Pathologic Evaluation Of Specimen Research Articles

Triaging and Evaluation of Products of Conception in Abortions and Post-Partum Hemorrhage.

The proper evaluation of abortion specimens and placentas from stillbirth and post-partum cases is important for adequate clinical care of post-abortion and post-partum patients. The following topics will be reviewed: (1) the importance of evaluation of both fetal and placental tissue in first trimester abortions to confirm an intrauterine pregnancy versus an ectopic pregnancy; (2) the clinical history associated with an abortion specimen or retained products of conception (POC) influences how the pathologist should triage the specimen; (3) the criteria for diagnosis of a molar pregnancy, which is critical for clinicians to know which patients need follow-up; (4) the utility of genetic studies for both diagnosis and appropriate follow-up of the patient; and (5) the pathologic evaluation of specimens from patients with post-partum hemorrhage for placenta accreta spectrum and subinvolution of maternal vessels.

Primary hepatic neuroendocrine tumor with sarcoid like granulomas: A case report

Primary hepatic neuroendocrine tumor (PHNET) is a rare entity comprising 0.3% of all neuroendocrine tumors. Tumors coexisting with granulomas are occasionally noted with malignancies in the lymph nodes draining the tumor or within the primary tumor itself. Tumor-related sarcoid reactions are noted only in carcinomas and its association with a NET has been extremely rare.: We report a case of PHNET in a 63-year male who presented with various comorbidities who was incidentally detected with a liver space-occupying lesion (SOL). Contrast enhanced CT scan of the abdomen revealed a well-defined exophytic mass in the liver involving segment 6. Subsequently, 68Ga DOTANOC PET/CT scanning revealed somatostatin receptor-expressing well-defined lesion measuring 5.1 x 5.0 cm in segment 6 (SUV MAX 19). A diagnosis of either a primary or a metastatic neuroendocrine tumor was made and non-anatomical wedge resection of the tumor was done with a detailed exploration of the abdominal cavity to look for a primary focus that did not reveal any other lesion or mass. Histologically, the tumor was confirmed to be a Neuroendocrine Tumor along with the presence of tumor-related sarcoid like granulomas in the adjoining hepatic parenchyma.: Diagnosis of a PHNET requires a combination of a negative abdominal survey at the time of the operative procedure, pathologic evaluation of specimen, and a negative imaging workup for extrahepatic NET in both the pre and postoperative settings.

Whole-Mount Pathologic Evaluation of Specimens Following Preoperative Radiation Therapy (RT) for Rectal Cancer Identifies More Lymph Nodes and Greater Tumor (T) Stage

Whole-Mount Pathologic Evaluation of Specimens Following Preoperative Radiation Therapy (RT) for Rectal Cancer Identifies More Lymph Nodes and Greater Tumor (T) Stage

New radiation therapy technique for breast cancer: should the IOERT boost be a standard technique?

The standard treatment for early breast cancer comprises wide local excision, sentinel lymph node biopsy or axillary lymph node dissection and whole-breast radiotherapy (WBRT), including boost radiation if indicated, and adjuvant medical treatment. Multiple randomized clinical trials and meta-analyses demonstrated the effectiveness and safety of WBRT, and revealed that local control plays a crucial role in overall survival [1,2]. The European Organisation for Research and Treatment of Cancer (EORTC) boost versus no boost trial demonstrated that the additional dose escalation to the tumor bed, the tumor bed boost, further improved local control rates [3]. The Early Breast Cancer Trialists’ Collaborative Group (EBCTCG [Oxford, UK]) overview suggested that differences in local treatment that substantially affect local recurrence rates would avoid approximately one breast cancer death over the next 15 years for every four local recurrences avoided and should reduce 15-year overall mortality [2]. The local recurrence rate is estimated for 1% per year, and varies according the literature between 4 and 7% after 5 years and up to 10–20% in the long-term follow-up [1,4–6]. The majority of patients who develop local recurrences do so within 2–5 years [1,7]. Patients with local recurrences have an increased risk of distant metastases, and local recurrence seems to be an independent predictor of distant metastasis [7–15]. Patients who develop recurrences in the short term have a worse prognosis than patients who develop recurrences in the long term [1,7]. Based on these data the reduction of local recurrence rates should be one of our treatment goals. Many factors contribute to the reduction of local recurrence rates, such as improved diagnostic tools, modern surgical techniques, the extensive pathologic evaluation of specimen and margins, the increasing use of adjuvant systemic therapies and the extensive use of radiation therapy. Standard radiation therapy comprises 50–55 Gy in daily fractionations for 5–6 weeks. The additional application of an external boost radiation of 10–16 Gy to the tumor bed can reduce the local failure rate by 40% [3,16–19]. With this therapy an excellent local tumor control can be achieved.

