Contributions Of Pathologists Research Articles

Contribution of Pathologists in Leading Clinical Cancer Research Through Interdisciplinary Collaboration in Saudi Arabia.

BackgroundInterdisciplinary collaboration is often the key to advance cancer research. This research collaboration is frequently observed between oncologists and pathologists. While clinical cancer research is often led by oncologists, the leading role of pathologists is likely limited to laboratory-based and preclinical research. Therefore, the magnitude and characteristics of clinical studies led by pathologists is largely unknown.ObjectivesThe objective of our study was to assess the quantity and quality of clinical cancer-related publications led by Saudi pathologists over a 10-year period.MethodsA PubMed search was conducted between January 2008 and December 2017 to extract all published clinical articles regarding cancer by at least one Saudi pathologist with the collaboration of other cancer specialists. Information about articles and authors were collected. The level of evidence (LOE) was independently assessed by two authors. Two five-year periods (2008 - 2012 and 2013 - 2017) were compared using the relevant parameters.ResultsA total of 127 publications met our inclusion criteria and were included. Review articles (27%) were the most common type of publication. There were no experimental studies. The LOE was III and IV in 59.1% and 40.9% of the included publications, respectively. Comparing the two five-year periods, the number of publications (p < 0.001), publications in international journals (p = 0.004), and international collaborations (p < 0.001) increased in the second period. The LOE and journal impact factor were the same in the two periods.ConclusionsThe pathologist-led clinical cancer research in Saudi Arabia increased over time. Despite the observed increase in international collaboration and publications in international journals, the LOE was low (III/IV) and did not change over time.

Les cancers du rein héréditaires vus par le pathologiste en 2020

Hereditary predispositions to adult kidney tumors involve around 5% of tumors and include a dozen of autosomal dominant syndromes. The most frequent tumors encountered in these setting are clear cell renal cell carcinomas, papillary renal cell carcinomas, chromophobe renal cell carcinomas and angiomyolipomas. Their detection is essential in order to adapt individual care and perform genetic screening of at-risk relatives, especially in the national french network PREDIR, labeled by the National Cancer Institute and dedicated to hereditary predispositions to kidney tumors. Targeted genetic analysis, which was guided in particular by the renal tumor subtype, has recently evolved into genetic analysis using panels of genes. Pathologist contribution's remains however central in the diagnosis of hereditary forms since we currently have immunohistochemical biomarkers that allow us to diagnose two specifically hereditary entities: hereditary leiomyomatosis and renal cell carcinoma associated-renal cell carcinoma, associated with a loss of fumarate hydratase and succinate dehydrogenase-deficient renal cell carcinoma associated with a loss of succinate deshydrogenase B expression. These diagnoses must however be confirmed by the identification of pathogenic germline variation in the corresponding genes. Improvement of kidney tumors characterization has also lead to identify new subtypes, expanding the algorithm of renal tumors associated with hereditary setting. Here we aim to review all subtypes of adult renal tumors encountered in predisposition syndromes.

A case of sudden death following minor intentional trauma; pathologist's contribution to the decision on the manner of death

Sudden death following trauma arouses a huge public interest. This in turn leads the investigators to take stern actions at the outset. Thorough post-mortem examination by a pathologist is an essential part of the medico-legal investigation of such deaths. A seemingly direct violence related death can end up as a natural death at the end of the post-mortem examination1. Similarly there can be limitations to the opinions that can be expressed by the pathologist at the end of the post-mortem examination for forensic pathologists are not Sherlock Holmes. We report a case of a man who died immediately after trauma due to a natural disease. DOI: http://dx.doi.org/10.4038/sljfmsl.v3i1.4945 Sri Lanka Journal of Forensic Medicine, Science & Law-May 2012-Vol.3 No.1 pp.7-9

Molecular targets in gynaecological cancers

The application of high throughput expression profiling and other advanced molecular biology laboratory techniques has revolutionised the management of cancers and is gaining attention in the field of gynaecological cancers. Such new approaches may help to improve our understanding of carcinogenesis and facilitate screening and early detection of gynaecological cancers and their precursors. Individualised prediction of patients' responses to therapy and design of personalised molecular targeted therapy is also possible. The studies of various molecular targets involved in the various signal pathways related to carcinogenesis are particularly relevant to such applications. At the moment, the application of detection and genotyping of human papillomavirus in management of cervical cancer is one of the most well established appliances of molecular targets in gynaecological cancers. Methylation, telomerase and clonality studies are also potentially useful, especially in assisting diagnosis of difficult clinical scenarios. This post-genomic era of clinical medicine will continue to make a significant impact in routine pathology practice. The contribution of pathologists is indispensable in analysis involving tissue microarray. On the other hand, both pathologists and bedside clinicians should be aware of the limitation of these molecular targets. Interpretation must be integrated with clinical and histopathological context to avoid misleading judgement. The importance of quality assurance of all such molecular techniques and their ethical implications cannot be over-emphasised.

