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* Context.--Organ weights are an essential part of autopsy analysis. Deviations from normal organ weights provide important clues to disease processes. The assessment of normal organ weights depends on reliable reference tables, but most widely available reference tables are based on data that are either decades old or derived from relatively small sample sizes. Objective.--To provide an updated reference table of organ weights based on contemporary sources and a large sample size. Design.--Organ weights from 4197 carefully screened autopsies performed on adults at the Palm Beach County Medical Examiner's Office in West Palm Beach, Florida, and the Mayo Clinic Hospital in Rochester, Minnesota. Results.--Height and body weight data in this study reflect the well-recognized increases in both variables, but most particularly in body weight, seen during the last decades. The study data show a strong positive association between organ weight and body weight for the heart, liver, and spleen. There is a similar but weaker association between body weight and the weight of the lungs and kidneys. Brain weight is independent of body weight but shows a strong negative association with age. Even when controlling for body weight, men's organs are heavier, except for the weight of the liver, which is comparable in men and women. These associations are in agreement with the findings of previous studies. The current study suggests that, for some of the commonly weighed organs, there has been an increase in median organ weight when compared with existing references. Conclusions.--The tables presented here provide an updated reference that should prove useful to autopsy pathologists in the forensic and hospital settings., Organ weights are a cornerstone of autopsy gross pathology. By weighing the major organs with a simple hanging balance and comparing the results with standard tables, pathologists can draw inferences [...]

To the Editor.--We have been following the recently published articles on microscopic photography using a smartphone with keen interest. (1,2) We agree that smartphone technology has the potential to revolutionize [...]

* Context.--The global control of malaria is more challenging than that of many other infectious diseases: malaria is vector borne, it is caused by 5 species of Plasmodium with different geographic distributions, infection is widespread in many regions, drug resistance is common, and the disease overlaps clinically with other infectious diseases. Therefore, malaria control programs, in addition to diagnosis and testing, must also target limiting spread of the disease through vector control. Although malaria control efforts have been successful in some regions, malaria remains one of the most important causes of death in sub-Saharan Africa, particularly in women and children. Objective.--To review the current literature regarding diagnostic methods available to detect clinical malaria, with an emphasis on comparing the strengths and limitations of each method. Data Sources.--Current World Health Organization malaria control report and other information, recent meta-analyses of diagnostic tests, primary literature concerning the performance characteristics of different tests, and primary literature concerning how diagnostic tests are used in daily practice. Conclusions.--The most commonly used method for identifying cases of malaria remains microscopic examination of peripheral blood, but there is growing use of malaria rapid diagnostic tests in many regions. One of the most important findings in the recent literature is that despite the widespread use of diagnostic tests, treatment is too often based on clinical findings rather than on results of diagnostic tests. (Arch Pathol Lab Med. 2013;137:805-811; doi: 10.5858/arpa.2011-0602-RA), The 2010 World Health Organization (WHO) report on malaria notes that there are 106 malaria-endemic countries or regions with half of the world's population at risk for acquiring malaria (Figure).1 [...]

An overview on developments and practices in the pathology of native European freshwater crayfish, such as Decapoda and Astacida. Discussion focuses on diagnostic techniques for detecting fungi, but pathogens such as ricksetta-like agents and viruses require more research for species conservation.

* Neuroendocrine differentiation in the neoplastic prostate varies from foci of adenocarcinoma showing immunoreactivity to the pure small cell carcinoma, which correlates with poor prognosis. Widely metastatic disease in unusual sites is reported for small cell carcinoma, and rarely is the serum prostate-specific antigen level elevated. We report a case of recurrent prostate adenocarcinoma presenting as bowel obstruction due to widespread metastatic disease in the omentum and peritoneum. The histopathology of the omental metastasis was that of a large cell neuroendocrine carcinoma, without evidence of an adenocarcinoma. The absence of a clinically evident second primary tumor, the concomitant elevated serum prostate-specific antigen level, and the positive tissue immunoreactivities to prostatic markers all supported the prostatic origin of the omental tumor. Review of the importance of prostatic neuroendocrine differentiation and its unusual metastatic patterns is presented. (Arch Pathol Lab Med. 2000;124:1074-1076), With the advent of more sophisticated and sensitive methods, the number of prostate carcinomas reported to have focal neuroendocrine differentiation has steadily increased, its prevalence reaching 100% using special histochemical [...]

