Diagnoses In Anatomic Pathology Research Articles

Mesenteric root pseudocyst: finding in an asymptomatic patient—a case report

BackgroundMesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain.Case presentationThis article describes the case report of an asymptomatic 28-year-old patient who presented a 6-cm abdominal cystic mass with mixed density, which was found incidentally by computed tomography. Exploratory laparoscopy was performed followed by conversion to conventional surgery to extract the tumor mass. The anatomical pathology diagnosis was pseudocyst of the mesentery root. Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain.ConclusionsMesenteric cysts are rare, and their nonspecific symptoms often lead to diagnosis based on imaging findings. Complete laparoscopic enucleation is the standard treatment.

Differentiate cavernous hemangioma from schwannoma with artificial intelligence (AI).

BackgroundCavernous hemangioma and schwannoma are tumors that both occur in the orbit. Because the treatment strategies of these two tumors are different, it is necessary to distinguish them at treatment initiation. Magnetic resonance imaging (MRI) is typically used to differentiate these two tumor types; however, they present similar features in MRI images which increases the difficulty of differential diagnosis. This study aims to devise and develop an artificial intelligence framework to improve the accuracy of clinicians’ diagnoses and enable more effective treatment decisions by automatically distinguishing cavernous hemangioma from schwannoma.MethodsMaterial: As the study materials, we chose MRI images as the study materials that represented patients from diverse areas in China who had been referred to our center from more than 45 different hospitals. All images were initially acquired on films, which we scanned into digital versions and recut. Finally, 11,489 images of cavernous hemangioma (from 33 different hospitals) and 3,478 images of schwannoma (from 16 different hospitals) were collected. Labeling: All images were labeled using standard anatomical knowledge and pathological diagnosis. Training: Three types of models were trained in sequence (a total of 96 models), with each model including a specific improvement. The first two model groups were eye- and tumor-positioning models designed to reduce the identification scope, while the third model group consisted of classification models trained to make the final diagnosis.ResultsFirst, internal four-fold cross-validation processes were conducted for all the models. During the validation of the first group, the 32 eye-positioning models were able to localize the position of the eyes with an average precision of 100%. In the second group, the 28 tumor-positioning models were able to reach an average precision above 90%. Subsequently, using the third group, the accuracy of all 32 tumor classification models reached nearly 90%. Next, external validation processes of 32 tumor classification models were conducted. The results showed that the accuracy of the transverse T1-weighted contrast-enhanced sequence reached 91.13%; the accuracy of the remaining models was significantly lower compared with the ground truth.ConclusionsThe findings of this retrospective study show that an artificial intelligence framework can achieve high accuracy, sensitivity, and specificity in automated differential diagnosis between cavernous hemangioma and schwannoma in a real-world setting, which can help doctors determine appropriate treatments.

The Current State of Communication of Urgent and Significant, Unexpected Diagnoses in Anatomic Pathology.

The concept of critical diagnoses in anatomic pathology is relatively recent and rigorous study of the issue is quite limited. The College of American Pathologists and Association of Directors of Anatomic and Surgical Pathology issued a consensus statement in 2012. There has been no multi-institutional study of communication policies since then. To survey the policies of anatomic pathology laboratories regarding communication of critical values. A survey of the Association of Directors of Anatomic and Surgical Pathology membership was performed using a 14-question electronic survey tool. Responses were received from 38 institutions. Thirty-five of 38 (92%) had a policy on anatomic pathology critical values. Twenty-five of 38 (66%) respondents had read the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology consensus statement. Twelve of 38 (32%) institutions divided critical values into 2 categories, of which 9 used the College of American Pathologists/Association of Directors of Anatomic and Surgical Pathology terminology; 24 used only a single term, of which 11 used critical value. There was substantial variation in the diagnoses that were considered critical. A direct phone call to the responsible provider was uniformly considered an acceptable means of communication; all other methods had mixed or low support. The most common time frame was same day; many laboratories did not specify a timeframe. Most laboratories document date, time, and person to whom the result was communicated in the final report or an addendum report. Eighteen of 38 (47%) laboratories report an auditing mechanism for communication. Policies for communication of critical/urgent/significant, unexpected results in anatomic pathology are the norm. However, there remains significant variation between institutions in the details of these policies.

