Background and objective The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. Results The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. Conclusions This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption.

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Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus

Pathology and genetics of tumours of the urinary system and male genital organs

Renal-cell carcinoma.

PURPOSE: To determine whether sonography could help accurately distinguish benign solid breast nodules from indeterminate or malignant nodules and whether this distinction could be definite enough to obviate biopsy. MATERIALS AND METHODS: Seven hundred fifty sonographically solid breast nodules were prospectively classified as benign, indeterminate, or malignant. Benign nodules had no malignant characteristics and had either intense homogeneous hyperechogenicity or a thin echogenic pseudocapsule with an ellipsoid shape or fewer than four gentle lobulations. Sonographic classifications were compared with biopsy results. The sensitivity, specificity, and negative and positive predictive values of the classifications were calculated. RESULTS: Benign histologic features were found in 625 (83%) lesions; malignant histologic features, in 125 (17%). Of benign lesions, 424 had been prospectively classified as benign. Two lesions classified as benign were found to be malignant at biopsy. Thus, the classification s...

Solid breast nodules: use of sonography to distinguish between benign and malignant lesions.

Renal cell carcinoma (RCC) denotes cancer originated from the renal epithelium and accounts for >90% of cancers in the kidney. The disease encompasses >10 histological and molecular subtypes, of which clear cell RCC (ccRCC) is most common and accounts for most cancer-related deaths. Although somatic VHL mutations have been described for some time, more-recent cancer genomic studies have identified mutations in epigenetic regulatory genes and demonstrated marked intra-tumour heterogeneity, which could have prognostic, predictive and therapeutic relevance. Localized RCC can be successfully managed with surgery, whereas metastatic RCC is refractory to conventional chemotherapy. However, over the past decade, marked advances in the treatment of metastatic RCC have been made, with targeted agents including sorafenib, sunitinib, bevacizumab, pazopanib and axitinib, which inhibit vascular endothelial growth factor (VEGF) and its receptor (VEGFR), and everolimus and temsirolimus, which inhibit mechanistic target of rapamycin complex 1 (mTORC1), being approved. Since 2015, agents with additional targets aside from VEGFR have been approved, such as cabozantinib and lenvatinib; immunotherapies, such as nivolumab, have also been added to the armamentarium for metastatic RCC. Here, we provide an overview of the biology of RCC, with a focus on ccRCC, as well as updates to complement the current clinical guidelines and an outline of potential future directions for RCC research and therapy.

Renal cell carcinoma.

https://www.gastrojournal.org/article/S0016-5085(96)00409-X/pdf

Endoscopic therapy for organized pancreatic necrosis

Papillary renal cell carcinoma (RCC) is known by its tendency to avascularity by angiography; however, data concerning its clinicopathologic spectrum and prognosis are not available. In a review of 224 renal cell carcinomas accesioned in our files, 34 were found to be papillary and 190 of other histologic types. A comparative analysis of these two gropus revealed marked differences. The majority of papillary tumors (85.3%) were in pathologic stage I, whereas more than half of the nonpapillary tumors had extended beyond the limits of the kidney. Follow-up data revealed that the survival for papillary RCC was significantly higher than that for nonpapillary tumors. This difference held true even when tumors in the same pathologic stage were compared. Many papillary tumors, particularly those with a favorable course, were massively necrotic, densely infiltrated by macrophages, or both. In view of these findings, the possibility that host mechanisms are involved in destruction and confinement of the tumor is discussed. Examination of kidney tissue distant from the tumor disclosed, in some cases, atypical hyperplastic changes of collecting tubules; this raises the possibility that some papillary tumors arise from distal tubular epithelium. Hypo- or avascularity was present in all papillary RCC's studied by angiography.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%28197612%2938%3A6%3C2469%3A%3AAID-CNCR2820380636%3E3.0.CO%3B2-R

Papillary renal cell carcinoma: a clinical, radiologic, and pathologic study of 34 cases.

Computed tomography (CT) provides a valuable new perspective in assessing abnormalities of the thorax. In the patient with a mediastinal mass or widening detected by plain chest radiography, a definitive diagnosis is sometimes possible which would not be obtainable by conventional noninvasive radiological techniques. In certain clinical situations, CT is a highly sensitive modality for examining the lungs. The proved and potential clinical uses of CT in solving diagnostic problems of the thorax are discussed.

Computed tomography of the thorax.

A total of 103 consecutive patients with suspected biliary obstruction were studied using both computed tomography (CT) and ultrasound (US) to evaluate the relative accuracy of the methods. In 47 patients with confirmed obstruction, CT and US were comparable accurate in differentiating obstruction from nonobstruction. The precise level of obstruction was identified by CT in 88% and by US in 60%; the cause of obstruction was accurately predicted by CT in 70% and by US in 38%. Both methods detected useful additional information, such as cholelithiasis or retroperitoneal adenopathy. The authors use US as a screening examination; if there is doubt about the level and cause of sonographically demonstrated obstruction, CT has proved to be an accurate means of further evaluation.

A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography.

Early experience with extracranial CT has shown this diagnostic method to be highly accurate in evaluating the liver, pancreas, kidneys, retroperitoneum, and pelvis. The diagnosis of neoplasm, inflammatory changes, and normal moophologic variants is possible. Initial data indicat that this modality may assume a primary role in the evaluation of the liver, pancreas, and retroperitoneum (e.g., the differentiation of medical from surgical jaundice and the distinction of solid from cystic lesions). In the thorax, the results appear far less dramatic. CT scans rarely surpass the diagnostic accuracy of conventional radiologic studies. Initial results indicate a need for studies comparing CT with radionuclide examinations, ultrasonography, and other conventional radiographic procedures as well as for evaluating its use in radiation therapy planning and follow-up.

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.127.1.53

Robert J. Stanley

Papers

Endoscopic therapy for organized pancreatic necrosis

Papillary renal cell carcinoma: a clinical, radiologic, and pathologic study of 34 cases.

Computed tomography of the thorax.

A prospective comparison of the evaluation of biliary obstruction using computed tomography and ultrasonography.

Computed tomography of the body: early trends in application and accuracy of the method