What is the pathologist saying? Interpretation of the prostate pathology report

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

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Multisite Quality Improvement Study of a Patient-Pathologist Consultation Program

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa202 ◽

2020 ◽

Author(s):

Rachel Jug ◽

Adam L Booth ◽

Anne F Buckley ◽

Jordan Newell ◽

Joshua Kesterson ◽

...

Keyword(s):

Quality Improvement ◽

Health Condition ◽

Further Education ◽

Pathology Report ◽

Newly Diagnosed ◽

Patient Centered ◽

Care Experience ◽

Clinical Encounters ◽

Written Information ◽

Experience Questionnaire

Abstract Objectives The aim of this multisite quality improvement study was to evaluate patients’ experiences with the patient-centered pathology (PCP) consultation program and to determine whether PCP enhanced their care experience. Methods Patients were invited to attend PCP consultations to review their pathology report and slides and have their questions answered by the pathologist privately, with the option to attend the appointment with family members or friends for support. A patient experience questionnaire (PEQ) was administered to patients, who participated voluntarily in the PCP, and survey data were collected and stored in REDCap. Statistical analysis was performed using SAS 9.4 (SAS Institute). Results Sixty-seven patients (95.5% female) aged 18 to 84 years across 4 institutions completed the PEQ. Overall, 58% and 15.8% of patients had breast and brain tumors, respectively, and 59.7% of tumors were newly diagnosed. Most patients thought it was important for them to learn as much as they could about their health condition. However, the majority of patients reported some degree of difficulty learning about their health condition based on written information, despite 97% having completed high school and/or further education. The majority of patients rated their pathologist as “excellent” across communication metrics. Ultimately, 100% of respondents were satisfied, found their visits to be useful, and would recommend the PCP to other patients. Conclusions Patients found that personalized clinical encounters with pathologists improved their understanding of their health condition and their satisfaction with their care experience. Patients thought pathologists communicated respectfully, effectively, and empathetically.

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Multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa118 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Yosuke Namba ◽

Yuzo Hirata ◽

Shoichiro Mukai ◽

Toshihiro Nishida ◽

Syo Ishikawa ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Node ◽

Lymph Node Metastases ◽

Peritoneal Dissemination ◽

Abdominal Cavity ◽

Muscularis Propria ◽

Ileocecal Resection ◽

Pathology Report ◽

Ascending Colon ◽

Node Metastases

Abstract Most cases of peritoneal dissemination of colorectal cancers are from T3 or T4 tumors. A 61-year-old woman was admitted for examination of a positive fecal occult blood test. Colonoscopy showed an ascending colon tumor that was diagnosed as an adenocarcinoma with massive submucosal invasion. Imaging modality revealed numerous nodules throughout the abdominal cavity. Peritoneal dissemination of the ascending colon or ovarian cancer and pseudomyxoma peritonei were considered in the preoperative differential diagnoses, and laparoscopic ileocecal resection was performed. Intraperitoneal observation revealed numerous white nodules in the peritoneum, omentum and Douglas fossa. Both the nodules and tumor were diagnosed as mucinous carcinoma based on a pathology report. The tumor invasion depth was limited to muscularis propria, and no regional lymph node metastasis was detected. Peritoneal dissemination of the ascending colon cancer was considered. We report a rare case of multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases.

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The Role of Microscopy in Preclinical Safety Assessment

Microscopy and Microanalysis ◽

10.1017/s143192760003748x ◽

2000 ◽

Vol 6 (S2) ◽

pp. 998-999

Author(s):

Barbara J. Dovey-Hartman

Keyword(s):

