BACKGROUND AND OBJECTIVE

Foreign body (FB) ingestion is a common pediatric concern in the Philippines, but local studies on flexible endoscopic management are lacking. This study aimed to describe the clinical profile and outcomes of children referred for flexible endoscopic management and identify factors associated with poor outcomes.

METHODS

This retrospective cohort study included 145 patients aged

RESULTS

Most FB ingestions (96.55%) were accidental, with coins as the most common FB (56.55%). Patients were admitted an average of 40.42 hours post-ingestion and referred for endoscopy within 9.28 hours. Flexible endoscopy was performed in 44.83% of cases, with a 98.46% success rate and an average procedure time of 32.25 minutes. Spontaneous passage occurred in 50.34% of cases. Poor outcomes were linked to age 48 hours; OR: 15.43, p = 0.0181), and prolonged procedures (>30 minutes; OR: 12, p = 0.0318). Good outcomes were associated with unremarkable physical exams (OR: 0.078; p = 0.0018), early admission (CONCLUSION

Flexible endoscopy is effective and safe for FB extraction in children. Early admission and timely intervention significantly improve outcomes, while delays and prolonged procedures increase the risk of complications.

Human ; Adolescent: 13-18 Yrs Old ; Child: 6-12 Yrs Old ; Foreign Bodies ; Endoscopy ; Child ; Retrospective Studies ; Aged ; Cohort Studies ; Eating ; Methods ; Numismatics ; Patients ; Philippines ; Physical Examination ; Time

Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

Human ; Male ; Child Preschool: 2-5 Yrs Old ; Endoscopy ; Propofol ; Dexmedetomidine ; Sleep Apnea, Obstructive ; Anesthetics ; Apnea ; Consensus ; Paper ; Patients ; Pharmaceutical Preparations ; Research Report ; Sleep ; Sleep Apnea Syndromes ; World Health Organization

Caesarean scar pregnancy (CSP) is a pregnancy where embryo is implanted in the myometrium of a previous caesarean scar and it is a rare type of ectopic pregnancy. Diagnosis and management of CSP is a challenge because caregivers lack awareness about the possibility of implantation in previous caesarean surgery scar. We present here six CSP cases. All patients presented with abdominal pain and/or bleeding per vaginum with history of previous caesarean section. On ultrasonography, caesarean scar pregnancy was diagnosed. We managed them endoscopically at an endoscopic surgery and training center during the year 2019 till the year 2022. The pre-operative and post-operative periods were uneventful and they were discharged on day 2 or 3 of surgery. Hystero-laparoscopic combined approach is a good option for managing CSP in expert hands. Although there are no clear guidelines for managing CSP, we suggest individualizing each patient's treatment plan, depending on their personal characteristics and available facilities at the managing center.

Human ; Female ; Adult: 25-44 Yrs Old ; Pregnancy ; Pregnancy, Ectopic ; Uterine Rupture ; Hysteroscopy

Abstract An 18-year-old female with Systemic Lupus Erythematosus (SLE) presented with bilateral thigh pain, fever, and diarrhea three days before admission. Diagnosed with SLE one month earlier, she reported prior symptoms, including joint pain, malar rash, hair loss, and hyperpigmented lesions. Initial investigations revealed elevated transaminase levels (AST 355, ALT 132), positive ANA, decreased complement levels (C3 68, C4 16.8), and raised creatine kinase (619). A muscle biopsy confirmed myositis. The patient was treated with immunosuppressant (a combination of steroids and hydroxychloroquine) and supportive therapy. By the eighth day of hospitalization, her symptoms, especially thigh pain, resolved. Electromyocardiography was done, and the results were normal, indicating therapeutic success. This case highlights the importance of prompt diagnosis and management of myositis as a rare SLE manifestation to achieve favorable outcomes.
Systemic Lupus Erythematosus (SLE) ; Myositis ; Muscle Biopsy ; Electromyocardiography

A unicornuate uterus with a non-communicating rudimentary horn is a rare Müllerian duct anomaly that is frequently underdiagnosed because of its variable clinical presentation and the limitations of conventional imaging modalities. Although not considered a direct cause of infertility, it may coexist with other reproductive pathologies and contribute to adverse reproductive outcomes. Presented here is a case series of three infertile women aged 30–36 years who were diagnosed with a unicornuate uterus and non-communicating rudimentary horn during fertility evaluation. Patient A presented with primary infertility, cyclic pelvic pain, endometriosis, and bilateral tubal disease; Patient B had a seven-year history of primary infertility and was initially suspected to have unilateral tubal obstruction; and Patient C was referred with a presumed diagnosis of uterine didelphys and was subsequently found to have a unicornuate uterus with a non-communicating rudimentary horn and ipsilateral renal agenesis. In all three cases, preoperative imaging failed to establish the definitive diagnosis, which was confirmed intraoperatively through laparoscopy, chromotubation, and hysteroscopy. Patients A and B underwent laparoscopic excision of the rudimentary horn with ipsilateral salpingectomy, while Patient C underwent only ipsilateral salpingectomy. Hysteroscopic transillumination was utilized in one case to facilitate safe laparoscopic dissection and delineation of the hemiuterine anatomy. All patients had uneventful postoperative recovery and were subsequently counseled regarding fertility options. This case series highlights the diagnostic challenges posed by unicornuate uterus with a non-communicating rudimentary horn, emphasizes the importance of a high index of suspicion during infertility work-up, and demonstrates the value of minimally invasive surgical management and hysteroscopic transillumination in selected cases. Early recognition and individualized treatment may help reduce reproductive complications and improve fertility counseling and management.

