Search

Objectives To model renal function 2 years following radical nephrectomy with quantitative analyses using clinical, histopathologic, and renal composite cortical volumes (CCV). Methods This retrospective study involved an assessment of the nonneoplastic kidney tissue by three blinded nephropathologists using modified Banff 1997 criteria for renal allograft pathology. Volumetric image acquisition was obtained by three independent radiologists using preoperative imaging. A 2-year estimated glomerular filtration (eGFR) calculator was created. Results Among the 126 patients, median age was 60 years; median CCV, 398.1 cm3; preoperative eGFR, 77 mL/min/1.73 m2; and 2-year postoperative eGFR, 54 mL/min/1.73 m2. Of the subjects, 64% had hypertension, 26% diabetes, and 37% were smokers. Increasing age, glomerulopathy/sclerosis, tubulointerstitial scarring, and arteriosclerosis were statistically significantly and adversely associated with eGFR. Conversely, increasing CCV was associated with a higher eGFR. Conclusions Quantitative analysis of the nephrectomized kidney in conjunction with patient age can accurately predict renal function at 2 years. [ABSTRACT FROM AUTHOR]

Objectives: To model renal function 2 years following radical nephrectomy with quantitative analyses using clinical, histopathologic, and renal composite cortical volumes (CCV).Methods: This retrospective study involved an assessment of the nonneoplastic kidney tissue by three blinded nephropathologists using modified Banff 1997 criteria for renal allograft pathology. Volumetric image acquisition was obtained by three independent radiologists using preoperative imaging. A 2-year estimated glomerular filtration (eGFR) calculator was created.Results: Among the 126 patients, median age was 60 years; median CCV, 398.1 cm3; preoperative eGFR, 77 mL/min/1.73 m2; and 2-year postoperative eGFR, 54 mL/min/1.73 m2. Of the subjects, 64% had hypertension, 26% diabetes, and 37% were smokers. Increasing age, glomerulopathy/sclerosis, tubulointerstitial scarring, and arteriosclerosis were statistically significantly and adversely associated with eGFR. Conversely, increasing CCV was associated with a higher eGFR.Conclusions: Quantitative analysis of the nephrectomized kidney in conjunction with patient age can accurately predict renal function at 2 years. [ABSTRACT FROM AUTHOR]

Background: HER2 positivitiy is found in approximately twenty percent of breast carcinomas. HER2 testing is essential in determining whether or not a given patient should receive therapy with trastuzumab. HER2 positivity is usually found in invasive ductal carcinomas with a high nuclear grade and sometimes in pleomorphic lobular carcinomas. It is also an important prognostic marker, with HER2 positive tumours having higher recurrence rates. Case Report:We present four cases of HER2 positive breast carcinomas that do not fit the usual histomorpholgic profile. One case is a pT1cN0 low grade invasive ductal carcinoma with a Nottingham score 5 out of 9. Important to note was the tubular architecture of the tumour with over 75% containing tubules. HER2 positivity was found by immunohistochemistry (3+ positivity) and dual in situ hybridization. The three other cases were invasive lobular carcinomas, all with intermediate grades (Two Nottingham scores of 6 out of 9, and one Nottingham score of 7out of 9). All cases were confirmed lobular by a lack of Ecadherin/p120 immunohistochemical staining, and were strongly positive for HER2 immunohistochemistry (3+). Three of the four cases were treated with adjuvant chemotherapy, trastuzumab, and an aromatase inhibitor, and did not have recurrent disease. The fourth case (a recent lobular carcinoma case) will be offered similar therapy. Conclusion Paragraph: HER2 is important biomarker for breast cancer patients so that the patients can be provided with appropriate treatment. Although certain histomorphologic characteristics of breast carcinomas make them more likely to exhibit HER2 positivity, it is important not to exclude the possibility that other carcinoma morphologies may have HER2 positivity as well. [ABSTRACT FROM AUTHOR]

Objectives: Continuous quality improvement in the pathology laboratory requires consistent feedback on technical quality. Pathologists work under significant time pressure, limiting their ability to communicate defects if feedback processes are time consuming, such as paper forms or regular email. We have introduced an innovative user-friendly electronic technical Quality Assurance ("TQA") form that has improved QA participation at Diagnostic Services Manitoba (DSM). Methods: The TQA form was developed as a desktop icon. One click opens the e-mail form auto-addressed to the Charge Technologist and Quality Analyst, for feedback on specimen registration, grossing, fixation, embedding, microtomy, staining, cover-slipping, labelling or other problem related to the case. The Charge Technologist provides follow-up and feedback. The Quality Specialist monitors investigation completion and data in an electronic document system (Intelex). The process was rolled out at as a pilot at 3 DSM sites in 2014, and 3 other sites joined in 2015 to complete the implementation. Results: In the 3 years before introduction (2011-13) there was an average of 22 feedback events from 5 people. Following implementation of the electronic TQA in 2014 the amount of feed-back started to increase. In the first year that all DSM sites used the process (2016) we had 156 completed forms (7x increase) from 25 people (5x increase). The new system provides more efficient follow-up, monitoring and trending of technical QA data. Conclusions: A user-friendly electronic feedback mechanism can significantly improve the number of pathologists and cytotechnologists actively contributing to quality improvement in the laboratory. [ABSTRACT FROM AUTHOR]

