David Bingham MD is a clinical assistant pathologist specializing in gastrointestinal pathology. He is from Connecticut, graduated from Yale with a BA, and went to Columbia P&S for medical school. He did a residency in Pathology at Stanford University, graduated in 1992 and has been here ever since as a faculty member.
- Anatomic and Clinical Pathology
- Gastrointestinal Diseases
Clinical Assistant Professor, Pathology
Boards, Advisory Committees, Professional Organizations
Moderator, South Bay Pathology Society (2017 - Present)
Residency: Stanford University Department of Pathology (1997) CA
Fellowship: Stanford University Department of Pathology (1995) CA
Board Certification: American Board of Pathology, Anatomic and Clinical Pathology (1997)
Medical Education: Columbia University College of Physicians and Surgeons (1992) NY
- Reply to "Risk Factors and Recommendations for Follow-Up of Gallbladder Polyps". AJR. American journal of roentgenology 2022: 1-2
Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations.
Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US. See also the editorial by Sidhu and Rafailidis in this issue.
View details for DOI 10.1148/radiol.213079
View details for PubMedID 35787200
Evaluation of early sonographic predictors of gangrenous cholecystitis: mucosal discontinuity and echogenic pericholecystic fat.
Abdominal radiology (New York)
PURPOSE: To identify early sonographic features of gangrenous cholecystitis.MATERIALS AND METHODS: 101 patients with acute cholecystitis and a pre-operative sonogram were retrospectively reviewed by three radiologists in this IRB-approved and HIPAA-compliant study. Imaging data were correlated with histologic findings and compared using the Fisher's exact test or Student t test with p<0.05 to determine statistical significance.RESULTS: Forty-eight patients had gangrenous cholecystitis and 53 had non-gangrenous acute cholecystitis. Patients with gangrenous cholecystitis tended to be older (67±17 vs 48±18years; p=0.0001), male (ratio of male:female 2:1 vs 0.6:1; p=0.005), tachycardic (60% vs 28%; p=0.001), and diabetic (25% vs 8%; p=0.001). Median time between pre-operative sonogram and surgery was 1day. On imaging, patients with gangrenous cholecystitis were more likely to have echogenic pericholecystic fat (p=0.001), mucosal discontinuity (p=0.010), and frank perforation (p=0.004), while no statistically significant differences were seen in the presence of sloughed mucosa (p=0.104), pericholecystic fluid (p=0.523) or wall striations (p=0.839). In patients with gangrenous cholecystitis and echogenic pericholecystic fat, a smaller subset had concurrent mucosal discontinuity (57%), and a smaller subset of those had concurrent frank perforation (58%). The positive likelihood ratios for gangrenous cholecystitis with echogenic fat and mucosal discontinuity were 4.6 (95% confidence interval 1.9-11.3) and 14.4 (2.0-106), respectively.CONCLUSION: Echogenic pericholecystic fat and mucosal discontinuity are early sonographic findings that may help identify gangrenous cholecystitis prior to late findings of frank perforation.
View details for DOI 10.1007/s00261-021-03320-4
View details for PubMedID 34985635
Pancreatic INI1-deficient undifferentiated rhabdoid carcinoma achieves complete clinical response on gemcitabine and nab-paclitaxel following immediate progression on FOLFIRINOX: a case report.
Journal of gastrointestinal oncology
2021; 12 (2): 874-879
INTRODUCTION: INI1-deficient undifferentiated rhabdoid carcinoma is a rare pancreatic carcinoma for which the optimal treatment is unknown. Pancreatic ductal adenocarcinoma, the most common histology of pancreas cancer, is treated with combination chemotherapy in the advanced setting, a strategy supported by strong evidence in well powered studies. In patients with excellent performance status, first-line treatment usually consists of the three-drug regimen FOLFIRINOX, with the combination of gemcitabine with nab-paclitaxel, typically less toxic than the three-drug regimen, reserved for second-line therapy. Given the lack of published reports describing treatment outcomes for patients with rare forms of pancreatic cancer, the same treatment approach used for pancreatic ductal adenocarcinoma is typically employed.OBSERVATION: This case describes a patient with metastatic pancreatic INI1-deficient undifferentiated rhabdoid carcinoma who was primarily resistant to FOLFIRINOX therapy but who then achieved an immediate, marked and sustained response to gemcitabine with nab-paclitaxel.CONCLUSION: Given the lack of data informing on optimal management of INI1-deficient pancreatic undifferentiated rhabdoid carcinoma, and the exceptional response achieved by gemcitabine with nab-paclitaxel, this case report highlights a surprising and potentially informative anecdote. Additional studies are needed to confirm responses observed in this report which when taken together may strongly influence first-line therapy choice for this rare malignancy. Given the difficult in acquiring sufficient numbers of these rare histologies in any one institution, multi-institution collaboration in studying outcomes of rare pancreatic malignancies is likely essential.
