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Background The diagnostic algorithm for idiopathic pulmonary fibrosis (IPF) guidelines has some shortcomings. The aim of the present study was to develop a novel software, “IPFdatabase”, that could readily apply the diagnostic criteria per IPF guidelines and make a ‘virtual’ diagnosis of IPF. Methods Software was developed as a step-by-step compilation of necessary information according to guidelines to enable a diagnosis of IPF. Software accuracy was validated primarily by comparing software diagnoses to those previously made at a Center for Interstitial Lung Diseases. Results Clinical validation on 98 patients (68 male, age 61.0 ± 8.5 years), revealed high software accuracy for IPF diagnosis when compared to historical diagnoses (sensitivity 95.5%, specificity 96.2%; positive predictive value 95.5%, negative predictive value 96.2%). A general radiologist and a general pathologist reviewed relevant data with and without the new software: interobserver agreement increased when they used the IPFdatabase (kappa 0.18 to 0.64 for radiology, 0.13 to 0.59 for pathology). Conclusion IPFdatabase is a useful diagnostic tool for typical cases of IPF, and potentially restricts the need for MDDs to atypical and complex cases. We propose this web-designed software for instant accurate diagnosis of IPF by virtual means and for educational purposes; the software is readily accessed with mobile apps, allows incorporation of updated version of guidelines, can be utilized for gathering data useful for future studies and give physicians rapid feedback in daily practice.

Context.— Prostate cancer is a common malignancy, and accurate diagnosis typically requires histologic review of multiple prostate core biopsies per patient. As pathology volumes and complexity increase, new tools to improve the efficiency of everyday practice are keenly needed. Deep learning has shown promise in pathology diagnostics, but most studies silo the efforts of pathologists from the application of deep learning algorithms. Very few hybrid pathologist–deep learning approaches have been explored, and these typically require complete review of histologic slides by both the pathologist and the deep learning system. Objective.— To develop a novel and efficient hybrid human–machine learning approach to screen prostate biopsies. Design.— We developed an algorithm to determine the 20 regions of interest with the highest probability of malignancy for each prostate biopsy; presenting these regions to a pathologist for manual screening limited the initial review by a pathologist to approximately 2% of the tissue area of each sample. We evaluated this approach by using 100 biopsies (29 malignant, 60 benign, 11 other) that were reviewed by 4 pathologists (3 urologic pathologists, 1 general pathologist) using a custom-designed graphical user interface. Results.— Malignant biopsies were correctly identified as needing comprehensive review with high sensitivity (mean, 99.2% among all pathologists); conversely, most benign prostate biopsies (mean, 72.1%) were correctly identified as needing no further review. Conclusions.— This novel hybrid system has the potential to efficiently triage out most benign prostate core biopsies, conserving time for the pathologist to dedicate to detailed evaluation of malignant biopsies.

Background Histological evaluation of ulcerative colitis (UC) patients has been debated ever since the first description of the disease and its role in follow-up has never been fully established. Recent evidence suggests an added benefit in accuracy when evaluating if the patient is in remission. Unfortunately, there are several different histological indices, and it is difficult to compare outcomes where different scores are applied. Histopathological evaluation is prone to subjective biases, despite the use of indices. In addition, these indices are developed by expert IBD pathologist, but applied at large, by general pathologist. Therefore, we evaluated the three most applied histological indices for UC on samples from patients in remission to compare test qualities and estimate their usefulness to identify remission by both general and GI specialized pathologist. Method Mucosal biopsies from 41 UC patients in clinical and endoscopic remission were collected as part of a larger study on UC. Three pathologists blinded to the patients’ clinical status evaluated them using Geboes score (GS), Nancy Index (NI) and Robarts Histopathological Index (RHI). We calculated the agreement between the pathologists using Inter-class correlation (ICC) and visualized it with ICC-plots and Bland-Altman plots. Association between clinical factors and histological category were analysed by Fisher’s exact test. Results The ICC value for GS, RHI and NI were 0.85, 0.73 and 0.70 respectively. The limits of agreement were ±6.1, ±4.0 and ±1.4, for GS, RHI and NI, respectively. Mayo endoscopic subgrade and UC clinical score did not show association with any histological scores. Despite clinical and endoscopic remission 7–35% of the patients displayed histological inflammation on a level classified as active disease, depending on the index and cut-off. Conclusion A substantial amount of UC patients in clinical and endoscopic remission display inflammation on a histological level, but the ability to classify these patients accurately and consistently could be improved.

The skin is the biggest organ of our body; hence limitless diversity of the various types of lesions leaves a general pathologist struggling. This diversity ranges from allergic, inflammatory, bullous to melanocytic and non-melanocytic neoplasms including a wide variety of adnexal tumours. At times distinguishing features are subtle, and not enough clinical presentation and details are provided which are mandatory for critical evaluation of skin biopsies in correct perspective. For the obvious reason, a general pathology atlas cannot do justice with this subject as the subject demands; however an attempt is made to adequately describe diagnostic features of more commonly encountered lesions.

