Explore the vast range of titles available.

IntroductionWe present a challenging case of visible and invisible multifocal dysplasia on a young patient with inflammatory bowel disease (IBD) and primary sclerosing cholangiopathy (PSC).MethodsA 42-year-old lady with Ulcerative Colitis (UC) diagnosed at the age of 16 and PSC at 38, was undergoing annual colonoscopy for dysplasia surveillance, as per BSG guidelines. She had endoscopically persistent active disease since 2020. She was intolerant to mesalazine/azathioprine and initially reluctant to start Infliximab.Surveillance in May 2023 showed a 20mm flat polyp in the splenic flexure (SF). Biopsies spoke of an inflammatory polyp. Repeat colonoscopy in June 2023 reported a 15 mm, probably dysplastic SF polyp; assessment was limited by inflammation. Biopsies showed low grade serrated-like dysplasia with reduction in SATB2 expression.Infliximab was eventually initiated to control inflammation and allow more accurate lesion assessment and, potentially, endoscopic resection.Surveillance in February 2024 noted largely reduced inflammatory activity; 3 large, non resectable dysplastic-appearing polyps were recognised. Histology showed low-grade dysplasia, possibly non-adenomatous/serrated variant (figure 1, left)/minimal deviation dysplasia. SATB2 expression was reduced in the splenic flexure lesion. Both sets of dysplasia biopsies were confirmed with expert opinion, due to the predominantly non-conventional nature of dysplasia. P53 was variably over-expressed, with stippling and clonal loss of MLH1. Of note, as her colitis was patchy with rectal sparing, the diagnosis was revised to Crohn’s colitis following discussion at the multidisciplinary IBD meeting.The patient had an elective panproctocolectomy.ResultsReview of the initial surgical specimen sections as well as extra sections by the original diagnostician confirmed the presence of multifocal, visible and invisible dysplasia in the entire spectrum of non-conventional dysplasia, encompassing serrated, eosinophilic, sessile-serrated-like (figure 1, upper right) and hypermucinous goblet cell rich type (figure 1, lower right). There was variable loss of MLH1 and null pattern of P53, which further confirmed the diagnosis.Abstract P276 Figure 1ConclusionsWe present a case of a young patient with clinically indolent IBD and concomitant PSC who benefitted by ‘aggressive’ medical treatment, as this allowed accurate dysplasia assessment. More importantly, this case demonstrates a challenging histological diagnosis of predominantly non-conventional IBD dysplasia, both visible and invisible, which was initially ‘missed’ in the resection specimen, despite the biopsy diagnosis of subtle, yet classical, dysplasia features. Pathologists need to be aware of these cytoarchitectural and immunohistochemical features to avoid misdiagnosis and disservice to patients and professional colleagues alike.What the mind does not know the eye cannot see!

IntroductionThe differentials of diffuse omental mass include metastasis and mesothelioma. We describe the challenges in recognising our man from Istanbul (known man in an unexpected location) masquerading as mesothelioma, misconstrued as PEComa and the truncated immune-phenotype was finally salvaged by NGS.Case Description77 year old man presented with diarrhoea and weight loss, underwent a CT colonogram that revealed a diffuse omental mass. In the absence of any other primary, this was radiologically suggestive of mesothelioma although there was no history of exposure.A laparoscopic biopsy was performed as CT biopsy was scanty for exhaustive IHC. The tumour was nested, epithelioid with prominent vessels. The cells had pericellular space with spidery cytoplasmic processes. Although distinctive, this was not diagnostic. Extended panel for lineage excluded mesothelial/epithelial nature (Calretinin, D2-40, CAM5.2, CK5/6, 34BE12, WT1, P40, Pan CK, GATA3, GLUT1, PAX8), neuroendocrine carcinoma (Chromogranin, INSM1, Synaptophysin), melanoma (S100, HMB45, Melan A, BRAFV600E, PRAME), sarcoma (CD34, Desmin, Myogenin, Myo D1, ERG) and lymphoma (CD45/LCA, MUM1). The SWI-SNF complex proteins INI1 and SMARC A4 were retained and so was FH with no accumulation of the metabolite 2 SC. NGS and MDM2 FISH was not available but Cathepsin K showed diffuse strong expression although the focal weak expression of SMA and TFE3 were interpreted as negative but TFE 3 was interpreted as focally positive by the external referral pathologist. A probable diagnosis of malignant PEComa (Perivascular Epithelioid Cell tumour) pending MDM2 FISH, molecular confirmation and GPNMB IHC (never received) was made. Referral to the external soft tissue pathologist confirmed lack of expression of other lymphoma/germ cell (CD30, ALK), macrophage (CD68) and more specific soft tissue sarcoma (EMA,MUC4) markers. MDM2 FISH was negative for liposarcoma which was another significant differential. Archer FusionPlex sarcoma panel V2 was negative. Crucially this does not screen for TSC1/2 abnormalities in PEComa but only TFE3 which was negative. Hence the probability of malignant PEComa was retained along with differentials of pseudo-endocrine sarcoma and GLI 1 altered sarcoma. At the regional sarcoma MDT, CD117 and DOG1 were performed - this was diffusely positive for DOG1 (Discovered on GIST1- K9 clone) but not CD117. The possibility of an unusual GIST with PDGFRA mutation was considered and then confirmed on NGS (V546E and Y849C activating mutations in exon 11 and 18 of PDGFRA gene).Our patient reports symptomatic relief from ascites (that developed later) following treatment with 2 cycles of imatinib and awaits interval scans.Abstract P318 Figure 1ConclusionThis case illustrates that GIST must be considered in all difficult to classify intra-abdominal tumours irrespective of cross-sectional imaging and morphology.

