Gilles Gariépy

A first report of tumor seeding because of EUS-guided FNA of a pancreatic adenocarcinoma

Tumor seeding along a needle tract is an established complication of percutaneous sampling of pancreatic masses under CT or transcutaneous US guidance. The risk of peritoneal carcinomatosis appears to be lower with EUS-guided FNA (EUS-FNA) compared with transcutaneous sampling methods. This is a potential advantage often cited for EUS-FNA because, to date, there is no case reported of tumor seeding from a pancreatic adenocarcinoma secondary to EUS-FNA. This report describes a case of apparent gastric-wall tumor seeding that occurred during EUS-FNA of a mass in the tail of the pancreas.

Retinoblastoma and p53 gene product expression in breast carcinoma: Immunohistochemical analysis and clinicopathologic correlation

We examined 100 breast cancers for retinoblastoma (Rb) and p53 protein expression by immunohistochemistry using the PMG3.245 and PAb 1801 antibodies. We assessed percentages of reactive cells and their intensity, as well as staining patterns. The results were correlated with neu protein reactivity and a panel of variables, including age, tumor size and type, nuclear grade, estrogen receptor/progesterone receptor content, and lymph node status. Retinoblastoma protein negativity, either partial or complete, was noted in 47% of cases. Surprisingly, a relatively stronger Rb reaction was seen in some high nuclear grade tumors. p53 positivity was found in 23% of cases and was a significant predictor of Rb loss. p53 also was correlated with poorly differentiated (nuclear grade III) neoplasms and neu expression but not with negative ER status. Tissue distribution profiles for Rb-negative and p53-positive cells were variable in this series, with both uniform and heterogeneous patterns observed. This suggests that Rb and p53 alterations may represent early or late events in transformation. Our findings further implicate Rb and p53 derangements in mammary oncogenesis.

Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis

OBJECTIVE To determine the prevalence of chronic endometritis (CE) in patients with recurrent implantation failure (RIF) after IVF and unexplained recurrent pregnancy loss (RPL). DESIGN Prospective observational study between November 2012 and March 2015. SETTING University-affiliated private IVF clinic. PATIENT(S) Women with RIF after IVF (group 1) and unexplained RPL (group 2). INTERVENTION(S) Office hysteroscopy followed by an endometrial biopsy was performed as part of the workup for RIF and RPL. The diagnosis of CE was histologically confirmed using immunohistochemistry stains for syndecan-1 (CD138). MAIN OUTCOME MEASURE(S) The prevalence of CE in each group and the sensitivity/specificity of office hysteroscopy in the diagnosis of CE. RESULT(S) Ninety-nine patients were included (46 in group 1 and 53 in group 2). The mean age was 36.3 ± 4.9 years in group 1 and 34.5 ± 4.9 years in group 2. Five biopsies were uninterpretable (three in group 1 and two in group 2) because of insufficient specimen. The prevalence of CE was 14% (6/43) in group 1 and 27% (14/51) in group 2. The sensitivity and specificity of office hysteroscopy in the diagnosis of CE were 40% (8/20) and 80% (59/74), respectively. CONCLUSION(S) We found a high prevalence of immunohistochemically confirmed CE in women with RIF and RPL. Office hysteroscopy is a useful diagnostic tool but should be complemented by an endometrial biopsy for the diagnosis of CE. CLINICAL TRIAL REGISTRATION NO NCT01762098.

Comparison of endoscopic ultrasonography‐guided fine‐needle aspiration cytology results with and without the stylet in 3364 cases

Endoscopic ultrasound‐guided fine‐needle aspiration cytology (EUS‐FNA) is traditionally carried out with the stylet, as it is believed to prevent blockage or contamination of the needle by tissue coming from the gastrointestinal wall. However, this recommendation has not been demonstrated on an empirical basis. The aim of the present study was to compare the yield of EUS‐FNA in a very large series of patients with (S+) and without (S–) the stylet.

Randomized controlled trial comparing stylet‐free endoscopic ultrasound‐guided fine‐needle aspiration with 22‐G and 25‐G needles

Previous studies comparing endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) results with different gauge needles have all been carried out with the stylet in place and show no clear advantage to the larger 22‐G needle. Similar data for stylet‐free EUS‐FNA (SF‐EUS‐FNA) are unavailable. The aim of the present study was to determine whether diagnostic yield and specimen adequacy is superior with the 22‐G needle as compared to the 25‐G needle.

Metastatic Adenocarcinoma of the Cervix: A Case Report

BACKGROUND Adenocarcinoma metastatic to the cervix is unusual. Very few cases of cervical metastases from gastrointestinal tract primary lesions have been reported in the literature, and most of them lack pathological evidence. CASE We report the case of a 75-year-old woman with a metastasis to the cervix from a large bowel adenocarcinoma that had been managed by right hemicolectomy 14 months previously. The cervical metastasis was the first sign of recurrence. CONCLUSION In women with cervical adenocarcinoma and a history of gastrointestinal or breast cancer or melanoma, specific screening should be undertaken to ensure that the cervical disease is not metastatic. The detection of adenocarcinoma in this subset of patients might be an indication of recurrent disease.

Endoscopic ultrasound-guided FNA of pelvic lesions: A large single-center experience.

Pelvic endoscopic ultrasound‐guided fine‐needle aspiration (PEUS‐FNA) of rectal or perirectal lesions is safe, minimally invasive, and well tolerated. It provides valuable information, which can greatly influence patient management. Herein, the authors present what to their knowledge is the largest series to date of PEUS‐FNA.