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Surgical Pathology (surgical + pathology)
Selected AbstractsSurgical Pathology of the Head and Neck,THE LARYNGOSCOPE, Issue 9 2000Karen H. Calhoun MD No abstract is available for this article. [source] Surgical pathology of renal epithelial neoplasms: recent advances and current statusHISTOPATHOLOGY, Issue 3 2000Fleming First page of article [source] Intraoperative cytology,Role in bone lesionsDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010Khaliqur Rahman M.D. Abstract In spite of becoming an integral part of surgical pathology, very few reports are available regarding the utility of intraoperative cytology (IOC) exclusively for bone lesions. This study was undertaken in a view to fill this lacuna. Sixty bone lesions were evaluated intraoperatively with the help of cytology smears prepared by touch, scrape, or crush technique. The diagnosis made on cytological preparation was compared with histopathological diagnosis taking the latter as gold standard. Different parameters like reasons for Intraoperative consultation, best technique for preparation of smear, average time taken to render a diagnosis, and finally the accuracy of IOC was evaluated. Common reasons for the intraoperative consultation were to make or confirm a diagnosis for proper surgical intervention and to evaluate the surgical resection margin. Scrape was found to be the best method for cytological smear preparation. Average time taken to render a diagnosis was 20 minutes. Sensitivity, specificity, and overall diagnostic accuracy was 96.7, 96.6, and 96.6%, respectively. Cytology can play a valuable role in the intraoperative diagnosis of bone lesions. The method is simple, cheap, quick, and has no complication. It should be undertaken routinely, as a rapid intraoperative diagnosis will expedite timely and proper management of the patients, along with early post operative treatment and thus avoid the aggravating delays. Diagn. Cytopathol. 2010;38:639,644. © 2009 Wiley-Liss, Inc. [source] Acute Postoperative Seizures after Frontal Lobe Cortical Resection for Intractable Partial EpilepsyEPILEPSIA, Issue 6 2003Simona Tigaran Summary: Purpose: To evaluate the incidence and prognostic importance of acute postoperative seizures (APOSs) occurring in the first week after a focal corticectomy in patients with partial epilepsy of frontal lobe origin. Methods: We retrospectively evaluated 65 patients who underwent a frontal lobe cortical resection for intractable partial epilepsy between April 1987 and December 2000. All patients were followed up for a minimum of 1 year after surgery. Results: APOSs occurred in 17 (26%) patients. None of the following factors was shown to be significantly associated with the occurrence of APOSs: gender, duration of epilepsy, etiology for seizure disorder, use of subdural or depth electrodes, surgical pathology, or postoperative risk factor for seizures. Patients with APOSs were older at seizure onset and at the time of surgery (p = 0.003 and p = 0.05, respectively). At last follow-up, patients who had APOSs had a seizure-free outcome similar to that of individuals without APOSs (47.1% vs. 50.0%; p = 0.77). Patients with APOSs appeared less likely to have a favorable outcome [i.e., fewer than three seizures per year and >95% decrease in seizure activity (58.8 vs. 70.8%; p = 0.35)]. This result may not have reached statistical significance because of the sample size. No evidence suggested that precipitating factors or the timing of APOSs was an important prognostic factor. Conclusions: The presence of APOSs after frontal lobe surgery for intractable epilepsy does not preclude a significant reduction in seizure tendency. These findings may be useful in counseling patients who undergo surgical treatment for frontal lobe epilepsy. [source] A fibrotic focus is a prognostic factor and a surrogate marker for hypoxia and (lymph)angiogenesis in breast cancer: review of the literature and proposal on the criteria of evaluationHISTOPATHOLOGY, Issue 4 2007G G Van den Eynden A fibrotic focus is a scar-like area in the centre of a carcinoma and can be regarded as a focus of exaggerated reactive tumour stroma formation. Although modern surgical pathology uses different histopathological and molecular markers to assess the aggressiveness and predict the behaviour of malignant tumours, markers reflecting stromal cell behaviour and interactions between epithelial cells and stromal cells are scarce. In this review we summarize all studies investigating the value of a fibrotic focus as a prognostic factor and as a surrogate marker for hypoxia and (lymph)angiogenesis in patients with breast cancer. These data show that a fibrotic focus can be used as a practical, easily assessable and reproducible