Discordant Pathology Research Articles

Bilateral Synchronous Testicular Cancer with Discordant Histopathology: A Case Report

AbstractBilateral testicular tumors account for 1 to 5% of all testicular tumors. Most bilateral tumors are observed metachronously. Synchronous tumors usually present with the similar histological pattern. Bilateral synchronous testicular tumors with discordant pathology are extremely rare. Only 56 cases have been documented since Bidard first described synchronous testicular tumors with discordant pathology in 1853. To our best knowledge, this study will be the 57th case in the literature.

Discordant Bilateral Testicular Pathology Does not Affect Sperm Retrieval Rate in Bilateral Microdissection Testicular Sperm Extraction (mTESE)

To assess the incidence of discordant testicular pathology in men undergoing bilateral microdissection testicular sperm extraction (mTESE) and association with sperm retrieval rate. We performed a retrospective single-institutional review of all patients undergoing mTESE from 2007 to 2021 and aggregated clinical history, physical exam, semen analysis, and operative findings. Specimens with discordant pathology were re-reviewed by an experienced genitourinary.ßpathologist and categorized in a standardized fashion. Data were analyzed using SPSS. One hundred fourteen non-obstructive azoospermia.ßmen undergoing 132 mTESEs were identified within the study period. Eighty-five percent (112/132) of cases had pathology specimens available, and within this specific cohort the success rate was 41.9% (47/112). A total of 206 pathological reports resulted including 52.4% Sertoli cell only, 4.9% Leydig cell hyperplasia, 8.7% fibrosis, 16.5% maturation arrest, and 17.5% hypospermatogenesis. Twelve percent of testicles had more than 1 pathologic diagnosis. Sixty-six men had synchronous bilateral testicular pathology, and 11/66 (16.6%) had at least partially discordant pathology on initial review. Focused re-review by a genitourinary pathologist confirmed exclusively discordant pathology in 7/66 (10.6%) cases, with a sperm retrieval rate of 57% (4/7). The sperm retrieval rate.ßin men with discordant pathology was not significantly different from those with concordant pathology. Over 1 in 10 men undergoing mTESE may have discordant pathology between testicles, though this may not affect sperm retrieval rate.ßat the time of procedure. Clinicians should consider submitting bilateral testicular specimens for pathology to (1) clarify their outcomes data, and (2) assist with clinical decision-making and surgical planning if a repeat mTESE is indicated.

MP34-15 DISCORDANT TESTICULAR PATHOLOGY IS COMMON IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA UNDERGOING BILATERAL MTESE

You have accessJournal of UrologyCME1 May 2022MP34-15 DISCORDANT TESTICULAR PATHOLOGY IS COMMON IN MEN WITH NON-OBSTRUCTIVE AZOOSPERMIA UNDERGOING BILATERAL MTESE Scott Lundy, and Sarah Vij Scott LundyScott Lundy More articles by this author , and Sarah VijSarah Vij More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002588.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Microdissection testicular sperm extraction (mTESE) represents the current gold standard for sperm retrieval in non-obstructive azoospermic (NOA) men. Despite being described over 20 years ago, however, overall success rates remain modest at roughly 50-60%, and the only consistent predictor of success is testicular pathology. It is currently unknown what portion of men have discordant testicular pathology when undergoing a bilateral procedure. The objective of this study is to assess the incidence of discordant testicular pathology in men undergoing bilateral mTESE. METHODS: We performed a retrospective single-institutional review of all patients undergoing mTESE from 2007-2021 and aggregated clinical history, physical exam, semen analysis, and sperm retrieval rates. Where available, permanent pathology specimens were reviewed by an experienced GU pathologist and categorized in a standardized fashion. Data was aggregated in Microsoft Excel and analyzed using SPSS. RESULTS: We identified a total of 159 unique men undergoing a total of 181 mTESEs from 204 testicles (97 left, 204 right) within the study period. Overall sperm retrieval rate (SRR) was 57%. 73% of all cases had unilateral or bilateral pathology specimens available, and within this specific cohort the success rate was 44%. A total of 235 pathological diagnoses were made including 49% sertoli cell only, 3% leydig cell hyperplasia, 9% fibrosis, 16% maturation arrest, 11% hypospermatogenesis, and 13% active spermatogenesis. 73 men had synchronous bilateral testicular pathology available, and 12/73 (16%) had at least partially discordant pathology. Of these 12 men, 7 had partially overlapping pathological diagnoses, and 5 had truly exclusive discordant pathologies. The SRR in men with discordant pathology was not statistically significant from the overall cohort. CONCLUSIONS: Roughly 1 in 6 men undergoing mTESE may have discordant testicular pathology between testicles. Clinicians should consider this possibility when counseling men on SRR who have prior pathology data available. Submitting bilateral pathology specimens may assist with clinical decision making if considering a repeat procedure after a failed or inadequate primary procedure. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e584 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Scott Lundy More articles by this author Sarah Vij More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP17-16 LONG-TERM OUTCOMES FOR PATIENTS WITH ANAPLASTIC BILATERAL WILMS TUMORS ENROLLED ON COG AREN0534

