Surgical Pathology Diagnosis Research Articles

Perforated Peptic Ulcer Combined with Posttraumatic Diaphragmatic Hernia in Third Gestation Trimester: a Clinical Case

Background. Gastric and duodenal ulcers are extremely rare in pregnancy, according to published literature. Peptic ulcer is found in 1 per 4,000 pregnant women, a figure probably underestimated due to its hampered diagnosis in pregnancy. Pregnancy peptic ulcer is considered less expected. Perforated gastric and duodenal ulcers comprise about 1.5 % of total acute abdominal diseases, and the perforation rate in ulcer patients ranges within 5–15 %. This complication afflicts the ages of 20–40 years in men much more frequently than in women. Three perforation types occur: free into abdominal cavity (87 %), contained (9 %), into lesser omentum and retroperitoneal tissue (4 %).Materials and methods. The clinical case describes surgical management of posttraumatic diaphragmatic hernia-comorbid perforated gastric ulcer in a pregnant woman in third trimester. Surgery with postoperative patient management enabled for a favourable outcome.Results and discussion. Perforation-entailing gastric and duodenal ulcers in pregnant women have received negligible attention due to rarity in clinical practice. Paul et al. described 14 cases of duodenal perforation in pregnancy, all fatal.Conclusion. Early diagnosis of surgical pathology during gestation is still difficult contributing to the development of severe complications associated with high mortality. The patient’s admission to a level III interspecialty hospital was key to enable a timely consilium-driven decision of caesarean intervention for saving the child, diagnosing intraoperatively life-threatening complicated surgical diseases and opting for radical surgery that ended in a favourable outcome.

Tao brush endometrial cytology is a sensitive diagnostic tool for cancer and hyperplasia among women presenting to clinic with abnormal uterine bleeding.

BackgroundAbnormal uterine bleeding requires the investigation of the endometrium. Histology is typically used but there remains room for the improvement and use of cytology.MethodsWomen presenting for clinically indicated office endometrial biopsy were prospectively enrolled. Tao endometrial brushing and office endometrial biopsy were performed, and surgical procedure if clinically indicated. Tao brush cytology specimens were blindly reviewed by up to three pathologists, consensus obtained, and scored as: benign, atypical (favor benign), suspicious, positive for malignancy, or non‐diagnostic. Cytology and histology were compared to surgical pathology to determine sensitivity, specificity, positive, and negative predictive values to detect AH (atypical hyperplasia) or EC (endometrial cancer).ResultsClinical indications of 197 enrolled patients included postmenopausal bleeding (90, 45.7%), abnormal uterine bleeding (94, 47.7%), and abnormal endometrium on ultrasound without bleeding (13, 6.6%). Of the 197 patients, 185 (93.9%) had cytology score consensus and a total of 196 (99.5%) had consensus regarding cytology positivity.Surgical pathology diagnoses (N = 85) were 13 (15.3%) FIGO grade 1 or 2 EC, 3 (3.5%) AH, and 69 (81.2%) benign endometrium. Sensitivity and specificity to detect EC or AH were 93.7% and 100%, respectively, via endometrial biopsy; 87.5% and 63.8%, respectively, via endometrial cytology when scores of malignancy, suspicious, or atypical were considered positive.ConclusionsIn a high‐risk population, Tao brush endometrial cytology showed high sensitivity to detect AH and EC comparable to biopsy histology when considering scores of malignancy, suspicious, atypical, and non‐diagnostic. Revisiting the potential value of endometrial cytology in the contemporary era of endometrial diagnostic workup is warranted.

Алгоритм діагностики поєднаної хірургічної патології у пацієнтів із захворюваннями ендокринної системи

Актуальність. Кожні 2 роки частота випадків ендокринної патології зростає на 23–30 %. Під час діагностичного пошуку у 25–30 % пацієнтів з патологією ендокринних органів виявляється 2–4 поєднаних хірургічних захворювання. Кількість симультанних оперативних втручань у цієї групи пацієнтів залишається на рівні 1,5–6 %. Мета дослідження. Розробити діагностичний алгоритм для виявлення поєднаних хірургічних захворювань у хворих з патологією ендокринної системи. Матеріали та методи. Проведено аналіз 764 історій хвороби пацієнтів з ендокринною патологією, яким були виконані оперативні втручання в період з 2012 по 2016 рік на базі КЗ «Міська клінічна лікарня екстреної та швидкої медичної допомоги м. Запоріжжя» та Запорізької обласної клінічної лікарні. Результати. Проведений аналіз результатів лікування даної групи пацієнтів показав, що виконання симультанних операцій у хворих з поєднаною хірургічною патологією складає 5,5 %. Висновки. Незначна кількість виконаних симультанних оперативних втручань у хворих з ендокринною патологією обумовлена низьким виявленням поєднаних хірургічних захворювань, що пов’язано з недостатнім обстеженням пацієнтів в передопераційному періоді. Для своєчасної і повної діагностики поєднаної хірургічної патології у хворих із захворюваннями ендокринної системи необхідно розширити стандартні протоколи обстеження пацієнтів та впровадити широке застосування додаткових методів обстеження. Запропонований нами алгоритм обстеження хворих з патологією органів ендокринної системи дозволить своєчасно діагностувати поєднану хірургічну патологію.

