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Pathology Specimens (pathology + specimen)
Selected AbstractsRegression modelling of weighted , by using generalized estimating equationsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES C (APPLIED STATISTICS), Issue 1 2000R. Gonin In many clinical studies more than one observer may be rating a characteristic measured on an ordinal scale. For example, a study may involve a group of physicians rating a feature seen on a pathology specimen or a computer tomography scan. In clinical studies of this kind, the weighted , coefficient is a popular measure of agreement for ordinally scaled ratings. Our research stems from a study in which the severity of inflammatory skin disease was rated. The investigators wished to determine and evaluate the strength of agreement between a variable number of observers taking into account patient-specific (age and gender) as well as rater-specific (whether board certified in dermatology) characteristics. This suggested modelling , as a function of these covariates. We propose the use of generalized estimating equations to estimate the weighted , coefficient. This approach also accommodates unbalanced data which arise when some subjects are not judged by the same set of observers. Currently an estimate of overall , for a simple unbalanced data set without covariates involving more than two observers is unavailable. In the inflammatory skin disease study none of the covariates were significantly associated with ,, thus enabling the calculation of an overall weighted , for this unbalanced data set. In the second motivating example (multiple sclerosis), geographic location was significantly associated with ,. In addition we also compared the results of our method with current methods of testing for heterogeneity of weighted , coefficients across strata (geographic location) that are available for balanced data sets. [source] Close temporal relationship between onset of cancer and scleroderma in patients with RNA polymerase I/III antibodiesARTHRITIS & RHEUMATISM, Issue 9 2010Ami A. Shah Objective This study was undertaken to examine the temporal relationship between scleroderma development and malignancy, and to evaluate whether this differs by autoantibody status among affected patients. Methods Study participants had a diagnosis of scleroderma, a diagnosis of cancer, cancer, an available serum sample, and a cancer pathology specimen. Sera were tested for autoantibodies against topoisomerase I, centromere, and RNA polymerase I/III by immunoprecipitation and/or enzyme-linked immunosorbent assay. Clinical and demographic characteristics were compared across autoantibody categories. Expression of RNA polymerases I and III was evaluated by immunohistochemistry using cancerous tissue from patients with anti,RNA polymerase antibodies. Results Twenty-three patients were enrolled. Six patients tested positive for anti,RNA polymerase I/III, 5 for anti,topoisomerase I, and 8 for anticentromere, and 4 were not positive for any of these antigens. The median duration of scleroderma at cancer diagnosis differed significantly between groups (,1.2 years in the anti,RNA polymerase I/III group, +13.4 years in the anti,topoisomerase I group, +11.1 years in the anticentromere group, and +2.3 years in the group that was negative for all antigens tested) (P = 0.027). RNA polymerase III demonstrated a robust nucleolar staining pattern in 4 of 5 available tumors from patients with antibodies to RNA polymerase I/III. In contrast, nucleolar RNA polymerase III staining was not detected in any of 4 examined tumors from the RNA polymerase antibody,negative group (P = 0.048). Conclusion Our findings indicate that there is a close temporal relationship between the onset of cancer and scleroderma in patients with antibodies to RNA polymerase I/III, which is distinct from scleroderma patients with other autoantibody specificities. In this study, autoantibody response and tumor antigen expression are associated. We propose that malignancy may initiate the scleroderma-specific immune response and drive disease in a subset of scleroderma patients. [source] Errors in the Interpretation of Mohs Histopathology Sections Over a 1-Year FellowshipDERMATOLOGIC SURGERY, Issue 12 2008MICHAEL E. MURPHY MD BACKGROUND Errors can occur in the interpretation of Mohs histopathology sections. Errors in histology interpretation can lead to incomplete removal of cancer and cancer persistence or the unnecessary removal of uninvolved tissue. Extensive proctored training is necessary to reduce these errors to an absolute minimum level. OBJECTIVE To analyze and quantify the number of cases and the amount of time required to reach a satisfactory level of expertise in the reading and interpretation of Mohs histopathology. METHODS A single-institution pilot study was designed to track