You have accessJournal of UrologyCME1 May 2022MP17-16 LONG-TERM OUTCOMES FOR PATIENTS WITH ANAPLASTIC BILATERAL WILMS TUMORS ENROLLED ON COG AREN0534 Rodrigo L.P. Romao, Jennifer H. Aldrink, Brett Tornwall, Kathleen Kieran, Andrew Murphy, Andrew Davidoff, Daniel Benedetti, Jeffrey Dome, Elizabeth Perlman, Ethan Smith, Conrad Fernandez, James Geller, Jack Brzezinski, Lindsay Renfro, Marcus Malek, David Mansur, Elizabeth Mullen, Nicholas Cost, Robert C. Shamberger, and Peter F. Ehrlich Rodrigo L.P. RomaoRodrigo L.P. Romao More articles by this author , Jennifer H. AldrinkJennifer H. Aldrink More articles by this author , Brett TornwallBrett Tornwall More articles by this author , Kathleen KieranKathleen Kieran More articles by this author , Andrew MurphyAndrew Murphy More articles by this author , Andrew DavidoffAndrew Davidoff More articles by this author , Daniel BenedettiDaniel Benedetti More articles by this author , Jeffrey DomeJeffrey Dome More articles by this author , Elizabeth PerlmanElizabeth Perlman More articles by this author , Ethan SmithEthan Smith More articles by this author , Conrad FernandezConrad Fernandez More articles by this author , James GellerJames Geller More articles by this author , Jack BrzezinskiJack Brzezinski More articles by this author , Lindsay RenfroLindsay Renfro More articles by this author , Marcus MalekMarcus Malek More articles by this author , David MansurDavid Mansur More articles by this author , Elizabeth MullenElizabeth Mullen More articles by this author , Nicholas CostNicholas Cost More articles by this author , Robert C. ShambergerRobert C. Shamberger More articles by this author , and Peter F. EhrlichPeter F. Ehrlich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002550.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Anaplastic histology in the setting of bilateral Wilms tumor (BWT) is associated with poor prognosis - NWTS-5 4-year EFS and OS were 43.8% and 55.2%, respectively. AREN0534 sought to improve outcomes for BWT. We analyzed the events and long-term outcomes for the rare subgroup of patients with BWT and anaplasia. METHODS: AREN0534 was open to enrollment from 2009 to 2015. Patients with focal(FA) or diffuse(DA) anaplasia were included in this sub-analysis. Location of relapse, progression and 7-year EFS and OS with 95% CI are reported. RESULTS: There were 25 patients with anaplastic BWT (17 DA and 8 with FA). 1/8 patients with FA had bilateral FA and 4/17 patients with DA had bilateral DA. There were 18 females and 7 males; median age of enrollment was 43.1 months (24.1- 113.7). For FA, 7-year EFS was 62.5%(95% CI, 24.99-100) and OS was 87.5%(95% CI, 62.8-100). One patient with FA died from local relapse due to FHWT in the contralateral kidney at 5 years off therapy. A second patient with stage II FA had progressive disease while on therapy. This patient did not have nodes sampled. Pathology at progression was DA. For DA, 7-year EFS was 58.8% (95% CI, 25.7-91.9) and OS was 70.1% (95% CI, 36.5-100). 7 patients had events, 3 with local tumor progression (all died) and 4 with relapse (2 died). All 4 relapses had initial positive surgical margins and occurred within a year of ending therapy. The sites of relapse were local (2), and lung only (2). Of the 10 patients who were without an event, 5 had positive margins. CONCLUSIONS: Patients with BWT and anaplasia often have discordant pathology. Late events are rare. Margin status at the time of definitive surgery does not seem to impact outcomes in the context of contemporary multimodal therapy including radiation to positive margins. Source of Funding: This project was supported by grants CA98543 (Children’s Oncology Group Chair’s grant) and CA98413 (COG SDC grant) from the National Institutes of Health. U10CA180899 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e292 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rodrigo L.P. Romao More articles by this author Jennifer H. Aldrink More articles by this author Brett Tornwall More articles by this author Kathleen Kieran More articles by this author Andrew Murphy More articles by this author Andrew Davidoff More articles by this author Daniel Benedetti More articles by this author Jeffrey Dome More articles by this author Elizabeth Perlman More articles by this author Ethan Smith More articles by this author Conrad Fernandez More articles by this author James Geller More articles by this author Jack Brzezinski More articles by this author Lindsay Renfro More articles by this author Marcus Malek More articles by this author David Mansur More articles by this author Elizabeth Mullen More articles by this author Nicholas Cost More articles by this author Robert C. Shamberger More articles by this author Peter F. Ehrlich More articles by this author Expand All Advertisement PDF DownloadLoading ...