integrative histological prognostic parameter in breast cancer. We propose a consensus methodology to assess the fibrotic focus in breast cancer. [source] Mitotic counting in surgical pathology: sampling bias, heterogeneity and statistical uncertaintyHISTOPATHOLOGY, Issue 1 2001F B J M Thunnissen Mitotic counting in surgical pathology: sampling bias, heterogeneity and statistical uncertainty Although several articles on the methodological aspects of mitotic counting have been published, the effects of macroscopic sampling and tumour heterogeneity have not been discussed in any detail. In this review the essential elements for a standardized mitotic counting protocol are described, including microscopic calibration, specific morphological criteria, macroscopic selection, counting procedure, effect of biological variation, threshold, and the setting of an area of uncertainty (,grey area'). We propose that the use of a standard area for mitotic quantification and of a grey area in mitotic counting protocols will facilitate the application of mitotic counting in diagnostic and prognostic pathology. [source] Autofluorescence and diffuse reflectance spectroscopy and spectral imaging for breast surgical margin analysisLASERS IN SURGERY AND MEDICINE, Issue 1 2010Matthew D. Keller MS Abstract Background and Objective Most women with early stage breast cancer have the option of breast conserving therapy, which involves a partial mastectomy for removal of the primary tumor, usually followed by radiotherapy. The presence of tumor at or near the margin is strongly correlated with the risk of local tumor recurrence, so there is a need for a non-invasive, real-time tool to evaluate margin status. This study examined the use of autofluorescence and diffuse reflectance spectroscopy and spectral imaging to evaluate margin status intraoperatively. Materials and Methods Spectral measurements were taken from the surface of the tissue mass immediately following removal during partial mastectomies and/or from tissues immediately after sectioning by surgical pathology. A total of 145 normal spectra were obtained from 28 patients, and 34 tumor spectra were obtained from 12 patients. Results After correlation with histopathology, a multivariate statistical algorithm classified the spectra as normal (negative margins) or tumor (positive margins) with 85% sensitivity and 96% specificity. A separate algorithm achieved 100% classification between neo-adjuvant chemotherapy-treated tissues and non-treated tissues. Fluorescence and reflectance-based spectral images were able to demarcate a calcified lesion on the surface of a resected specimen as well. Conclusion Fluorescence and reflectance spectroscopy could be a valuable tool for examining the superficial margin status of excised breast tumor specimens, particularly in the form of spectral imaging to examine entire margins in a single acquisition. Lasers Surg. Med. 42:15,23, 2010. © 2010 Wiley-Liss, Inc. [source] Craniofacial Resection for Nonmelanoma Skin Cancer of the Head and Neck,THE LARYNGOSCOPE, Issue 6 2005Douglas D. Backous MD Abstract Objectives/Hypothesis: We reviewed our experience with craniofacial resection for advanced, nonmelanoma skin cancer of the head and neck to determine prognostic factors, local control rate, disease free survival, morbidity, and mortality. Study Design: Retrospective review of consecutive patients treated at a tertiary referral center from 1982 to 1993. Methods: Charts of patients having craniofacial resection for aggressive nonmelanoma cutaneous malignancies were reviewed and living patients followed for 10 additional years. Demographics, histology, previous interventions, treatment, surgical pathology, reconstructions, and complications were examined. The product-limit method was used to calculate survival functions, and the log-rank test was used to compare survival distributions. Results: Thirty-five patients, mean age 66.7 years, received treatment at our facility. Follow-up ranged from 2 to 191 (mean 47.4) months. Histology included 20 squamous cell carcinomas (SCC) and 15 basal cell carcinomas (BCC). Sixty percent had craniofacial resection alone, and 28.6% also had postoperative radiotherapy. There were two perioperative deaths, and 37.1% suffered early and 14.3% late surgical complications. Two- and five- year survival was significantly better (P = .02) with BCC (92% and 76%) than with SCC (54% and 24%). Long-term disease-specific survival was 20%, and 11.4% of our subjects were living with disease. Intracranial extension (P = .02), perineural invasion (P = .049), and prior radiotherapy significantly decreased 5-year survival. Conclusions: Acceptable mortality and morbidity is possible using craniofacial resection to treat advanced nonmelanoma skin cancer. Although