What's up My Sleeve? High Prevalence of Unexpected Histopathologic Findings in Vertical Sleeve Gastrectomy Specimens
Philipp W Raess, Marilyn Baird-Howell, Rajesh Aggarwal, Noel N Williams, Emma E Furth. University of Pennsylvania, Philadelphia, PA
Background: Laparoscopic vertical sleeve gastrectomy is used with increasing frequency as a therapeutic option for morbid obesity. Prior to the procedure, patients undergo a rigorous pre-operative evaluation including upper GI series. Thus, these patients are presumed to have no significant gastric pathology. We performed a retrospective review of primary vertical sleeve gastrectomy specimens to determine the prevalence of unexpected histologic findings in sleeve gastrectomy specimens.
Design: Retrospective review of all primary vertical sleeve gastrectomy specimens performed for morbid obesity at our institution from July 2008 until August 2012 (n = 250). Review of pathologic diagnoses and gross descriptions was performed for all specimens. Select cases were re-reviewed to confirm diagnoses.
Results: The median age of patients undergoing laparoscopic sleeve gastrectomy in this cohort was 43 (range 19-80) and the female:male ratio was 2.2:1. A median of 5 blocks were submitted for histologic analysis. While the diagnosis of “stomach tissue with no specific pathologic change” was the most prevalent, it accounted for only 35.2% of all cases. The other diagnoses and their frequency were: lymphoid aggregates, 31.2%; chronic inflammation, 12%; and gastritis (including all subtypes), 12%. Importantly, H. pylori was identified via morphology or immunohistochemistry in 5.2% of our total study population and in 33.3% of cases of gastritis. Autoimmune gastritis, intestinal metaplasia, or necrotizing vasculitis was identified in an additional 3.2% of cases. During laparoscopy, the surgeons identified unanticipated neoplastic findings in 0.8% of cases (n = 2; ovarian mucinous cystadenocarcinoma, gastric lipoma).
Conclusions: Unanticipated diagnoses are prevalent in vertical sleeve gastrectomy specimens performed for morbid obesity. Only 35.5% of cases had unremarkable histopathology, and approximately 15% of cases had diagnoses requiring additional clinical follow-up. As only oxyntic mucosa lines these specimens, patients with gastritis will require subsequent endoscopy and antral biopsy to evaluate for H. pylori. Lymphoid aggregates occur frequently but are of unknown significance. Pathologists should be aware of the high prevalence of potential diagnoses requiring clinical follow-up when examining vertical sleeve gastrectomy specimens.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 112, Monday Morning