Pancreatic Serous Cystadenoma with Compression of the Main Pancreatic Duct: An Unusual Entity

Serous cystadenoma is a common benign neoplasm that can be managed without surgery in asymptomatic patients provided that the diagnosis is certain. We describe a patient, whose pancreatic cyst exhibited a radiological appearance distinct from that of typical serous cystadenoma, resulting in diagnostic difficulties. CT and MRI showed a 10 cm-polycystic tumor with upstream dilatation of the main pancreatic duct (MPD), suggestive of intraductal papillary mucinous tumor (IPMT). Ultrasonographic aspect and EUS-guided fine-needle aspiration gave arguments for serous cystadenoma. ERCP showed a communication between cysts and the dilated MPD, compatible with IPMT. The patient underwent left pancreatectomy with splenectomy. Pathological examination concluded in a serous cystadenoma, with only a ductal obstruction causing proximal dilatation

Delphi:A Democratic and Cost-Effective Method of Consensus Generation in Transplantation

The Thrombotic Microangiopathy Banff Working Group (TMA-BWG) was formed in 2015 to survey current practices and develop minimum diagnostic criteria (MDC) for renal transplant TMA (Tx-TMA). To generate consensus among pathologists and nephrologists, the TMA BWG designed a 3-Phase study. Phase I of the study is presented here. Using the Delphi methodology, 23 panelists with &gt;3 years of diagnostic experience with Tx-TMA pathology listed their MDC suggesting light, immunofluorescence, and electron microscopy lesions, clinical and laboratory information, and differential diagnoses. Nine rounds (R) of consensus resulted in MDC validated during two Rs using online evaluation of whole slide digital images of 37 biopsies (28 TMA, 9 non-TMA). Starting with 338 criteria the process resulted in 24 criteria and 8 differential diagnoses including 18 pathologic, 2 clinical, and 4 laboratory criteria. Results show that 3/4 of the panelists agreed on the diagnosis of 3/4 of cases. The process also allowed definition refinement for 4 light and 4 electron microscopy lesions. For the first time in Banff classification, the Delphi methodology was used to generate consensus. The study shows that Delphi is a democratic and cost-effective method allowing rapid consensus generation among numerous physicians dealing with large number of criteria in transplantation.</p

Thrombotic Microangiopathy in the Renal Allograft:Results of the TMA Banff Working Group Consensus on Pathologic Diagnostic Criteria

The Banff community summoned the TMA Banff Working Group to develop minimum diagnostic criteria (MDC) and recommendations for renal transplant TMA (Tx-TMA) diagnosis, which currently lacks standardized criteria. Using the Delphi method for consensus generation, 23 nephropathologists (panelists) with &gt;3 years of diagnostic experience with Tx-TMA were asked to list light, immunofluorescence, and electron microscopic, clinical and laboratory criteria and differential diagnoses for Tx-TMA. Delphi was modified to include 2 validations rounds with histological evaluation of whole slide images of 37 transplant biopsies (28 TMA and 9 non-TMA). Starting with 338 criteria in R1, MDC were narrowed down to 24 in R8 generating 18 pathological, 2 clinical, 4 laboratory criteria, and 8 differential diagnoses. The panelists reached a good level of agreement (70%) on 76% of the validated cases. For the first time in Banff classification, Delphi was used to reach consensus on MDC for Tx-TMA. Phase I of the study (pathology phase) will be used as a model for Phase II (nephrology phase) for consensus regarding clinical and laboratory criteria. Eventually in Phase III (consensus of the consensus groups) and the final MDC for Tx-TMA will be reported to the transplantation community.</p