Independent risk factors and feasibility of ultrasound diagnosis of ultrasound-guided non-cytologically diagnostic thyroid nodules.

To explore the independent risk factors and feasibility of ultrasound diagnosis of ultrasound-guided non-cytologically diagnostic thyroid nodules. This study included 200 patients with thyroid nodules that were diagnosed or suspected of being Thyroid Imaging Reporting and Data System (TI-RADS) 4 nodules between January 2017 and January 2019. All patients received surgical treatment and pathological diagnosis, and were divided into a cytologically diagnostic group and a non-cytologically diagnostic group based on whether they could be diagnosed by ultrasound-guided fine needle aspiration cytology (UG-FNAC). Patients were further divided into benign and malignant groups according to the results of surgical pathology. Logistic regression analysis was used to clarify the risk factors that could not be cytologically diagnosed in TI-RADS 4 nodules. For the diagnosis of benign and malignant nodules, we combined contrast-enhanced ultrasound (CEUS) and ultrasound elastography (UE) to establish a joint scoring strategy. The diagnostic value of the joint scoring strategy was evaluated by receiver operating characteristic (ROC) curve. A total of 216 TI-RADS type 4 nodules were detected in 200 patients. Among them, 40 nodules were included in the non-cytologically diagnostic group, and 176 nodules were included in the cytologically diagnostic group. The multi-parameter logistic regression showed that: aspect ratio <1, irregular edge, scattered coarse calcification, middle layer, and lower layer were independent influencing factors leading to undiagnosed puncture cytology. Among the 216 nodules in 200 patients, 168 were pathologically diagnosed as malignant nodules (malignant group), and 48 nodules were diagnosed as benign nodules (benign group). According to the joint scoring strategy, the distribution of comprehensive scores changes significantly at 5-6 scores while in malignant nodules, the distribution of comprehensive scores changes significantly at 6-7 scores. ROC curve analysis showed that the diagnostic value was the highest when '6 scores' was used as the critical point for diagnosis [area under curve (AUC) =0.893, P<0.05]. The combined scoring strategy of CEUS and UE was an effective method to diagnose TI-RADS4 nodules could not be diagnosed by UG-FNAC.

Current status of postoperative pathological diagnosis of lung cancer in China: a multicenter big data study