The Pathologist in Breast Cancer: Contemporary Issues in the Interdisciplinary Approach

The pathologist's contribution to the interdisciplinary team approach in breast cancer management is a cornerstone for decision-making. Continuous communication with the radiologist, surgeon, oncologist, and radiation oncologist is essential. Preoperative diagnosis, surgical specimen work-up with size determination, sentinel lymph node examination, processing forms to facilitate the work-up, and diagnostic templates are some of the items covered in this review of the pathologist's contribution to the interdisciplinary team in breast cancer. Use of diagnostic templates or synoptic reports routinely provide the complete diagnostic information required for treatment decisions.

Pathologists' roles in clinical utilization management. A financing model for managed care.

In ancillary or laboratory utilization management, the roles of pathologists have not been explored fully in managed care systems. Two possible reasons may account for this: pathologists' potential contributions have not been defined clearly, and effective measurement of and reasonable compensation for the pathologist's contribution remains vague. The responsibilities of pathologists in clinical practice may include clinical pathology and laboratory services (which have long been well-defined and are compensated according to a resource-based relative value system-based coding system), laboratory administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mechanisms such as percentage of total service revenue or fixed salary, the involvement of pathologists seems less today than in the past, owing to increased clinical workload and time constraints in an expanding managed care environment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely accounts for the current situation. Furthermore, the importance of pathologist-driven utilization management in laboratory services lacks recognition among hospital administrators, managed care executives, and pathologists themselves, despite its potential benefits for reducing cost and enhancing quality of care. We propose a financial compensation model for such services and summarize its advantages.

Breast carcinoma and breast saving therapy--a critical comment from the viewpoint of the pathologist

The pathologist's contribution to decision-making for or against breast conserving treatment is based on his examination of the specimen from primary tumour surgery. First-line criteria for the assessment of the specimen are completeness, contour and versus plurifocal/multicentric spread), intracanalicular tumour components, lymphangiosis and haemangiosis. Second-line criteria are the histological and cytological grade of malignancy, preconditions for breast conserving treatment are favorable in consolidated in situ carcinomas up to 25 mm in diameter and in unifocal invasive carcinomas up to stage pT2 with low grade malignancy and without additional intraductal spread or angiosis. Breast conserving treatment is not indicated for multifocal or pT4 carcinomas and for carcinomas with extensive intraductal components or angiosis. When considering an unselected group of breast cancer patients, the pathological anatomic preconditions for breast conserving treatment will be very favourable in one-quarter of the cases. This approach will be feasible with limitations only in another one-fourth of the cases, whereas in about 50% of the patients, breast conserving treatment is dubious or should be rejected.

How Does Japan Differentiate Hyperplasia from Neoplasia?

A Japanese pathologist's contribution to the discussion of the problem on differentiation of hyperplasia from neoplasia is to introduce his experience and knowledge in human and experimental pathology of gastric, hepatic, and uterine cervical cancers, all of which are prevalent in Japan. Canine and rodent gastric cancers induced experimentally by N-ethyl-N'-nitro-N-nitrosoguanidine or N-methyl-N'-nitro-N-nitrosoguanidine, respectively, show different histologic types which are similar to human gastric cancer when examined routinely by endoscopic method. Dogs show more similarities to human gastric cancer than rats in the morphologic features and responses to chemotherapy. Serial liver biopsies performed on patients with liver diseases revealed the final stages of liver cell carcinoma in some of them. They all progressed to liver cirrhosis before terminating in carcinoma. However, this does not mean that the hyperplastic nodule is an obligatory precursor of carcinoma in human. Among experimental models of liver cancer produced by a large number of agents, only carbon tetrachloride and luteoskyrin seem to induce liver cell carcinoma combined with cirrhotic lesions in rodents. The mode of manifestation of atypical changes in the proliferating cells as preneoplastic or neoplastic lesions seems to differ according to tissue. The cellular pathology of cervicovaginal smears is a reliable index for detection of carcinoma in the cervix, where the appearance of atypical cells represents a landmark between benign and malignant tumors.

Proposal for a National Autopsy Data Bank. A Potential Major Contribution of Pathologists to the Health Care of the Nation

This report highlights the salient deliberations of the Anatomic Pathology Committee of the College of American Pathologists (CAP) and of its consultants and advisors in formulating a proposal for the establishment of a National Autopsy Data Bank (NADB). It has constituted the major thrust of this Committee for the past five years and is presented in considerable detail in order to familiarize the pathology community and other interested parties with the plan, which, if implemented, would enable pathologists to contribute even further to the health care of the nation while concomitantly realizing benefits both individually and collectively. In order for the proposal to culminate in an optimally functioning NADB, the support and participation of a majority of, if not all, pathologists with autopsy responsibilities would be needed. Goals, objectives, justification, and merits, background, legal considerations, pilot studies, and management plans are discussed and the singular advantages that could accrue with implementation are delineated. If achieved, it would be the first time that any medical discipline or organization would have amassed such kinds of accurate biomedical information potentially so useful to so many for so little.