Overall survival is more closely associated with peritoneal than primary appendiceal pathological grade in pseudomyxoma peritonei with discordant pathology

Background: The WHO classification of mucinous appendix neoplasms and pseudomyxoma peritonei (PMP) describes low- and high-grade histology and is of prognostic importance. The grade of the metastatic peritoneal disease can occasionally be different from the primary appendix tumour. This analysis aimed to report outcomes from a high-volume centre in patients with pathological discordance.

ASO Visual Abstract: Overall Survival is More Closely Associated with Peritoneal than Primary Appendiceal Pathological Grade in Pseudomyxoma Peritonei with Discordant Pathology

ASO Visual Abstract: Overall Survival is More Closely Associated with Peritoneal than Primary Appendiceal Pathological Grade in Pseudomyxoma Peritonei with Discordant Pathology

ASO Author Reflections: Discordant Pathology in Pseudomyxoma Peritonei and Its Impact on Survival following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

ASO Author Reflections: Discordant Pathology in Pseudomyxoma Peritonei and Its Impact on Survival following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

Overall Survival is More Closely Associated with Peritoneal than Primary Appendiceal Pathological Grade in Pseudomyxoma Peritonei with Discordant Pathology.

The WHO classification of mucinous appendix neoplasms and pseudomyxoma peritonei (PMP) describes low- and high-grade histology and is of prognostic importance. The metastatic peritoneal disease grade can occasionally be different from the primary appendix tumor. This analysis aimed to report outcomes from a high-volume center in patients with pathological discordance. This was a retrospective analysis of prospective data of patients treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for PMP at a single institution between January 2016 and December 2020. Reporting was by pathologists with a special interest in peritoneal malignancy. Discordant pathology was classified as a low-grade primary appendix tumor with high-grade peritoneal disease, or a high-grade primary appendix tumor with low-grade peritoneal disease. Outcomes analyzed were overall and recurrence-free survival, and Kaplan-Meier survival curves and the log-rank test were used to analyze the outcomes. Between 2016 and 2020, 830 patients underwent CRS and HIPEC for PMP, of whom 37 (4.4%) had discordant pathology. The primary appendix tumors were low-grade in 23 patients and high-grade in 14 patients. The median Peritoneal Cancer Index (PCI) was significantly higher in patients with a low-grade primary tumor (31 vs. 16; p=0.001), while complete cytoreduction (CC0/1) was achieved in 31/37 (83.8%) patients. The median follow-up was 19 months. Overall survival was worse in those with high-grade peritoneal disease (p=0.029), whereas recurrence-free survival was similar in both groups (p=0.075). In PMP with pathological discordance, the peritoneal disease grade influences prognosis and survival.