The gastrointestinal tract is the most common extranodal site of involvement by lymphoma, with B-cell tumors outnumbering T-cell tumors by a wide margin. Diffuse large B-cell lymphoma is the most common lymphoid neoplasm involving the gastrointestinal tract; but a variety of other B- and T-cell neoplasms occur in the gastrointestinal organs, often with characteristic associations and/or manifestations. Although the diagnosis of gastrointestinal lymphomas can sometimes seem daunting to general pathologists, a knowledge of the most commonly encountered entities, in combination with a reasoned and pragmatic approach to the diagnostic workup, makes it possible to approach most cases with confidence.

Introduction The classification of lymphomas by the World Health Organization (WHO) and its updates is widely known and adopted by hematopathologists. However, its application in clinical practice is poorly understood. Objective Analyze and compare an initial evaluation by a general pathologist in relation to an evaluation by a hematopathologist. Material and methods Retrospective case series, which included patients with the novo lymphoma diagnosis, relapse and resistance/failure of treatment. An initial evaluation was issued by a general pathologist, which was then sent to a hematopathologist for a revision. Discrepancies were sorted by: “Major”, where the therapeutic approach was modified, “Minor”, where the diagnosis changed, but therapeutic approach remain the same, and “In Accordance”, meaning full concordance between initial evaluation and revision. Results Fourteen cases were analyzed (5 females and 9 males). Mean age was 44 years. In Accordance were found in 2 cases (14%), Major discrepancies were found in 11 (79%) and Minor Discrepancies were found in 1 (7%). Immunohistochemical studies were performed, presenting a variance between initial evaluation and revision of 5 (0–8) and 9.5 (6–18), respectively. Conclusion There is a great need to generate pathologists with the necessary training and experience to perform the diagnostics attached to the current WHO classification.

Background and Objectives: Management of oral premalignant lesions depends on clinical assessment and grading of oral epithelial dysplasia (OED), which remains one of the most important predictors of malignant potential. Numerous grading systems for OED exists with varying sets of assessing criteria and are largely considered subjective. The present study attempted to assess the inter- and intra-observer variability in three grading systems: Binary system, WHO (2005) and Ljubljana systems. Methodology: Histopathological grading of 63 cases of leukoplakia was performed by two oral pathologists and one general pathologist, who were blinded, using all the three grading systems at different time intervals and was repeated twice. Inter- and intra-observer variability was then evaluated by multivariate kappa analysis. Results: Inter-observer agreement in the two set of observations was found to be “slight” in WHO (k = 0.001 and 0.039), “slight” and “poor” in binary (k = 0.108 and −0.007), “poor” and “slight” in Ljubljana's (k = −0.027 and 0.106) grading systems. Intra-observer agreement ranged from “slight” to “fair” (k = 0.128 and 0.295) in WHO, “fair” to “moderate” (k = 0.224 and 0.420) in binary and “slight” to “fair” (k = 0.161 and −0.353) in Ljubljana's grading systems. Conclusions: The binary system of classification proved to have an overall better inter- and intra-observer agreement. This study also showed better intra-observer agreement in all the grading systems as well as in individual histopathological parameters. Defining the individual parameters more objectively with the reproducible structuring of the grading systems and training of the pathologists would help reduce the variability in diagnosing dysplasia.

Purpose: To determine the association between conjunctival epithelial dysplasia (squamous intraepithelial neoplasia) and its melanosis (microscopic non-proliferative melanin pigmentation) in conjunctival biopsies. Methods: In this retrospective case series, histopathological slides from all conjunctival biopsies obtained in Khalil Hospital affiliated with Shiraz University of Medical Sciences for a period of 6 years (April 2009–July 2015) were reviewed. After considering the exclusion criteria (non-melanotic pigmentation, melanocytic proliferations, and squamous cell carcinoma), conjunctival biopsies were divided histopathologically into two groups of dysplastic and non-dysplastic. Then, the slides were reviewed by one ophthalmopathologists and one general pathologist. Melanin pigmentation was recorded in both groups as 0, 1+, 2+, and 3+. The data were analyzed, and the groups were compared. Results: Overall, 685 cases with a mean age of 47.78 (±17.74) years were included in this study. Dysplastic and non-dysplastic groups comprised 135 (19.7%) and 550 (80.3%) specimens, respectively. Seventy-six percent (76%) of the specimens in the dysplastic group versus 40% in the non-dysplastic group had melanosis (P = 0.001). However, the degree of dysplasia (1+, 2+, and 3+) was not statistically correlated with the degree of melanosis (1+, 2+, and 3+) (P = 0.393). Conclusion: Our results demonstrated that melanosis is a common finding in conjunctival epithelial dysplasia and might indicate an association with conjunctival epithelial dysplasia.