* Background.--Under the auspices of the College of American Pathologists, the current state of knowledge regarding pathologic prognostic factors (factors linked to outcome) and predictive factors (factors predicting response to therapy) in colorectal carcinoma was evaluated. A multidisciplinary group of clinical (including the disciplines of medical oncology, surgical oncology, and radiation oncology), pathologic, and statistical experts in colorectal cancer reviewed all relevant medical literature and stratified the reported prognostic factors into categories that reflected the strength of the published evidence demonstrating their prognostic value. Accordingly, the following categories of prognostic factors were defined. Category I includes factors definitively proven to be of prognostic import based on evidence from multiple statistically robust published trials and generally used in patient management. Category IIA includes factors extensively studied biologically and/or clinically and repeatedly shown to have prognostic value for outcome and/or predictive value for therapy that is of sufficient import to be included in the pathology report but that remains to be validated in statistically robust studies. Category IIB includes factors shown to be promising in multiple studies but lacking sufficient data for inclusion in category I or IIA. Category III includes factors not yet sufficiently studied to determine their prognostic value. Category IV includes factors well studied and shown to have no prognostic significance. Materials and Methods.--The medical literature was critically reviewed, and the analysis revealed specific points of variability in approach that prevented direct comparisons among published studies and compromised the quality of the collective data. Categories of variability recognized included the following: (1) methods of analysis, (2) interpretation of findings, (3) reporting of data, and (4) statistical evaluation. Additional points of variability within these categories were defined from the collective experience of the group. Reasons for the assignment of an individual prognostic factor to category I, II, III, or IV (categories defined by the level of scientific validation) were outlined with reference to the specific types of variability associated with the supportive data. For each factor and category of variability related to that factor, detailed recommendations for improvement were made. The recommendations were based on the following aims: (1) to increase the uniformity and completeness of pathologic evaluation of tumor specimens, (2) to enhance the quality of the data needed for definitive evaluation of the prognostic value of individual prognostic factors, and (3) ultimately, to improve patient care. Results and Conclusions.--Factors that were determined to merit inclusion in category I were as follows: the local extent of tumor assessed pathologically (the pT category of the TNM staging system of the American Joint Committee on Cancer and the Union Internationale Contre le Cancer [AJCC/UICC]); regional lymph node metastasis (the pN category of the TNM staging system); blood or lymphatic vessel invasion; residual tumor following surgery with curative intent (the R classification of the AJCC/UICC staging system), especially as it relates to positive surgical margins; and preoperative elevation of carcinoembryonic antigen elevation (a factor established by laboratory medicine methods rather than anatomic pathology). Factors in category IIA included the following: tumor grade, radial margin status (for resection specimens with nonperitonealized surfaces), and residual tumor in the resection specimen following neoadjuvant therapy (the ypTNM category of the TNM staging system of the AJCC/UICC). Factors in category lib included the following: histologic type, histologic features associated with microsatellite instability (MSI) (ie, host lymphoid response to tumor and medullary or mucinous histologic type), high degree of MSI (MSI-H), loss of heterozygosity at 18q (DCC gene allelic loss), and tumor border configuration (infiltrating vs pushing border). Factors grouped in category III included the following: DNA content, all other molecular markers except loss of heterozygosity 18q/DCC and MSI-H, perineural invasion, microvessel density, tumor cell-associated proteins or carbohydrates, peritumoral fibrosis, peritumoral inflammatory response, focal neuroendocrine differentiation, nuclear organizing regions, and proliferation indices. Category IV factors included tumor size and gross tumor configuration. This report records findings and recommendations of the consensus conference group, organized according to structural guidelines defined herein. (Arch Pathol Lab Med. 2000;124:979-994), College of American Pathologists Consensus Statement 1999 CATEGORY I FACTORS Local Extent of Tumor Assessed Pathologically (pT Category) Overview.--Despite universal recognition of the prognostic importance of the local extent of [...]

* Background.--Under the auspices of the College of American Pathologists, a multidisciplinary group of clinicians, pathologists, and statisticians considered prognostic and predictive factors in prostate cancer and stratified them into categories reflecting the strength of published evidence and taking into account the expert opinions of the Prostate Working Group members. Materials and Methods.--Factors were ranked according to the previous College of American Pathologists categorical rankings: category I, factors proven to be of prognostic importance and useful in clinical patient management; category II, factors that have been extensively studied biologically and clinically but whose importance remains to be validated in statistically robust studies; and category III, all other factors not sufficiently studied to demonstrate their prognostic value. Factors in categories I and II were considered with respect to variations in methods of analysis, interpretation of findings, reporting of data, and statistical evaluation. For each factor, detailed recommendations for improvement were made. Recommendations were based on the following aims: (1) increasing uniformity and completeness of pathologic evaluation of tumor specimens, (2) enhancing the quality of data collected pertaining to existing prognostic factors, and (3) improving patient care. Results and Conclusions.--Factors ranked in category I included preoperative serum prostate-specific antigen level, TNM stage grouping, histologic grade as Gleason score, and surgical margin status. Category II factors included tumor volume, histologic type, and DNA ploidy. Factors in category III included perineural invasion, neuroendocrine differentiation, microvessel density, nuclear roundness, chromatin texture, other karyometric factors, proliferation markers, prostate-specific antigen derivatives, and other factors (oncogenes, tumor suppressor genes, apoptosis genes, etc). (Arch Pathol Lab Med. 2000;124:995-1000), College of American Pathologists Consensus Statement 1999 CATEGORY I Prostate-Specific Antigen[1-6] Method Variation Issues * Multiple methods are available ([is greater than] 30 different assays). Hybritech and Abbott AXSYM are [...]