Objective: To reveal the current status and problem of surgical pathological diagnosis and to construct a structured pathological database of lung cancer in China, and to further improve the level of pathological standards and scientific data. Methods: Case report form (CRF) was made according to the diagnostic criteria of radical resection specimens of lung cancer, including general information, smoking history, pathological report (including molecular data), treatment and prognosis, etc. The original clinicopathological data of patients with primary lung cancer who underwent surgical resection in 23 centers from January 2013 to December 2017 were retrospectively collected. After desensitization, filtering and natural language processing, combined with domain knowledge base, and the raw data in the form of continuous text were structured. Results: A total of 153 817 non-structured pathological reports, 57 748 molecular reports and 13 295 pieces of treatment and/or follow-up information were collected. Finally, 75 941 effective structured documents (including 86 979 primary lesions) were obtained. The quality of treatment and follow-up data was not satisfactory; Number of CRF index involved showed an increasing trend with time coursing, and had no significant difference between general hospitals and cancer hospitals (P<0.05). The indexes with low use rate until 2017 were peripheral lung disease, pTNM stage, spread though air space, and pathological evaluation of neoadjuvant treatment response. The ratio of male to female was 1.2∶1.0; 8 648 cases (11.39%) had smoking history, and the ratio of smokers to non-smokers was 0.92∶1.00. Age group of the highest incidence was 60-69 years, accounting for 38.76%. The top five common pathological subtypes were adenocarcinoma (74.58%), squamous cell carcinoma (18.01%), small cell carcinoma (2.18%), adenosquamous carcinoma (1.71%) and sarcomatoid carcinoma (0.82%); histological subtypes were significantly correlated with gender, age and smoking status (P<0.05): adenocarcinoma (58.5%) and squamous cell carcinoma (31.6%) were the main pathological types in male patients, while adenocarcinoma (91.6%) and squamous cell carcinoma (3.4%) were the main pathological types in female patients; adenocarcinoma (85.6%) was the main type of non-smoking patients, adenocarcinoma and squamous cell carcinoma accounted for 50.6% and 37.7% respectively in smoking patients; the proportion of adenocarcinoma decreased with age, while squamous cell carcinoma and small cell carcinoma increased. The top five common immunohistochemical (IHC) markers were TTF1, CK7, ALK-Ventana, Napsin A and p63 and the most common panel included 7-9 IHC markers. The overall EGFR mutation rate was 51.32% (all 10 335/20 139 by PCR), the total ALK positive rate was 6.18% (2 084/33 726, PCR, FISH and IHC-Ventana platform positive rates were 3.01%, 8.93% and 6.58%, respectively), the KRAS mutation rate was 7.01% (all 662/9 441 by PCR). The positive rates of EGFR, ALK and KRAS were 58.14% (9 986/17 175), 6.59% (1 791/27 176) and 7.52% (607/8 068) in adenocarcinoma, 5.83% (113/1 939), 0.40% (1/251) and 1.76% (15/852) in squamous cell carcinoma, respectively. Due to the poor quality of prognostic data, it was difficult to obtain effective survival analysis. Conclusions: The standardization of pathological reports (including molecular detection) of lung cancer in China is generally fine, but most of the models are still in the state of unstructured continuous text. The postoperative pathological staging, pathological evaluation of neoadjuvant therapy response and high-quality prognosis data need paying more attention and improvement. Panel of IHC markers is balanced although further precision. The use of lung cancer structured report template and intelligent structured database management mode to improve the degree of the pathologic diagnosis standardization and data quality is recommended.

Comparison of the diagnostic value of high frequency ultrasound and ultrasound-guided fine needle aspiration biopsy in papillary thyroid microcarcinoma

Objective:To explore the application value of high frequency ultrasound and ultrasound-guided fine needle aspiration biopsy（US-FNAB） in the diagnosis of papillary thyroid microcarcinoma（PTMC）, and to compare the characteristics and value of the two methods, so as to find a more convenient and non-invasive diagnostic method of PTMC, reduce unnecessary puncture and operation. Methods:The data of 190 postoperative pathologically confirmed PTMC patients admitted to Henan Province Cancer Hospital and Henan Provincial Hospital from January to June 2020 were retrospectively analyzed, with a total of 305 nodules, including 198 PTMC nodules and 107 benign thyroid nodules（BTN）. According to the postoperative pathological results, they were divided into groups, and the relationship between the ultrasound appearance of the nodules and whether the cervical lymph nodes could be explored and PTMC was analyzed by chi-square test and logistic regression, and its diagnostic value was evaluated. The Kappa consistency test was used to analyze the consistency between ultrasound, FNAB and surgical pathological diagnosis results. The accuracy, sensitivity and specificity of high-frequency ultrasound and US-FNAB were compared, and the ROC curve was used to calculate the maximum area under the curve to evaluate its effectiveness. Results:The chi-square test showed that there were statistically significant differences in the morphology, margin, internal echo, echo uniformity, calcification, aspect ratio, blood flow signal, and whether the cervical lymph nodes can be detected and other ultrasound signs between the PTMC group and the BTN group. Logistic regression analysis showed that irregular shape, unclear edges, internal hypoechoic, intranodular calcification are independent risk factors for PTMC. By consistency test, the consistency between high-frequency ultrasound, US-FNAB examination and surgical pathological diagnosis was good, Kappa value was 0.802 and 0.893（P<0.05）. Each nodule was examined by high-frequency ultrasound, and the diagnostic sensitivity, specificity, accuracy and AUC were 95.45%, 83.18%, 91.15% and 0.877 respectively. US-FNAB was performed on 189 of 305 thyroid nodules, and the diagnostic sensitivity, specificity, accuracy and AUC were 96.03%, 93.65%, 95.24% and 0.948 respectively. Conclusion:High frequency ultrasonic features such as internal hypoechoic, calcification in the nodules, unclear edges, and irregular morphology are of high value for the diagnosis of PTMC. Through data analysis, both high-frequency ultrasound and US-FNAB examination have high diagnostic value for PTMC. Compared with US-FNAB, high-frequency ultrasound has the advantages of low examination cost, non-invasive, simple operation and so on. For some patients with PTMC who do not have high risk factors, ultrasound can be used to actively monitor disease progression to avoid some unnecessary surgery.