Background Many clinically indicated skin biopsies show minimal histological changes referred to as "invisible dermatoses." They pose a challenge to general pathologists and dermatopathologists. This study determines the discrepancy between the general pathologists' diagnosis and the dermatopathologist's diagnosis and helps define a pathway for reaching the correct diagnosis. Methods In total, 81 skin cases were selected from a tertiary hospital pathology department. They were diagnosed by general pathologists as "no specific diagnosis," or "minimal pathologic changes." These cases were reviewed carefully and diagnosed by a dermatopathologist. His diagnoses were compared with the original diagnoses. Results Out of the 81 cases, 43 cases (53%) were reported by the dermatopathologist to have a specific diagnosis while 38 cases (46.9%) remained nonspecific. Both inflammatory and neoplastic diagnoses of potential clinical significance were made in the first group of 43 cases. The remaining 38 cases with nonspecific results were due to inadequate biopsy, inactive lesions or inadequate clinical data. Conclusion "Invisible dermatoses" describes skin diseases with clinically evident but histologically hidden changes. They are difficult cases for general pathologists and dermatopathologists to diagnose. Hence, it is important to be aware that minor changes on a skin biopsy do not mean it is disease-free.

Hematopathology remains a difficult diagnostic field. With the significant ongoing changes in the classification system that happened over the past several decades, the general pathologist faces many challenges when dealing with patients suspected to have lymphoma or leukemia. The authors assessed referred hematopathology cases that were reviewed by specialized hematopathologists. Of 309 cases, major discrepancy was found in 23% of them. The discrepancy ranged from lymphoma reclassification to other major revisions that had significant impact on patient treatment and management. This paper highlights some of the challenges that may face the general practicing pathologist when dealing with suspected hematopoietic neoplasms.

As the information obtained from previable fetal and stillbirth autopsies is used not only to explain the loss to the parents, but for future pregnancy planning, general pathologists need to be comfortable in dealing with these autopsies. The importance of an adequate fetal examination has been emphasized in a recent policy on the subject by the American Board of Pathology http://www.abpath.org/FetalAutopsyPoli'cy.pdf. This second review paper covers the approach to hydrops fetalis. The approach to the nonanomalous and anomalous fetus was covered in the first part of this series.

ContextMost sellar region masses (85%–90%) are pituitary adenomas; however, other neoplasms or even inflammatory or cystic nonneoplastic lesions may occasionally be encountered in this location. A practical, non–electron-microscopically based approach is essential for the daily practice of diagnosing and subclassifying adenomatous and nonadenomatous sellar region lesions.ObjectiveTo provide an algorithmic approach to sellar region masses for the pathologist and to formulate a cost-effective, limited panel of stains and immunostains that can be used in daily practice at most small to medium-sized centers.DesignPool collective experience of 3 neuropathologists practicing at academic medical centers with expertise in diagnosis and treatment of sellar region masses to craft a single-page algorithmic diagram and to liberally illustrate the range of lesions present in the sellar region.ResultsAfter formulating a differential diagnosis, the general pathologist can generate a confident final diagnosis of adenoma using 1 histochemical (reticulin) and 1 immunohistochemical (synaptophysin) stain, supplemented by 5 immunohistochemical stains (CAM5.2, follicle-stimulating hormone, growth hormone, prolactin, and adrenocorticotropic hormone), which provide subtyping of the adenoma in the overwhelming majority of examples. CAM5.2 and clinical information further help identify clinically aggressive variants such as sparsely granulated growth hormone adenomas and silent adrenocorticotropic hormone adenomas, respectively. MIB-1, thyroid transcription factor 1, and S-100 protein can be of further assistance in select cases where increased mitotic activity or possible nonadenomatous spindle cell lesions are suspected.ConclusionsAdenomas, normal anterior or posterior gland, and nonadenomatous masses can be easily diagnosed in a nontertiary pathology laboratory setting.

This article shows the evolving history of the Banff classification for allograft biopsies and gives helpful clues on properly diagnosing each classification. In today’s pathology practice, a general pathologist who does not regularly sign out many transplant kidney cases may be unsure of the details that the nephrologist may need to know for proper patient treatment. This article also discusses the latest Banff classification and the differential diagnoses one may encounter when diagnosing an allograft biopsy.

As the information obtained from previable fetal and stillbirth autopsies is used not only to explain the loss to the parents, but for future pregnancy planning, general pathologists need to be comfortable in dealing with these autopsies. The importance of an adequate fetal examination has been emphasized in a recent policy on the subject by the American Board of Pathology http://www.abpath.org/FetalAutopsyPolicy.pdf. This review paper covers the approach to the fetal and stillbirth autopsy. This first article covers the approach to the nonanomalous and anomalous autopsy. Hydrops fetalis will be covered in the second part of this series to be published subsequently.