Human ; Female ; Adult: 25-44 Yrs Old ; Infertility, Female ; Laparoscopy ; Salpingectomy ; Hysteroscopy ; Pathology ; Endometriosis ; Fallopian Tube Diseases ; Transillumination ; Uterine Didelphys

Appendicitis is one of the most commonly encountered general surgery emergencies worldwide and has been extensively studied. However, anatomical variations in the position of the appendix may result in atypical clinical presentations, leading to diagnostic difficulty and delays in management. Reported here is a case of subhepatic appendicitis in a young adult patient who successfully underwent laparoscopic appendectomy. Subhepatic appendicitis is a rare surgical entity that should be considered in patients presenting with right upper quadrant abdominal pain. Contrast-enhanced computed tomography and laparoscopy are valuable tools in the diagnosis and management of this uncommon condition.

Human ; Female ; Adult: 25-44 Yrs Old ; Laparoscopy ; Appendectomy ; Appendix ; Appendicitis ; Abdominal Pain

Background: Frozen section biopsy (FSB) is a critical intraoperative diagnostic procedure that supports real-time surgical decision-making. Its accuracy and clinical value depend not only on technical laboratory processes but also on physicians’ knowledge, attitudes, practices, and adherence to institutional clinical guidelines. In tertiary hospitals with high surgical volume, variations in guideline compliance may affect diagnostic reliability and patient safety. Objective: This study examined the knowledge, attitudes, and practices of medical doctors regarding FSB and assessed their adherence to institutional clinical guidelines and standards. Methodology: A descriptive-correlational research design was conducted among 105 surgical residents and fellows at a tertiary hospital in the Philippines. Data were collected using a validated, researcher-developed questionnaire that measured knowledge, attitudes, practices, and adherence to FSB clinical guidelines. Descriptive statistics were used to summarize levels of knowledge, attitude, practice, and adherence. Correlation analysis was performed to determine the relationships among these variables. Results: The respondents demonstrated a generally knowledgeable level of FSB knowledge (mean = 2.51), a neutral attitude toward FSB implementation (mean = 3.17), and a high level of procedural practice compliance (mean = 4.03). Adherence to institutional clinical guidelines was rated as sometimes observed across key domains, particularly in referral processes and endorsement protocols. Significant associations were identified between components of knowledge, attitudes, and practices and adherence to FSB standards. Conclusion While medical doctors showed adequate procedural practice and foundational knowledge of FSB, inconsistencies in adherence to institutional clinical guidelines remain. Strengthening policy dissemination, clarifying professional roles in FSB decision-making, and reinforcing interdisciplinary communication are necessary to enhance compliance, improve diagnostic reliability, and promote patient safety.
Frozen Sections ; Biopsy

Introduction: Metaplastic thymoma is an exceptionally rare thymic epithelial neoplasm, with fewer than 40 cases reported in the literature. It is defined by a distinctive biphasic proliferation of epithelioid epithelial nests and bland spindle cell fascicles, accompanied by a characteristic immunohistochemical profile. In limited cytology specimens, the lack of architectural context and potentially incomplete sampling can obscure the biphasic nature, leading to diagnostic difficulty. We describe a case initially interpreted as an epithelioid neoplasm on fine needle aspiration (FNA), with subsequent resection confirming metaplastic thymoma. Case Description: A 66-year-old male presented with an anterior mediastinal mass. FNA revealed a highly cellular specimen composed predominantly of polygonal tumor cells arranged in cohesive sheets. The cells displayed round to ovoid, hyperchromatic nuclei with moderate to marked pleomorphism, irregular nuclear membranes, conspicuous nucleoli, and abundant eosinophilic cytoplasm. Dystrophic calcifications were noted within a hemorrhagic background. An epithelioid tumor was favored on cytologic evaluation. The patient subsequently underwent video-assisted thoracoscopic surgery with excision of the mass. The specimen was well-encapsulated, lobulated, and traversed by fibrous septations. Microscopically, the tumor demonstrated a biphasic architecture: cohesive nests of epithelioid cells closely admixed with intersecting fascicles of bland spindle cells. Immature T-lymphocytes were not identified. Immunohistochemical staining showed diffuse cytokeratin and p40 positivity in the epithelioid component. In contrast, the spindle cell component lacked cytokeratin expression but exhibited strong vimentin positivity and patchy EMA reactivity. Both components were negative for CD5 and CD117. The Ki-67 proliferation index was low (1–2%). Discussion: Diagnosing metaplastic thymoma on cytology is challenging due to the tumor’s inherently biphasic architecture, which may not be adequately represented in limited FNA samples. In this case, the cytologic material disproportionately sampled the epithelioid component, masking the spindle cell element critical for diagnosis. Additionally, the lymphocyte-poor background mimicked type A or AB thymoma, further contributing to potential misclassification. Accurate diagnosis relies on careful integration of cytologic features with histologic, immunohistochemical, radiologic, and clinical data. Recognition of this rare entity is important, as its behavior differs substantially from other anterior mediastinal tumors, including thymic carcinoma and more aggressive thymoma subtypes. Conclusion Metaplastic thymoma can present as a purely epithelioid lesion on limited biopsy material, obscuring its hallmark biphasic nature. Awareness of this rare thymic neoplasm and correlation with resection findings are essential to avoid misdiagnosis. When accurately identified and completely excised, metaplastic thymoma carries an excellent prognosis.
Biopsy, Fine-Needle ; Thymoma