Evaluating triage protocols for endoscopic ultrasound-guided fine needle biopsies of the pancreas

Pancreatic endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) acquires both direct smear and small core biopsy specimens. The triage protocols for pancreatic FNBs to cytopathology (CP) or gastrointestinal surgical pathology (GIP) are controversial and vary by institution. Pancreatic EUS-FNBs obtained with the SharkCore FNB were reviewed from January 2014 to June 2019. The specimen characteristics and pathology data, including tissue triage, were obtained from the electronic medical records. We assessed the diagnostic yield, defined as malignant, specific neoplastic, or benign, and the operating characteristics at the time of rapid on-site evaluation (ROSE) and final diagnosis. We reviewed 324 pancreatic FNBs from 313 patients. Of the 324 FNBs, 260 (80%) obtained concurrent direct smear and core biopsy specimens, 30 (12%) of which were divided between CP and GIP. Of the 51 core-only specimens, 47 (92%) were reviewed by CP and 4 (8%) by GIP. ROSE improved the overall diagnostic yield by 10% and accuracy by 9%. When core specimens were reviewed independently, the diagnostic accuracy was 93% for CP (n = 248) and 100% for GIP (n = 33). All false-negative results of the CP-reviewed cores were due to sampling error. Concurrent smear review improved EUS-FNB performance, increasing the negative predictive value by 10% and accuracy by 3% compared with core review alone. CP and GIP can accurately interpret pancreatic EUS-FNB specimens. However, triage of concurrent EUS-FNB-acquired smear and core specimens to CP may be most efficient as CPs are trained to assess adequacy at the time of ROSE, as well as interpretall parts of the biopsy, minimizing the risk of discordant pathology reports.

3:18 PM Abstract No. 201 Percutaneous biopsy of hepatocellular carcinoma in the setting of endovascular locoregional therapy

Percutaneous biopsy for the characterization of intermediate and advanced stage hepatocellular carcinoma (HCC) is projected to increase in the era of precision medicine. Given its controversial role in management, the purpose of this study was to profile the safety and efficacy of acquiring high-volume HCC core biopsies. Between April 2016 and September 2019, 30 patients with embolotherapy-naïve advanced HCC, were enrolled in this IRB-approved prospective trial. Multiple co-axial 18G core-biopsies of a targetable HCC were obtained during transarterial chemoembolization (TACE) or radioembolization (TARE). Cores were sent to pathology, the Center for Personalized Diagnostics (CPD) for solid-tumor next generation sequencing, or prepared for custom sequencing using an HCC panel developed in our lab. From 30 patients, 33 LR4 (1) or LR5 (32) HCCs were biopsied. A median of 7 core biopsies were obtained during the initial treatment. Nine tumors were biopsied a second time (post-TACE), and 2 were biopsied a third time (recurrence). Of 44 biopsy encounters, 1 (2.3%) minor (SIR class A or B) and 0 major biopsy-attributable adverse events were reported during the postprocedural period. Three (9.1%) biopsies revealed discordant pathology of cholangiocarcinoma resulting in a change in management. Four (12%) biopsies revealed poorly differentiated carcinoma, ultimately favored to represent HCC over cholangiocarcinoma. Five (15%) biopsies were negative for tumor, only 1 of which was later confirmed as sampling error. Of 12 cores sent to CPD, 9 (75%) were adequate for analysis. In custom sequenced samples, TERT, CTNNB1, and ALB were the most frequent variant alleles in a markedly heterogeneous pool. No changes in genetic mutations were identified in post-TACE samples when compared to pre-TACE biopsies. Obtaining a high-volume of co-axial percutaneous core biopsies during HCC treatment by TACE or TARE is safe, providing desperately needed tissue for the molecular characterization of intermediate and advanced stage HCC. Biopsy results may change management in imaging discordant tumors.

Simultaneous Vs Sequential Retroperitoneal, Thoracic and Cervical Resection of Post Chemotherapy Residual Masses in Patients With Metastatic Nonseminomatous Germ Cell Tumors of the Testis