IntroductionEUS guided tissue acquisition is well established and extensively used investigation to confirm the histopathological diagnosis in PB lesions. The European Society of Gastrointestinal Endoscopy (ESGE) and Joint Advisory Group (JAG) suggests the frequency of obtaining a diagnostic tissue sample of at least 85% for EUS-FNA (1). The aim of this study was to determine the diagnostic yield, safety and efficacy of EUS-FNA in HPB lesions in a non-HPB centre in the UK.MethodsWe carried out a retrospective audit of all patients (identified from endoscopy and pathology database) who underwent EUS guided tissue acquisition between 1st October 2019 and 30th November 2021. Data collected include patient demographics, cross-sectional imaging, cytopathological diagnoses (Panc 1 to 5 based on European cytopathology classification of Pancreatobiliary terminology), treatment modality, complications and 30-day procedure related mortality. Final diagnoses were confirmed from EUS biopsy, surgical resection specimen or cross-sectional imaging (discussed in a MDT setting if histology negative).Results130 patients [mean age 67.6 years, 43.8% females] underwent EUS-FNA procedures.119 (91.5%) samples were deemed as adequate for analysis. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 88.5%, 100%, 86.9%, 100%, and 78.2% respectively [with Panc III included as false negative in patients with cancer as final diagnosis]. One patient, who had mild post procedure pancreatitis, was treated conservatively without hospital admission. There was no procedure related mortality.Histopathological diagnoses of cancer on EUS biopsy (n=77) – Adenocarcinoma (66), NET (6), Lymphoma (4), Squamous carcinoma (1)Abstract O12 Table 1EUS biopsy analysis EUS biopsy Analysis EUS biopsy including inadequate tissue sampling (n=130) EUS biopsy excluding inadequate tissue sampling (n=119) Diagnostic accuracy 86.9% 95% Sensitivity 88.5% 92.7% Specificity 100% 100% Positive predictive value 100% 100% Negative predictive value 78.2% 85.7% ConclusionsThis study confirms that EUS-FNA of HPB lesions can be highly effective and safely carried out in a non-HPB centre. Overall adequacy of tissue acquisition is in compliance with ESGE & JAG guidelines. Our diagnostic yield is in in keeping with the published literature.