Objectives To evaluate the accuracy of reporting of the Leibovich score (LS) by general pathologists at our centre by comparing the LS in their initial reports with the LS in subsequent review reports by our specialist urological pathologists. We also assessed whether a revision in the LS subsequently altered the risk group. Patients and Methods In all, 54 consecutive patients had had their initial histology after nephrectomy reported by a general pathologist between August 2008 and March 2012. The histological slides were subsequently re-reviewed by the two specialist urological pathologists and revised LS were given if appropriate. The cases were then discussed at the Uro-oncology Multi disciplinary meeting (MDT) and the reason for the revised LS was discussed with the participating panel and reviewed by the uropathologist. Results The general pathologists allocated the 54 patients into low- (13 patients), intermediate- (25) and high-risk (16) categories. After a review of the slides by the specialist urological pathologists and discussion at the MDT meeting the LS was revised in 23 patients (42.6%). The 23 patients who had their LS revised were divided into two groups for the purpose of the present study. On revision of the LS a total of eight patients (14.8%) changed their prognostic group. The change in the prognostic group in the eight patients was increased from intermediate- to high-risk in four patients. There was a reduction in the LS in four patients, which was from high- to intermediate-risk category in one patient and intermediate- to low-risk in three patients. Conclusion In the present study, histopathology review by a specialist urological pathologist led to a change in LS in 42.6% of cases leading a change in risk grouping in 14.8% of cases. This level of discrepancy is not insignificant. However, the few cases evaluated in the present study does limit robust conclusions and further studies are needed to investigate this issue, so that recommendations can be made to enhance diagnostic accuracy and reproducibility.

Context.—Like other pathology services in developing settings, pediatric pathology in Africa is faced with major challenges such as limited access to resources and few opportunities for professional advancement. Additionally, the discrepancy between the large burden of pediatric diseases, many of which individually are rare enough to prove challenging to the general pathologist, and the amount of specialized training available compounds the underlying problems and makes the provision of a high-quality service difficult. Pediatric neoplasms in particular are a chief cause for concern among general pathologists practicing in Africa.Objectives.—To provide relevant pediatric pathology information with an emphasis on pediatric malignancies to pathologists practicing in Africa, where children represent a very high proportion of the population and training in pediatric pathology is incomplete.Data Sources.—Authors' experience and relevant literature.Conclusions.—The limitations inherent in working within a low-resource setting may be reduced by thoughtful and purposeful triaging of specimens, prudent use of cytology in facilitating rapid and inexpensive diagnoses, and collaboration within and outside of the continent. Increased investment in and advocacy for child health, including the creation of additional hospitals dedicated to the care of children, are likely necessary to significantly advance children's health in the region.

Clinical management of primary cutaneous melanomas is based on histopathological staging of the tumour. The aim of this study was to investigate, in a non-selected population in clinical practice, the agreement rate between general pathologists and pathologists experienced in melanoma in terms of the evaluation of histopathological prognostic parameters in cutaneous malignant melanomas, and to what extent the putative variability affected clinical management. A total of 234 cases of invasive cutaneous malignant melanoma were included in the study from the Stockholm-Gotland Healthcare Region in Sweden. Overall interobserver variability between a general pathologist and an expert review was 68.8-84.8%. Approximately 15.5% of melanomas 1 mm after review. In conclusion, review by a pathologist experienced in melanoma resulted in a change in recommendations about surgical excision margins and/or sentinel node biopsy in subgroups of Ti melanomas.

Clear cell tumors of the central nervous system (CNS) encompass a variety of tumor subtypes that are challenging to diagnose given their similar morphologic features. Here, I use a case-based approach to review the clinicopathologic and radiologic features to help guide the general pathologist in the diagnosis of clear cell tumors of the CNS. First, the reader is invited to study 6 images of different CNS tumors with clear cell morphology. Then, each case is expanded in light of clinical and radiologic data and includes a histopathologic description of the tumor. A brief discussion follows with up-to-date diagnostic tools. Finally, I propose an immunohistochemical algorithm to navigate through the complex features that characterize clear cell tumors of the CNS. This review aims to provide a comprehensive approach to diagnosing clear cell neoplasms of the CNS based on improved assessment of the clinicopathologic and radiologic features of each entity.

