Surgical Pathology Diagnosis Research Articles

Clinical value of abdominal ultrasound in the diagnosis of acute appendicitis

Objective To investigate the clinical value of abdominal ultrasound in the diagnosis of acute appendicitis. Methods From March 2015 to April 2017, 60 patients with acute appendicitis admitted to Hangzhou Hospital of Zhejiang Medical Hospital Health Care Group were selected in this study.All patients were diagnosed by abdominal ultrasound and performed surgical treatment.The clinical value of abdominal ultrasound in the diagnosis of acute appendicitis was analyzed. Results The diagnostic rate of acute simple appendicitis was 94%(33/35). The diagnostic rate of acute gangrene perforated appendicitis was 87%(7/8). The diagnostic rate of abscess classification around the appendix was 100%(5/5). The diagnosis of abdominal gray-scale ultrasound examination was consistent with the results of surgical pathological diagnosis, with an accuracy rate of 93%(56/60). Conclusion In the diagnosis of acute appendicitis, abdominal gray-scale ultrasound examination is a direct, simple, safe and accurate method, which is worthy of extensive promotion and application. Key words: Abdominal gray-scale ultrasound; Acute appendicitis; Clinical value; Ultrasound; Abscess around the appendix; Diagnosis; Diagnosis; Appendicitis; Surgical pathology

Outcome after liver resection for primary and recurrent intrahepatic cholangiocarcinoma.

BackgroundLiver resection is the only curative therapeutic option for intrahepatic cholangiocarcinoma (ICC), but the approach to recurrent ICC is controversial. This study analysed the outcome of liver resection in patients with recurrent ICC.MethodsDemographic, radiological, clinical, operative, surgical pathological and follow‐up data for all patients with a final surgical pathological diagnosis of ICC treated in a tertiary referral centre between 2001 and 2015 were collected retrospectively and analysed.ResultsA total of 190 patients had liver resection for primary ICC. The 1‐, 3‐ and 5‐year overall survival (OS) rates were 74·8, 56·6 and 37·9 per cent respectively. Independent determinants of OS were age 65 years or above (hazard ratio (HR) 2·18, 95 per cent c.i. 1·18 to 4·0; P = 0·012), median tumour diameter 5 cm or greater (HR 2·87, 1·37 to 6·00; P = 0·005), preoperative biliary drainage (HR 2·65, 1·13 to 6·20; P = 0·025) and local R1–2 status (HR 1·90, 1·02 to 3·53; P = 0·043). Recurrence was documented in 87 patients (45·8 per cent). The mean(s.d.) survival time after recurrence was 16(17) months. Independent determinants of recurrence were median tumour diameter 5 cm or more (HR 1·71, 1·09 to 2·68; P = 0·020), high‐grade (G3–4) tumour (HR 1·63, 1·04 to 2·55; P = 0·034) and local R1 status (HR 1·70, 1·09 to 2·65; P = 0·020). Repeat resection with curative intent was performed in 25 patients for recurrent ICC, achieving a mean survival of 25 (95 per cent c.i. 16 to 34) months after the diagnosis of recurrence. Patients deemed to have unresectable disease after recurrence received chemotherapy or chemoradiotherapy alone, and had significantly poorer survival.ConclusionPatients with recurrent ICC may benefit from repeat surgical resection.

Virtual Predictive Autopsy: From knowledge and understanding to education, research and communication in digital tissue – based diagnosis.