IntroductionEUS guided tissue acquisition is well established and extensively used investigation to confirm the histopathological diagnosis in PB lesions. The European Society of Gastrointestinal Endoscopy (ESGE) and Joint Advisory Group (JAG) suggests the frequency of obtaining a diagnostic tissue sample of at least 85% for EUS-FNA (1). The aim of this study was to determine the diagnostic yield, safety and efficacy of EUS-FNA in HPB lesions in a non-HPB centre in the UK.MethodsWe carried out a retrospective audit of all patients (identified from endoscopy and pathology database) who underwent EUS guided tissue acquisition between 1st October 2019 and 30th November 2021. Data collected include patient demographics, cross-sectional imaging, cytopathological diagnoses (Panc 1 to 5 based on European cytopathology classification of Pancreatobiliary terminology), treatment modality, complications and 30-day procedure related mortality. Final diagnoses were confirmed from EUS biopsy, surgical resection specimen or cross-sectional imaging (discussed in a MDT setting if histology negative).Results130 patients [mean age 67.6 years, 43.8% females] underwent EUS-FNA procedures.119 (91.5%) samples were deemed as adequate for analysis. Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 88.5%, 100%, 86.9%, 100%, and 78.2% respectively [with Panc III included as false negative in patients with cancer as final diagnosis]. One patient, who had mild post procedure pancreatitis, was treated conservatively without hospital admission. There was no procedure related mortality.Histopathological diagnoses of cancer on EUS biopsy (n=77) – Adenocarcinoma (66), NET (6), Lymphoma (4), Squamous carcinoma (1)ConclusionsThis study confirms that EUS-FNA of HPB lesions can be highly effective and safely carried out in a non-HPB centre. Overall adequacy of tissue acquisition is in compliance with ESGE & JAG guidelines. Our diagnostic yield is in in keeping with the published literature.Abstract P291 Table 1EUS biopsy analysis EUS biopsy Analysis EUS biopsy including inadequate tissue sampling (n=130) EUS biopsy excluding inadequate tissue sampling (n=119) Diagnostic accuracy 86.9% 95% Sensitivity 88.5% 92.7% Specificity 100% 100% Positive predictive value 100% 100% Negative predictive value 78.2% 85.7%

IntroductionEUS guided tissue acquisition is a well established investigation to confirm the histopathological diagnosis for submucosal lesions in upper gastrointestinal tract. The European Society of Gastrointestinal Endoscopy (ESGE) and Joint Advisory Group (JAG) suggests the frequency of obtaining a diagnostic tissue sample of at least 85% for EUS-FNA (1). The aim of this study was to determine the diagnostic adequacy and safety of EUS guided tissue acquisition in submucosal lesions.MethodsWe carried out a retrospective audit of all patients (identified from endoscopy and pathology database) who underwent EUS guided tissue acquisition between 1st October 2019 and 30th November 2021. Data collected include patient demographics, cross-sectional imaging, cytopathological diagnoses, treatment modality, complications and 30-day procedure related mortality. Final diagnoses were confirmed from EUS biopsy, surgical resection specimen or cross-sectional imaging (discussed in a MDT setting if histology negative).Results39 patients [mean age 66.7 years, 36.8% females] underwent 39 EUS-FNA procedures (18 and 21 patients had a cancer and benign diagnosis respectively).33 (85%) samples were deemed adequate for analysis by the cytopatholgist (5 diagnosed as lipoma on EUS appearance and 1 diagnosed as GIST on CT/EUS appearance under surgical follow up). Sensitivity, specificity, diagnostic accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 94.8%, 100%, 85%, 100%, and 94.1% respectively. There was no procedure related complications or mortality.Histopathological diagnoses of cancer on EUS biopsy (n=17) – GIST (14), Schwanomma (1), Granular cell tumor (1), Adenocarcinoma (1).ConclusionsThis study confirms that EUS-FNA of submucosal lesions can be highly effective and safely carried out. Overall adequacy of tissue acquisition is in compliance with ESGE & JAG guidelines. Our diagnostic yield is in in keeping with the published literature.Abstract P317 Table 1EUS biopsy analysis EUS biopsy Analysis EUS biopsy including inadequate tissue sampling (n= 39) EUS biopsy excluding inadequate tissue sampling (n=33) Diagnostic accuracy 85% 100% Sensitivity 94.8% 100% Specificity 100% 100% Positive predictive value 100% 100% Negative predictive value 94.1% 100%

We report a case of a young female patient with long-standing oral and genital Behçet’s disease (BD), who presented with progressive severe colonic inflammation and perforation, requiring multiple laparotomies. The case had ultimately a favourable outcome despite posing a number of diagnostic and therapeutic challenges. Intestinal complications, although rare, should be considered as important differential diagnoses in patients with BD presenting with abdominal pain, and is a difficult-to-prove differential diagnosis to Crohn's disease.