Laparoscopic Approach of the Left Side of the Pancreas

IntroductionLaparoscopic left-sided pancreatectomy (LLP) is an increasingly used surgical technique for the treatment of benign and malignant lesions of the left side of the pancreas. The results of LLP as a treatment for primary pancreatic lesions of the head and tail of the pancreas were evaluated. MethodsFrom November 2011 to November 2017, 18 patients underwent surgery for primary lesions of the pancreas by means of a laparoscopic distal pancreatectomy. An intra-abdominal drain tube was used in all cases, and the recommendations of the International Study Group for Pancreatic Fistula (ISGPF) were followed. ResultsThe mean age was 66.5 years (IQR 46–74). Among the 18 left pancreatectomies performed, four were with splenic preservation, and one was a central pancreatectomy. There were two conversions. The median surgical time was 247.5 minutes (IQR 242–275). The median postoperative hospital stay was 7 days (IQR 6–8). After 90 days, complications were detected in five patients: three grade II, one grade III and one grade V according to the modified Clavien-Dindo classification. There was one grade B pancreatic fistula, and four patients had to be readmitted to hospital because of peripancreatic collections. The anatomic pathology diagnosis was malignant neoplasm in 38.9% of cases, all of them with negative resection margins. ConclusionsLLP can be considered the technique of choice in the treatment of primary benign pancreatic lesions and an alternative to the open approach in selected patients diagnosed with malignant pancreatic lesions.

Abordaje laparoscópico del páncreas izquierdo

IntroductionLaparoscopic left-sided pancreatectomy (LLP) is an increasingly used surgical technique for the treatment of benign and malignant lesions of the left side of the pancreas. The results of LLP as a treatment for primary pancreatic lesions of the head and tail of the pancreas were evaluated. MethodsFrom November 2011 to November 2017, 18 patients underwent surgery for primary lesions of the pancreas by means of a laparoscopic distal pancreatectomy. An intra-abdominal drain tube was used in all cases, and the recommendations of the International Study Group for Pancreatic Fistula (ISGPF) were followed. ResultsThe mean age was 66.5years (IQR 46-74). Among the 18 left pancreatectomies performed, four were with splenic preservation, and one was a central pancreatectomy. There were two conversions. The median surgical time was 247.5minutes (IQR 242-275). The median postoperative hospital stay was 7days (IQR 6-8). After 90days, complications were detected in five patients: three gradeII, one gradeIII and one gradeV according to the modified Clavien-Dindo classification. There was one gradeB pancreatic fistula, and four patients had to be readmitted to hospital because of peripancreatic collections. The anatomic pathology diagnosis was malignant neoplasm in 38.9% of cases, all of them with negative resection margins. ConclusionsLLP can be considered the technique of choice in the treatment of primary benign pancreatic lesions and an alternative to the open approach in selected patients diagnosed with malignant pancreatic lesions.

Glomus tumor in the abdominal wall

ABSTRACT The glomus tumor is a rare benign soft tissue tumor. We report a case of a 45-year-old male patient who presented with a painful mass in the abdominal wall. The patient underwent total tumor resection and the anatomical pathology diagnosis was of glomus tumor. The glomus tumor presents differential diagnosis of carcinoid tumor, hemangiopericytoma and vascular leiomyoma.

Second Opinion Reviews for Cancer Diagnoses in Anatomic Pathology: A Comprehensive Cancer Center's Experience.

The objective of this study was to define the rates of discrepancy between outside pathological diagnoses and secondary reviews. We assessed the rates of discordance between outside diagnoses and secondary reviews, categorizing by organ site and minor or major (affecting patient care) discordances. A total of 9,289 consecutive surgical pathology (SP) and cytopathology (CP) cases reviewed in 2015 were identified. For 8,191 outside SP cases reviewed, the overall discordance rate (DR) was 14.2% (2.2% major, 12.0% minor). Specifically, neuropathology had the highest DR (10.9%), cutaneous and breast the lowest (1.1% each). Among 1,098 CP cases, the total DR was 13.7% (3.0% major, 10.7% minor). The majority of CP cases (1,066) were non-gynecological and had a total DR of 13.4% (2.7% major, 10.7% minor). While major DR was low, certain subspecialties had high DRs. This project can help identify areas where focused education could help improve pathological diagnostic accuracy for cancer.