Background: The digital world is entering all compartments of tissue – based diagnosis, especially education, training and performance of surgical pathology. Theory: Communication is a requirement of life. It is based upon knowledge, understanding, and adequate response. Understanding tries to implement and spread concordant or target related actions. Analysis of liquid biopsy, cytology, biopsy, surgical specimens and autopsy comprise the tissue – based sources. They are transferred into images and create the basis of education and training, followed by research and publication. Present Stage: Liquid biopsies require the automated application of digital tools, such as digital visualization and statistical analysis of the obtained DNA / protein figures. Manual interference does not occur.Tissue of cytology, aspirations, biopsies, and surgical specimens are still fixed and processed in conventional manner, and placed on glass slides. Digital microscopy replaces conventional light microscopy in some pathology institutes. It is usually applied close to its analogue performance. Diagnosis assistants are used for quantification of specific image features, for example to score the expression of functional cellular markers. Digital microscopy is an important compartment of the available Hospital Information System too. At present, autopsies do not contribute to tissue – based diagnosis in a notable frequency. Even big University Pathology Institutes report an autopsy frequency less than 100 cases, in comparison to approximately 100,000 biopsy specimens or even more per year. Most authors name live imaging investigations (CT, MR, Ultrasound, etc.) for reason. An additional factor might be the diminishing impact of understanding in medical diagnostics: Highly precise information of individual (small) tissue compartments is frequently considered to be sufficient for treatment. They include receptor expressions, intra-cellular pathway abnormalities, gene alterations, etc. This seems to be a contradiction to ‘organ communitive information’ obtained from autopsies. Such post mortem information can also be obtained during the patient’s life time and predict the probable trails of recovery or death by use of digital pathology. The procedure is called ‘predictive autopsy’ and described in detail herein. Future aspects: Digital pathology is entering the field of ‘automated diagnosis’, starting with automated recognition of ‘regions of interest’ and associated characteristics such as automated diagnosis, digital self - recognition, automated failure repair, treatment advises, etc. The field of ‘digital autopsy’ will remain reserved for education because of need for ‘real autopsies’. The proposed ‘predictive autopsies’ offer additional perspectives of digital tissue – based diagnosis, which include the digital analysis of tissue / organ dysfunctions and syntax at life time, and the impact on forecast the recover /disease progress of the patient. Conclusions: Digital pathology is on its way to enter numerous implementations of tissue – based diagnosis. We propose digital ‘predictive autopsies’ as a new tool to analyze, explain, and forecast the involvement of all organs in the individual patient’s disease development and interpret the ‘cause of death’ more in detail.

A new classification of hepatic alveolar echinococcosis (HAE) calcification and biological activity using CT and PET-CT

ObjectivesThe aim of this study is to establish a pattern of calcification and biological activity in hepatic alveolar echinococcosis (HAE) using CT and PET-CT. Material and methodA Retrospective study is conducted on 60 patients in the First Affiliated Hospital of Xinjiang Medical University from June 2016 to April 2017 with confirmed diagnosis of hepatic alveolar echinococcosis or with confirmed diagnosis of surgical pathology of HAE. All patients underwent abdominal CT scan and double-phase enhanced PET-CT examination was confirmed with a single lesion. The CT and PET-CT features were analyzed, and the maximum standard uptake value (SUVmax) of the focal lesion on the PET-CT was measured. According to the calcification, HAE patients were classified into I, II, III categories. Kruskal–Wallis H test was used to compare the difference of SUVmax between lesions of different HAE types. ResultSixty patients with hepatic alveolar echinococcosis were evenly divided into I, II and III categories by different calcifications patterns in CT and biological activity on PET-CT. The median SUVmax of I, II and III were 3.41 (2.17–3.75), 7.45 (6.77–9.01) and 6.67 (6.28–9.01), respectively. The median SUVmax within three types was statistically significant (χ2 = 4.429, P < 0.05). DiscussionThe combination of Computed tomography (CT), with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET), warrants one of the most reliable diagnostic imaging modalities for early diagnosing and monitoring the characteristic calcifications and biological activity in the course of the disease (alveolar echinococcosis). The biological activity of different calcifications pattern of HAE is different. ConclusionThis study is intended to help further differentiate the recognition and interpretation of hepatic lesions based on their calcification pattern and biological activity, and make a ground for future studies.

Digital image-assisted quantitative nuclear analysis improves diagnostic accuracy of thyroid fine-needle aspiration cytology.