Background: Patients with Crohn disease are at increased risk of gastrointestinal malignancies, including small bowel adenocarcinoma. Diagnosis is difficult as symptoms of small bowel adenocarcinoma overlap with Crohn disease, and many cases are discovered incidentally. Additionally, the carcinomas can be difficult to detect grossly and diagnose microscopically. This case is illustrative of these issues. Case Report: A 52-year-old male had a 12-month history of iron deficiency anemia and a 15 pound weight loss. Colonoscopy revealed an ascending colon lesion suspicious for cancer. An abdominal CT scan revealed jejunal wall thickening with upstream small bowel dilatation. During surgery, stricturing and creeping fat were noted. Gross examination revealed creeping fat, mucosal pseudopolyps, stricturing, dilatation and wall thickening compatible with Crohn disease. Microscopic examination showed ulceration, pseudopolyps, and pyloric metaplasia consistent with Crohn disease. One block submitted as a random section showed well differentiated glands within the muscularis propria. 3/23 Lymph nodes showed metastatic high-grade adenocarcinoma. Additional sections of the small bowel revealed grossly inconspicuous adenocarcinoma with both low grade acinar and high-grade mucinous signet ring components. A diagnosis of small bowel adenocarcinoma in the setting of Crohn jejunitis was made. Conclusion Paragraph: Crohn disease increases the risk of small bowel adenocarcinoma. Careful examination of the gross specimen is crucial to rule out an inconspicuous malignancy as Crohn related adenocarcinoma is often undetected by preoperative work up. [ABSTRACT FROM AUTHOR]

Background: Knowledge of gross pathology is essential for pathologists and pathology assistants however training in gross pathology presents unique challenges. Specimen handling for fixation, rarity of specific specimen types and scheduling of learners can be barriers to comprehensive training. Conventional specimen photography can help overcome some of these issues, but two-dimensional photographs are limited in their ability to provide details from three-diemensional specimens. To overcome some of these limitations, we sought to explore 3D reconstruction to enhace training in gross surgical pathology. Objective: Assess the feasibility of 3D reconstruction technology for building a virtual surgical gross pathology specimen library. Methods: Multiangle photographs of fresh and fixed surgical specimens were acquired using a Nikon D800 camera equipped with a 24-70mm f1.4G lens. Images were cropped and processed to achieve similar lighting and exposure levels. Photogrammetry software was used for 3D reconstruction. Data and Results: Nineteen specimen reconstructions were attempted using 8 different surgical specimens. Adaptations to photography techniques and adjustments to the photogrammetry software settings allowed us to produce 16 successful reconstructions. The 6 best reconstructions have been included in our initial collection. The models can be 3D printed, and so far we have printed one model for demonstration purposes. Conclusions: We have domonstrated that with photogrammetry software, 2D gross photos can be converted into high-resolution 3D models with preserved detailed gross features. This technique is a promising solution to enhance training and education in gross pathology. [ABSTRACT FROM AUTHOR]

Background: Alveolar soft part sarcoma (ASPS) is a rare malignant soft-tissue neoplasm that typically arises in the deep soft tissues of the extremities of young adults. In most patients ASPS presents as a slow growing painless mass, frequently associated with metastatic disease at presentation. Primary ASPS of the gynecological tract is exceedingly uncommon, and its' biologic behavior is variable. We report an example of ASPS involving the uterine cervix. Case Report: A 35-year-old female underwent a total abdominal hysterectomy for fibroids and menorrhagia. Gross examination identified a well circumscribed submucosal mass of the cervix. Histologically the mass was composed of epithelioid cells arranged in nests and alveolarlike structures surrounded by an extensive capillary network. Tumour cells had eosinophilic to clear cytoplasm with mild cytologic atypia. No lymphovascular invasion was identified. Immunohistochemistry documented diffuse nuclear expression of TFE3 within tumour cells and variable actin positivity. Cytokeratins and melanocytic markers were negative. Ancillary cytogenetic testing confirmed the presence of a TFE3(Xp11.23) rearrangement characteristic of ASPS. Further patient workup did not identify any evidence of metastases. Conclusions: Alveolar soft part sarcoma of the cervix is rare and approximately 30 cases have been reported to date. Cytogenetic testing for TFE3 rearrangement is essential in excluding TFE3 positive PEComa; a potential mimic. Although there is limited published data, most examples of ASPS of the cervix have a benign outcome. Tumour size, completeness of resection and absence of lymphovascular invasion are considered favorable findings. [ABSTRACT FROM AUTHOR]