Second Opinion Reviews for Cancer Diagnoses in Anatomic Pathology: A Comprehensive Cancer Center’s Experience

Aim The objective of this study was to define the rates of discrepancy between outside pathological diagnoses and secondary reviews. Materials and methods We assessed the rates of discordance between outside diagnoses and secondary reviews, categorizing by organ site and minor or major (affecting patient care) discordances. Results A total of 9,289 consecutive surgical pathology (SP) and cytopathology (CP) cases reviewed in 2015 were identified. For 8,191 outside SP cases reviewed, the overall discordance rate (DR) was 14.2% (2.2% major, 12.0% minor). Specifically, neuropathology had the highest DR (10.9%), cutaneous and breast the lowest (1.1% each). Among 1,098 CP cases, the total DR was 13.7% (3.0% major, 10.7% minor). The majority of CP cases (1,066) were non-gynecological and had a total DR of 13.4% (2.7% major, 10.7% minor). Conclusion While major DR was low, certain subspecialties had high DRs. This project can help identify areas where focused education could help improve pathological diagnostic accuracy for cancer.

Characteristics and pattern of recurrence after curative surgery in oesophageal cancer.

Recurrence in oesophageal cancer continues to remain high after curative surgery. The aim of this study was to determine the presence of recurrence after curative surgery during follow-up, and the associated variables. A retrospective and prospective follow-up study in patients with an anatomical-pathological diagnosis of oesophageal cancer who underwent curative surgery (n = 57) in the health district of A Coruña (Spain) during the period 2003-2008. The calculation of recurrence-free survival was made using a competing risks survival analysis. Out of the 57 patients included in the study, 87.7% were men with a mean age of 61.4 ± 10.3 years. The median follow-up period was 18.5 months, during which 28 recurrences were detected (50.9%). Patients with dysphagia on diagnosis of the disease, as well as patients in stages III-IV, have a higher probability of recurrence during the follow-up period. The median disease-free interval was 8.5 months. After one year of follow up, 57.1% of the recurrences were diagnosed and 82.1% after 2 years of followup. The median post-recurrence survival rate was 4.7 months. After adjusting for a multivariate regression model, the variable with an independent effect for predicting recurrence is the TNM classification (HR = 8.49). The majority of the recurrences will be developed during the 2 years after surgery, with a very poor prognosis. The predictor variable for recurrence is the TMN classification.

Reducing False-Negative and False-Positive Diagnoses in Anatomic Pathology Consultation Material

Previous studies have shown that there are disagreements in interlaboratory consultation, including false-negative and false-positive diagnoses. To date, methods to reduce false-negative and false-positive diagnoses have been poorly documented. To identify features associated with false-negative and false-positive diagnoses in anatomic pathology. We reviewed the results of interlaboratory consultation in our institution during a 9-year period. For false-negative and false-positive diagnoses, methods that might have prevented the error were identified. Disagreements were identified in 810 of 8082 consults (10%). Fifty-four false-negative cases (0.7% of all consults) and 27 false-positive cases (0.3%) were identified. False-negative cases were more common in breast (20 of 1131; 1.8%), genitourinary (16 of 970; 1.7%), hematologic (3 of 242; 1.3%), and cytology (3 of 404; 0.8%) than in all other sites combined (P < .001); no significant difference in sites were identified for false-positive cases. Overall, there was no difference in the percentage of cases that were reviewed by more than one pathologist in either false-negative cases (109 of 810; 13.5%) or false-positive cases (135 of 810; 16.7%), compared with all other consults (858 of 7272; 11.8%) (P = .74 and .59, respectively). However, on review, 12 of all 27 false-positive cases (44%) might have been prevented by the use of immunohistochemistry alone, and 36 of all 54 false-negative cases (67%) might have been prevented by the use of a second review; special stains, including immunohistochemistry; additional levels; changes in processing; and hedges. Approximately one-half of false-negative and false-positive cases (48 of 81; 59%) might be preventable by the use of a combination of pathologic methods.

Quality Assurance Measures for Critical Diagnoses in Anatomic Pathology

Quality Assurance Measures for Critical Diagnoses in Anatomic Pathology

Evaluation of efficacy and clinical impact of 18F-FDG-PET in the diagnosis of recurrent medullary thyroid cancer with increased calcitonin and negative imaging test

