Biomedical subjects

Judy I Wyatt

Publications and source records attributed to Judy I Wyatt.

3 recordsLinked to original sources

PubMed2005

Diagnostic variation and outcome for high-grade gastric epithelial dysplasia.

HYPOTHESIS: High-grade dysplasia (HGD) of the gastric epithelium is associated with high prevalence of invasive carcinoma, and distinction by endoscopic biopsy is difficult. DESIGN: Cohort study, 1996 to 2003. SETTING: Tertiary care center. PATIENTS: Consecutive sample of 22 patients with initial diagnosis of gastric HGD by endoscopic biopsy. Biopsy specimens were separately reviewed by 3 experienced pathologists. Clinical management was individually decided. MAIN OUTCOME MEASURES: Strength of interpathologist agreement (kappa) and final pathological diagnosis. RESULTS: The diagnosis was revised to intramucosal carcinoma in 14% to 32% of patients or suspicious for invasive carcinoma in 23% to 41%. The strength of agreement between any 2 pathologists for distinguishing between dysplasia and invasive carcinoma was fair (kappa = 0.35-0.36). A diagnosis of intramucosal carcinoma or suspicious for invasive carcinoma by 2 pathologists correlated strongly with subsequent detection of invasive carcinoma. Three patients underwent gastrectomy for HGD, and invasive carcinoma was detected in all (2 patients, T1 N0; 1 patient, T2 N0). Six patients had invasive carcinoma on endoscopic surveillance at a median of 15 months (range, 3-34 months) after diagnosis of HGD and underwent endoscopic mucosal resection (2 patients, T1 NX), gastrectomy (2 patients, T1 N0), or no resection (2 patients). Another patient had metastatic gastric adenocarcinoma despite having a diagnosis of only HGD by endoscopy. Seven patients (32%) died of unrelated causes, without invasive carcinoma, at a median of 19 months (range, 1-38 months). Three patients were alive with persistent HGD at 26 to 61 months. Two patients had no dysplasia on follow-up. CONCLUSIONS: Experienced pathologists often disagreed in distinguishing invasive carcinoma from HGD in gastric biopsy specimens. One third of patients with gastric HGD died of causes unrelated to cancer. Invasive carcinoma was detected in 67% of the remainder.

Aged↗

PubMed2003

Heterotopic gastric mucosa in a duplicate gallbladder.

A 7-year-old girl presented with recurrent acute pancreatitis. Detailed investigations, including endoscopic retrograde cholangiography, suggested a poorly defined biliary tract abnormality. At laparotomy, this was discovered to be a duplicate gallbladder each with a separate cystic duct but contained within a single serosal envelope. Both gallbladders were removed, and histologic examination found the inferior organ to be lined by heterotopic fundic-type gastric mucosa. Despite the absence of any remaining structural biliary abnormality and no evidence of residual ectopic gastric mucosa, the patient experienced a few further episodes of self-limiting mild acute pancreatitis during the following 3 years. The presence of heterotopic gastric mucosa in a duplicate gallbladder has not been described previously.

Acute Disease↗

PubMed2003

Gallbladder polyps in children--classification and management.

Polypoid lesions of the gallbladder (PLG) are rare in childhood. The authors describe 2 additional cases. A 12 year-old-girl was found to have a 5-mm gallbladder polyp during an ultrasound examination for nonspecific abdominal pain. Investigation showed no other biliary tract abnormality. During the next 5 years, she was reviewed periodically with ultrasound scans and underwent cholecystectomy when the diameter of the polyp increased to 1 cm. Histology results showed a benign cholesterol polyp. A 12-year-old-boy was found to have an incidental gallbladder polyp, which 2 years later remained static in size for 10 months. The polyp had disappeared spontaneously. The authors suggest that PLGs in children may be either primary or secondary. Only 11 primary PLGs have been reported, and their histology is variable (adenoma, gastric heterotopia, and epithelial hyperplasia). Secondary PLGs may be found in association with metachromatic leukodystrophy, Peutz-Jeghers syndrome, or pancreato-biliary malunion. The pathologic spectrum of PLGs in children appears to be different from that in adults. For primary PLGs, cholecystectomy is advisable if there are biliary symptoms or if the polyp is > or =1 cm in size. Asymptomatic cases should be maintained under ultrasound surveillance.

Abdominal Pain↗