View details for DOI 10.21037/jgo-20-478
View details for PubMedID 34012674
Longitudinal Ultrasound Assessment of Changes in Size and Number of Incidentally-Detected Gallbladder Polyps.
AJR. American journal of roentgenology
Background: Recent European multisociety guidelines recommend routine follow-up imaging of gallbladder polyps (including polyps <6 mm in patients without risk factors) and size change of ≥2 mm to prompt cholecystectomy. Objective: To assess longitudinal changes in the number and size of gallbladder polyps on serial ultrasound examinations. Methods: This retrospective study included patients who underwent at least one screening ultrasound examination between January 2010 and December 2020 as part of a hepatocellular carcinoma screening and surveillance program that demonstrated a gallbladder polyp. Number of polyps and size of largest polyp were recorded based primarily on review of examination reports. Longitudinal changes on serial examinations were summarized. Pathologic findings from cholecystectomy were reviewed. Results: Among 9683 patients, 759 (8%) had at least one ultrasound examination showing a polyp. Of these, 434 patients (248 male, 186 female; mean age, 50.6 years) had multiple examinations (range, 2-19 examinations; mean 4.8 examinations per patient; mean interval between first and last examinations of 3.6 ± 3.1 years, maximum 11.0 years). Among these 434 patients, 257 had one polyp, 40 had two polyps, and 137 had more than 2 polyps. Polyp size was ≤6 mm in 368 patients, 7-9 mm in 52 patients, and ≥10 mm in 14 patients. Number of polyps increased in 9%, decreased in 14%, both increased and decreased on serial examinations in 22%, and showed no change in 55%. Polyp size increased in 10%, decreased in 16%, both increased and decreased on serial examinations in 18%, and showed no change in 56%. In 9% of patients, gallbladder polyps were not detected on follow-up imaging; in 6% of patients, gallbladder polyps were not detected on a follow-up examination but then detected on later studies. No gallbladder carcinoma was identified in nineteen patients who underwent cholecystectomy. Conclusion: Gallbladder polyps fluctuate in size, number, and visibility over serial examinations. Using 2 mm threshold for growth, 10% increased in size. No carcinoma was identified. Clinical Impact: Recent European multisociety guidelines that propose surveillance of essentially all polyps and a 2 mm size change as basis for cholecystectomy are likely too conservative for clinical application.
View details for DOI 10.2214/AJR.21.26614
View details for PubMedID 34549608
- Not in the Same Vein: Inflammatory Bowel Disease, Malignancy, and Enterocolic Lymphocytic Phlebitis. Digestive diseases and sciences 2020
- Gut Dysthymia: Paraneoplastic Chronic Watery Diarrhea. Digestive diseases and sciences 2020
- Ruptured Oncocytic Intraductal Papillary Neoplasm: Think Beyond the Pancreas DIGESTIVE DISEASES AND SCIENCES 2019; 64 (6): 1436–38
Ruptured Oncocytic Intraductal Papillary Neoplasm: Think Beyond the Pancreas.
Digestive diseases and sciences
View details for PubMedID 30607688
Antigen Identification for Orphan T Cell Receptors Expressed on Tumor-Infiltrating Lymphocytes
2018; 172 (3): 549-+
The immune system can mount T cell responses against tumors; however, the antigen specificities of tumor-infiltrating lymphocytes (TILs) are not well understood. We used yeast-display libraries of peptide-human leukocyte antigen (pHLA) to screen for antigens of "orphan" T cell receptors (TCRs) expressed on TILs from human colorectal adenocarcinoma. Four TIL-derived TCRs exhibited strong selection for peptides presented in a highly diverse pHLA-A∗02:01 library. Three of the TIL TCRs were specific for non-mutated self-antigens, two of which were present in separate patient tumors, and shared specificity for a non-mutated self-antigen derived from U2AF2. These results show that the exposed recognition surface of MHC-bound peptides accessible to the TCR contains sufficient structural information to enable the reconstruction of sequences of peptide targets for pathogenic TCRs of unknown specificity. This finding underscores the surprising specificity of TCRs for their cognate antigens and enables the facile indentification of tumor antigens through unbiased screening.