Electron Microscopy ◽

Vital Role ◽

Pathology Report ◽

Clinical Phase ◽

Transmission Electron ◽

New Chemical Entities ◽

Regulatory Submissions ◽

Hematoxylin And Eosin ◽

Preclinical Safety

Microscopy plays a vital role in assessing the safety of New Chemical Entities (NCE) in the pre-clinical phase of drug development. Light microscopy (LM), transmission electron microscopy (TEM) and scanning electron microscopy (SEM) are used at the Schering-Plough Research Institute (SPRI) for evaluation of NCE. To support regulatory submissions, NCE are routinely tested in rodents in short-term studies such as one-month toxicity studies, and in longterm studies such as oncogenicity studies that may last 24 months. At the completion of a study, the animals are necropsied and the required tissues collected and stored in fixative. The tissues for LM are processed to slides and stained with Hematoxylin and Eosin (H&E). The information derived from the examination of these tissues by LM becomes an essential part of the pathology report. The LM examination of these tissues usually yields the information needed to either progress a NCE or otherwise deter or halt development.

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Selected Aspects of Ocular Toxicity Studies With a Focus on High-Quality Pathology Reports: A Pathology/Toxicology Consultant’s Perspective

Toxicologic Pathology ◽

10.1177/0192623320946712 ◽

2020 ◽

pp. 019262332094671

Author(s):

Brian Short

Keyword(s):

Species Selection ◽

Toxicity Study ◽

Pathology Report ◽

Ocular Toxicity ◽

High Quality ◽

Contract Research Organization ◽

Toxicity Studies ◽

Fit For Purpose ◽

Pathology Reports ◽

Study Designs

Ocular toxicity studies are the bedrock of nonclinical ocular drug and drug–device development, and there has been an evolution in experience, technologies, and challenges to address that ensures safe clinical trials and marketing authorization. The expectations of a well-designed ocular toxicity study and the generation of a coherent, integrative ocular toxicology report and subreports are high, and this article provides a pathology/toxicology consultant’s perspective on achieving that goal. The first objective is to cover selected aspects of study designs for ocular toxicity studies including considerations for contract research organization selection, minipig species selection, unilateral versus bilateral dosing, and in-life parameters based on fit-for-purpose study objectives. The main objective is a focus on a high-quality ocular pathology report that includes ocular histology procedures to meet regulatory expectations and a report narrative and tables that correlate microscopic findings with key ophthalmic findings and presents a clear interpretation of test article-, vehicle-, and procedure-related ocular and extraocular findings with identification of adversity and a pathology peer review. The last objective covers considerations for a high-quality ophthalmology report, which in concert with a high-quality pathology report, will pave the way for a best quality toxicology report for an ocular toxicity study.

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Significance of acquired diverticular disease of the vermiform appendix: a marker of regional neoplasms?

Journal of Clinical Pathology ◽

10.1136/jclinpath-2011-200647 ◽

2012 ◽

Vol 65 (7) ◽

pp. 638-642 ◽

Cited By ~ 14

Author(s):

Klaus Kallenbach ◽

Sofie Vetli Hjorth ◽

Ulla Engel ◽

Nis Hallundbæk Schlesinger ◽

Susanne Holck

Keyword(s):

Diverticular Disease ◽

Vermiform Appendix ◽

Diagnostic Process ◽

Pathology Report ◽

Colorectal Carcinomas ◽

Valuable Contribution ◽

Appendiceal Neoplasms ◽

Neoplastic Lesions ◽

Putative Marker ◽

Space Occupying Lesion

AimTo assess the prevalence of acquired diverticulum of the appendix (DA), including incipient forms and its possible significance as a marker of local/regional neoplasms.Materials and MethodsThe pathology database at Hvidovre Hospital was searched for appendix specimens, received between 2001 and 2010, coded for DA or for a space-occupying lesion. Slides were reviewed to determine DA status and the nature of lesions possibly causing DA.ResultAmong 4413 appendix specimens, DA were identified in 39 (0.9%, CI 0.6% to 1.2%) cases, 17 (43.6%, 28.0% to 59.2%) of which additionally harboured an appendiceal neoplasm/neoplastic precursor, whereas this figure was 1.2% (CI 0.9% to 1.6%) for non-DA specimens (p<0.0001). Six of the 39 DA specimens comprised incipient DA, three of which coexisted with appendiceal neoplasms. In addition, local/regional non-neoplastic lesions (six cases) and colorectal carcinomas (four cases) coexisted with DA.ConclusionDA has significance as a putative marker of local/regional neoplasms. Therefore, a DA specimen proved significantly more likely to harbour a neoplastic growth than a non-DA counterpart. Submission for microscopy of the entire DA specimen, whether transmural or only incipient, and a comment in the pathology report on the occasional concurrence of local/regional neoplasms in this setting seem appropriate. The observation of DA may thus provide a valuable contribution in the diagnostic process.