disease-specific survival remains poor, positive trends were noted in local control beginning at 2 years of follow-up. Because patients often have few remaining options for cure, craniofacial resection is justified when technically feasible. [source] Pathologic stage T2a and T2b prostate cancer in the recent prostate-specific antigen era: Implications for unilateral ablative therapyTHE PROSTATE, Issue 13 2008Thomas J. Polascik Abstract BACKGROUND Early detection of small volume prostate cancer (PCa) has led to the concept of focal therapy to treat in an organ-sparing manner. We evaluated trends in pathologic staging among patients with localized PCa undergoing radical prostatectomy (RP), defining the frequency of unilateral cancers during 1988,1995, 1996,2000 and 2001,2006. METHODS Data were abstracted from the Duke Prostate Cancer Outcome database selecting 3,676 men with available pathology treated with RP. Based on surgical pathology, trends in as pathological T (pT) stage, pathological Gleason Score (pGS), and percent tumor involvement (PTI) were evaluated. RESULTS pT2a increased from 2.8% of men undergoing RP in 1988,1995 to 13.0% during 2001,2006 (P,,<,,0.0005). PTI analysis shifted towards low volume disease, e.g. PTI,,,5% increased from 10% during 1988,1995, to 37% in 2001,2006 (P,<,0.005). Of all pT2a disease throughout 1988,2006, an increase in proportion of pT2a tumors from 10% during 1988,1995 to 69.4% during 2001,2006 was identified. Over three eras, pT2a had minimal (65% had PTI,,,5%) or small volume (14% had PTI 5.01,10.00) disease, and 59% were low grade (pGS,,,6). Using a Cox Hazard model, pT2a versus pT2b disease, surgical margins, PTI, and PSA statistically contributed to PSA disease-free survival in the contemporary era 2001,2006. CONCLUSIONS The increasing prevalence of unilateral pT2a/T2b PCa characterizes a growing proportion of men recently electing RP. These tumors are associated with lower PTI, pGS,,,7, and demonstrated better PSA-free survival in the 2001,2006 era. These low risk pathologic characteristics may allow for unilateral focal therapy in carefully selected patients. Prostate 68: 1380,1386, 2008. © 2008 Wiley-Liss, Inc. [source] Predicting occult malignancy in nipple dischargeANZ JOURNAL OF SURGERY, Issue 9 2010Chris Alcock Abstract Background:, This study was a retrospective analysis of patients who underwent minor or major duct surgery for pathological nipple discharge. The results of clinical examination, mammography, ultrasonography and cytodiagnosis of the nipple discharge were studied in order to predict those patients at risk of underlying or occult malignancy. Methods:, Between January 2004 and December 2006, 55 female patients aged between 24 and 82 years old underwent major or minor duct excision, 49 of which were for pathological nipple discharge. Results of several preoperative investigations were compared with the surgical pathology to determine how their sensitivity and specificity faired in predicting malignant ductal pathology. Results:, Of the 49 patients undergoing surgery for nipple discharge, 21 were diagnosed with intraductal papilloma, 19 with duct ectasia, 6 with carcinoma, 2 with benign breast disease and 1 with lobular carcinoma in situ. In all of the patients determined to have malignancy, none demonstrated malignant changes on mammography or ultrasonography. Only 2 of the 6 patients with malignancy were found to have atypical cells on cytological analysis. The sensitivity of blood detected in nipple discharge at predicting malignancy was 0.83, specificity of 0.53, positive predictive value of 0.20 and negative predictive value 0.96. Conclusions:, Despite the various tests used in the assessment of pathological nipple discharge, this study highlights their limited help at predicting the cause. This, together with several other studies, demonstrates that ductal surgery remains the only reliable way of providing a diagnosis, in addition to being the major therapeutic measure. [source] Authors' reply: Routine surgical pathology in general surgery (Br J Surg 2006 93 362,368)BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2006L. E. Matthyssens No abstract is available for this article. [source] Preoperative breast magnetic resonance imaging in early breast cancer,CANCER, Issue 8 2009Implications for partial breast irradiation Abstract BACKGROUND: Accelerated partial breast irradiation (APBI) of patients with early breast cancer is being investigated on a multi-institutional protocol National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/RTOG 0413. Breast magnetic resonance imaging (MRI) is more sensitive than mammography (MG) and may aid in selection of patients appropriate for PBI. METHODS: Patients with newly diagnosed breast cancer or ductal carcinoma