Is Milan for kids?: The Milan System for Reporting Salivary Gland Cytology in pediatric patients at an academic children's hospital with cytologic-histologic correlation.

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a useful framework for the diagnosis of salivary gland fine-needle aspiration (FNA) biopsies. In this study, the MSRSGC was applied to salivary gland FNAs in pediatric patients to assess its usefulness and look at pitfalls. The laboratory information system was queried over a 15-year period for all salivary gland FNAs in patients 18 years old or younger. Patient demographics, FNA diagnosis categorized according to the MSRSGC, and follow-up surgical pathology diagnoses were examined and correlated. Thirty-two cases were identified, with an average age of 12 years (range, 0.6-18 years). A majority of the cases (84.4%) were from the parotid region. Twenty of 32 cases (62.5%) had follow-up resection. MSRSGC recategorization diagnoses of the 32 FNA cases were 34% benign neoplasm, 31% nonneoplastic, 16% nondiagnostic, 9% atypia of undetermined significance, 3% salivary neoplasm of uncertain malignant potential, 3% suspicious for malignancy, and 3% malignant. Overall, the sensitivity and specificity were 100% and 80%, respectively. On follow-up resection, 55% were neoplastic: pleomorphic adenomas (n = 6; 55%), pilomatricoma (n = 3; 28%), mucoepidermoid carcinoma (n = 1; 9%), schwannoma (n = 1; 9%), and myofibroma (n = 1; 9%). The MSRSGC performed fairly well in the pediatric population with a low overall risk of malignancy (6%) and high sensitivity. Although the majority of pediatric salivary gland FNAs were benign, 55% of resected cases were positive for a neoplasm, with benign neoplasms outnumbering malignancy. Challenging entities included inflammatory conditions, like immunoglobulin G4-related sialadenitis, and skin and soft tissue lesions near the salivary gland.

Metastatic Adrenocortical Carcinoma Co-Secreting Multiple Steroid Hormones

Background: Adrenocortical carcinoma is a rare disease which may be complicated by co-secretion of multiple steroid hormones.Clinical Case: A 53- year-old female was discovered to have 1 cm left and 1.7 cm right adrenal nodules by Chest CT scan in 2004. She had a follow-up abdominal CT scan in 2011 revealing enlargement of the left adrenal mass to 5.7 cm and a stable 1.8 cm right adrenal nodule. A laparoscopic left adrenalectomy was performed in 2012 and the surgical pathology diagnosis was benign adrenal hyperplasia. In 5/2016 the patient developed left abdominal pain and a CT scan revealed a 1.7 cm mass in the left adrenalectomy surgical bed, a 1.4 cm nodular density adjacent to the left diaphragm and the stable 1.8 cm right adrenal nodule. 6/2016 lab tests: 24 hr urinary cortisol 15 ug/24 hr (<50 μg/24hr), aldosterone 8.7 ng/dL (<31 ng/dL), renin activity 0.7 ng/ml/hr (0.5–4 ng/mL/hr) and DHEA-S 94 ug/dL (32–240 μg/dL). A re-examination of the 2012 surgical pathology resulted in an addendum diagnosis of an adrenal cortical neoplasm of indeterminate malignant potential. In 1/2018 she underwent an exploratory laparotomy with surgical resection of the 1.7 cm mass in left paracolic gutter and biopsy of numerous small retro-peritoneal and multiple liver lesions. Pathology revealed metastatic adrenocortical carcinoma with low grade mitotic activity (3 mitoses per 10 HPF) and intermediate grade Ki-67 (15–25%). 5/2018 lab results: 1. aldosterone 20 ng/dL, 2. renin activity 0.2 ng/mL/hr and 3. testosterone 34 ng/dL (<75 ng/dL). Mitotane was started in 06/2018 but was discontinued in 9/2018 due to side effects. In 3/2020 she was hospitalized for generalized weakness and was discovered to be severely hypokalemic K+ 1.5 mmol/L (3.6–5.2 mmol/L) with an aldosterone of 300 ng/dL and renin activity of 0.1 ng/mL/hr. She was treated with IV KCl to correct her hypokalemia and was discharged on oral KCl 20 meq bid and spironolactone 50 mg bid. She was readmitted to the hospital on 10/12/2020 after a near-syncopal event and lab tests revealed a K+ of 1.4, aldosterone 508 ng/dL, renin activity 0.7 ng/mL/hr, AM cortisol 13.6 μg/dL (5–20 ug/dL), testosterone 161 ng/dL, and DHEA-S 377 ug/dL, indicating co-secretion of multiple steroid hormones. Her hypokalemia was treated with IV KCl and her spironolactone dose was increased to 100 mg bid.Conclusion: This case report details the rare occurrence of an adrenocortical carcinoma which was hormonally silent but eventually metastasized and became hormonally active, co-secreting multiple steroid hormones with a predominance of aldosterone. Serial adrenal hormone lab profiles are important for optimal management of patients with this disease.

