BACKGROUND:The inferior deep epigastric lymph node basin has been described as a lymphatic pathway for systemic cancer dissemination from the intra-abdominal cavity. This study aimed to determine the incidence and conditions of involvement of this basin in patients with peritoneal metastases of ovarian and colorectal cancer. METHODS:This single-center prospective pilot trial conducted over 3 years (from December 10, 2020, to September 1, 2023) included patients with peritoneal metastases of ovarian and colorectal cancer presenting for cytoreductive surgery. For each patient, bilateral inferior deep epigastric lymph node harvesting and histologic analysis was performed. RESULTS:This study enrolled 40 patients, 20 with peritoneal metastases of ovarian cancer and 20 with peritoneal metastases of colorectal cancer. Of the 20 patients with peritoneal metastases of ovarian cancer, 6 (30%) had positive inferior deep epigastric lymph nodes, including 5 with high peritoneal cancer index (31, 28, 25, 17, 16). Of the patients with peritoneal metastases of colorectal cancer, 2 had positive inferior deep epigastric lymph nodes (10%) with peritoneal cancer index of 25 and 15, respectively. CONCLUSION:The inferior deep epigastric lymph node basin represents a drainage route for the peritoneum and provided an alternative pathway for systemic dissemination in 30% of patients with peritoneal metastases of ovarian cancer and 10% of patients with peritoneal metastases of colorectal cancer. Inferior deep epigastric lymph nodes were positive in patients with high-grade disease, high peritoneal cancer index, and extensive pelvic peritoneal disease.

Oesophageal involvement is a very rare presentation of Crohn’s disease. It can occur as an isolated mass causing dysphagia and can be mistaken for malignancy. Here, we report a case of a 75-year-old woman presenting with dysphagia and weight loss. Gastroscopy showed an ulcerating mass, and her barium swallow showed a bird beak appearance at the level of the gastro-oesophageal junction (GEJ). Repetitive biopsies were inconclusive. Fluorodeoxyglucose-positron emission tomography showed high glucose uptake (standardised uptake value: 10.2) at the level of the GEJ. Endoscopic ultrasound classified the lesion as uT3N1. Step-by-step surgical exploration revealed an oesophageal mass. A frozen section examination showed an absence of malignancy and the presence of inflammatory tissue. A partial oesophagogastrostomy was performed, and reconstruction was achieved by a Merendino procedure. Definitive histopathological examination revealed isolated oesophageal Crohn’s disease.

Background Esophageal immature squamous metaplasia is hardly reported in the literature. This entity can, however, be misinterpreted as high grade dysplasia or invasive squamous cell carcinoma and hence represent a potential pitfall. Case presentation Histopathological examination of a superficial esophageal lesion removed by endoscopic submucosal dissection revealed a squamous cell carcinoma associated with immature squamous cell metaplasia arising from esophageal glands. Immunohistochemical stainings allowed to distinguish malignant from metaplastic cells. Conclusions Immunohistochemistry for Ber-EP4 is helpful in making the distinction between esophageal squamous cell carcinoma and immature squamous metaplasia. This can avoid overstaging and overtreatment, especially in early esophageal cancer.

Aims Oral steroid is usually administered in Western countries to prevent post-ESD esophageal stricture after extensive resection. A single local injection of triamcinolone acetonide (TA) at the end of ESD has been demonstrated to be effective for resections comprising 50 to 90% of circumference in Japan.

Although not reaching curative criteria (sm1, poorly differentiated) but R0 resection, considering the patient clinical condition, a watchful waiting strategy was adopted.

Results A 69-years-old man presented dysphagia and weight loss for several years was referred after the discovery of a 6mm lesion with high-grade dysplasia.

Prediction of subepithelial lesions (SEL) based on classical endoscopic appearance is often difficult.

A woman, followed for chronic myeloid leukaemia, presented for a routine examination. Her medical history was marked by recurrent Helicobacter pylori gastritis and polymyalgica rheumatica. She was under dasatinib and hormone replacement therapy. At clinical examination, she complained about digestive disorders with altered bowel habits. Biology, including leucocyte count, remained normal. A colonoscopy was performed. Endoscopic examination revealed a colonic mucosa covered by multiple tiny nodular lesions (<5mm) from the hepatic angle to the sigmoid and with an abnormal pattern of vascularisation (Fig. 1). Staged biopsies were taken. Microscopic examination revealed discrete achi-tectural distortions. The stroma contained a mixed inflammatory infiltrate composed of neutrophils, eosinophils and lymphocytes. Immunohistochemistry for CD3, CD5, CD20 and CD79 did not bring arguments for a lymphoma. There were no malignant or dysplastic cells. (Fig. 2). What is your diagnosis?

Aims Endoscopic enhancement modalities mainly focus on early neoplasia detection, characterization and demarcation. Few studies have reported the use of new enhancement modalities during ESD to help in submucosal visibility.