in situ (DCIS) routinely undergo contrast-enhanced, bilateral breast MRI at the Cleveland Clinic. We retrospectively reviewed the medical records of all early-stage breast cancer patients who had a breast MRI, MG, and surgical pathology data at our institution between June of 2005 and December of 2006. Any suspicious lesions identified on MRI were further evaluated by targeted ultrasound ± biopsy. RESULTS: A total of 260 patients met eligibility criteria for NSABP B-39/RTOG 0413 by MG, physical exam, and surgical pathology. The median age was 57 years. DCIS was present in 63 patients, and invasive breast cancer was found in 197 patients. MRI identified suspicious lesions in 35 ipsilateral breasts (13%) and in 16 contralateral breasts (6%). Mammographically occult, synchronous ipsilateral foci were found by MRI in 11 patients (4.2%), and in the contralateral breast in 4 patients (1.5%). By univariate analysis, lobular histology (infiltrating lobular carcinoma [ILC]), pathologic T2, and American Joint Committee on Cancer stage II were significantly associated with additional ipsilateral disease. Of patients with ILC histology, 18% had ipsilateral secondary cancers or DCIS, compared with 3% in the remainder of histologic subtypes (P = .004). No patient older than 70 years had synchronous cancers or DCIS detected by MRI. CONCLUSIONS: Breast MRI identified synchronous mammographically occult foci in 5.8% of early breast cancer patients who would otherwise be candidates for APBI. Cancer 2009. © 2009 American Cancer Society. [source] 6 The AERIS Course: a Focused Abdominal CT Interpretation Course for Abdominal Emergencies Requiring Immediate SurgeryACADEMIC EMERGENCY MEDICINE, Issue 2008Eric Schultz Emergency physicians rely heavily on CT scanning to guide their clinical decisions. A significant number of EDs do not have radiology coverage, especially at night, so the EM physician may be called on to interpret their own CT scans to guide patient management. Many EM physicians look at their CT scans but have never had any formal training. Especially in the setting of acute surgical emergencies such as expanding abdominal aortic aneurysms (AAAs), ruptured spleen or perforated viscus, delay for a radiologist interpretation may result in significant morbidity and mortality. In a collaboration between emergency medicine and radiology, our team created a systematic approach to abdominal CT interpretation designed to help EM physicians perform wet reads on CT scans in the setting of acute surgical emergencies. First, a general survey is done covering all of the important organs such as the aorta, liver, spleen, kidneys, pancreas, stomach and bowel, then a focused scan into the suspected pathology. We put this system onto a Power Point presentation. The two hour presentation covered basic CT anatomic pathology then taught the presentations of common surgical emergencies such as appendicitis, nephrolithiasis and surgical catastrophes such as ruptured AAAs and mesenteric ischemia. The Abdominal Emergencies Requiring Immediate Surgery (AERIS) scan is only intended to be a focused scan for acute surgical pathology, and not to replace the diagnostic scan of a radiologist. This course was given at a single University program, and will be given at residency programs throughout the New York metro area. Eventually we hope that focused CT interpretation will become part of the standardized EM curriculum. [source] Giovanni Filippo Ingrassia: A five-hundred year-long lessonCLINICAL ANATOMY, Issue 7 2010Francesco Cappello Abstract Giovanni Filippo Ingrassia was born five centuries ago in Regalbuto, a small town in the center of Sicily. After his medical course in Padua, under the guidance of Vesalius and Fallopius, he gained international fame as a physician and was recruited as a Professor of human anatomy in Naples and later in Palermo. He is remembered as "the new Galen" or "the Sicilian Hippocrates." He contributed to the knowledge of human anatomy through the description of single bones rather than the whole skeleton. In particular, he was the first to describe the "stapes," the "lesser wings of the sphenoid" and various other structures in the head (probably the pharyngotympanic tube) as well as in the reproductive system (corpora cavernosa and seminal vesicles). He was also a pioneer in the study of forensic medicine, hygiene, surgical pathology, and teratology. As Protomedicus of Sicily, he developed the scientific culture in this country. During those years, he faced the spread of malaria and plague with competence and authoritativeness. Indeed, he was one of the first physicians to suppose that certain diseases could be transmitted between individuals, therefore, introducing revolutionary measures of prevention. He is remembered for his