КЛИНИЧЕСКИЙ СЛУЧАЙ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ПЕПТИЧЕСКОЙ ЯЗВЫ ГАСТРОЭНТЕРОАНАСТОМОЗА

In the article a clinical case of surgical treatment of peptic ulcer of gastroenteroanastomosis complicated with perforation and gastrointestinal bleeding, is described. The patient was observed with the diagnosis: cholelithiasis, chronic calculous cholecystitis, for which planned laparoscopic cholecystectomy with draining of the abdominal cavity was performed. According to the discharge record, the operation ran without peculiarities. Later the patient was rehospitalized with complaints of weakness, nausea, vomiting, pain in the upper parts of the abdomen; he was diagnosed with ulcer of gastroenteroanastomosis and continuing bleeding that were indications for the surgical intervention for life-saving indications. From the patient words, a part of the stomach was resected more than 20 years before for gastric ulcer. Until the latest time, the patient felt satisfactory, but within 6 months pain in the abdomen reappeared, however, on examination cholelithiasis was identified, and the pain syndrome was attributed to this pathology. Assumably, after the first operation performed in 1995, a complication developed in the early postoperative period in the form of obstruction of gastroenteroanastomosis (anastomositis?), and additional gastroenteroanastomosis was applied. Conclusion. Peptic ulcer of anastomosis is an actual problem of the gastric surgery which may not only appear long time after the operation, but may give the same complications as «essential» peptic ulcer, and really threaten the life of patients. It should be noted that in some cases the intraoperative picture, experience and sensations of a surgeon play a decisive role in the diagnosis of surgical pathology even if they differ from the data of additional methods of examination.

FEATURES OF DIFFERENTIAL DIAGNOSIS OF URGENT SURGICAL ABDOMINAL PATHOLOGY DURING A PANDEMIC OF CORONAVIRUS INFECTION

Summary. Aim. To analyze the features of differential diagnosis of urgent surgical pathology during a coronavirus infection pandemic.&#x0D; Materials and methods. The work is based on the analysis of the results of additional examination of 28 patients at the admission department, who sought medical help in an urgent manner.&#x0D; Results. The advantages and disadvantages of using instrumental methods for detecting atypical forms of coronavirus infection and acute abdominal pathology are analyzed. Based on this, a diagnostic algorithm was developed using express tests for the determination of COVID-19 and urgent ultrasound protocols, which made it possible to identify lung lesions without clinical symptoms in 8 (28.6 %) patients, and to confirm acute surgical pathology in 5 (17.9 %) patients.&#x0D; Conclusion. Еxamining patients with suspected acute abdominal pathology for the purpose of differential diagnosis with the gastrointestinal form of COVID-19, it is necessary to use rapid tests for detecting antibodies to coronavirus infection and sonographic examination of the abdominal organs (FAST protocol), chest organs (BLUE protocol).