BACKGROUND

Thyroid fine-needle aspiration biopsy (FNAB) is widely used for thyroid nodule characterization, with approximately 2.7% of samples classified as "inadequate." Non-diagnostic samples pose limitations, resulting in repeated procedures, and unnecessary diagnostic thyroidectomies. Conventional smear (CS) is commonly the method of choice for cytologic preparation of thyroid FNAB. The cell block technique is an alternative that concentrates cells providing additional material for better evaluation and ancillary testing. While conventional smears are commonly used, introducing routine complementary cell blocks could potentially lower costs associated with repeat procedures and improve patient management.

OBJECTIVE

The study aimed to investigate the diagnostic value of incorporating the cell block technique as adjunct to conventional smear technique in reducing nondiagnostic rates (Bethesda Category I) in thyroid-fine needle aspiration biopsies (FNAB) conducted in 2 private hospitals.

METHODOLOGY

This is a multi-center, retrospective cross-sectional study with 701 samples from 528 adult patients, who underwent thyroid FNAB between January 2020 - September 2022. The primary outcome of interest is the reduction in non-diagnostic rates with the combined use of conventional smears and cell block.

RESULTS

The non-diagnostic rates were significantly higher with cell block technique (28.10%) as compared to conventional smears (16.26%), p-value < .01. The results show that conventional smears have lower non-diagnostic rates. With smear cytology alone, 114 (16.3%) of all samples were nondiagnostic. With the addition of cell block technique, 15 of these samples were reclassified as benign (n = 13), Bethesda III (n = 1) or Bethesda IV (n = 1). The rest of the non-diagnostic samples (n = 99) remained Bethesda I. Overall, the equivalent decrease in non-diagnostic rate was 2.1%.

CONCLUSION

The combined use of cell block and conventional smears did not significantly decrease nondiagnostic rates in thyroid FNAB. In general, conventional smears demonstrated superior diagnostic efficacy across all Bethesda categories, establishing it as the preferred sampling preparation method for thyroid FNAB. Cell blocks should be considered a supplementary technique, particularly in cases where ancillary methods like immunohistochemistry or molecular testing are needed.

Biopsy, Fine-needle ; Thyroid Nodule ; Thyroid Gland ; Thyroid Diseases

OBJECTIVE

The aim of this study was to determine the upgrade rate in diagnosis of biopsy-proven papillary breast lesions on core needle biopsy and their respective surgical excisions, and to assess for predictive factors associated with an upgrade at St. Luke’s Medical Center – Global City.

METHODOLOGY

A retrospective review of our institution’s database identified 184 papillary breast lesions diagnosed by core needle biopsy. The study population consisted of 71 samples that met the inclusion criteria. The overall upgrade and concordance rates were determined and analyzed if there was any significant association with clinical demographics, radiologic findings, and core diameter on gross examination. Continuous variables were presented as mean and median, and Shapiro-Wilk test was used to assess normality of data. Categorical variables were expressed as frequencies and percentages. Simple logistic regression analysis with Firth’s bias correction was performed to determine the variables associated with a diagnostic upgrade. P values ≤0.05 were considered statistically significant.

RESULTS

A total 71 patients, all female, were included in the study. The overall upgrade rate was 8.45% (95% CI: 3.16-17.49%) in comparison with the diagnosis of the initial CNB and SE alone. This translated to 6/71 samples in this study. The overall concordance was 91.55% based on clinical significance, and an individual diagnosis concordance rate of 78.87%. None of the predictive factors (i.e., age, history of breast cancer, BI-RADS score, and gross core diameter) assessed showed an association with a diagnostic upgrade.

CONCLUSION

The computed overall upgrade rate is within range of currently published literature. The concordance rates for both clinical significance and individual diagnosis were quite high, suggesting good reproducibility of histopathologic diagnosis within our institution. This was also found to be consistent with other studies. Of the predictive factors, none showed an association to a diagnostic upgrade. Despite the latter, our findings may be of value within the medical center in further exploring and expanding the data set at hand, such that it may hopefully contribute to local guidelines in managing PBLs in the future.

Papilloma ; Biopsy, Core Needle