ObjectiveTo compare a simultaneous vs sequential approach to residual post chemotherapy mass resections in metastatic testis cancer. MethodsA retrospective review was performed of patients who underwent retroperitoneal and thoracic/cervical resection of post chemotherapy residual masses between 2002 and 2018. Group 1: “Simultaneous” (Combined Retroperitoneal and Thoracic/Cervical resections on the same date); Group 2: “Sequential” (Retroperitoneal and Thoracic/Cervical resections at separate dates). ResultsDuring the study period, 35 simultaneous and 17 sequential resections were performed. The median age at surgery was 28 years (Range 16-61). The median follow-up from last surgical procedure was 62.7 months (Range 0.4-194). Histology revealed teratoma in 38 (73.1%) patients, necrosis in 8 (15.4%) and viable tumor in 6 (11.5%). Discordant pathology findings between thoracic/cervical and abdominal resections were noted in 16 (30.8%) patients.No differences were observed between the simultaneous vs sequential groups in median operating time (585 minutes vs 545 minutes, P = .64), blood loss (1300 vs 1300 mls, P = .42), or length of stay (9 vs 11 days, P = .14). There was no difference between the 5-year (65.7% vs 68.6%) relapse-free survival between the 2 groups (P = .84) or the 5-year (88.6% vs 100%) overall and disease-specific survival (P = .25). ConclusionSimultaneous resection of retroperitoneal and thoracic/cervical post chemotherapy metastases is a feasible in some patients. It requires multidisciplinary collaboration and a longer primary procedure.

Mucocele-like lesions diagnosed on breast core biopsy: Low risk of upgrade and subsequent carcinoma.

Mucocele-like lesions of the breast diagnosed on core biopsy are usually excised to exclude the possibility of partial sampling of an invasive mucinous carcinoma. The goal of this study was to correlate the pathologic and radiologic features of mucocele-like lesions to determine if excision is mandatory. Over a 16 year period we identified 32 patients with mucocele-like lesions diagnosed on 27 (84%) stereotactic and 5 (16%) ultrasound-guided core biopsies. The indications for core biopsy were: calcifications in 24 (75%), a mass in 7 (22%), and a mass with calcifications in 1 (3%). There were 22 (69%) mucocele-like lesions without atypia and 10 (31%) with atypical ductal hyperplasia or detached groups of atypical cells. Of the 22 mucocele-like lesions without atypia, 19 (86%) were excised: 15/19 (79%) were benign, 3/19 (16%) had atypical ductal hyperplasia and 1/19 (5%) had ductal carcinoma in situ. None of the patients with mucocele-like lesions without atypia were upgraded to invasive carcinoma. The single patient who was upgraded to low-grade ductal carcinoma in situ had a history of ductal carcinoma in situ in the same breast. Of the 10 patients with mucocele-like lesions with atypia, 9 (90%) were excised: 5/9 (56%) were benign, 1/9 (11%) had atypical ductal hyperplasia and 3/9 (33%) had invasive carcinoma. Of the patients with mucocele-like lesions with atypia who were upgraded to invasive carcinoma, one had a BIRADS 5 mass and discordant pathology and one had a history of Hodgkin lymphoma and mantle radiation. There were 24 patients with mucocele-like lesions with or without atypia who were not upgraded on excision, and none developed breast cancer after a median of 51 months (range 7-192). These findings indicate that mucocele-like lesions without atypia are unlikely to be upgraded on excision and are associated with a low risk for the subsequent development of carcinoma.

Safety and Outcomes of Percutaneous Biopsy of 61 Hepatic Adenomas.

Given the recent classification of hepatic adenoma (HA) into subtypes and recognition of imperfect specificity of MRI to differentiate HA from focal nodular hyperplasia (FNH), there is a resurgent interest in the role of biopsy to diagnose HA. The purpose of this study was to determine the safety and outcomes of biopsy of HAs. A retrospective review of the electronic medical records of all patients who underwent hepatic mass biopsy revealing HA from 2000 through 2013 was performed. The biopsy procedure parameters were evaluated. Complications were graded using the Common Terminology Criteria for Adverse Events. Pathology-specific outcomes related to the diagnosis of HA were assessed. Sixty patients (52 women and eight men) were identified with a mean age of 42 ± 13 (SD) years and a mean follow-up of 2.3 ± 3.0 years after biopsy. One patient had two HAs biopsied during the same procedure, resulting in a total of 61 biopsy-proven HAs. Of the 60 patients, one patient (2%) had a single major complication, which involved bleeding that resulted in a blood transfusion, and six patients (10%) had a minor complication. A total of six (10%) discordant biopsy results were found: Four biopsy-proven HAs (7%) revealed FNH on surgical resection or repeat biopsy, one HA (2%) showed well-differentiated hepatocellular carcinoma (HCC) at subsequent biopsy, and one HA (2%) showed findings suggestive of HCC on follow-up imaging. Complications after biopsy of HAs are uncommon. Although uncommon, discordant pathology results between biopsy and surgical resection may occur.