AimTo evaluate the efficacy and clinical impact of the FDG-PET in the diagnosis of suspicion of recurrence of medullary thyroid cancer (MTC) in patients with elevated serum calcitonin and negative imaging test. Material and methodsWe performed a retrospective study of 31 consecutive cases from February 2001 to October 2007 of 17 women and 14 men, mean age 56.2 years (range: 26–88), with anatomical-pathology diagnosis of MTC and suspicion of recurrence due to abnormal elevation of calcitonin and negative imaging tests. All the patients underwent whole body FDG-PET scan with a dedicated PET or PET-CT 60min after intravenous injection of 333–434 MBq of 18F-FDG. Results were confirmed by pathology study in 45.2% of the patients and by clinical follow-up with a mean of 4 years (range: 16 months–8 years). ResultsSensitivity was 88%, specificity 84.6%, positive predictive value (PPV) 88%, negative predictive value (NPV) 84.6% and diagnostic accuracy 87%. The results of the FDG PET modified the therapeutic strategy in 14 cases (45.2%). A comparison was made of the mean values of calcitonin using the Student's t-test between positive PET studies for the disease and negative ones. No significant differences were found (p=0.3). ConclusionsIn patients with MTC and suspected recurrence with elevated calcitonin and negative imaging test, the FDG is the best test for the diagnosis of occult recurrence in MTC with elevated calcitonin and negative imaging techniques with elevated clinical impact. It facilitates the therapeutic management of the patients with MTC recurrence, and should be included in the diagnosis algorithm in these patients.

Reducing the pre-analysis time in the anatomicalpathological diagnosis of breast conditions, utopia or reality?

Surgical pathology diagnosis of a breast lesion is an important stage in the diagnostic process of breast diseases. Quality of the pre-analytical phase is essential to ensure reliable and reproducible diagnoses, and is based on neutral-buffered formalin fixation of tissue specimens. It is important to respect aminimum fixation timewithformalin inorder to guarantee the quality of subsequent morphological, immunohistochemical and cytogenetic studies. We present here an alternative to formalin fixation, based on tissue dehydration, enabling the shortening of technical stages and sign out. Furthermore, this method ensures better nucleic acid preservation, which opens the way for the development of high-throughput molecular testing in breast cancer.

Evaluación de la eficacia y del impacto clínico de la PET-18F-FDG en el diagnóstico de recurrencia del carcinoma medular de tiroides con calcitonina elevada y pruebas de imagen negativas

AimTo evaluate the efficacy and clinical impact of the FDG-PET in the diagnosis of suspicion of recurrence of medullary thyroid cancer (MTC) in patients with elevated serum calcitonin and negative imaging test. Material and methodsWe performed a retrospective study of 31 consecutive cases from february 2001 to october 2007 of 17 women and 14 men, mean age 56.2 years (range: 26-88), with anatomical-pathology diagnosis of medullary thyroid cancer and suspicion of recurrence due to abnormal elevation of calcitonin and negative imaging tests. All of the patients underwent whole body FDG-PET scan with a dedicated PET or PET-CT 60minutes after intravenous injection of 333-434 MBq of 18F-FDG. Results were confirmed by pathology study in 45.2% of the patients and by clinical follow-up with a mean of 4 years (range: 16 m-8 years) ResultsSensitivity was 88%, specificity 84.6%, positive predictive value 88%, negative predictive value 84.6% and diagnostic accuracy 87%. The results of the FDG PET modified the therapeutic strategy in 14 cases (45.2%). A comparison was made of the mean values of calcitonin using the Student's «t» test between positive PET studies for the disease and negative ones. No significant differences were found (P=.3). ConclusionsIn patients with MTC and suspected recurrence with elevated calcitonin and negative imaging test, the FDG is the best test for the diagnosis of occult recurrence in MTC with elevated calcitonin and negative imaging techniques with elevated clinical impact. It facilitates the therapeutic management of the patients with MTC recurrence, and should be included in the diagnosis algorithm in these patients.

Quality Assurance Measures for Critical Diagnoses in Anatomic Pathology

We sought to characterize how well computerized "case flags" performed in evaluating critical diagnoses in anatomic pathology. All cases identified by a pathologist at sign-out and flagged as a critical diagnosis in anatomic pathology in 2 hospital laboratories during a 3-year period were reviewed. A subset of all critical diagnoses consisting of only treatable, immediately life-threatening (TILT) diagnoses was selected, and a text search for key words was used to evaluate performance during a 6-month period. During a 3-year period, there were 635 cases (0.5% of all cases) that were flagged as critical diagnoses. A key word search identified 269 TILT cases, which represented 1.8% of all cases during this time; 30 (11.2%) were critical diagnoses, of which 24 (80%) had documentation of a call to the clinician and only 2 (7%) were flagged as a critical diagnosis. Critical diagnoses in anatomic pathology remain poorly defined. Computerized case flags underestimate the number of critical diagnosis cases in a laboratory and cannot identify missed critical diagnoses. A more limited and clearly defined approach to quality assurance of critical diagnoses emphasizing TILT diagnoses and selected key word searches can be performed and requires reviewing only 1.8% of all cases.