The authors described a case of sclerosing angiomatoid nodular transformation of the spleen (SANT) in a 50-year-old woman presented with persistent neutrophilia and unintentional weight loss. An incidental splenic mass was initially found on abdominal ultrasound. It was found to be progressive in size and with high likelihood of central necrosis on further CT of abdomen and pelvis. The patient subsequently underwent an uneventful laparoscopic splenectomy. The splenic specimens were sent for laboratory analysis and the histopathological findings were highly suggestive of SANT. The patient then had routine surgical follow-ups and was eventually discharged with no further clinical concern.

With continuing advances in CMOS technology, feature sizes of modern Silicon chip-sets have gone down drastically over the past decade. In addition to desktops and laptop processors, a vast majority of these chips are also being deployed in mobile communication devices like smart-phones and tablets, where multiple radio-frequency integrated circuits (RFICs) must be integrated into one device to cater to a wide variety of applications such as Wi-Fi, Bluetooth, NFC, wireless charging, etc. While a small feature size enables higher integration levels leading to billions of transistors co-existing on a single chip, it also makes these Silicon ICs more susceptible to variations. A part of these variations can be attributed to the manufacturing process itself, particularly due to the stringent dimensional tolerances associated with the lithographic steps in modern processes. Additionally, RF or millimeter-wave communication chip-sets are subject to another type of variation caused by dynamic changes in the operating environment. Another bottleneck in the development of high performance RF/mm-wave Silicon ICs is the lack of accurate analog/high-frequency models in nanometer CMOS processes. This can be primarily attributed to the fact that most cutting edge processes are geared towards digital system implementation and as such there is little model-to-hardware correlation at RF frequencies. All these issues have significantly degraded yield of high performance mm-wave and RF CMOS systems which often require multiple trial-and-error based Silicon validations, thereby incurring additional production costs. This dissertation proposes a low overhead technique which attempts to counter the detrimental effects of these variations, thereby improving both performance and yield of chips post fabrication in a systematic way. The key idea behind this approach is to dynamically sense the performance of the system, identify when a problem has occurred, and then actuate it back to its desired performance level through an intelligent on-chip optimization algorithm. We term this technique as self-healing drawing inspiration from nature's own way of healing the body against adverse environmental effects. To effectively demonstrate the efficacy of self-healing in CMOS systems, several representative examples are designed, fabricated, and measured against a variety of operating conditions. We demonstrate a high-power mm-wave segmented power mixer array based transmitter architecture that is capable of generating high-speed and non-constant envelope modulations at higher efficiencies compared to existing conventional designs. We then incorporate several sensors and actuators into the design and demonstrate closed-loop healing against a wide variety of non-ideal operating conditions. We also demonstrate fully-integrated self-healing in the context of another mm-wave power amplifier, where measurements were performed across several chips, showing significant improvements in performance as well as reduced variability in the presence of process variations and load impedance mismatch, as well as catastrophic transistor failure. Finally, on the receiver side, a closed-loop self-healing phase synthesis scheme is demonstrated in conjunction with a wide-band voltage controlled oscillator to generate phase shifter local oscillator (LO) signals for a phased array receiver. The system is shown to heal against non-idealities in the LO signal generation and distribution, significantly reducing phase errors across a wide range of frequencies.