Intraoperative assessment of pancreatic parenchymal margin during pancreatectomies is challenging and misinterpretation by the pathologist is a cause of incorrect frozen section (FS) diagnosis. Although the current literature supports that pancreatic margin FS diagnosis and its accuracy has no impact on the patient outcome for pancreatic ductal adenocarcinoma (PDAC) patients and reexcision in an attempt to achieve a negative intraoperative pancreatic margin after positive FS is not associated with increased overall survival; still it remains a routine practice in many institutions. To this end, we sought to assess the interobserver variation and accuracy of FS diagnosis between subspecialized gastrointestinal/pancreatobiliary (GI) and general pathologists. Seventy seven consecutive pancreatic parenchymal margin FSs performed on pancreatectomies for PDAC from 2010 to 2013 were retrieved at our institution. These were retrospectively evaluated by 2 GI and 2 general pathologists independently without knowledge of the original FS diagnosis or the final diagnosis. The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of GI versus general pathologist was 97.8% versus 87.5%, 61.1% versus 66.7%, 78.6% versus 41.4%, 95% versus 95.2%, and 93.5% versus 85.1%, respectively. The interobserver agreement between GI and general pathologists was fair (κ = .337, P < .001). The interobserver agreement between 2 GI pathologists was fair (κ = .373, P = .0005) and between 2 general pathologists was slight (κ = .195, P = .042). Although overall accuracy of subspecialized GI pathologists was higher than that of general pathologists, none had an accuracy of 100%. Our study reaffirms the challenging nature of these FSs.

Backgrounds Urologists use biopsy Gleason scores for patient counseling, prognosis prediction, and decision making. The accuracy of Gleason grading is very important. However, the variability of Gleason grading between general pathologists cannot be overlooked. Here we evaluate the discrepancy in the Gleason grading between 2 urologic pathologists and general pathologists as well as improvement in the accuracy of Gleason grading by general pathologists as a result of review by urologic pathologists. Methods The subjects enrolled in the study were 755 patients who underwent prostate needle biopsy at affiliate hospitals of Nara Medical University over a period of 2 years. The biopsy samples were diagnosed by general pathologists. All biopsy samples were sent to Nara Medical University where they were diagnosed by 2 urologic pathologists. The results were then returned to the general pathologists. We compared the diagnostic accuracy of the general pathologists with that of the urologic pathologists for the parameters of no malignancy, atypical small acinar proliferation, high grade prostatic intraepithelial neoplasia and Gleason score (6, 3 + 4, 4 + 3 and 8–10). We then evaluated the concordance rate between the general and urologic pathologists for each of four consecutive 6-month periods. Results The overall concordance rate of urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 71.8 % (140/198), 79.8 % (168/225), 89.7 % (166/185) and 89.9 % (133/148), respectively. The concordance rate of the Gleason score between urologic pathologists and general pathologists in the first, second, third and last 6-month periods was 47.5 %(38/80), 62.6 %(57/91),76.9 %(50/65) and 78.7 %(48/61), respectively, and the kappa value was 0.55, 0.68, 0.81 and 0.84, respectively. The concordance rate improved significantly over the course of each period (P = 0.04). Conclusion The concordance rate of the Gleason grading between the general pathologists and the urologic pathologists was 47.5 %. However, improvement of the concordance rate as a result of review by the urological pathologist could be seen.

The unique pattern of distribution of bone tumors and the nature of their interaction with native bone creates distinct radiologic-pathologic correlates that are critical in the diagnostic evaluation of these lesions. The rarity of these lesions makes them especially daunting for the general pathologist and radiologist faced with the diagnostic evaluation of these entities. This chapter presents a richly illustrated synopsis of common pediatric bone lesions based on a rational integrated approach incorporating the gross anatomy of the lesions (via radiologic imaging) and pathologic analysis. This chapter presents entities and their mimics based on their anatomic location within the bone just as they would present in “real life”. This integrated approach, with emphasis on overlapping features of different entities, provides practical guidance for health care providers and trainees.

This brief overview of disorders affecting the biliary tree in children includes both common and rare entities. The general pathologist will encounter them infrequently but this article may act as an aide-memoire in what to consider in evaluating paediatric liver or gall bladder specimens. Many aspects of the pathology of hepatobiliary disease in children are not yet fully understood, therefore providing opportunities for research.

e12006Background: Changes in classic pathological features of lymph node negative breast cancer (LNBC) can have a profound impact on local-regional and systemic therapy recommendations. The impact of routine subspecialty pathology review on the care of these patients has not been well described. Methods: Women diagnosed with LNBC from January 1 to December 21, 2012 referred to our cancer centre were identified. As per routine institutional practice, patients ≤ 65 years whose pathology had originally been reported by a general pathologist, had their pathology automatically sent for subspecialty review by a breast pathologist. Medical records were examined to determine if original pathology was changed and if treatment recommendations were altered. Results: Of 468 patients diagnosed with LNBC, 187 patients had their pathology initially reported by a general. Eighty-two (82/187) had at least one change on subspecialty pathology review including increase in tumour grade (35), increase in tumour size (18), and...