Insights Into Selected Genetic Diseases Affecting the Female Reproductive Tract and Their Implication for Pathologic Evaluation of Gynecologic Specimens

Recent advances in the understanding of genetic conditions involving the female genital tract and mechanisms of carcinogenesis in this setting affect patient management and thus necessitate appropriate pathologic evaluation of specimens. In the past, specimens from prophylactic surgery were a rarity; however, they are now more frequently encountered and often require a significant variation from routine processing methods. Pathologists also receive more specimens requiring prospective workup for possible underlying genetic conditions such as microsatellite instability. To summarize the current knowledge of important genetic and hereditary conditions affecting the female reproductive organs while highlighting the resulting practical significance for specimen handling, "grossing," and microscopic evaluation in gynecologic pathology. This update is based on a review of recent peer-reviewed literature and the experience with cases at the parent institutions. Gynecologic specimens received from patients with certain genetic conditions require specific clinicopathologic knowledge for appropriate pathologic examination. The evaluation of prophylactic resection specimens focuses on the detection of cancer precursors and possible occult disease, which may require a more thorough and detailed examination than an obvious carcinoma. Standardized protocols for handling prophylactic gynecologic resection specimens are available for some, but not all, types of specimens. The prospective evaluation of a gynecologic pathology specimen for potential genetic conditions such as microsatellite instability is a very recent subject. Currently, well-established protocols are not available; however, as clinical and prognostic significance has become more clearly elucidated, familiarity with this evolving field is increasingly important to properly assess these pathologic specimens.

Local secretion of a soluble TGF-β receptor reverses glioma-mediated inhibition of NK cells in the rat 9L glioma model

cele (MMC) support a ‘two-hit‘ hypothesis for postnatal neurologic deficits, with a primary developmental abnormality followed by a secondary insult. The exact mechanism by which this secondary injury occurs remains poorly elucidated. Possible etiologies include chemical injury secondary to amniotic fluid exposure, direct intrauterine trauma to the spinal cord, and mechanical cord stretching by hydrodymanic pressure in the subarachnoid space. With careful histologic evaluation of pathologic specimens, the impact of the in utero environment on neural development and the response to secondary injury may be better assessed.

Changes in the histocytological grading of epithelial ovarian carcinoma following treatment.

Although the microscopic grade of epithelial ovarian carcinoma is recognized as an important prognostic factor, the grading systems are still controversial. A cytohistological grading system is described using the sum of the scores (from 1 to 4) of eight histological and cytological features. This grading is applied to the initial surgical specimens of 37 patients seen at UCLA Center for the Health Sciences; it is also used for evaluation of pathologic specimens obtained at subsequent laparotomies. The evolution of the score at subsequent laparotomies (stable, increasing, or decreasing) is correlated with the type of therapy, response to treatment, and prognosis. An increasing score at the second-look laparotomy is a poor prognostic factor with a significantly shorter patient survival (p less than 0.05). The tumor score at second-look laparotomy is significantly increased in cases of macroscopically positive operation (p less than 0.05) and tumor progression (p less than 0.001). The type of therapy has no significant effect on the tumor score. A multivariate analysis shows that a decreasing score is related to a lower mitotic activity. Conversely, an increasing score is related to a change in tumor pattern. This study demonstrates the prognostic value of our grading system, which needs to be further validated by prospective studies.

Metastatic malignant disease to the parotid gland.

A survey of over 250 consecutive parotidectomies performed at The Mason Clinic indicates a surprising incidence of metastatic malignant disease to the parotid gland. Four percent of all parotidectomies performed indicated a metastatic focus of malignancy from an ;unsuspected primary outside areas of the head and neck usually implicated in parotid disease. Twenty-five percent of all cancer discovered at parotidectomy was metastatic malignant disease to the parotid gland. The most common site was the lung. A high index of suspicion, evaluation of pathologic specimens by electron microscopy, and detailed metastatic work-up for patients with malignant disease in parotid lymph nodes are recommendations which should be considered by the surgeon performing parotid procedures.