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Bladder Cancer in an Inguinoscrotal Vesical Hernia

Case Reports in Oncological Medicine ◽

10.1155/2012/142351 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Lucas Regis ◽

Fernando Lozano ◽

Jacques Planas ◽

Juan Morote

Keyword(s):

Adjuvant Radiotherapy ◽

Bladder Tumor ◽

Resection Margin ◽

Diagnostic Delay ◽

Subsequent Treatment ◽

Pathology Report ◽

Inguinoscrotal Hernia ◽

Bladder Dome ◽

Open Surgical Treatment ◽

Anatomical Pathology

We present the case of a 79-year-old male who, due to hematuria, underwent cystoscopy that showed a lesion in the bladder dome. Transurethral resection was attempted, but access to the tumor by this route was impossible. Given the findings, a body CT scan was performed showing an inguinoscrotal hernia with vesical carcinoma contained. Open surgical treatment of the vesical carcinoma contained within the inguinoscrotal hernia was performed in conjunction with the hernia repair. The anatomical pathology report confirmed a high-grade urothelial carcinoma (stage pT2b) with a free resection margin of <1 mm. Adjuvant radiotherapy was selected for subsequent treatment. The presence of bladder tumor in an inguinoscrotal hernia is an uncommon finding and a diagnostic delay can be assumed. The initial therapeutic plan may need to be changed from the usual approaches due to the atypical presentation.

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Is Endoscopic Assessment of the Esophagus and Stomach Enough to Determine the Need for Biopsy at These Sites in Pediatric Patients Undergoing Endoscopy for Elevated TTG?

Pediatric and Developmental Pathology ◽

10.1177/1093526621991486 ◽

2021 ◽

pp. 109352662199148

Author(s):

M. Cristina Pacheco ◽

Nicole Green ◽

Jane Dickerson ◽

Dale Lee

Keyword(s):

Sensitivity And Specificity ◽

Pediatric Patients ◽

Tissue Transglutaminase ◽

Immunoglobulin A ◽

High Specificity ◽

Visual Assessment ◽

Pathology Report ◽

Low Sensitivity ◽

Endoscopic Assessment

Objectives The goal of our study was to determine whether visual assessment of the esophagus and stomach could predict abnormal histology and determine the frequency of interventions based on biopsies in patients undergoing endoscopy for elevated tissue transglutaminase immunoglobulin A antibody (TTG). Methods Pathology records were searched for patients with biopsy performed for elevated TTG. Pathology report, endoscopy report, and follow-up were obtained and slides from the duodenum reviewed. Pathology was considered gold standard for sensitivity and specificity calculations. Results 240 patients were included. 215 patients had esophageal biopsies performed. Esophageal endoscopic visual assessment had sensitivity of 47% and specificity of 93% for abnormal histology. 16(7%) patients had therapy or referral related to results and, of these, 6(38%) had visually normal endoscopy. 237 biopsies were performed of stomach. Gastric endoscopic visual assessment had a sensitivity and specificity of 20% and 87%. 24(10%) patients had therapy based on findings and, of these, 12 (50%) had visually normal endoscopy. Conclusions Endoscopic assessment of esophagus and stomach has low sensitivity and high specificity for pathologic abnormalities when indication for endoscopy is elevated TTG. When endoscopy is visually normal clinical interventions based on biopsy are rare, and foregoing biopsy may be considered.