Objective Guidelines on histopathological techniques and reporting for adult and paediatric gastrointestinal neuromuscular pathology have been produced recently by an international working group (IWG). These addressed the important but relatively neglected areas of histopathological practice of the general pathologist, including suction rectal biopsy and full-thickness intestinal tissue. Recommendations were presented for the indications, safe acquisition of tissue, histological techniques, reporting and referral of such histological material. Design Consensual processes undertaken by the IWG and following established guideline decision group methodologies. Results and conclusion This report presents a contemporary and structured classification of gastrointestinal neuromuscular pathology based on defined histopathological criteria derived from the existing guidelines. In recognition of its origins and first presentation in London at the World Congress of Gastroenterology 2009, this has been named ‘The London Classification’. The implementation of this classification should allow some diagnostic standardisation, but should necessarily be viewed as a starting point for future modification as new data become available.

The aim of the present study was to examine the impact of a specialized pathologist on the accuracy of frozen section analysis for adnexal masses. We included women who underwent frozen section diagnosis for adnexal mass surgery. A specialized and a general pathologist read the sections. We calculated sensitivity, specificity, positive and negative predictive values, and accuracy for the whole series, as well as for the specialized and general pathologist groups. We included 325 patients; in 103 patients (31.7%), frozen section diagnosis was performed by the specialized and in 222 (68.3%), by the general pathologist. There was a significant difference in terms of correspondence between the specialized and the general pathologist groups (P= 0.024). We registered four overdiagnoses (both performed by the general pathologist [1.8% vs 0%]) and 56 underdiagnoses of which 14 (13.6%) were made by the specialized pathologist and 46 (20.7%) by the general pathologist. In 14 cases (4.3%), diagnosis could not be made on frozen section and was postponed to final histology for definitive diagnosis (1/103 [0.9%] for the specialized pathologist and 13/222 [5.8%] for the general pathologist). Our data confirm previous reports on the accuracy of frozen section analysis of adnexal masses and show a significant positive impact of the specialized pathologist as opposed to the general pathologist.

After postings at home and abroad as a general pathologist, Anthony John Chetwynd Balfour (Tony) was appointed to Halton in 1976. This meant that he became involved with all air accidents in the UK and military planes overseas. Often on site as an aviation pathologist in the RAF (for example, in Lockerbie …

Peter Stewart Macfarlane served with the Paratroop regiment in Palestine during his national service. He then worked in general practice in his home town of Greenock and trained as a general pathologist in Glasgow’s Western Infirmary before taking a consultant post in the Stirling and Falkirk royal infirmaries in 1959. In 1971 he supervised the organisation of the …

Introduction: Smartphone applications (apps) have become increasingly prevalent in medicine. Due to most pathologists, pathology trainees, technicians, and medical students use smartphones; apps can be a different way for general pathology education. “General pathologist-helper (GP-HELPER)” is a novel app developed as a reference tool in general pathology and especially for general pathologists, developed for Android and iOS platforms. Materials and Methods: “GP-HELPER,” was created using Mobincube website platform. This tool also integrates “FORUM GP-HELPER,” an external website created using Miarroba website ( http://forum-gp-helper.mboards.com ) and “COMMUNITY GP-HELPER” a multichannel chat created using Chatango website platform. Results: The application was released in July 2015, and it is been periodically updated since then. The app has permanent information (offline data) about different pathology protocols (TNM latest edition, protocols regarding management of tumors of unknown primary origin, and flowcharts for some of the most difficult tumors to diagnose) and a database with more than 5000 immunohistochemistry results from different tumors. Online data have links to more than 1100 reference pathology video lectures, 250 antibodies information, more than 70 pathology association websites, 46 pathology providers, and 78 outstanding pathology journal websites. Besides this information, the app has two interactive places such as “FORUM GP-HELPER” and “COMMUNITY GP-HELPER” that let users to stay in touch everywhere and every time. Expert consult section is also available. Conclusions: “GP-HELPER” pretends to integrate offline and online data about pathology with two interactive external places in order to represent a reference tool for general pathologists and associate members.

Edited by A Neil Crowson, Cynthia Magro, Martin C Mihm Jr Published by Lippincott Williams and Wilkins, Philadelphia, USA, 2010, pp 455, hardback, £108. ISBN-13: 978-0-7817-7205-1 An ever-increasing number of dermatopathology texts are now appearing in the book shops. There are books for beginners, atlases, those focusing on very specific areas as well as the better known larger tomes which embrace the whole subject in great detail. When buying a book, it can prove to be a difficult decision when faced with such a bewildering array of titles. This new addition to the list only focuses on non-lymphoid neoplasia of the skin and is aimed at the general pathologist as well as dermatologists with an interest in histology. The book is split into 11 chapters, four …

Molecular diagnostic tools form a necessitity in the modern practice of pathology. This review aims to introduce some basic principles of molecular diagnostics to a pathologist involved in the practice of histology. Some common clinical scenarios and the application of molecular techniques in those settings to obtain an accurate diagnosis is discussed.