Background and aims Endoscopic ultrasound fine-needle aspiration/biopsy (EUS-FNA/FNB) is highly accurate, but discrepancies between cytological and surgical diagnoses are still observed. We aimed to determine its accuracy and monitor quality indicators in our facilities. Patients and methods We performed a retrospective review of all cases of pancreatic solid lesions evaluated by EUS-FNA/FNB, between July 2015 and June 2018, in two centers. Cytological and surgical findings were categorized into five groups: benign, malignant, suspect of malignancy, undetermined and insufficient for diagnosis. Final diagnosis was based on surgical diagnosis and, in patients who did not undergo surgery, on clinical outcome after 6 months follow-up. Results Altogether, 142 patients were included. FNA was the preferred tissue acquisition method (88%), with a predilection for the FNA 22G needle (57%). Cytology was insufficient for diagnosis in 2 cases, therefore a full diagnostic sample was available in 98.6% of the patients (>90%, ESGE target). Fifty-five (38.7%) patients underwent surgery. In term of cancer diagnosis, comparison with final surgical pathology (n=55) revealed 89% true positives, 5.5% true negatives, 3.6% false positives and 1.8% false negatives. When combining surgical diagnosis and clinical outcomes together, EUS-guided sampling sensitivity was 97.4% (92.5-99.5), specificity was 92.3% (74.9-99.1), positive predictive value was 98.2% (93.6- 99.5), negative predictive value was 88.9% (72.3-96.1) and accuracy was 96.4% (91.9-98.8). Post-procedural acute pancreatitis was reported in 2 patients (1.4%). Conclusions These results reveal a performance for diagnostic tissue sampling well above the ESGE proposed target standard. Also, the uncommon high specificity illustrates the determining role of the pathologist's final interpretation and diagnosis.

Aims Endoscopic submucosal dissection (ESD) allows « en-bloc » resection of superficial gastrointestinal neoplasia. Standardized macroscopic and microscopic approaches are required to adequately assess the curative status. Nevertheless, margin assessment is sometimes challenging especially if samples are not correctly orientated within paraffin blocks.The aim of the study was to compare margin status of ESD specimens embedded using one of two methods: a manual embedding technique (MET) or an automatic embedding technique (AET).

Colorectal cancer (CRC) has become the most common malignancy in our country. Routine screening colonoscopy is on the rise. With the recent advances in endoscopic treatment, many T1 colorectal carcinomas are now found and their percentage amenable to endoscopic resection has increased. Endoscopists and pathologists dealing with the steadily increasing number of excised colorectal polyps have to collaborate closely to optimize patient care. Therapeutic management of patients after endoscopic resection is based on precise histological criteria that determine the risk of metastasis and the need for complementary surgery. This paper summarizes the procedures for the macroscopic management of endoscopic excisions and presents the identified risk factors which should be included in a standardized pathology report.

A new gel lifting solution was used for the removal of a rectal non granular LST pseudo-depressed type, with suspicious pit pattern by ESD in a 64 y/o male. Briefly, 12ml of ORISETM gel (Boston Scientific) was injected with strong submucosal lifting, no per-procedural bleeding, no needed added per-procedural injection. An easy dissection of 15 min let us remove en-bloc a 30x25mm specimen revealing clear margins of a well-differentiated adenocarcinoma, without lymphovascular invasion or budding but submucosal invasion of 1038µm, giving a 1-2% risk of lymph node metastasis.

Selected gastrointestinal (GI) neuroendocrine tumors (NETs) are suitable for endoscopic submucosal dissection (ESD) but its efficacy and safety in western countries are limited. The aim of this study is to review two European centers experience of endoscopic treatment of superficial GI NET by ESD.

A 83 years-old woman, chronically treated by PPI for gastro-esophageal reflux disease underwent an esophagogastroduodenoscopy (EGD). It showed a 30 mm Paris O-IIa verrucous esophageal lesion on 30% of the circumference at 25 cm from the incisors. The patient was not exposed to alcohol or tobacco. The lesion was lugol negative and atypical pattern with NBI and near focus examination was not in favor of squamous cell carcinoma (SCC). The biopsies revealed a dense eosinophilic infiltration associated to moderate to severe squamous dysplasia, a feature that might be reactional for our pathologist. Human papilloma virus (HPV) was not detected. Biopsies of the upper, medial and lower esophagus were negative for eosinophilic infiltration. Knowing the absence of risk factor for SCC, the atypical aspect of the lesion, the absence of symptoms and the old age of the patient, and after discussion with our pathologist, no endoscopic treatment was proposed and the patient was rescheduled for a follow-up endoscopy at 6 months. The patient came back at 15 months for control EGD. At that time, the lesion involved 30% of the esophageal circumference and its shape changed with a Paris O-Is center. Targeted biopsies revealed SCC. EUS disclosed no lymphadenopathy and was in favor of T1 lesion. Distant metastasis were excluded by thoraco-abdominal CT scan and 18F-FDG PET/CT. An endoscopic en-bloc resection by endoscopic submucosal dissection (ESD) was then performed. The patient had no symptoms after the resection. Histopathological examination of the specimen showed a moderately differentiated SCC invading the submucosa on 700 µm. Lateral and deep margins were free from malignancy and dysplasia. No lymphovascular infiltration or perineural infiltration was observed, but tumor budding was present (pT1bsm2). Considering the age of the patient endoscopic follow-up was proposed.