Immunoglobulin rearrangement analysis from multiple lesions in the same patient using next-generation sequencing.

For patients who have multiple lymphomas with discordant pathology, it is relevant to determine whether there is one disseminated lymphoma or two unrelated lymphomas. Patients with disseminated, clonally related lymphomas are usually treated with the most powerful drugs available, while patients with unrelated (primary) lymphomas receive mainly standard first-line therapies. We used next-generation sequencing on the Ion Torrent Personal Genome Machine to characterize the immunoglobulin heavy gene V-D-J rearrangements in two diagnostic tissue samples, including formalin-fixed and paraffin-embedded tissue, of two patients with iatrogenic immunodeficiency-associated Epstein-Barr virus lymphoproliferative disorder, with ulcerative colitis as underlying disease. The immunoglobulin rearrangement sequences obtained by next-generation sequencing revealed undoubtedly clonally related lesions in two tissue biopsies that were taken over time in the first patient, which is concordant with disseminated lymphoma. The other patient showed two clonally unrelated lesions, which is incompatible with clonal dissemination. This information was not inferred from evaluation of the heavy and light chain rearrangements by fragment analysis, which is currently the gold standard. Our study demonstrates the diagnostic application of next-generation sequencing of immunoglobulin rearrangement assessment in pathology for clinical decision-making in patients with several simultaneous or subsequent lymphoproliferations.

The growing fibroadenoma.

BackgroundFibroadenomas (FAs) are the most common tumors of the breast clinically and pathologically in adolescent and young women but may be discovered at any age. With increasing use of core biopsy rather than excision for diagnosis, it is now commonplace to follow these lesions with imaging.PurposeTo assess the incidence of epithelial abnormalities (atypia, in situ or invasive, ductal or lobular malignancies) in FAs diagnosed by core biopsy and to re-evaluate the management paradigm for any growing FA.Material and MethodsA retrospective review of the senior author’s pathology results over 19 years identified 2062 nodular FAs (biopsied by ultrasound or stereotactic guidance). Eighty-three core biopsied FAs were identified which subsequently enlarged.ResultsTwelve of 2062 of core biopsied nodules demonstrated atypia, in situ, or invasive malignancy (ductal or lobular) within or adjacent to the FA (0.58%). Eighty-three FAs enlarged and underwent either surgical excision (n = 65), repeat core biopsy (n = 9), or imaging follow-up (n = 9). The incidence of atypia, in situ or invasive malignancy was 0/83 (0%). Two enlarging FAs were subsequently surgically diagnosed as benign phyllodes tumors (PT).ConclusionMalignancy in or adjacent to a core biopsied FA is rare. The risk of cancer in a growing FA is even rarer; none were present in our series. FAs with abnormal epithelial abnormalities require excision. Otherwise, FAs without epithelial abnormality diagnosed by core biopsy need no specific follow-up considering the negligible incidence of conversion to malignancy. The breast interventionalist must know how to manage discordant pathology results.

Discordant Presentation of Biliary Atresia in Premature Monozygotic Twins

Discordant Presentation of Biliary Atresia in Premature Monozygotic Twins

HEREDITARY INTRAVENTRICULAR CONDUCTION DISORDERS IN THE FAMILY FROM KRASNOYARSK

Pedigree of the family from Krasnoyarsk city with hereditary disorders of intracardiac conduction was studied. The diagnosis of each family member was verified by electrocardiography (ECG), echocardiography , bicycle ergometry , ECG Holter monitoring. The family 10-year follow-up showed familial aggregation of intracardiac conduction disorders in grandson, niece, son of the proband niece, ie, in the III-degree relatives. Family history of III-degree relatives with intracardiac conduction disorders and discordant pathology is identified.

HEREDITARY INTRAVENTRICULAR CONDUCTION DISORDERS IN THE FAMILY FROM KRASNOYARSK

Pedigree of the family from Krasnoyarsk city with hereditary disorders of intracardiac conduction was studied. The diagnosis of each family member was verified by electrocardiography (ECG), echocardiography , bicycle ergometry , ECG Holter monitoring. The family 10-year follow-up showed familial aggregation of intracardiac conduction disorders in grandson, niece, son of the proband niece, ie, in the III-degree relatives. Family history of III-degree relatives with intracardiac conduction disorders and discordant pathology is identified.