​FormerFormer consultant pathologist Bradford Royal Infirmary (b 1912; q Cambridge and Middlesex Hospital, London, 1938; MD, FRCPath), d 26 January 2006. Figure 1 Herbert Spencer Kellett (“Bert”) was a well-respected pathologist, particularly in the histopathology of lymphomas and bone tumours. After his first year at Emmanuel College, Cambridge, he changed from chemistry to medical subjects, obtaining a first in biochemistry part 2 on the Krebs cycle. He was appointed as the second consultant pathologist to the Bradford Royal Infirmary in 1948, starting as a general pathologist dealing with all aspects of pathology, and retired in 1977. In retirement he continued to work part time at the Leeds Cancer Centre, where he set up a regional register of lymphomas at Cookridge. Predeceased by his wife, Muriel, in 1995, he leaves two sons and four grandchildren.

There is little guidance on which placentas should be subjected to histopathology, how to conduct this investigation or how to evaluate the results. The aims of our study were to: (a) determine if requests for placental pathology adhered to local guidelines; (b) correlate clinical diagnosis with histological report; and (c) determine if the expertise of the pathologist influenced the report. Guidelines were established for requesting placental histology. Pathology reports during two 3-month periods were studied and inappropriate requests identified. The clinical diagnosis was compared with the pathological report. During the first 3 months, all examinations were performed by a general pathologist. During the second 3 months, a paediatric pathologist performed all the examinations. A histology scoring system was devised to standardise reports. Its application in the first and second study periods was compared. According to guidelines, 190 placentas should have been submitted for histology during the 6 mont...

The Neuropathology of Dementia . Edited by margaret m esiri and james h morris.(Pp 440; £75.00.) Published by Cambridge University Press, Cambridge. 1997. ISBN 0-521-43311-8. This distinguished pair of Oxford neuropathologists offer a new book to the “pathologist faced with the task of determining the cause of dementia in cases requiring post-mortem diagnosis”. They are credited with editorship; actually, they have written 11 chapters and two appendices, among them those chapters which deal with the pathological processes which account for 90% of adult dementia (Alzheimer’s disease, vascular disease, and Lewy body disease). For the remaining eight chapters and appendix, Professor Esiri and Dr Morris recruited acknowledged experts. After an introductory chapter on dementia, which describes the clinical syndrome and describes its neuroanatomical basis, there are two chapters in which Esiri and Morris define the practical approach to the pathological diagnosis of dementia. The first of these chapters describes (and illustrates diagrammatically) the neuroanatomical structures which are particularly pertinent to cases of dementia. The diagrams of neural connectivity in the hippocampus and neocortex may daunt the general pathologist, but the chapter provides a useful summary of pathological processes which affect each anatomical region of the brain; that is to say, it offers a regional approach to the differential diagnosis of dementia. The second of these chapters …

by EDWARD P. RICHARDSON, JR., and UMBERTO De GIROLAMI, 176 pp., ill., Philadelphia, W.B. Saunders, 1995. $55.00 Peripheral nerve pathology is off the beaten track for most pathologists, even for many neuropathologists. This monograph, part of the Major Problems in Pathology series, is primarily intended for the general pathologist involved in diagnostic work, although the authors hope that it may also be of benefit to neurologists involved in clinical diagnosis and treatment of patients with peripheral neuropathies. The material is arranged conventionally, beginning with introductory chapters on normal peripheral nerve anatomy and general pathologic reactions …

Malignant tumors of infants and children, unlike their adult counterparts, are commonly undifferentiated or show minimal evidence of differentiation. Because of this, many of these tumors pose a formidable dilemma to the general pathologist in distinguishing one from another. A broad sampling of the more common malignant neoplasms and of newly recognized histologic subtypes which are restricted more or less to the pediatric age group is presented. The minimal microscopic criteria required to establish a diagnosis are given using widely accepted pathologic classifications and seminal journal references as a guide. Ancillary microscopic features, helpful histochemical stains, immunohistochemistry, and ultrastructural morphology are described for most tumors. Histologic distinction from diagnostic mimickers is discussed. Where appropriate, histologic grading and tumor subclassification are presented and their prognostic relevance is reviewed.