Consensus statement on effective communication of urgent diagnoses and significant, unexpected diagnoses in surgical pathology and cytopathology from the College of American Pathologists and Association of Directors of Anatomic and Surgical Pathology.

Recognizing the difficulty in applying the concept of critical values to anatomic pathology diagnoses, the College of American Pathologists and the Association of Directors of Anatomic and Surgical Pathology have chosen to reevaluate the concept of critical diagnoses. To promote effective communication of urgent and significant, unexpected diagnoses in surgical pathology and cytology. A comprehensive literature search was conducted and reviewed by an expert panel. A policy of effective communication of important results in surgical pathology and cytology is desirable to enhance patient safety and to address multiple regulatory requirements. Each institution should create its own policy regarding urgent diagnoses and significant, unexpected diagnoses in anatomic pathology. This policy should be separate from critical results or panic-value policies in clinical pathology, with the expectation of a different time frame for communication. Urgent diagnosis is defined as a medical condition that, in most cases, should be addressed as soon as possible. Significant, unexpected diagnosis is defined as a medical condition that is clinically unusual or unforeseen and should be addressed at some point in the patient's course. Further details of this statement are provided.

Antigen Retrieval Immunohistochemistry

As a review for the 20th anniversary of publishing the antigen retrieval (AR) technique in this journal, the authors intend briefly to summarize developments in AR-immunohistochemistry (IHC)-based research and diagnostics, with particular emphasis on current challenges and future research directions. Over the past 20 years, the efforts of many different investigators have coalesced in extending the AR approach to all areas of anatomic pathology diagnosis and research and further have led to AR-based protein extraction techniques and tissue-based proteomics. As a result, formalin-fixed paraffin-embedded (FFPE) archival tissue collections are now seen as a literal treasure of materials for clinical and translational research to an extent unimaginable just two decades ago. Further research in AR-IHC is likely to focus on tissue proteomics, developing a more efficient protocol for protein extraction from FFPE tissue based on the AR principle, and combining the proteomics approach with AR-IHC to establish a practical, sophisticated platform for identifying and using biomarkers in personalized medicine.

Critical diagnoses in anatomic pathology.

Critical diagnoses in anatomic pathology.

Tissue floaters and contaminants in the histology laboratory.

Abstract Context.—Anatomic pathology diagnosis is often based on morphologic features. In recent years, an appropriate increased attention to patient safety has led to an emphasis on improving maintenance of patient identity. Decreasing or eliminating cross-contamination from one specimen to another is an example of a patient identity issue for which process improvement can be initiated. Objective.—To quantify the presence of cross-contamination from histology water baths and the slide stainers. Design.—We assessed for the presence of contaminants in water baths at cutting stations and in linear stainer stain baths. We assessed the potential for tissue discohesion and carryover in tissue samples and we assessed the potential for carryover onto blank slides sent through the stainer. Results.—In the 13 water baths examined (totalling 195 L of water), only one fragment of tissue was identified. The stain baths, however, contained abundant tissue contaminants, ranging in size from 2 to 3 cells to hundreds of ...

Tissue Floaters and Contaminants in the Histology Laboratory

Anatomic pathology diagnosis is often based on morphologic features. In recent years, an appropriate increased attention to patient safety has led to an emphasis on improving maintenance of patient identity. Decreasing or eliminating cross-contamination from one specimen to another is an example of a patient identity issue for which process improvement can be initiated. To quantify the presence of cross-contamination from histology water baths and the slide stainers. We assessed for the presence of contaminants in water baths at cutting stations and in linear stainer stain baths. We assessed the potential for tissue discohesion and carryover in tissue samples and we assessed the potential for carryover onto blank slides sent through the stainer. In the 13 water baths examined (totalling 195 L of water), only one fragment of tissue was identified. The stain baths, however, contained abundant tissue contaminants, ranging in size from 2 to 3 cells to hundreds of cells. The first sets of xylenes and alcohols were the most heavily contaminated. Cross-contamination to blank slides occurred at a rate of 8%, with the highest frequency in the late afternoon. Cross-contamination can present a significant challenge in the histology laboratory. Although the histotechnologists' water baths are not heavily contaminated, the stainer baths do contain contaminating tissue fragments. Cross-contamination does occur onto blank slides in the experimental setting.