A 80-year-old woman, hospitalized for atrial fibrillation and cardiac decompensation, presented anemia and melena during her stay. An esogastroduodenoscopy revealed a 2 × 2 cm Paris type 0-IIa+IIc neoplastic lesion at 30 to 32 cm from the incisors. The IPCL pattern analysis with NBI and near focus revealed V-3 type suggesting the presence of submucosal infiltration. The biopsy revealed a poorly differentiated squamous cell carcinoma. Endoscopic ultrasound disclosed a 15 mm mucosal lesion with extension in the submucosa (uT1N0Mx). There was no distant metastasis on work-up (thoracic and abdominal CT scan, bronchoscopy and PET CT).

FHL2 is a multifunctional scaffolding protein; its expression is associated with poor prognosis in colorectal cancer. ADAM-17 is a metalloprotease implicated in ectodomain shedding. FHL2 regulates ADAM-17 plasma membrane localisation, and FHL2 deficiency leads to decreased activity of ADAM-17 in mouse macrophages. Presence and relationship of the ADAM-17/FHL2 complex with colorectal cancer progression is unknown. We studied FHL2 and ADAM-17 expression in several colon cancer cell lines by immunocytochemistry and western blot. To highlight the interaction between both molecules, we used the Duolink ® kit for proximity ligation assay on SW480 cells. We also performed proximity ligation assay on biopsies and surgical specimens of colorectal adenocarcinoma and on matched normal mucosa. Furthermore, biopsies of colorectal adenoma with matched normal mucosa were selected. For quantification, pictures of the malignant, adenomatous and normal tissues were taken. Proximity ligation assay signals were quantified. Mean numbers of proximity ligation assay signals and of proximity ligation assay signals/nucleus were calculated. All cell lines showed FHL2 immunoreactivity; strongest positivity was observed in SW480 cells. ADAM-17 was expressed in all cell lines. Proximity ligation assay signals were present in SW480 cells. Quantitative analysis revealed that the interaction between FHL2 and ADAM-17 is more frequent in malignant than in normal tissue (p = 0.005). The mean number of ADAM-17/FHL2 proximity ligation assay signals was higher in colorectal adenocarcinoma than in adenoma with low-grade dysplasia (p = 0.0004). FHL2 interacts with ADAM-17 in normal, dysplastic and malignant colon epithelial cells. Colocalisation of these proteins is more frequent in malignant than in normal and dysplastic cells, suggesting a role for ADAM-17/FHL2 complex in the development of colorectal cancer.

La maladie de Destombes-Rosai-Dorfman fut décrite pour la première fois en 1965 par le pathologiste français Paul Destombes et est caractérisée par la présence, chez des enfants ou des adultes jeunes, de grands histiocytes à cytoplasme clair avec empéripolèse dans des organes variés. Près de 50 ans plus tard, si le spectre clinique a évolué, la cause de cette maladie est toujours inconnue. La classification révisée des histiocytoses publiée en 2016 a identifié plusieurs formes de maladie de DRD, allant des formes familiales aux formes associées à la maladie associée aux IgG4. Près de 90 % des patients présentent une atteinte ganglionnaire, le plus souvent cervicale, mais tous les organes peuvent être touchés. L’évolution est spontanément favorable mais un traitement est nécessaire lorsque des complications compressives, lytiques ou obstructives surviennent. Les traitements les plus fréquemment employés sont la chirurgie ou la radiothérapie, les stéroïdes, les immunosuppresseurs (méthotrexate, azathioprine) ou des traitements calqués sur ceux d’autres histiocytoses (interféron-α et cladribine).Rosai-Dorfman disease (RDD) was first described by the French pathologist Paul Destombes in 1965. It frequently affects children or young adults and is characterized by the presence of large histiocytes with emperipolesis. More than 50 years after this first description, the pathogenesis of this rare disease is still poorly understood. The revised classification of histiocytoses published in 2016 identified various forms of RDD, from familial RDD to IgG4-associated RDD. Almost 90% of the patients with RDD have cervical lymph nodes involvement although all the organs may virtually be involved. Outcomes are typically favorable. Treatments may be necessary in case of compression or obstruction, and are not well codified. The main therapeutic strategies rely on surgery, radiotherapy, steroids, immunosuppressive drugs or interferon-alpha and cladribine.