The general pathologist occupies a unique position in the spectrum of medicine in that he represents a specialty to which most other medical specialists must refer. In smaller hospitals the general pathologist is often called upon to suggest tests to aid in diagnosis while in larger hospitals he must be more or less of an authority in neuropathology as well as in general pathology, for he must render diagnoses acceptable to the neurologic surgeon, the dermatologist and the ophthalmologist. The rise in special pathology has followed the rising star of the specialty in question rather than that of pathology in general. The contributions of Fuchs and Parinaud to ophthalmologic pathology, of Unna, Boeck and Darier to dermatologic pathology and of Nissl, Alzheimer, Charcot, Marie, Dejerine and Freud to neurologic pathology were basically stimulated by clinical rather than by general pathologic study. The expanding horizon of the field of pathology tends to remove the average worker from the individual specialties, and this is especially true of neuropathology where the details of the anatomy, the poor accessibility of the tissues under consideration and the complexity of the pathologic changes tend to build a formidable barrier between the pathologist and his work. This review of neuropathologic methodology for the general pathologist may well have been designated neuropathologic errors and safeguards. The first major obstacle to the adequate pathologic study of a given case may begin with the limitations of the necropsy permit. The clinician should see to it that permission is granted for removal of the brain and the spinal cord if the clinical picture so warrants. Adequate consultation between the clinical neurologist or neurologic surgeon is invaluable before the autopsy is begun, for many times the medical record is not sufficiently detailed and important features of the case are carried in the mind of the attending physician. Since all neurologic signs and symptoms are referable to the site or sites of the pathologic process rather than to its nature, the pathologist does not lose face in asking the neurologist what tissues he believes to be important. In some instances of peripheral neuritis for example, the pathologic process is restricted to the nerve fibers in the distal portions of the extremities. I have often received a specimen bottle filled with nerve bundles from the brachial and lumbosacral plexuses with the remark, "You should be satisfied this time"—yet the. specimen is worthless. Every pathologist has a routine method for removal of the brain and spinal cord, yet in important cases the removal must be individualized to fit the pathologic

In the paper on the responses of intestinal epithelium to irradiation which Dr. Lamerton has contributed this afternoon, he has raised various matters which cannot fail to interest the general pathologist, concerned as the latter is with the broad problems of the reactions of cells to the operation of a wide variety of noxious agents. While I can claim no special knowledge of the mechanism through which exposure to ionizing radiations damages cells and tissues, I can perhaps usefully review a few instances in which exposure to potentially harmful conditions of other kinds can be successfully overcome. For although every injurious factor must in one way or another disturb its internal economy, each cell possesses in miniature, what the body as a whole displays so conspicuously, a capacity for compensation or adaptation, so that once the damaging agent has ceased to act, a train of reparative processes is set in motion which can mitigate, or even obliterate all traces of, the original injury. It will be bes...

An imprint method used as a means to provide rapid diagnosis at the time of postmortem examination is described. Although this method is not new, it has hitherto received relatively little attention in this country. The method is simple and as reliable as the frozen-section method, yet less time-consuming. Experience has shown that this technic can be employed in the diagnosis of cancer as well as nonneoplastic diseases. It is the intent of this communication to emphasize the usefulness of the technic and its wide application in postmoretn material. Smears so prepared can be readily interpreted by the general pathologist.

The ability of the Mohs surgeon to interpret frozen sections generated during Mohs surgery has been questioned recently. In this study 1000 Mohs micrographie slides were interpreted by a Mohs surgeon and subsequently by a general pathologist. The disputed slides were then reviewed independently by two Mohs surgeons, two pathologists, and a dermatopathologist. Overall, there was a 98.9% agreement in interpretation among the Mohs surgeons, the pathologists, and the dermatopathologist. Results would indicate that a well-trained and experienced Mohs surgeon is competent to interpret slides prepared under his or her supervision during Mohs surgery.

The Commonwealth of Massachusetts medicolegal system is discussed. The current situation necessitates active participation by general pathologists. The rudimentary skills needed in forensic pathology are delineated. It is emphasized that since medicolegal cases are nationally increasing and since recent comprehensive studies confirm the present shortage of full time forensic pathologists, it is imperative that general pathologists become more involved.

Am J Clin Pathol 67: 440–443, 1977. An autopsy protocol offers procedures and technics that can be utilized by the general pathologist in performing postmortem examinations in cases of skin- and scuba-diving deaths.

Siegmund (1956), although a general pathologist, made constant efforts to view the phenomena occurring in the periodontium in the context of processes known and described in general pathology. He considered that the phenomena which are the subject of periodontology, whatever their anatomo-clinical names, were fundamentally dependent on vascular functional disturbances. Irritations at the periphery of the periodontium, or those transmitted deeply through the medium of the tooth, would lead to ischaemia or hyperaemia, depending on the situation, and give rise to possibilities for dystrophic or inflammatory lesions.

There has been for many years an almost complete lack of communication between the general pathologist and the experimental morphologist on the question of the ability of skeletal muscle to regenerate. I have consistently taught first-year medical students that the difference between muscle regeneration in the lowly salamander on which I work and the mammal was merely one of degree. This idea, I now realize, was routinely erased during the second year, when the same medical students were told by pathologists that neither skeletal nor cardiac muscle can regenerate in the human. The writing of an editorial on the subject . . .

In this discussion of grading of tumors of the central nervous system, I would like to confine my remarks to three phases of the problem. First, the historical background of grading of tumors; second, the use of such a system as applied to gliomas in the central nervous system; and third, to discuss some of the criticisms that have arisen since the publication of the method of grading.