Thyroid fine-needle aspiration (FNA) plays a key role in triaging thyroid nodules. Yet many cases are assigned to indeterminate categories. The new category "noninvasive follicular thyroid neoplasm with papillary-like features" (NIFTP) complicates thyroid cytology. Digital image-derived nuclear measurements might objectively distinguish papillary thyroid carcinoma (PTC) from benign nodules and NIFTP. All thyroid FNAs from 2012 to 2016 of atypia of undetermined significance (A; n=8) and suspicious for malignancy (S; n=2) with sufficient cellularity and surgical follow-up, all FNAs preceding NIFTP (n=6), and a random sample of PTC (n=9) and benign (n=10) cytology were studied. A modified Giemsa-stained slide from each case was scanned using the Aperio imaging system, and long (dl ) and short (ds )-axis diameters were measured for 125 nuclei per case. Nuclear area and elongation were calculated. Nuclear area was larger in PTC (mean, 77.2μm2 [range, 70.6-86.0μm2 ]) than benign (mean, 43.3μm2 [range 38.2-52.2μm2 ]) (P<.001). Nuclear areas from indeterminate FNAs segregated according to final histology (A/S PTC mean 72.7μm2 , A/S benign mean 53.7μm2 ; P=0.004), and were not significantly different from definitive FNAs of the same diagnosis. NIFTP nuclear area was smaller than PTC (mean, 54.8μm2 [range, 46.7-66.1μm2 ]; P<.001). Nuclear elongation showed similar results, but with greater group overlap. Nuclear area and elongation can be calculated using a commercial digital imager; both correlate with the final surgical pathology diagnosis of PTC versus benign, including NIFTP. Area provides greater resolution than elongation. This technique could be used to resolve indeterminate cytology in which PTC is considered.

Clinical Faceoff: Should Routine Histopathological Analysis be Performed on Specimens Obtained During Primary Arthroplasty Surgery?

Clinical Faceoff: Should Routine Histopathological Analysis be Performed on Specimens Obtained During Primary Arthroplasty Surgery?

Overall survival and tumor recurrence after surgical resection for primary malignant chest wall tumors: a single-center, single-surgeon experience.

Malignant primary chest wall tumors (PCWTs) comprise a rare group of thoracic tumors with unique anatomical considerations, and experience with wide surgical resection is limited to specialty referral centers and specific diagnoses. We investigated the tumor recurrence and overall survival (OS) for patients with a variety of PCWTs diagnoses at our institution. From 1991 to 2010, patients with malignant PCWT undergoing wide surgical resection for curative intent under a single surgeon were reviewed. Diagnosis and grade (if applicable) of surgical pathology, along with patient demographics, neoadjuvant chemotherapy or radiation therapy, and outcomes (complications, recurrence, and OS) at follow-up were analyzed. One hundred fifteen patients were included in the study. The most common tumor diagnoses included pleomorphic sarcoma and liposarcoma. Negative margins were achieved in 70 (74%) of cases. Postoperative complications were reported in 21 (20%) cases. The 5-year survival rate was 54%, while the 10-year survival rate was 29%. The local and distant recurrence rates were 50% and 38%, respectively. OS was significantly less in patients with any recurrence ( p < 0.001) but not significantly different between pathology grades ( p = 0.28). Wide resection for malignant PCWT is feasible when undertaken for a heterogenous group of diagnoses.

Reliability of clinical diagnosis of masses of the cerebellopontine angle: A retrospective multi-institutional study.

To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology. Retrospective chart review. Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017. Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses. Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05). Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.

Differentiating Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features from Classic Papillary Thyroid Carcinoma: Analysis of Cytomorphologic Descriptions Using a Novel Machine-Learning Approach