Аналіз ефективності відеолапароскопії при гострому апендициті у вагітних

Diagnosis and treatment of acute surgical abdominal pathology in pregnant women is still complex and not fully resolved issue. The most frequent reason of urgent surgery in pregnant is acute appendicitis. This pathology remains an urgent problem nowadays. Still there is no consensus on the choice of appendectomy method depending on gestational term. The introduction of endoscopic surgery into widespread clinical practice significantly changed the views on the possibility of using it in pregnant women. But possibility of performing laparoscopy in pregnant women still causes some caution. Moreover, laparoscopic techniques at different stages of pregnancy are far from being improved. Material and methods. The study involved 73 pregnant women with acute appendicitis (group I) and 43 non-pregnant women (group II), who were hospitalized to the clinic. The informativeness of laparoscopic method was studied according to the following criteria: sensitivity (Se), specificity (Sp), accuracy (Ac) and efficiency (De). For each of these criteria was calculated a 95% confidence interval (CI). Results and discussion. Research did not reveal correlation of frequency direct and indirect laparoscopic signs from gestational terms. The frequency of these signs was almost the same in the groups of pregnant and non-pregnant women. The most difficult laparoscopic diagnosis was with catarrhal changes in the wall of appendix, since morphological changes in this form of inflammation extended only to the mucous and submucosal membranes, and macroscopic changes were minimal. Such symptom as the imposition of fibrin in catarrhal appendicitis was absent in all cases. The rest of the signs were observed in all women studied, while macroscopic changes in destructive forms of appendicitis, indicating inflammation, were frequent compared with catarrhal ones. Attention drawn to high parameters of informativeness diagnostic laparoscopy in pregnant women in the first trimester. This is due to the coincidence of clinical and histological diagnoses in this trimester. Considering the number of truly negative results of the study in the II and III trimesters of pregnancy, the indicators of informativeness of laparoscopy did not differ much from the gestational age. Conclusion. Thus, laparoscopy as a diagnostic method for acute appendicitis turned out to be quite informative in both pregnant and non-pregnant women: it allowed confirming or excluding diagnosis of acute appendicitis, it also accurately determined the localization of appendix, choosing correct treatment tactics and safely perform an adequate low-traumatic surgery

Endometrial findings among transgender and gender nonbinary people using testosterone at the time of gender-affirming hysterectomy

To describe clinical characteristics and associated endometrial findings of transgender and gender nonbinary people using gender-affirming testosterone. Retrospective case series. Academic medical center and public safety net hospital. Eighty-one patients using gender-affirming testosterone therapy undergoing hysterectomy for the indication of gender affirmation from 2000 to2018. None. Preoperative clinical characteristics and endometrium surgical pathology diagnoses. Median age was 31 years (interquartile range [IQR] 27-40), and median body mass index 27 kg/m2 (IQR 24-30). Six patients (7%) were parous and 60 (74%) had amenorrhea. Thirty-three patients (40%) had proliferative and 40 (50%) atrophic endometrium. Endometrial polyps were found in nine patients (11%) of the sample. Endometrial findings were similar in the subgroup of 60 patients with preoperative amenorrhea. There were no cases of endometrial hyperplasia or malignancy. In bivariate analysis, those with proliferative endometrium were found to be, on average, 5.6 years younger than those with atrophic endometrium. There were no clinical factors associated with having proliferative versus atrophic endometrium in multivariable models. People using gender-affirming testosterone may have either proliferative or atrophic endometrium, including people who present with amenorrhea. Further study is needed to develop evidence-based guidelines for appropriate screening for endometrial hyperplasia or cancer in this population.

Accuracy of Subclassification and Grading of Renal Tumors on Fine Needle Aspiration Cytology Alone

Background: Fine needle aspiration (FNA) of renal masses can distinguish between benign and malignant neoplasms in 73–94% of cases. Previous studies suggested the correct subclassification of renal cell carcinomas (RCCs) by cytomorphology can be achieved in up to 80% of cases. However, as RCCs become increasingly subclassified by molecular signatures, correct subclassification based on cytology alone is increasingly difficult. Design: Two FNA passes (2 stained with Diff-Quik® and 2 with the Papanicolaou method) were performed on all fresh nephrectomy specimens for a 1-year period. There were 30 cases in this study, with 29 primary renal tumors and 1 case of metastatic lung adenocarcinoma. Each case was assigned a random number and came with 2 slides (1 from each staining method). Eight cytopathologists were asked to provide a diagnosis and the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading if applicable. Fleiss’ Kappa and Cohen’s Kappa equations were used to look at inter-rater variability. Results: When compared to the surgical pathology diagnosis, the average percent correct diagnosis for all cytopathologist was 35%. Chromophobe RCCs had the best average percent accuracy at 72% followed by clearcell RCC at 48%. Average accuracy for grading RCCs was 40%. Inter-rater variability among the cytopathologists for all RCC diagnoses was fair with a Fleiss’ Kappa coefficient of 0.28. For the WHO/ISUP grade, the weighted coefficient for each pathologist ranged from 0.11 to 0.45, ranging from fair to moderate, respectively. Conclusions: Renal tumors are difficult to classify on cytopathology alone. Core needle biopsy and ancillary studies are necessary if diagnosis will change management.

The feasibility of anterior 180° 99m Tc-sestamibi parathyroid SPECT/CT.