Accuracy and Upgrade Rates of Percutaneous Breast Biopsy: The Surgeon's Role

We sought to evaluate the impact of needle core size and number of core samples on diagnostic accuracy and upgrade rates for image-guided core needle biopsies of the breast. A total of 234 patients underwent image-guided percutaneous needle biopsies and subsequent surgical excision. Large-core needles (9 gauge or less) were used in 14.5 per cent of cases and the remainder were performed with smaller core needles. More than four core samples were taken in 78.9 per cent of patients. In 71.8 per cent of cases, needle biopsy pathology matched surgical excision pathology. After surgical excision, upgraded pathology was revealed in 10.7 per cent of cases. Of 11 patients (52.4%) with benign needle core pathology who had upgraded final pathology on surgical excision, 10 had a Breast Imaging Recording and Data System score 4 or 5 imaging study. Lesions smaller than 10 mm were more likely to be misdiagnosed (P = 0.01) or have upgraded pathology (P = 0.009). Other predictors of upgraded pathology were patient age 50 years or older (P = 0.03) and taking four or fewer core samples (P = 0.003). Needle core size did not impact accuracy or upgrade rates. Surgeons should exercise caution when interpreting needle biopsy results with older patients, smaller lesions, and limited sampling. Discordant pathology and imaging still mandate surgical confirmation.

Pathology the Gold Standard – A Retrospective Analysis of Discordant “Second-Opinion” Lymphoma Pathology and Its Impact on Patient Care.

A change in diagnosis on review of pathology, “second-opinion pathology”, is not uncommon for hematological malignancies with a range of between 11–20%. Hence, there is a significant potential for incurring a diagnostic error with implications during the clinical management of patients.We conducted a retrospective review to evaluate both potential and actual medical error noted in the management of lymphoma patients treated at Princess Margaret Hospital (PMH), by evaluating results of pathological review and identifying patients with a change in diagnosis between the initial referring centre and PMH (i.e. discordant pathology). All consecutive cases seen in medical or radiation oncology clinics between January 01, 2000 to June 30, 2003 with follow-up data collected to Dec 31, 2003 were evaluated. Only patients who had lymphoma first diagnosed after January 01, 2000 who had a referring centre pathology report and had clinical care at PMH were included.RESULTS: There were 2818 consecutive lymphoma patients identified of whom only 1065 (38%) met inclusion/exclusion criteria. There were 176 cases with discordant pathology identified in 171 individual patients (discordance rate of 16%); specimens evaluated were from nodal tissue – 129, extra-nodal – 36 and bone marrow – 11. The most common reasons for discordance were: malignant ↔ non-malignant – 27 cases, Non-Hodgkins ↔ Hodgkins – 14 cases, lymphoma ↔ solid tumour – 18 cases and more aggressive lymphoma ↔ less aggressive lymphoma – 47 cases. We found that disagreement in morphology was most often responsible for change (40%) followed by morphology and immunohistochemistry (27%). Cutaneous biopsies were found to have a higher rate of discordance than other biopsy sites.The 176 cases were graded by 6 blinded reviewers (pathologists and clinicians as well as physicians not affiliated with PMH) on a scoring system from minimal to severe with respect to potential for harm. Grading: not significant = 20 cases, minimal = 38 cases, moderate = 73 cases and severe = 43 cases. Overall, 66% of cases were deemed to have a moderate to severe potential for harm based on their discordant pathology.For these discordant cases, actual clinical management was based on PMH pathology interpretation in 52% versus 2% who were treated based referring centre diagnosis. 63 of 176 cases (37%) required additional biopsies or a more definitive biopsy to resolve the discordance. This resulted in 21 patients having significant surgical procedures such as partial gastrectomies, lumpectomies and mediastinal surgery. Overall, based on treatment policies and the treating physician's opinion, there were 16 patients who were over-treated, 4 patients under-treated, 9 patients who had a significant change in planned treatment and 2 patients incorrectly treated.CONCLUSIONS: a discordance rate of 16% was similar to previous studies and this high rate maybe improved through centralization of lymphoma pathology;these types of patients are clearly at risk for harm, as best exemplified by patients who were felt to have a benign pathology that was actually malignant;Discordant pathology has clear clinical implications including serial biopsies, invasive testing and treatment delays.