Background: Recent studies show various cytomorphologic features that can assist in the differentiation of classic papillary thyroid carcinoma (cPTC) from noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Differentiating these two entities changes the clinical management significantly. We evaluated the performance of support vector machine (SVM), a machine learning algorithm, in differentiating cases of NIFTP and encapsulated follicular variant of papillary thyroid carcinoma with no capsular or lymphovascular invasion (EFVPTC) from cases of cPTC with the use of microscopic descriptions. SVM is a supervised learning algorithm used in classification problems. It assigns the input data to one of two categories by building a model based on a set of training examples (learning) and then using that learned model to classify new examples. Methods: Surgical pathology cases with the diagnosis of cPTC, NIFTP, and EFVPTC, were obtained from the laboratory information system. Only cases with existing fine-needle aspiration matching the tumor and available microscopic description were included. NIFTP cases with ipsilateral micro-PTC were excluded. The final cohort consisted of 59 cases (29 cPTCs and 30 NIFTP/EFVPTCs). Results: SVM successfully differentiated cPTC from NIFTP/EFVPTC 76.05 ± 0.96% of times (above chance, P < 0.05) with the sensitivity of 72.6% and specificity of 81.6% in detecting cPTC. Conclusions: This machine learning algorithm was successful in distinguishing NIFTP/EFVPTC from cPTC. Our results are compatible with the prior studies, which show cytologic features are helpful in differentiating these two entities. Furthermore, this study shows the power and potential of this approach for clinical use and in developing data-driven scoring systems, which can guide cytopathology and surgical pathology diagnosis.

A 54-year-old man with primary mediastinum choriocarcinoma

Primary mediastinum choriocarcinoma, an extragonadal germ cell tumor, is a rare malignant tumor that is more common in men. We present a case of primary mediastinum choriocarcinoma in a male patient who initially presented with gynecomastia and progressed to superior vena cava syndrome. Both surgical biopsy and pathologic diagnosis were challenging. After standard induction chemotherapy, the resected tumor underwent squamous cell transformation, which has rarely been reported in cases of choriocarcinoma. His critical condition was resolved using induction chemotherapy with a combination of bleomycin, etoposide, and cisplatin, followed by resection of the residual tumor. However, tumor recurrence occurred 9 months later, and he was treated with salvage radiotherapy and chemotherapy. This was a rare and challenging case from the aspects of initial approaches, pathologic differential diagnosis, and different treatment modalities.

Effects of shRNA Expression Vector-mediated Glutathione S-transferase P1 Gene Silencing on Prostate Cancer DU145 Cells

Objective: This study aims to explore the impact of silent GSTP1 gene on the proliferation activity, cell cycle and apoptotic rate of the androgen-independent prostate cancer cell strain DU145. Methods: Thirty subjects with benign prostatic hyperplasia (BPH) who had been subject to urinary surgical resection and pathological diagnosis, 30 subjects with radically cured prostate cancer (PCa), and another 30 subjects with hormone refractory prostate cancer (HRPC) were enrolled. The GSTP1 expression in the subjects was tested with the immunohistochemical S-P method, the GSTP1 expression in the blood serum of the patients with prostatic hyperplasia and prostate cancer was tested with Elisa, and the mRNA level of the GSTP1 gene after the DUl45 cells were transfected with shRNA was tested. Results: Four of the HRPC patients were complicated with bone metastasis, two with bladder invasion, and five with liver and lung metastasis. GSTP1 showed high expression in tissues with prostatic hyperplasia and hormone refractory prostate cancer and low expression in tissues with prostate cancer, and the differences were statistically significant (P 0.05). The GSTP1 mRNA content decreased significantly after shRNA554 intervention, with an IOD value of 67.1±8.7. The intervention effect was evidently lower than that of the carrier shRNA255 group (162.2±12.6) and the shRNA593 group (114.5±10.6) with statistically significant difference (P<0.01). Conclusion: The expression vector-mediated GSTP1-shRNA554 transfection can reduce the mRNA level of the GSTP1 gene of the androgen-independent prostate cancer DU145 cells and inhibit the proliferation activity of the in vitro cultivated DU145 cells.