intellectual authority and honesty. Five-hundred years after his birth, his teaching is still alive. In this article, we survey the life and contribution of this pioneer of early anatomical study. Clin. Anat. 23:743,749, 2010. © 2010 Wiley-Liss, Inc. [source] Epineurial compartments and their role in intraneural ganglion cyst propagation: An experimental studyCLINICAL ANATOMY, Issue 7 2007Robert J. Spinner Abstract New patterns of intraneural ganglion cyst formation are emerging that have not previously been explained in current pathoanatomic terms. We believe there are three important elements underlying the appearance of these cysts: (a) an articular branch of the nerve that connects to a nearby synovial joint; (b) ejected synovial fluid following the path of least resistance along tissue planes; and (c) the additional effects of pressure and pressure fluxes. The dynamic nature of cyst formation has become clearly apparent to us in our clinical, operative and pathologic practice, but the precise mechanism underlying the process has not been critically studied. To test our hypothesis that a fibular (peroneal) or tibial intraneural cyst derived from the superior tibiofibular joint could ascend proximally into the sciatic nerve, expand within it and descend into terminal branches of this major nerve, we designed a series of simple, qualitative laboratory experiments in two cadavers (four specimens, six experiments). Injecting dye into the outer or "epifascicular" epineurium of the fibular and the tibial nerves we observed its ascent, cross over and descent patterns in three of three specimens as well as its cross over after an outer epineurial sciatic injection. In contrast, injecting dye into the inner or "interfascicular" epineurium led to its ascent within the tibial nerve and its division within the sciatic nerve in one specimen and lack of cross over in a sciatic nerve injection. Histologic cross-sections of the nerves at varying levels demonstrated a tract of disruption within the outer epineurium of the nerve injected and the nerve(s) into which the dye, after cross over, descended. Those specimens injected in the inner epineurium demonstrated dye within this tract but without disruption of or dye intrusion into the outer epineurium. In no case did the dye pass through the perineurial layers. Coupled with our observations in previous detailed studies, these anatomic findings provide proof of concept that sciatic cross over occurs due to the filling of its common epineurial sheath; furthermore, these findings, support the unifying articular theory, even in cases wherein patterns of intraneural ganglion cyst formation are unusual. Additional work is needed to be done to correlate these anatomic findings with magnetic resonance imaging and surgical pathology. Clin. Anat. 20:826,833, 2007. © 2007 Wiley-Liss, Inc. [source] Integrated 18F-FDG PET/CT for the initial evaluation of cervical node level of patients with papillary thyroid carcinoma: comparison with ultrasound and contrast-enhanced CTCLINICAL ENDOCRINOLOGY, Issue 3 2006Han-Sin Jeong Summary Objective, To compare the diagnostic accuracy of integrated 18F-fluorodeoxyglucose PET/CT with ultrasonography (US) and contrast enhanced CT (CECT) alone in the initial evaluation of cervical lymph node levels of patients with papillary thyroid carcinoma. Patients and measurements, From July 2004 to March 2005, 26 consecutive patients with papillary thyroid carcinoma, confirmed by aspiration cytology analysis, underwent US, CECT and PET/CT. The sensitivity, specificity and diagnostic accuracy of the US, CECT and PET/CT studies for the final status of 312 cervical node levels (levels I,V: 260, level VI: 52) were compared by employing a generalized estimating equation test. The final status of cervical node levels was determined by the surgical pathology and follow-up data. Results, At all lymph node levels (levels I,VI), PET/CT showed a sensitivity of 30·4%, a specificity of 96·2% and a diagnostic accuracy of 86·9%. The corresponding values for US and CECT were 41·3%, 97·4%, 89·1% (US) and 34·8%, 96·2%, 87·2% (CECT). Considering only the lateral cervical node group (levels I,V), PET/CT showed a sensitivity of 50·0%, a specificity of 97·0% and a diagnostic accuracy of 92·3%. The corresponding values for US and CECT were 53·9%, 97·9%, 93·5% (US) and 42·3%, 96·6%, 91·2% (CECT). The diagnostic results for US, CECT and PET/CT upon initial evaluation of the cervical lymph nodes did not differ significantly on a level-by-level basis. Conclusion, Our preliminary results suggest that integrated PET/CT does not provide any additional benefit when compared to US and CECT for the initial evaluation of cervical node levels in patients with papillary thyroid carcinoma. [source] | ||||||||||||||||||||||