Rapid and simultaneous determination of multiple classes of abused drugs and metabolites in human urine by a robust LC-MS/MS method - application to urine drug testing in pain clinics.

A simple LC-MS/MS method was developed and validated for quantitatively analyzing six classes of 26 abused drugs and metabolites in human urine: (1) illicit drugs; (2) opiates; (3) synthetic opioids; (4) sedative; (5) stimulants; and (6) γ-aminobutyric acid analogs. All urine samples were diluted with a mixture of isotope-labeled internal standards, hydrolyzed with β-glucuronidase and directly injected in a gradient chromatographic run. The mobile phase was composed of 0.

Colorectal cancer screening and surveillance in Crohn's colitis.

Aims: To assess colonoscopic screening and surveillance for detecting neoplasia in patients with long-standing colonic Crohn's disease (CD).

Patients And Methods: Colonoscopy and biopsy records from patients with colonic CD were evaluated at the Cedars-Sinai Inflammatory Bowel Disease Center during a 17-year period (1992-2009).

Results: Overall, 904 screening and surveillance examinations were performed on 411 patients with Crohn's colitis (mean 2.

The significance of "indefinite for dysplasia" grading in Barrett metaplasia.

Context: For a confident diagnosis of dysplasia in Barrett metaplasia, the epithelial atypia should also involve the surface epithelium. However, pathologists are often faced with biopsies where the crypts show dysplasia, but the surface epithelium is either uninvolved or unevaluable. We previously grouped these cases with indefinite for dysplasia (IND).

P16 and Ki67 Immunostains Decrease Intra- and Interobserver Variability in the Diagnosis and Grading of Anal Intraepithelial Neoplasia (AIN).

Background: Significant variation is reported in the diagnosis of HPV-associated AIN. We previously observed that band-like positivity for p16 in >90% of contiguous cells coupled with Ki67 positivity in >50% of lesional cells is strongly associated with high grade AIN. This study was undertaken to determine if addition of p16 and Ki67 immunostaining would reduce inter- and intraobserver variability in diagnosis and grading of AIN.

Primary hepatic carcinoid tumor presenting as Cushing's syndrome.

Hepatic carcinoid tumors are very uncommon; most are clinically non-functional and very few present with the symptoms of carcinoid syndrome. ACTH-producing carcinoid tumors most commonly originate in the lung or thymus and present insidiously with bronchospasm and/or chest mass. Occasionally, ectopic ACTH syndromes have been reported in association with pancreatic islet cell tumors, medullary thyroid cancer, pheochromocytoma, small-cell lung carcinoma, and rarely, ovarian and prostate tumors.

Goblet cell mimickers in esophageal biopsies are not associated with an increased risk for dysplasia.

Context: Identification of intestinal-type goblet cells (ITGCs) in hematoxylin-eosin-stained sections of esophageal biopsies is essential for the diagnosis of Barrett metaplasia. However, we have seen cases diagnosed as Barrett metaplasia based solely on cells that pose morphologic similarity to ITGCs on hematoxylin-eosin staining or stain positive with Alcian blue.

Objective: To determine the clinical significance of goblet cell mimickers.

P16 and Ki67 immunostaining is a useful adjunct in the assessment of biopsies for HPV-associated anal intraepithelial neoplasia.

P16 is a tumor suppressor gene product, shown to be overexpressed in most cervical carcinomas and dysplasias associated with high-risk human papilloma virus (HPV) infection. HPV is also associated with anal squamous dysplasias and carcinomas. Significant interobserver and intraobserver variation exists in the interpretation of biopsies for anal intraepithelial neoplasia (AIN).

Frozen section examination of liver, gallbladder, and pancreas.

Context: Frozen section of the liver is a comparatively frequent request that most often applies to a relatively limited number of situations. The only indication for frozen tissue examination of a gallbladder with any frequency is the presence of a polypoid mucosal lesion or a suspicious thickening of the gallbladder wall. A variety of intraoperative consultations may be applicable during surgery of the pancreas.

Toll-like receptor-4 is required for intestinal response to epithelial injury and limiting bacterial translocation in a murine model of acute colitis.

Inflammatory bowel disease (IBD) arises from a dysregulated mucosal immune response to luminal bacteria. Toll-like receptor (TLR)4 recognizes LPS and transduces a proinflammatory signal through the adapter molecule myeloid differentiation marker 88 (MyD88). We hypothesized that TLR4 participates in the innate immune response to luminal bacteria and the development of colitis.

A pilot study of adalimumab in infliximab-allergic patients.

The anti-TNF-alpha antibody infliximab (Remicade) is highly effective in the treatment of Crohn's disease. A subset of patients experience allergic reactions as a result of antibodies to infliximab (ATIs). The purpose of the current study is to describe the safety and efficacy of adalimumab (Humira) in patients previously allergic or intolerant to infliximab.

Thyroid carcinoma arising from a sacrococcygeal mass: a malignant teratoma?

A 59-year-old African American male with a remote history of Graves' disease presented with a 13-cm sacrococcygeal mass that was resected. Pathologic examination revealed this to be papillary thyroid carcinoma with large areas of hemorrhage and necrosis. No other teratomatous elements were identified.

Paneth cell carcinoma of the ampulla of Vater.

We describe a Paneth cell carcinoma arising within the ampulla of Vater in a 64-year-old man. The phenotype of virtually all neoplastic cells was consistent with that of Paneth cells, based on routine morphology and their strong positive immunostaining for lysozyme. Additional widespread positive immunostaining for carcinoembryonic antigen and CA 19.