Analysis of risk factors for blood vessel invasion in stage I non-small cell lung cancer

Objective To analyze the risk factors of blood vessel invasion in stage Ⅰ non-small cell lung cancer (NSCLC). Methods A retrospective analysis of 166 patients with stage Ⅰ NSCLC who underwent surgical resection and pathological diagnosis from January 2016 to March 2018 in China-Japan Friendship Hospital was conducted. The presence of blood vessel invasion in tumor tissue was detected by immunohistochemistry. Clinicopathological factors which may affect blood vessel invasion were evaluated by univariate analysis and multiple logistic regression analysis. For statistically significant factors revealed by multivariate analysis, the diagnostic efficiency and best cut-off point were calculated by the receiver operating characteristic curve. Results The univariate analysis identified that the smoking history (P = 0.020), maximum standardized uptake value (SUVmax) (P = 0.001), tumor diameter (P = 0.001), TNM stage (P = 0.002), and lymphatic invasion (P = 0.023) were factors affecting blood vessel invasion status. Multivariate analysis showed that SUVmax was an independent risk factor for blood vessel invasion (OR = 1.097, 95% CI 1.014-1.187, P = 0.021). The preoperative SUVmax of primary tumor was a predictor for blood vessel invasion with the highest diagnostic accuracy at a cut-off value of 4.85, the sensitivity and specificity were 66.0% and 71.7%, respectively. Conclusion The SUVmax is an independent predictor for blood vessel invasion in stage Ⅰ NSCLC, and the risk of blood vessel invasion rises with the increase of SUVmax. Key words: Carcinoma, non-small-cell lung; Neoplasm invasiveness; Blood vessel invasion; Risk factors

The diagnostic value of focal liver lesion (≤2 cm) undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound

Objective To evaluate and explore the diagnostic value of focal liver lesion (FLL) (≤2 cm) undetectable on conventional ultrasound by image fusion with contrast-enhanced ultrasound(CEUS). Methods A total of 50 patients with 65 lesions(≤2 cm) were enrolled. All lesions were undetectable on conventional ultrasound but showed clearly in CT/MRI images. Ultrasound-CT/MRI image fusion with CEUS was performed, and the nodule detection rate and enhancement perfusion mode were analyzed. Results All the 50 patients were matched successfully, 56 lesions (86.2%) were detected by image fusion combined with CEUS, among which 27 lesions (41.5%) were significantly different from surrounding parenchyma on conventional ultrasound, 54 lesions(83.1%) showed different enhancement from the surrounding parenchyma on CEUS. There were 46 lesions that were eventually diagnosed by surgical pathology or clinical comprehensive diagnosis. The diagnostic accuracy of image fusion with CEUS was 91.3% (42/46). According to different groups of MRI matching sequences, the detection rates of T2 sequence group and enhanced sequence group were 87.5% (28/32) and 91.3% (21/23), respectively, there was no statistically significant difference between the two groups (P=0.686). Conclusions CT/MRI image fusion combined with CEUS has high detection rate and diagnosis accuracy for small FLL undetectable on conventional ultrasound. Key words: Contrast-enhanced ultrasound; Image fusion; Focal liver lesion

Death within 30 days of fine needle aspiration: Post‐mortem confirmation of FNA diagnoses and the contribution of FNA to patient mortality

Fine needle aspiration (FNA) diagnoses are usually confirmed via surgical pathology or via evaluation of clinical outcomes. However, such confirmation may not occur for patients who die shortly after FNA, and autopsy may be a useful quality assessment tool in these cases. Also, there is little data investigating the relationship between FNA and mortality. We sought to demonstrate the autopsy as a quality assessment tool for the FNA and assess the contribution of FNA to mortality in patients who die soon after the procedure. A search of our database was performed from 1992 to 2016 for patients who were autopsied after dying within 30 d of an FNA. Concordance between findings from FNA, autopsy, and any intervening surgical pathology material was determined. Finally, a subjective determination of the likelihood that FNAs contributed to deaths was made by reviewing autopsy reports. The contribution was categorised as either "unlikely", "possible", or "probable". Fifty-eight patients (average age = 58 y) met the search criteria. Thirty-six (62%) patients had malignancies. Surgical pathology material was obtained concurrently or following FNA in 20 cases (34%). There was 73% concordance between FNA and autopsy findings, which compares to 80% concordance between FNA and surgical pathology diagnoses. The FNA was determined to be at least possibly contributory to death in 7/58 cases (3 cases designated as "probable," and 4 as "possible"). Autopsy can be used to validate FNA diagnoses and, like surgical pathology, confirms that FNA diagnoses are mostly accurate. However, in a small number of patients, FNA can precipitate death.

