Physician Case Studies

The Caris Diagnostics Difference

GI clinicians know that their endoscopic expertise and subspecialty focus is critical to the delivery of optimal patient care. The same is true for subspecialized GI pathologists; their expertise is critical, not only for esoteric cases, but for routine cases as well. Caris Diagnostics'™ (a division Caris Life Sciences™) pathologists consistently prove that subspecialty expertise adds value everyday by:

  • Recognizing the effect of medications
  • Identifying subtle histologic diagnoses
  • Recognizing that some innocuous processes mimic IBD
  • Correctly classifying inflammatory conditions
  • Accurately grading dysplasia and recognizing the absence of dysplasia
    • Minimize ‘indefinite’ diagnoses
  • Accurately classifying polyps, including:
    • Malignant polyps
    • Newly recognized entities, such as sessile serrated adenomas
  • Diagnosing normal as ‘normal’

 

Daily multi-headed microscope consensus conference

With over 10,000 GI specimens seen each week, our team of academic-caliber pathologists benefit from an abundance of interesting cases and the experience of veteran GI pathologists.

Our Diagnosis:

  • Active duodenitis with reactive epithelial atypia, consistent with chemotherapy effect.
  • No dysplasia or malignancy is present.

The Caris Difference

  • No confusion as to whether the patient has a malignant process (primary or metastatic) involving the duodenum.
  • No dysplasia or malignancy is present.

Our Diagnosis:

  • Lymphocytic Colitis.

The Caris Difference

  • Patient’s outside slides were requested and reviewed
    • Our opinion that these outside biopsies (incorrectly interpreted as ‘Ulcerative colitis’) also represented Lymphocytic Colitis
  • Avoidance of complications related to immunosuppressive therapy
  • Allows for appropriate therapy for lymphocytic colitis
  • No need for continuance of lifetime colonic surveillance

Outside Diagnosis:

  • Active Ileitis with Ulceration, Hemorrhage, and Granulation Tissue.
    • Comment refers to the possibilities of Ischemia, Infection, Drug-induced Ileitis, and Crohn’s Disease.
  • Gastroenterologist asks Caris for consultation due to confusion on how to treat and further evaluate.

Our Diagnosis:

  • Active ileitis with fissuring ulcers and transmural inflammation, most consistent with Crohn’s disease.
  • Clinician notified that the patient has Crohn's disease, not infection or ischemia.

The Caris Difference

  • Specific diagnosis rendered
  • No additional diagnostic work-up for ischemia is necessary
  • Allows for immediate and effective therapy
  • No concern about giving immunosuppressive therapy to a patient with an infectious process

Our Diagnosis:

  • Benign Anorectal Mucosa with Evidence of Trauma/Prolapse.

The Caris Difference

  • Findings suggestive of IBD; however, case reviewed at daily conference and determined to represent only trauma /prolapse changes. Patient was not labeled with chronic colitis/proctitis
  • Inappropriate treatment with immunosuppressive agents was avoided

Our Diagnosis:

  • Absent Plasma Cells, Consistent with an Immunodeficiency Disorder.

Clinician Contacted:

  • Patient later confirmed to be IgA deficient.

The Caris Difference

  • Identification of a potentially treatable condition
    • Likely to have been considered ‘normal’ by general pathologists
  • Extremely subtle features recognized that may explain diarrhea, malabsorption, sinopulmonary disease or bacterial infections
  • Information may prevent a reaction to a future blood transfusion

Our Diagnosis:

  • Colonic Spirochetosis.

The Caris Difference

  • Provides a reasonable explanation for this patient’s diarrhea and weight loss (spirochetosis can also cause rectal bleeding, abdominal pain, purulent discharge, and an appendicitis-like picture)
  • Avoidance of complications related to immunosuppressive therapy
  • Identifies a condition that may respond to antibiotic therapy
  • Recognition of a subtle finding that may be easily overlooked

Our Diagnosis

  • Sessile Serrated Adenoma.

The Caris Difference

  • Recognizing that many bland polyps previously thought to be hyperplastic polyps are actually pre-malignant lesions
  • Understanding the difference between:
    • Large hyperplastic polyps
    • Traumatized hyperplastic polyps
    • Mixed hyperplastic-adenomatous polyps
    • 'Traditional' serrated adenomas
    • Sessile serrated adenomas
    • Sessile serrated adenomas with dysplasia or carcinoma
  • Seeing over 2000 biopsies / day with 26 expert GI pathologists convening daily to discern subtle cases maximizes the specifitity of diagnoses
    • Including newly identified lesions, such as sessile serrated adenomas, that may explain so-called interval cancers.