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Objective: Our aim was to determine the prevalence of associated vulvar adenocarcinoma, invasive Paget's disease, and recurrence of Paget's disease of the vulva.Study Design: A retrospective review of tumor and pathology registries at 8 institutions is presented. Patients with recurrent disease were excluded. Histologic slide review was performed.Results: The median age of the 100 patients was 70 years. The median duration of pruritus before surgery was 2 years. Thirty-four percent of patients experienced a recurrence at a median of 3 years. There was a 12% prevalence of invasive vulvar Paget's disease and a 4% prevalence of associated vulvar adenocarcinoma. One patient died of Paget's disease with associated vulvar adenocarcinoma.Conclusions: Paget's disease of the vulva is rarely associated with an underlying vulvar adenocarcinoma or invasive Paget's disease, but there is a high recurrence rate. [ABSTRACT FROM AUTHOR]

Background: The 21st Century Cures Act mandates patients' access to their electronic health record (EHR) notes. To our knowledge, no previous work has systematically invited patients to proactively report diagnostic concerns while documenting and tracking their diagnostic experiences through EHR-based clinician note review., Objective: To test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes., Methods: In a large integrated health system, patients aged 18-85 years actively using the patient portal and seen between October 2019 and February 2020 were invited to respond to an online questionnaire if an EHR algorithm detected any recent unexpected return visit following an initial primary care consultation ("at-risk" visit). We developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to several dimensions of the diagnostic process based on notes review and recall of recent "at-risk" visits. Additional questions assessed patients' trust in their providers and their general feelings about the visit. The primary outcome was a self-reported diagnostic concern. Multivariate logistic regression tested whether the primary outcome was predicted by instrument variables., Results: Of 293 566 visits, the algorithm identified 1282 eligible patients, of whom 486 responded. After applying exclusion criteria, 418 patients were included in the analysis. Fifty-one patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements "the care plan the provider developed for me addressed all my medical concerns" [odds ratio (OR), 2.65; 95% confidence interval [CI], 1.45-4.87) and "I trust the provider that I saw during my visit" (OR, 2.10; 95% CI, 1.19-3.71) and agreed with the statement "I did not have a good feeling about my visit" (OR, 1.48; 95% CI, 1.09-2.01)., Conclusion: Patients can identify diagnostic concerns based on a proactive online structured evaluation of visit notes. This surveillance strategy could potentially improve transparency in the diagnostic process., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Hair loss affects millions of people worldwide, but currently available treatment options are often dissatisfying due to side effects or limited efficacy. Pea sprout extract has been shown to improve hair density when applied topically, but its mode of action and effectiveness upon oral administration remain unknown. Our study has now shown that the application of a fluid containing 2% pea sprout extract on a defined scalp zone of 10 volunteers enhances the expression of defined genes relevant for hair, namely fibroblast growth factor-7 (FGF7) and noggin, by 56 and 85%, respectively. Additionally, a subsequent pilot nutrition intervention study in 21 volunteers proved that pea sprout extract is also effective when consumed as dietary supplement. The daily intake of 100 mg pea sprout extract (AnaGain™ Nu) for 8 weeks significantly reduced hair loss already after 28 days of treatment (p < 0.002). No adverse events were reported. Consequently, pea sprout extract may be an effective means to safely promote hair growth and reduce hair loss in individuals experiencing excessive hair shedding., (© 2019 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd.)

Context: Immunohistochemistry is a useful tool for diagnosing salivary gland and head and neck tumors., Objective: To review immunohistochemical markers, which can aid in the diagnosis of selected salivary gland and head and neck tumors., Data Sources: Literature review and authors' personal practice experience., Conclusions: Salivary gland and head and neck tumors include a large diverse group of tumors with complex and overlapping histologic features. Immunohistochemistry plays an important role in resolving the differential diagnosis of some salivary gland and head and neck tumors and can provide information for the prognosis of certain tumors.

This article calls on pathologists to take a larger role in improving the performance of the American health care system. To improve outcomes for populations and individuals require that pathologists increase their activities outside of the traditional laboratory in interdisciplinary collaborations, outcomes research, health care systems development, and clinical care.

Genetic alteration of the von Hippel-Lindau (VHL) tumor suppressor gene has been linked to hereditary and sporadic clear cell renal cell carcinomas (RCCs). Inconsistent data on immunodetection of the VHL gene product (pVHL) in normal tissues and tumors have been reported. We immunohistochemically reevaluated the usefulness of a specific rabbit polyclonal anti-pVHL antibody in 531 cases of renal and nonrenal neoplasms and normal tissues. Positive immunostaining was observed in nearly 100% of primary renal neoplasms, 95% of metastatic RCCs, and 90% of clear cell carcinomas of the ovary and uterus. In normal tissues, positive immunoreactivity was observed only in renal tubules, exocrine pancreas, islets, and bile ducts. Western blot and reverse transcription-polymerase chain reaction confirmed the immunostaining results. These data indicate that this anti-pVHL antibody is a useful marker in assisting diagnosis of metastatic RCC and may serve as a diagnostic marker for clear cell carcinomas of the ovary and uterus.

We describe a case of true histiocytic sarcoma (HS) with features of HS in clinical manifestation, histological presentation, and immunohistochemical panels. The flow cytometry studies were used for the diagnosis. The tumor presents in the small intestine with involvement of regional mesenteric lymph nodes of a 68-year-old female. Histological examination reveals that tumor cells are large and pleomorphic. They have vesicular chromatin and abundant eosinophilic cytoplasm. Immunohistochemical studies show the tumor cells to be positive for CD45 (LCA), CD45RO, CD4, CD68, and lysozyme; and negative for all other T-, B-, macrophage, follicular dendritic- and hematopoietic-cell markers. Proliferation rate is 5% by MIB stain. Flow cytometry studies reveal large atypical cells positive for CD4, CD14, and CD45. There are 29 cases of HS reported in the literature since 2001. All of these cases are summarized. The diagnostic methods and the possible prognostic factors are discussed. We believe that the correct diagnosis of HS is important for clinical treatment and prognostic prediction, although it is very rare.