Perspectives and perceptions of urgent and alert values in surgical pathology and cytopathology: A survey of clinical practitioners and pathologists.

In previous editorials, Chapman and Otis in 2011 and Layfield in 2014 have summarized much of the work responsible for establishing the concept of critical diagnoses in surgical pathology and cytopathology. Both editorials end with a list of 8 key policy points needed for an effective strategy of handling and communicating critical diagnoses. We have developed and distributed a Web-based survey to elicit clinicians' attitudes regarding many of those key policy points, such as how, when, and to whom critical diagnoses should be reported; we have allowed some level of collaboration with the clinical staff when developing our communication policies as the Association of Directors of Anatomic and Surgical Pathology (ADASP) consensus statement recommends. We have identified important areas of disagreement between pathologists and clinicians regarding what entities should be considered critical and who should be responsible for correlating histologic findings with the larger clinical context. Identifying these discordant points of view and fostering interdepartmental agreement on the best practices in the communication of critical diagnoses is an important patient care and safety issue. Chapman and Otis have also suggested the importance of increased access to accurate patient information and the clinical history, including the level of clinical suspicion of malignancy, and of forming a periodic review and quality assurance process. Here we explore methods of increasing the ability of pathologists and cytopathologists to identify unexpected diagnoses, including optimization of their workstations for better access to the electronic medical record, and we examine the progress of quality assurance methods in surgical pathology and cytopathology since the ADASP consensus statement in 2012.

Congenital Lobar Overinflation: A Rare Enigmatic Lung Lesion on Prenatal Ultrasound and Magnetic Resonance Imaging.

To report the ultrasound (US) features in prenatal cases of suspected congenital pulmonary airway malformation or unspecified lung lesions with a final surgical pathologic diagnosis of congenital lobar overinflation (CLO). Institutional Review Board-approved radiology and clinical database searches from 2001 to 2017 were performed for prenatally diagnosed lung lesions with a final diagnosis of CLO. All patients had detailed US examinations in addition to magnetic resonance imaging (MRI). Size, echotexture, and vascularity were assessed with US, and the signal and vascularity were assessed with MRI. Follow-up prenatal US scans, postnatal imaging, and postnatal outcomes were reviewed. The study population consisted of 12 patients. The median gestational age was 23.3 weeks. The median congenital pulmonary airway malformation volume-to-head circumference ratio was 0.66. Lesion locations were 6 in the lower lobes (4 right and 2 left), 5 in the upper lobes (3 left and 2 right), and 1 in the right middle lobe. The texture was homogeneously echogenic relative to the normal lung in 100% with no visualized macrocysts. Hypervascularity by color Doppler US was observed in 5 cases (41.7%). A T2 hyperintense lung lesion was identified by MRI in 12 of 12 cases (100%), with elongated vessels identified in 11 of 12 cases (91.7%). All 12 cases had pathologically proven CLO. Congenital lobar overinflation should be considered in cases of prenatal echogenic lung lesions without macrocysts or classic findings of bronchial atresia. Hypervascularity may be an important imaging feature of a subset of CLO. Most cases become less conspicuous, decrease in size without overt hydrops, and are asymptomatic postnatally.

Acute gynecological diseases in urgent surgical practice

Objective. To analyze the cases of admittance of the patients, suffering an acute gynecological diseases, into Urgent Surgical Department.&#x0D; Маterials and methods. In 2012 - 2016 yrs in Department of Surgery 1702 women were operated for an acute appendicitis, in 345 (20%) of them various acute gynecological diseases were revealed, demanding performance of urgent surgical interventions.&#x0D; Results. Correct diagnosis of gynecological pathology was established preoperatively in 82 (24%) of 345 patients. In rest of them the presence of an acute gynecological pathology was established intraoperatively. To all these patients the urgent operative intervention was performed.&#x0D; Conclusion. Not rarely differentiated diagnosis of acute surgical and gynecological pathology is difficult. To differentiate an acute appendicitis from gynecological acute pathology, except applying of the special investigations methods, it is important to gather a detailed gynecological anamnesis.