errors in the interpretation and mapping of Mohs histopathology sections. A Mohs surgery fellow independently preread Mohs cases and rendered his interpretation on the Mohs map. One of the Mohs program directors subsequently reviewed and corrected all cases. Errors were scored on a graded scale and tracked over the 1-year fellowship to determine the number of cases and amount of time necessary to reduce errors to a baseline minimal level. RESULTS One thousand four hundred ninety-one Mohs surgery cases were required to generate 1,347 pathology specimens for review and grading over 6 months of Mohs surgery fellowship before reducing errors to a minimum acceptable level of less than 1 critical error per 100 cases read. CONCLUSIONS The number of cases and time required to reduce errors in the interpretation of Mohs histology is substantial. Direct and immediate mentored correction of errors is essential for improvement. These results can act as a guide for Mohs surgery training programs to help determine the minimum number of directly proctored cases required to obtain expertise in this crucial component of Mohs surgery. [source] Clinical and operative management of persistent hyperparathyroidism after renal transplantation: A single-center experienceHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2007Hanna Gilat MD Abstract Background. Persistent (tertiary) hyperparathyroidism (TH) after renal transplantation may cause considerable morbidity and necessitate parathyroidectomy. This study investigated the characteristics of this patient subgroup. Methods. The medical data and pathology specimens of 20 kidney transplant recipients who underwent parathyroidectomy for TH in 2001 to 2004 were reviewed. Results. Treatment consisted of subtotal resection of 3.5 glands in 13 patients, resection of 3 to 3.5 glands under intraoperative parathyroid hormone monitoring (iPTH) in 5 patients, and selective resection in 2 patients with markedly asymmetric gland enlargement. Eighteen patients had hyperplasia,diffuse in 10, nodular in 4, or both in 2; 2 patients had 1 large nodule in every gland. Six patients had postoperative complications. Follow-up of 2 years revealed recurrent hypercalcemia in 1 patient and a high level of PTH (>60 pg/mL) in 12. Conclusion. Subtotal resection for TH may be insufficient. The use of iPTH monitoring is recommended. Renal transplant recipients have distinctive characteristics and require special perioperative attention. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source] Reporting lung cancer pathology specimens.HISTOPATHOLOGY, Issue 1 2009Impact of the anticipated 7th Edition TNM Classification based on recommendations of the IASLC Staging Committee Led by the International Association for the Study of Lung Cancer (IASLC), there are currently several major international collaborative projects underway that will have a significant impact on the future reporting of lung cancer pathology. In particular, the IASLC Staging Committee has just completed an analysis of >100 000 lung cancer cases, providing the basis for proposed revisions of the current TNM staging classification. The purpose of this review is not to provide a comprehensive document on recommendations for specimen processing, but rather to discuss how the anticipated changes in the 7th edition TNM will impact on specimen processing, specifically looking at tumour size, how to deal with multiple tumours and visceral pleural invasion. TNM staging of carcinoid tumours and small cell carcinoma is also discussed. [source] Relationship between sonographic and pathologic findings in epidermal inclusion cystsJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2001Hak Soo Lee MD Abstract Purpose We evaluated the sonographic findings in epidermal inclusion cysts and related them to the pathologic findings. Methods We retrospectively reviewed the sonograms and pathology specimens of 24 patients with pathologically proven epidermal inclusion cysts. We evaluated the lesions for shape, size, internal echogenicity, posterior sound enhancement, and presence of color Doppler signals. We classified the masses into 5 sonographic types according to their internal echogenicity. The relationship between the sonographic types and the pathologic findings was examined. Results The masses were ovoid or spherical in 17 cases (71%), lobulated in 5 (21%), and tubular in 2 (8%). The longest diameter ranged from 1 to 6 cm (mean, 3.1 cm). Twenty-three cases (96%) were associated with posterior sound enhancement. Color Doppler signals were absent in 20 cases, but some vascularity was noted in 4 ruptured epidermal cysts, in areas of granulation tissue. The most common sonographic type was a hypoechoic lesion with scattered echogenic reflectors (10 cases). Sonographic findings were related to the lamellation of keratin debris and the granulation tissue secondary to rupture. Most cases with a lobulated configuration (4 of 5) or color Doppler signals (4 of 4) were ruptured cysts. Conclusions Epidermal inclusion cysts most often appeared sonographically as a hypoechoic mass containing variable echogenic foci without color Doppler signals. Ruptured epidermal cysts, however, may have lobulated contours and show color Doppler signals, mimicking a solid mass. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:374,383, 2001 [source] An analysis of oral and maxillofacial pathology found in adults over a 30-year periodJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 7 2006A. V. Jones Background:, The aim of this study was to determine the range of histologically diagnosed lesions in 44 000 oral and maxillofacial pathology specimens, from adults 17 years and older, submitted for diagnosis to our laboratory over a 30-year period (1973,2002). Materials:, All entries for specimens from the patients were retrieved and compiled into 12 diagnostic categories. Results:, During the period, 44 007 specimens comprised a male-to-female ratio of 0.9:1. The diagnostic category with the largest number of specimens was mucosal pathology (36.0%) followed by odontogenic cysts (13.8%). Malignant tumours accounted for 5.4% of all specimens and benign tumours 4.6%. Conclusion:, This survey showed that while the majority of diagnoses are benign, approximately one in 19 cases required major head and neck surgery for malignant disease. [source] Transcriptome dissection of gastric cancer: Identification of novel diagnostic and therapeutic targets from pathology specimensPATHOLOGY INTERNATIONAL, Issue 3 2009Wataru Yasui Gastric cancer is the fourth most common malignancy in the world, and mortality due to gastric cancer is second only to that from lung cancer. ,Transcriptome dissection' is a detailed analysis of the entire expressed transcripts from a cancer, for the purpose of understanding the precise molecular mechanism of pathogenesis. Serial analysis of gene expression (SAGE) is a suitable technique for performing transcriptome dissection. Gastric cancers of different stages and histology were analyzed on SAGE, and one of the largest gastric cancer SAGE libraries in the world was created (GEO accession number GSE 545). Through SAGE, many candidate genes have been identified as potential diagnostic and therapeutic targets for the treatment of gastric cancer. Regenerating islet-derived family, member 4 (Reg IV) participated in 5-fluorouracil (5-FU) resistance and peritoneal metastasis, and its expression was associated with an intestinal phenotype of gastric cancer and with endocrine differentiation. GW112 expression correlated with advanced tumor stage. Measurement of Reg IV and GW112 levels in sera indicated a sensitivity of 57% for detection of cancer. SPC18 participated in tumor growth and invasion through transforming tumor growth factor-, upregulation. Palate, lung, and nasal epithelium carcinoma-associated protein (PLUNC) was a useful marker for gastric hepatoid adenocarcinoma. Expression of SOX9, HOXA10, CDH17, and loss of claudin-18 expression were associated with an intestinal phenotype of gastric cancer. Information obtained from transcriptome dissection greatly contributes to diagnosis and treatment of gastric cancer. [source] Chromogenic in situ hybridization analysis of HER-2/neu status in breast carcinoma: Application in screening of patients for trastuzumab (Herceptin®) therapyPATHOLOGY INTERNATIONAL, Issue 8 2001Hiroyuki Kumamoto Evaluation of HER-2/neu status is important in the management of patients with breast carcinoma, especially in determining the possible application of trastuzumab, a humanized anti-HER-2/neu monoclonal antibody. Chromogenic in situ hybridization (CISH) detection of the HER-2/neu oncogene is a newly developed in situ hybridization method that utilizes a robust and unique-sequence DNA probe labeled with digoxygenin, and sequential incubations with antidigoxygenin fluorescein, antifluorescein peroxidase, and diaminobenzidine. In this study, we examined 20 archival specimens of human breast carcinoma using CISH, and we correlated findings with immunohistochemical findings for HER-2/neu. HER-2/neu immunohistochemistry was carried out with HercepTestTM, a standardized immunohistochemical examination system for HER-2/neu overexpression in surgical pathology specimens. CISH analysis could be done in 18 out of 20 cases examined. Gene copy signals for HER-2/neu were recognized as intranuclear brown dots in both neoplastic and non-neoplastic cells. Seven carcinomas showed an increased number or size of signals and were interpreted as being positive for HER-2/neu amplification. Eight cases were positive with the HercepTestTM. Seven out of eight carcinoma cases found to overexpress immunoreactive HER-2/neu also demonstrated HER-2/neu gene amplification