\"The pick of the group stage matches from an attendance point of view was the India South Africa game February 22 at the Melbourne Cricket Ground at which there were more than 86,000 people cheering their respective teams, a phenomenal result given that neither of the host teams was involved\".[iii] \"The crowd of 93,013 at the final match at the Melbourne Cricket Ground (MCG) has set a new Australian record for one day international (ODI) attendance, surpassing the old record of 87,182 set at the last World Cup Final at the MCG in 1992\".[iv] There are 10 radio licensees broadcasting the ICC Cricket World Cup 2015 matches live into 80 territories and for those following the tournament on new media, the website has attracted 26.25 million unique visitors accumulating an incredible 227 million page views, which is a significant increase on any previous ICC event\", Richardson went on.[v] On face of it, such numbers suggest that Michael Holding was being unnecessarily harsh. [...]it had, arguably, very little to do with the popularity of the event itself. [...]the bat speed created is probably greater than it has ever been in the history of the game.[xix] The batsman today has it good as never before. Notes [i]Please see the interview with Michael Holding \"Holding: How could anyone think this is the best World Cup ever?\", ESPNcricinfo , available at http://www.espncricinfo.com/ci/content/video_audio/856645.html, accessed on 27 April 2015. [ii] \"ICC Cricket World Cup 2015 Breaking Records And Capturing Hearts\", International Cricket Council , 28 March 2015, available at http://www.icc-cricket.com/cricket-world-cup/news/2015/media-releases/87514/icc-cricket-world-cup-2015-breaking-records-and-capturing-hearts, accessed on 27 April 2015. [iii] Ibid. [iv]Magotra, Ashish (2015): \"Australia's win ends a boring World Cup and don't let ICC tell you otherwise\", Firstpost , March 30, available at http://www.firstpost.com/sports/boring-end-boring-world-cup-dont-let-icc-tell-otherwise-2178871.html, accessed on 27 April 2015. [v] \"ICC Cricket World Cup 2015 Breaking Records And Capturing Hearts\", , 28 March 2015, International Cricket Council, available at http://www.icc-cricket.com/cricket-world-cup/news/2015/media-releases/87514/icc-cricket-world-cup-2015-breaking-records-and-capturing-hearts, accessed on 27 April 2015. [vi] ibid [vii] White, Jim (2010): \"Twenty20 will kill Test cricket within 20 years, says West Indian great Michael Holding\", The Telegraph , 1 June, available at http://www.telegraph.co.uk/sport/cricket/twenty20/7790638/Twenty20-will-kill-Test-cricket-within-20-years-says-West-Indian-great-Michael-Holding.html, accessed on 27 April 2015. [viii] \"Holding bounces T20 cricket\", Jamaica Observer , May 21 2010, available at http://www.jamaicaobserver.com/sport/Holding-bounces-T20-cricket_7633730, accessed on 27 April 2015. [ix] Bhogle, Harsha (2013): \"Cricket can't afford to be snobbish about its followers\" March 29, ESPNcricinfo , available at http://www.espncricinfo.com/magazine/content/story/627128.html, accessed on 27 April 2015. [x] ibid. [xi] \"Those new one-day rules explained ... \" ,July 8, 2005, ESPNcricinfo , available at http://www.espncricinfo.com/natwestchallenge/content/story/213010.html, accessed on 27 April 2015 and \"Amended playing conditions to take effect\" October29, 2012, ESPNcricinfo, available at http://www.espncricinfo.com/ci-icc/content/story/588728.html, accessed on 27 April 2015. [xii] \"ODI fielding restrictions big test for bowlers - Mills\" February 16, 2013, ESPNcricinfo , available at http://www.espncricinfo.com/new-zealand-v-england-2013/content/story/605096.html, accessed on 27 April 2015. [xiii] Gardner, Alan (2013): \"Remove fielding restrictions in ODIs\", April 28, ESPNcricinfo , available at http://www.espncricinfo.com/magazine/content/story/630749.html [xiv] Kimber Jarrod (2015): \"Modern batting is about scoring 360 degrees\" February, The Cricket Monthly, available at http://www.thecricketmonthly.com/story/824595/-modern-batting-is-about-scoring-360-degrees [xv] Sidharth Monga (2015) \"Restore bat-ball balance in ODIs, says ESPNcricinfo's panel\", March 31, available at, http://www.espncricinfo.com/ci/content/story/857577.html [xvi] Manjrekar, Sanjay (2014): \"Can we do something about monster bats?\" 25 April, ESPNcricinfo , available at http://www.espncricinfo.com/magazine/content/story/739039.html, accessed on 27 April 2015. [xvii] \"The evolution of cricket bats mean now batsmen are carrying a weapon to the crease\", December 23, 2012, news.com.au , available at http://www.news.com.au/sport/cricket/the-evolution-of-cricket-bats-mean-now-batsmen-are-carrying-a-weapon-to-the-crease/story-fndpt0dy-1226542405236 [xviii] ibid [xix] Edwards, Paul (2013): \"The blade maketh the man\", 18 February, ESPNcricinfo , available at http://www.espncricinfo.com/magazine/content/story/605244.html, accessed on 27 April 2015.

The 87-year-old artist announced his solidarity with fellow cartoonists by drawing a cartoon featuring his hero punching an assailant in the air and shouting, \"Moi aussi je suis un Charlie\" (I am Charlie too). The magazine's critics rightly take on Western commentators for homogenising Muslims, but their perception of a community prone to get hurt by any criticism isn't far removed from the stereotypes they rail against. The 9/11 attack on the World Trade Center in the US provided popular support for such demonisation.