For 99mTc-sestamibi parathyroid single photon emission computed tomography/computed tomography (SPECT/CT), the traditional full-arc 360° acquisition technique has been suggested but not the theoretically low tissue-attenuated anterior 180° method. We aimed to compare the diagnostic performances and target-to-background ratios of anterior 180° and 360° SPECT/CT imaging. Ninety-nine patients who underwent 99mTc-sestamibi scintigraphy and received a surgical-pathological diagnosis of parathyroid adenoma or hyperplasia were enrolled. The SPECT/CT reconstructed images with anterior 180° and full-arc 360° data were interpreted by two physicians using a scoring scale, and the lesions were semi-quantified using target-to-background ratios for both image sets. In total, 113 abnormal parathyroid lesions were identified on the SPECT/CT images. The agreements of interpretation between the two image sets and readers were very good (κ value: 0.83-1.00). The accuracies of summative interpretation for the anterior 180° and full-arc 360° SPECT/CT were 83.04% and 82.46%, respectively. The target-to-background ratios were significantly higher for the anterior 180° than the full-arc 360° images (P < 0.01). The anterior 180° SPECT/CT technique, a time-saving method, can provide satisfactory diagnostic performance and superior lesion contrast compared with the full-arc 360° SPECT/CT technique in 99mTc-sestamibi parathyroid imaging.

Remote Reporting from Home for Primary Diagnosis in Surgical Pathology: A Tertiary Oncology Center Experience during the COVID-19 Pandemic

Background: The COVID-19 pandemic accelerated the widespread adoption of digital pathology (DP) for primary diagnosis in surgical pathology. This paradigm shift is likely to influence how we function routinely in the postpandemic era. We present learnings from early adoption of DP for a live digital sign-out from home in a risk-mitigated environment. Materials and Methods: We aimed to validate DP for remote reporting from home in a real-time environment and evaluate the parameters influencing the efficiency of a digital workflow. Eighteen pathologists prospectively validated DP for remote use on 567 biopsy cases including 616 individual parts from 7 subspecialties over a duration from March 21, 2020, to June 30, 2020. The slides were digitized using Roche Ventana DP200 whole-slide scanner and reported from respective homes in a risk-mitigated environment. Results: Following re-review of glass slides, there was no major discordance and 1.2% (n = 7/567) minor discordance. The deferral rate was 4.5%. All pathologists reported from their respective homes from laptops with an average network speed of 20 megabits per second. Conclusion: We successfully validated and adopted a digital workflow for remote reporting with available resources and were able to provide our patients, an undisrupted access to subspecialty expertise during these unprecedented times.

Implementation of Collodion Bag Protocol to Improve Whole-slide Imaging of Scant Gynecologic Curettage Specimens

Background: Digital pathology has been increasingly implemented for primary surgical pathology diagnosis. In our institution, digital pathology was recently deployed in the gynecologic (GYN) pathology practice. A notable challenge encountered in the digital evaluation of GYN specimens was high rates of scanning failure of specimens with fragmented as well as scant tissue. To improve tissue detection failure rates, we implemented a novel use of the collodion bag cell block preparation method. Materials and Methods: In this study, we reviewed 108 endocervical curettage (ECC) specimens, representing specimens processed with and without the collodion bag cell block method (n = 56 without collodion bag, n = 52 with collodion bag). Results: Tissue detection failure rates were reduced from 77% (43/56) in noncollodion bag cases to 23/52 (44%) of collodion bag cases, representing a 42% reduction. The median total area of tissue detection failure per level was 0.35 mm2 (interquartile range [IQR]: 0.14, 0.70 mm2) for noncollodion bag cases and 0.08 mm2 (IQR: 0.03, 0.20 mm2) for collodion bag cases. This represents a greater than fourfold reduction in the total area of tissue detection failure per level (P < 0.001). In addition, there were no out-of-focus levels among collodion bag cases, compared to 6/56 (11%) of noncollodion bag cases (median total area = 4.9 mm2). Conclusions: The collodion bag method significantly improved the digital image quality of fragmented/scant GYN curettage specimens, increased efficiency and accuracy of diagnostic evaluation, and enhanced identification of tissue contamination during processing. The logistical challenges and labor cost of deploying the collodion bag protocol are important considerations for feasibility assessment at an institutional level.

Validation of Whole Slide Imaging for primary surgical pathology diagnosis of prostate biopsies.