following CISH analysis. There was a significant correlation between immunohistochemical and CISH analyses (P< 0.001). We found that CISH was a specific, sensitive and easily applicable method for the detection of HER-2/neu gene amplification, which may be used together with immunohistochemical examination for the evaluation of patients with breast carcinoma. [source] Role of Cytomegalovirus, Epstein-Barr Virus, and Human Herpes Virus-8 in Benign Lymphoepithelial Cysts of the Parotid GlandTHE LARYNGOSCOPE, Issue 8 2004Thomas L. Yen MD Abstract Objective: To provide background and evaluate the role of herpesviruses in benign lymphoepithelial cysts (BLC) of the parotid gland. Study Design: Case series derived from review of pathology specimens. Methods: Radiolabeled polymerase chain reaction (PCR) analysis was used to detect for the presence of cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpes virus 8 (HHV-8) DNA sequences in 14 paraffin embedded specimens and 1 freshly aspirated BLC specimen. Thirteen normal parotid tissue specimens obtained from paraffin embedded blocks were used as a control group. Results: CMV was detected with nearly equal frequency between the two groups (23% of normal vs. 20% in BLC). HHV-8 was found in 13% of the BLC group and in none of the normal group (P = .4841). There was significant difference in EBV detection between the normal (0%) and the BLC (33%) groups (P = .0437). Conclusion: CMV and HHV-8 does not appear to be associated with BLCs. Although EBV is found more frequently in BLC than in normal parotid controls, further studies are needed to elucidate the role of this virus in BLC pathogenesis. [source] Adenocarcinoma complicating restorative proctocolectomy for ulcerative colitis with mucosectomy performed by Cavitron Ultrasonic Surgical Aspirator®COLORECTAL DISEASE, Issue 4 2009B. C. Branco Abstract This is a report of adenocarcinoma arising in an ileal pouch after restorative proctocolectomy (RPC) with rectal mucosal stripping performed by Cavitron Ultrasonic Surgical Aspirator (CUSA®) for ulcerative colitis. The CUSA® was introduced to simplify and optimize ileal pouch,anal anastomosis with mucosectomy and has been shown to shorten the operative time and reduce blood loss. Its use however, may increase the number of pathology specimens made uninterpretable on account of tissue ablation. In the present case, even though preoperative colonoscopy had clearly shown dysplasia, the surgical pathology report could not detect any neoplasia in the specimen; hence, the patient was not surveyed for pouch cancer. Six years later, the patient presented with intestinal obstruction caused by cancer. While protocols for universal pouch surveillance remain somewhat controversial, we conclude on the basis of this case and a review of the literature that in RPC with mucosectomy performed by CUSA®, pouch cancer surveillance is particularly important because remnants of rectal epithelium may have been left behind and tissue ablation may have made the surgical pathology report uninterpretable. [source] Retrospective analysis of pre- and peri-operative imaging in confirmed proximal colonic cancers , possible implications for screening flexible sigmoidoscopyCOLORECTAL DISEASE, Issue 2 2009R. Peravali Abstract Objective, Faecal occult blood testing is being introduced for population screening in the United Kingdom. Flexible sigmoidoscopy may provide a viable alternative. The outcomes of the flexible sigmoidoscopy trial are awaited but the most obvious disadvantage is that only the lower third of the colon is examined and proximal pathology cannot be excluded. The relationship between proximal pathology and distal findings at flexible sigmoidoscopy is uncertain. The aim of this study was to determine the incidence of distal neoplasia in patients with confirmed proximal cancers of the colon. Method, All confirmed proximal colonic cancers (defined as those proximal to the splenic flexure) were identified from a database of pathology specimens at a single centre between January 1999 and August 2006. A retrospective analysis of preoperative and peri-operative mucosal imaging (contrast enema, colonoscopy and CT colonography) was conducted to identify any distal neoplasia in these patients. Results, A total of 348 patients were identified. Pre- or peri-operative mucosal imaging was identified in 231 (66%) and 49 (21%) had distal neoplasia. Nineteen (8%) of these patients would have gone on to have a colonoscopy based on the UK flexible sigmoidoscopy trial protocol and 92% of the cohort would not have had a colonoscopy. Conclusion, Nearly 80% of confirmed proximal cancers in our series did not have any demonstrable distal neoplasia. Only 8% of our cohort would have proceeded to colonoscopy. A very significant number of proximal cancers would not have been detected. [source] | |||||||||||||||||||