Expression of the high mobility group proteins HMGI(Y) correlates with malignant progression in Barrett's metaplasia.

Expression of the high mobility group proteins HMGI(Y) has been shown to be a marker of malignancy in thyroid and pancreatic lesions and to correlate significantly with malignant progression in the colon. The aim of this study was to determine whether HMGI(Y) expression is associated with malignant progression in Barrett's metaplasia (BM). Immunoperoxidase staining for HMGI(Y) was performed on sections of formalin-fixed paraffin-embedded endoscopic esophageal biopsies from 42 patients with BM.

Intraoperative consultation for renal lesions. Implications and diagnostic pitfalls in 324 cases.

Intraoperative consultation rarely is requested for lesions in the kidney. Of 324 renal lesions submitted for gross or frozen section intraoperative consultation, 199 specimens were submitted for gross consultation only; no diagnostic pitfalls were noted. The clinical implications and diagnostic pitfalls in 125 specimens submitted for frozen section were the focus of our study.

Non-dysplastic and dysplastic Barrett's mucosa and adenocarcinoma lack a subepithelial myofibroblastic cell layer.

A subepitheal myofibroblastic (SMF) cell layer has been described in the colon, and referred to as pericryptal myofibroblastic cell layer. SMF cells have been shown to produce basement membrane proteins, including type IV collagen and laminin. The aim of this work was to determine the status of the SMF cell layer in Barrett's metaplasia (BM), with and without dysplasia, and compare that to the previously reported distribution of SMF in normal colon and colonic adenomas and carcinoma.

Pancreatic acinar cell metaplasia in autoimmune gastritis.

Objective: To determine the frequency and significance of pancreatic acinar cells in the gastric oxyntic mucosa.

Design: One hundred gastric oxyntic mucosal biopsy specimens from patients with chronic active gastritis (n = 30), multifocal atrophic gastritis (n = 15), autoimmune gastritis (n = 18), and normal gastric oxyntic mucosa (n = 37) were evaluated for the presence of pancreatic acinar cells. Formalin-fixed, paraffin-embedded tissues were stained with hematoxylin-eosin, and those positive for pancreatic acinar cells were immunostained with antibodies against trypsin and pancreatic amylase.

Estrogen receptor-beta is expressed in Barrett's metaplasia and associated adenocarcinoma of the esophagus.

Estrogen receptor-beta (ER-B) has been identified in benign and malignant tissues of a variety of human organs including the colon. In breast carcinoma, ER-B was found to be a significant predictor of response to adjuvant hormonal therapy with tamoxifen. The aim of the present study was to determine whether esophageal adenocarcinoma, and its precursosr, Barrett's metaplasia, express ER-B.

Gastric mucosal atrophy: interobserver consistency using new criteria for classification and grading.

Background And Aims: Considerable difficulties persist amongst pathologists in agreeing on the presence and severity of gastric atrophy. An international group of pathologists pursued the following aims: (i) to generate an acceptable definition and a simple reproducible classification of gastric atrophy; and (ii) to develop guidelines for the recognition of atrophy useful for increasing agreement among observers.

Methods: After redefining atrophy as the 'loss of appropriate glands' and examining histological samples from different gastric compartments, three categories were identified: (i) negative; (ii) indefinite; (iii) atrophy, with and without intestinalization.

Acid suppression therapy may not alter malignant progression in Barrett's metaplasia showing p53 protein accumulation.

Objectives: Several previous studies have shown that malignant progression in Barrett's metaplasia (BM) occurs even in patients treated with fundoplication or acid suppression therapy (AST). The aim of this study was to test the hypothesis that AST may not alter malignant progression in BM if key genes involved in DNA repair and cell cycle control, particularly p53, are defective.

Methods: Initial and follow-up biopsies from 21 patients with BM treated with AST and observed for 1-13 yr were entered in the study.

Is immunostaining for Helicobacter pylori superior to the special stain thiazine in detecting small numbers of H. pylori in gastric biopsies?

Helicobacter pylori is implicated in the pathogenesis of gastritis and duodenal ulcers, gastric lymphoma of the mucosa-associated lymphoid tissue (MALT) type, and gastric adenocarcinoma. Eradication of H. pylori with antibiotic therapy therefore is essential, not only for the successful treatment of active gastritis, but also for the treatment and prevention of the MALT lymphoma.

Diagnosing primary and metastatic renal cell carcinoma: the use of the monoclonal antibody 'Renal Cell Carcinoma Marker'.

The diagnosis of primary or metastatic renal cell carcinoma (RCC) can be difficult, especially in small biopsies, because of the wide variety of histologic appearances and clinical presentations that RCC can assume. An immunomarker specific for RCC is currently not available. We tested the relevant diagnostic use of the Renal Cell Carcinoma Marker (RCC Ma), a monoclonal antibody, against a normal human proximal tubular brush border antigen.

Morphometric assessment of gastric antral atrophy: comparison with visual evaluation.

Aims: As part of a multinational effort to reach a consensus in the definition and evaluation of atrophic gastritis, we applied morphometric techniques to 22 antral biopsy specimens examined visually by 12 experienced gastrointestinal pathologists.

Methods And Results: Atrophy was defined as loss of glands. Each pathologist graded atrophy with both non-standardized and standardized approaches.