View details for PubMedID 29275860
View details for PubMedCentralID PMC5786495
- Double Rarities, Double Challenges: Extra-Mammary Paget's Disease and Anal Adenocarcinoma. Digestive diseases and sciences 2016; 61 (4): 996-999
- Double Rarities, Double Challenges: Extra-Mammary Paget's Disease and Anal Adenocarcinoma DIGESTIVE DISEASES AND SCIENCES 2016; 61 (4): 996-999
- Gastric Outlet Obstruction Caused by Heterotopic Pancreas in an Adolescent DIGESTIVE DISEASES AND SCIENCES 2015; 60 (4): 835-837
Molecular assessment of surgical-resection margins of gastric cancer by mass-spectrometric imaging.
Proceedings of the National Academy of Sciences of the United States of America
2014; 111 (7): 2436-2441
Surgical resection is the main curative option for gastrointestinal cancers. The extent of cancer resection is commonly assessed during surgery by pathologic evaluation of (frozen sections of) the tissue at the resected specimen margin(s) to verify whether cancer is present. We compare this method to an alternative procedure, desorption electrospray ionization mass spectrometric imaging (DESI-MSI), for 62 banked human cancerous and normal gastric-tissue samples. In DESI-MSI, microdroplets strike the tissue sample, the resulting splash enters a mass spectrometer, and a statistical analysis, here, the Lasso method (which stands for least absolute shrinkage and selection operator and which is a multiclass logistic regression with L1 penalty), is applied to classify tissues based on the molecular information obtained directly from DESI-MSI. The methodology developed with 28 frozen training samples of clear histopathologic diagnosis showed an overall accuracy value of 98% for the 12,480 pixels evaluated in cross-validation (CV), and 97% when a completely independent set of samples was tested. By applying an additional spatial smoothing technique, the accuracy for both CV and the independent set of samples was 99% compared with histological diagnoses. To test our method for clinical use, we applied it to a total of 21 tissue-margin samples prospectively obtained from nine gastric-cancer patients. The results obtained suggest that DESI-MSI/Lasso may be valuable for routine intraoperative assessment of the specimen margins during gastric-cancer surgery.
View details for DOI 10.1073/pnas.1400274111
View details for PubMedID 24550265
Inherited pancreatic endocrine tumor syndromes: Advances in molecular pathogenesis, diagnosis, management, and controversies
2008; 113 (7): 1807-1843
Pancreatic endocrine tumors (PETs) can occur as part of 4 inherited disorders, including Multiple Endocrine Neoplasia type 1 (MEN1), von Hippel-Lindau disease (VHL), neurofibromatosis 1 (NF-1) (von Recklinghausen disease), and the tuberous sclerosis complex (TSC). The relative frequency with which patients who have these disorders develop PETs is MEN1>VHL>NF-1>TSC. Over the last few years, there have been major advances in the understanding of the genetics and molecular pathogenesis of these disorders as well in the localization and the medical and surgical treatment of PETs in such patients. The study of PETs in these disorders not only has provided insights into the possible pathogenesis of sporadic PETs but also has presented several unique management and treatment issues, some of which are applicable to patients with sporadic PETs. Therefore, the study of PETs in these uncommon disorders has provided valuable insights that, in many cases, are applicable to the general group of patients with sporadic PETs. In this article, these areas are reviewed briefly along with the current state of knowledge of the PETs in these disorders, and the controversies that exist in their management are summarized briefly and discussed.
View details for DOI 10.1002/cncr.23648
View details for Web of Science ID 000259661800011
View details for PubMedID 18798544
- Splenic diffuse large B-cell lymphoma in a patient with type 1 Gaucher disease: diagnostic and therapeutic challenges ANNALS OF HEMATOLOGY 2006; 85 (11): 817-820