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Misdiagnosis of a Giant Uterine Leiomyosarcoma: Clinic and Image Challenges

Case Reports in Oncological Medicine ◽

10.1155/2017/3568328 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Jila Agah ◽

Sedighe Karimzadeh ◽

Fateme Moharrer Ahmadi

Keyword(s):

Abdominal Distension ◽

Gastrointestinal Disorder ◽

Cystic Mass ◽

Pathology Report ◽

Uterine Leiomyosarcoma ◽

Peripheral Tissues ◽

Chief Complaints ◽

Magnetic Resonance Imaging Mri ◽

Diagnostic Modalities ◽

Serous Cyst Adenoma

A 41-year-old woman (G3P2L2Ab1) was referred to gynecology clinic with chief complaints of abdominal distension and localized abdominal wall pruritus for three months. She was misdiagnosed with gastrointestinal disorder and ultimately had undergone imaging. Ultrasonography and computed tomography (CT) scan disclosed a huge solid-cystic mass originating from the ovary. On clinical examination the patient had no pain or tenderness and no gynecologic complaints. Laboratory tests showed normal tumor markers and hemoglobin at 8 g/dl. Laparotomy was carried out as diagnosis of ovarian serous cyst adenoma, but a huge tumor with attachment to uterus and ovaries and extension to pelvic floor, peripheral tissues of ureter, and upper abdomen was found. Hysterectomy with bilateral salpingooophorectomy was done. Pathology report demonstrated uterine leiomyosarcoma measuring 40 centimeters and weighing 10 kilograms. In conclusion, as pelvic masses even in a large size may present unspecific symptoms misdiagnosis may occur which lead to overgrowth, local invasion, or other complications. So, it is rather to suggest ultrasonography in patients with persistent abdominal or pelvic symptoms and if needed, more exact diagnostic modalities like magnetic resonance imaging (MRI) could be offered to avoid misdiagnosis and mismanagement.

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IsHelicobacter pyloriBeing Treated Appropriately? A Study of Inpatients and Outpatients in a Tertiary Care Centre

Canadian Journal of Gastroenterology ◽

10.1155/2007/628408 ◽

2007 ◽

Vol 21 (5) ◽

pp. 285-288 ◽

Cited By ~ 3

Author(s):

Jose Nazareno ◽

David K Driman ◽

Paul Adams

Keyword(s):

Tertiary Care ◽

Gastric Biopsy ◽

Pathology Report ◽

Tertiary Care Centre ◽

Delivery Of Care ◽

Ulcer Disease ◽

Appropriate Treatment ◽

Significant Difference ◽

H Pylori

BACKGROUND:Helicobacter pyloriis causally associated with peptic ulcer disease and gastric cancer. Although effective treatment is available, studies have shown that patients withH pyloriare often not well managed. Recently, there has also been increasing awareness of patient safety concerns arising from missed follow-up of abnormal test results.OBJECTIVE: To examine whether inpatients and outpatients diagnosed withH pylorireceive appropriate treatment.PATIENTS AND METHODS: All patients who were diagnosed withH pyloriby gastric biopsy in London, Ontario between January 1, 2004, and December 31, 2004, were identified. The hospital charts of these patients were reviewed. Outpatient office charts, clinic notes, pathology reports and endoscopy reports were also reviewed.RESULTS: One hundred ninety-three patients were diagnosed withH pyloriby gastric biopsy in 2004. Of the 193 patients, 143 (74%) were outpatients and 50 (26%) were inpatients. Overall, 89% of patients received treatment forH pylori. Ninety-two per cent of outpatients were treated, while only 60% of inpatients received treatment (P<0.001). Among the inpatients, the pathology report was available in 40% of the cases before the patient was discharged from the hospital. After discharge from the hospital, 30% of inpatients received appropriate treatment and follow-up. There was no significant difference in treatment whether the patient was admitted to a medical or a nonmedical service.CONCLUSION:H pyloriis treated relatively poorly in inpatients compared with outpatients. Results of the present study reveal opportunities to improve delivery of care for inpatients on a number of different levels. More research is needed to ensure safety, effectiveness and timeliness in the test result management process.

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