institute, Irving, TX

Heterotopic gastric mucosa in the proximal esophagus also reported as inlet patch is considered a congenital anomaly of the cervical esophagus Few studies have addressed the clinicopathologic aspects of this entity. Reliable prevalence data are not available due to the small size of published series. This study was designed to determine the prevalence of the inlet patch and its clinical and histopathologic associations in a large nationwide series of patients.


Hyperplastic Polyp of the Colon: Age and Gender Distribution of 65,453 Cases

Jeremy S. Ditelberg MD, Miraca Life Sciences Research Institute, Newton, MA

The hyperplastic polyp (HP) is the most common polyp of the colon. This study examined 65,453 cases of HP in order to define age and gender characteristics.


High-Grade Dysplasia in Colonic Adenomas Among 600,000 Colonoscopy Patients

M.H. Saboorian, R.H. Lash, Miraca Life Sciences Research Institute, Irving, TX

High-grade dysplasia (HGD) in colorectal adenomas is relevant for follow-up and management of patients with polyps. While some authors advocate that the presence of high-grade dysplasia in adenomas should be part of the routine pathology report (Rex, Goldblum, Hornick, Odze), others prefer not to report it (Appleman). The study by Toll et al, demonstrates that patients who have a colorectal adenoma > 1 cm with high-grade dysplasia may be at high risk of developing further adenomas with high-grade dysplasia or carcinoma. Prior studies by Bertagne et al have described HGD in up to 32% of patients with adenomas. The aim of this study was to determine the rate of the HGD in a large cohort of US outpatient colonoscopy patients.


Eosinophilic Gastritis: A Histopathologic Diagnosis in Search of Clinical Correlates

Thida Lwin, Shelby Melton, Robert M. Genta, Miraca Life Sciences Research Institute, Irving, TX and Department of Pathology, Dallas VA Medical Center – UT Southwestern Medical Center, Dallas, Texas

Eosinophilic gastritis remains a poorly characterized condition that pathologists may consider when “greater than normal” numbers of eosinophils are found in the gastric mucosa. In contrast to eosinophilic esophagitis, no clinicopathologic diagnostic criteria have been identified for eosinophilic gastritis. Furthermore, the normal eosinophilic content in the lamina propria of the gastric mucosa has rarely been investigated. While acknowledging this uncertainty, the updated Sydney System specifically stated that intraepithelial eosinophils must always be viewed as abnormal. Increased numbers of eosinophils in the lamina propria have been reported following eradication therapy for H. pylori, in reactive gastropathy caused by certain drugs, and in focal responses to tissue-invading parasites, particularly Anisakis spp. larvae.

Increased gastric eosinophils can also be identified in patients with the rare eosinophil-associated gastrointestinal disorders.

The purpose of this study was to identify a set of histologic features that could serve as a foundation for the development of diagnostic criteria for eosinophilic gastritis and to investigate its clinical and pathological associations. To achieve these goals, we reviewed the histopathology, clinical, and endoscopic information of all patients whose gastric biopsies had been diagnosed as having increased eosinophilic infiltrates at a large gastrointestinal pathology referral laboratory.


Collagenous Colitis: A Clinical and Demographic Review of 2,368 Cases

Jeremy S. Ditelberg MD, Miraca Life Sciences Research Institute, Newton, MA

High-grade dysplasia (HGD) in colorectal adenomas is relevant for follow-up and management of patients with polyps. While some authors advocate that the presence of high-grade dysplasia in adenomas should be part of the routine pathology report (Rex, Goldblum, Hornick, Odze), others prefer not to report it (Appleman).

The study by Toll et al, demonstrates that patients who have a colorectal adenoma > 1 cm with high-grade dysplasia may be at high risk of developing further adenomas with high-grade dysplasia or carcinoma. Prior studies by Bertagne et al have described HGD in up to 32% of patients with adenomas. The aim of this study was to determine the rate of the HGD in a large cohort of US outpatient colonoscopy patients.


CMV Colitis in Patients Undergoing Colonoscopy in Community-Based Endoscopy Centers

Reenu K. Malhotra, Anuradha Singhal, Robert M. Genta, Miraca Life Sciences Research Institute, Irving, TX

Clinically apparent cytomegalovirus (CMV) colitis in adults is most frequently found in immunosuppressed patients, although sporadic cases have been reported in apparently immunocompetent subjects. We hypothesized that, since most patients with clinically apparent CMV colitis are hospitalized, the prevalence of CMV colitis in patients undergoing colonoscopy in outpatient endoscopy centers would be low. We also endeavored to determine whether in outpatient settings immunocompetent and immunosuppressed patients present with different manifestations.


Gastric Cardiac Polyps : A Clinicopathologic Study of 330 Cases

SD Melton and RM Genta, Department of Pathology, Dallas VA Medical Center – UT Southwestern Medical Center, Dallas, Texas, Miraca Life Sciences Research Institute, Irving, TX

Clinically apparent cytomegalovirus (CMV) colitis in adults is most frequently found in immunosuppressed patients, although sporadic cases have been reported in apparently immunocompetent subjects.

We hypothesized that, since most patients with clinically apparent CMV colitis are hospitalized, the prevalence of CMV colitis in patients undergoing colonoscopy in outpatient endoscopy centers would be low. We also endeavored to determine whether in outpatient settings immunocompetent and immunosuppressed patients present with different manifestations.

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