Whole slide imaging (WSI) is an important component of digital pathology which includes digitization of glass slides and their storage as digital images. Implementation of WSI for primary surgical pathology diagnosis is evolving, following various studies which have evaluated the feasibility of WSI technology for primary diagnosis. The present study was a single-center, observational study which included evaluation by three pathologists and aimed at assessing concordance on specialty-specific diagnosis and comparison of time taken for diagnosis on WSI and conventional light microscopy (CLM). Seventy prostate core biopsy slides (reported between January 2016 and December 2016) were scanned using Pannoramic MIDI II scanner, 3DHISTECH, Budapest, Hungary, at 20× and 40×. Sixty slides were used for validation study following training with 10 slides. Intraobserver concordance for diagnosis between the two platforms of evaluation was analyzed using Cohen's κ statistics and intraclass correlation coefficient (ICC); observation time for diagnosis was compared by Wilcoxon signed-rank test. Interpretation on WSI using 20× and 40× was comparable with no major discordance. A high level of intraobserver agreement was observed between CLM and WSI for all three observers, both for primary diagnosis (κ = 0.9) and Grade group (κ = 0.7-0.8) in cases of prostatic adenocarcinoma. The major discordance rate between CLM and WSI was 3.3%-8.3%, which reflected the expertise of the observers. The time spent for diagnosis using WSI was variable for the three pathologists. WSI is comparable to CLM and can be safely incorporated for primary histological diagnosis of prostate core biopsies.

The post-war period of the scientific work of Professor T.Ya. Arieva. Research and publication topics for the period 1946–1958

The results of the search, restoration and systematization of research topics and publications of the first head of the Department of Thermal Injuries of the Military Medical Academy named after S.M. Kirov professor Tuviy Yakovlevich Ariev in the post-war period. The presentation of the material is connected with the urgent tasks that the faculty of the Academy solved in the first years after the end of the Great Patriotic War. The objective difficulties of the work of scientists in Leningrad in the second half of the 1940s are underlined. Nevertheless, T.Ya. Aryev, like many of his colleagues, was able to summarize the clinical material accumulated in front-line medical institutions in the shortest possible time and, only 4 years after returning from the army, to defend his doctoral dissertation. The high quality of the research performed is evidenced by the fact that the materials obtained formed the basis for a separate chapter in the multivolume edition The Experience of Soviet Medicine in the Great Patriotic War 19411945. In addition, T.Ya. Ariev took part in writing several more chapters in this work, the topics of which were also related to the topic of his doctoral dissertation research. He willingly shared the knowledge gained, the experience of preparing for the defense of dissertations and the principles of scientific leadership with young scientists and their leaders. Continued service as head of the Department of Military Field Surgery at the Saratov Military Medical Faculty allowed him to accumulate invaluable experience in the formation and leadership of the scientific and clinical team. Analysis of the subject matter of publications in the 1950s. testifies to the intensive work on improving the diagnosis and treatment of urgent surgical pathology in peacetime. About the high authority among colleagues that T.Ya. Ariev for 4 years of service at the faculty is evidenced by the right to give a speech. The experience accumulated in Saratov will allow him not only to head, but also to effectively manage for many years the first department and clinic of thermal injuries in our country, created in 1960 at the S.M. Kirov.

Comparative study between fine needle aspiration cytology and histopathology in the diagnosis of breast lump

Aims and Objectives: 1.To compare the results of fine needle aspiration cytology (FNAC) and histopathological study of biopsy in detecting breast cancer in suspicious breast lumps in outpatient setting.; 2. To study the accuracy of FNAC in diagnosing various breast lumps.; 3. To know whether the cancer patients can be managed based on FNAC diagnosis alone without histological study. Methodology: It was a hospital based retrospective study carried out from the data retrieved from the Dept. of Pathology of Mysore Medical College, Mysore in a period from August 2016 – September 2016. Period of Study: 2 months, Sample Size: 50 patients. Results: In the present study, FNAC had sensitivity of 50%, specificity of 100%, positive predictive value of 100%, negative predictive value of 88.37%. In this case FNAC is highly specific with maximum positive predictive value. Conclusion: Benign neoplasms of the breast are more common than malignant one.The present study shows FNAC correlation with histopathology with high specificity and maximum positive predictive value. The sensitivity of FNAC is less compared to biopsy. However, FNAC can be used as an indicative diagnosis (one stop) for breast cancer examination in outpatient setting. Accuracy of FNAC enables to proceed with surgery or not. It bridges the gap between clinical evaluation and final surgical pathological diagnosis in majority of cases. It enables the clinician to obtain a diagnosis in high percentage of cases with minimal expenditure of time, amd money and often to avoid unnecessary surgery. Keywords: Fine needle aspiration cytology, Sensitivity, Specificity, Diagnostic accuracy.

Differential Diagnoses in Surgical Pathology: Soft Tissue and Bone.

Differential Diagnoses in Surgical Pathology: Soft Tissue and Bone.