A histologic scoring system for prognosis of patients with Alcoholic hepatitis

BACKGROUND & AIMS: There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90-day) mortality. METHODS: We analyzed data from 121 patients admitted to the Liver Unit (Hospital Clinic, Barcelona, Spain) from January 2000 to January 2008 with features of AH and developed a histologic scoring system to determine the risk of death using logistic regression. The system was tested and updated in a test set of 96 patients from 5 academic centers in the United States and Europe, and a semiquantitative scoring system called the Alcoholic Hepatitis Histologic Score (AHHS) was developed. The system was validated in an independent set of 109 patients. Interobserver agreement was evaluated by weighted κ statistical analysis. RESULTS: The degree of fibrosis, degree of neutrophil infiltration, type of bilirubinostasis, and presence of megamitochondria were independently associated with 90-day mortality. We used these 4 parameters to develop the AHHS to identify patients with a low (0-3 points), moderate (4-5 points), or high (6-9 points) risk of death within 90 days (3%, 19%, and 51%, respectively; P < .0001). The AHHS estimated 90-day mortality in the training and test sets with an area under the receiver operating characteristic value of 0.77 (95% confidence interval, 0.71-0.83). Interrater agreement values were 0.65 for fibrosis, 0.86 for bilirubinostasis, 0.60 for neutrophil infiltration, and 0.46 for megamitochondria. Interestingly, the type of bilirubinostasis predicted the development of bacterial infections. CONCLUSIONS: We identified histologic features associated with the severity of AH and developed a patient classification system that might be used in clinical decision making

A Histologic Scoring System for Prognosis of Patients With Alcoholic Hepatitis

There is no histologic classification system to determine prognoses of patients with alcoholic hepatitis (AH). We identified histologic features associated with disease severity and created a histologic scoring system to predict short-term (90 day) mortality

The Role of Economic Policy in Climate Change Adaptation

This paper assesses the role of the public sector in adaptation to climate change. We first offer a definition and categorisation of climate change adaptation. We then consider the primary economic principles that can guide the assignment of adaptation tasks to either the private or the public sector, as well as those guiding assignment within the public sector itself. We find that the role of the state in adaptation policy is limited. We identify information policy, the provision of a suitable regulatory framework in some markets, the formation of human capital and policies that foster economic growth and technological and medical knowledge as the main areas in which the public sector has a role in climate change adaptation

Renal transplant dysfunction and humoral immunity : pathological aspects and immunoproteomic approach

Bien que le rejet humoral en transplantation rénale soit de mieux en mieux caractérisé, des difficultés diagnostiques persistent et son pronostic reste sombre. Objectifs : dans un tel contexte, nous avons privilégié 2 objectifs : (1) préciser les mécanismes physiopathologiques en cause lorsque des signes d’inflammation microvasculaire tels qu’une glomérulite sont observés isolément sur biopsie systématique ; (2) évaluer le rôle de l’autoimmunité au cours de la transplantation dans le but d’identifier d’éventuels marqueurs prédictifs d’une évolution particulière au cours de la greffe. Méthodes : dans un premier temps, nous avons effectué une analyse clinico-pathologique d’une cohorte de 20 patients avec glomérulite isolée sur biopsie systématique à 3 mois de la greffe, couplée à un phénotypage par analyse transcriptomique. Après cette première étape, les distorsions du répertoire B induites par la greffe ont été évaluées de manière séquentielle par technique d’immuno-empreinte chez 43 patients transplantés rénaux dans l’optique de la caractérisation éventuelle de nouveaux biomarqueurs à valeur diagnostique et pronostique. Résultats et conclusion : il n’y avait pas de différence significative à 3 ans de la transplantation entre le groupe de patients avec glomérulite isolée et le groupe témoin.Cependant, la cohorte de patients étudiée est hétérogène puisqu’une évolution péjorative a été observée chez une minorité de patients, pour lesquels des anticorps anti-HLA (non spécifiques du donneur) étaient plus souvent présents et le grade lésionnel plus élevé. L’étude du répertoire B illustre l’importante hétérogénéité interindividuelle des profils de réactivitévis à vis du tissu rénal. Après transplantation, l’apparition de bandes de réactivité additionnelles était notée chez 19/43 patients, et ce dans toutes les catégories anatomocliniques représentées. L’identification des cibles antigéniques est un complément indispensable de cette approche.

Etude anatomo-pathologique de biopsies systématiques de reins transplantés à 1 an dans le cadre d'un protocole thérapeutique randomisé d'évaluation de l'équivalence immunosuppressive du mycophénolate mofétil par rapport à la ciclosporine

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF