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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.
- 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
- 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
- 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 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
- 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
- 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
- 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
- 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
- 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
Gastroenterology
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