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Physician Case Studies

GI clinicians know that their endoscopic expertise and subspecialty focus is critical to the delivery of optimal patient care. The same is true for subspecialized GI pathologists; their expertise is critical, not only for esoteric cases, but for routine cases as well. Miraca Life Sciences pathologists consistently prove that subspecialty expertise adds value everyday by:

  • Recognizing the effect of medications
  • Identifying subtle histologic diagnoses
  • Recognizing that some innocuous processes mimic IBD
  • Correctly classifying inflammatory conditions
  • Accurately grading dysplasia and recognizing the absence of dysplasia
    • Minimize 'indefinite' diagnoses
  • Accurately classifying polyps, including:
    • Malignant polyps
    • Newly recognized entities, such as sessile serrated adenomas
  • Diagnosing normal as 'normal'

Daily multi-headed microscope consensus conference

With over 10,000 GI specimens seen each week, our team of academic-caliber pathologists benefit from an abundance of interesting cases and the experience of veteran GI pathologists.

Our Diagnosis:

  • Active duodenitis with reactive epithelial atypia, consistent with chemotherapy effect
  • No dysplasia or malignancy is present

The Miraca Life Sciences Difference:

  • No confusion as to whether the patient has a malignant process (primary or metastatic) involving the duodenum
  • No dysplasia or malignancy is present

Our Diagnosis:

  • Lymphocytic Colitis

The Miraca Life Sciences Difference:

  • Patient's outside slides were requested and reviewed
    • Our opinion that these outside biopsies (incorrectly interpreted as 'Ulcerative Colitis') also represented Lymphocytic Colitis
  • Avoidance of complications related to immunosuppressive therapy
  • Allows for appropriate therapy for lymphocytic colitis
  • No need for continuance of lifetime colonic surveillance

Outside Diagnosis:

  • Active Ileitis with Ulceration, Hemorrhage and Granulation Tissue
    • Comment refers to the possibilities of Ischemia, Infection, Drug-induced Ileitis and Crohn's Disease
  • Gastroenterologist asks Miraca Life Sciences for consultation due to confusion on how to treat and further evaluate

Our Diagnosis:

  • Active ileitis with fissuring ulcers and transmural inflammation, most consistent with Crohn's disease
  • Clinician notified that the patient has Crohn's disease, not infection or ischemia

The Miraca Life Sciences Difference:

  • Specific diagnosis rendered
  • No additional diagnostic work-up for ischemia is necessary
  • Allows for immediate and effective therapy
  • No concern about giving immunosuppressive therapy to a patient with an infectious process

Our Diagnosis:

  • Benign Anorectal Mucosa with Evidence of Trauma/Prolapse

The Miraca Life Sciences Difference:

  • Findings suggestive of IBD; however, case reviewed at daily conference and determined to represent only trauma /prolapse changes. Patient was not labeled with chronic colitis/proctitis
  • Inappropriate treatment with immunosuppressive agents was avoided

Our Diagnosis:

  • Absent Plasma Cells, Consistent with an Immunodeficiency Disorder

Clinician Contacted:

  • Patient later confirmed to be IgA deficient

The Miraca Life Sciences Difference:

  • Identification of a potentially treatable condition
    • Likely to have been considered 'normal' by general pathologists
  • Extremely subtle features recognized that may explain diarrhea, malabsorption, sinopulmonary disease or bacterial infections
  • Information may prevent a reaction to a future blood transfusion

Our Diagnosis:

  • Colonic Spirochetosis

The Miraca Life Sciences Difference:

  • Provides a reasonable explanation for this patient's diarrhea and weight loss (spirochetosis can also cause rectal bleeding, abdominal pain, purulent discharge, and an appendicitis-like picture)
  • Avoidance of complications related to immunosuppressive therapy
  • Identifies a condition that may respond to antibiotic therapy
  • Recognition of a subtle finding that may be easily overlooked

Our Diagnosis:

  • Sessile Serrated Adenoma

The Miraca Life Sciences Difference:

  • Recognizing that many bland polyps previously thought to be hyperplastic polyps are actually pre-malignant lesions
  • Understanding the difference between:
    • Large hyperplastic polyps
    • Traumatized hyperplastic polyps
    • Mixed hyperplastic-adenomatous polyps
    • 'Traditional' serrated adenomas
    • Sessile serrated adenomas
    • Sessile serrated adenomas with dysplasia or carcinoma
  • Seeing over 2,000 biopsies / day with 26 expert GI pathologists convening daily to discern subtle cases maximizes the specifitity of diagnoses
    • Including newly identified lesions, such as sessile serrated adenomas, that may explain so-called interval cancers
Are we entering the post-helicobacter era? Learn more about Dr. Genta's ACG 2012 Presidential Award Poster, The Aging of the American Stomach.