Adult exogenous lipoid pneumonia: A rare and underrecognized entity in cytology - A case series.

Background:Exogenous lipoid pneumonia (ELP) is a rare benign entity without specific clinical or imaging presentation. Although cytological studies – either bronchoalveolar lavage (BAL) or fine-needle aspiration (FNA) – may be pursued in patients with ELP, a definitive diagnosis is frequently rendered only on histology. The aim of this study is to highlight the cytological features of ELP.Methods:A search of cytopathology (CP) and surgical pathology (SP) diagnoses of ELP was conducted. The corresponding clinical and imaging features were obtained, and the morphology, particularly the presence and size of the intracytoplasmic vacuoles and background, was assessed.Results:Nine cases of ELP were identified, including eight with corresponding CP and SP. A neoplasm was suspected in three based on imaging, but ELP was not in the differential clinically or radiographically in any. Among the cases, six patients had BALs and three FNAs. All of the samples showed multiple large vacuoles within macrophages with at least some equal to or larger than the size of the cell nucleus. Similar vacuoles were noted extracellularly on smears.Conclusions:ELP is typically described in case reports in the clinical or radiological literature. To the best of our knowledge, this represents the largest series of adult ELP in CP. When large vacuoles are present in macrophages in cytology specimens, at least a suspicion of ELP can be suggested to initiate appropriate therapy, identify/remove the inciting agent, and preclude a more invasive procedure.

Diagnosis and treatment aspects of surgical pathology in athletes

Diagnosis and treatment aspects of surgical pathology in athletes

Preoperative Magnetic Resonance Volumetry in Predicting Myometrial Invasion, Lymphovascular Space Invasion, and Tumor Grade: Is It Valuable in International Federation of Gynecology and Obstetrics Stage I Endometrial Cancer?

The aim of this retrospective single-center study was to evaluate the relationship between maximum tumor size, tumor volume, tumor volume ratio (TVR) based on preoperative magnetic resonance (MR) volumetry, and negative histological prognostic parameters (deep myometrial invasion [MI], lymphovascular space invasion, tumor histological grade, and subtype) in International Federation of Gynecology and Obstetrics stage I endometrial cancer. Preoperative pelvic MR imaging studies of 68 women with surgical-pathologic diagnosis of International Federation of Gynecology and Obstetrics stage I endometrial cancer were reviewed for assessment of MR volumetry and qualitative assessment of MI. Volume of the tumor and uterus was measured with manual tracing of each section on sagittal T2-weighted images. Tumor volume ratio was calculated according to the following formula: TVR = (total tumor volume/total uterine volume) × 100. Receiver operating characteristics curve was performed to investigate a threshold for TVR associated with MI. The Mann-Whitney U test, Kruskal-Wallis test, and linear regression analysis were applied to evaluate possible differences between tumor size, tumor volume, TVR, and negative prognostic parameters. Receiver operating characteristics curve analysis of TVR for prediction of deep MI was statistically significant (P = 0.013). An optimal TVR threshold of 7.3% predicted deep myometrial invasion with 85.7% sensitivity, 46.8% specificity, 41.9% positive predictive value, and 88.0% negative predictive value. Receiver operating characteristics curve analyses of TVR, tumor size, and tumor volume for prediction of tumor histological grade or lymphovascular space invasion were not significant. The concordance between radiologic and pathologic assessment for MI was almost excellent (κ value, 0.799; P < 0.001). Addition of TVR to standard radiologic assessment of deep MI increased the sensitivity from 90.5% to 95.2%. Tumor volume ratio, based on preoperative MR volumetry, seems to predict deep MI independently in stage I endometrial cancer with insufficient sensitivity and specificity. Its value in clinical practice for risk stratification models in endometrial cancer has to be studied in larger cohort of patients.