Interobserver variability between experienced and inexperienced observers in the histopathological analysis of Wilms tumors: a pilot study for future algorithmic approach

Background Histopathological classification of Wilms tumors determines treatment regimen. Machine learning has been shown to contribute to histopathological classification in various malignancies but requires large numbers of manually annotated images and thus specific pathological knowledge. This study aimed to assess whether trained, inexperienced observers could contribute to reliable annotation of Wilms tumor components for classification performed by machine learning. Methods Four inexperienced observers (medical students) were trained in histopathology of normal kidneys and Wilms tumors by an experienced observer (pediatric pathologist). Twenty randomly selected scanned Wilms tumor-slides (from n = 1472 slides) were annotated, and annotations were independently classified by both the inexperienced observers and two experienced pediatric pathologists. Agreement between the six observers and for each tissue element was measured using kappa statistics (κ). Results Pairwise interobserver agreement between all inexperienced and experienced observers was high (range: 0.845–0.950). The interobserver variability for the different histological elements, including all vital tumor components and therapy-related effects, showed high values for all κ-coefficients (> 0.827). Conclusions Inexperienced observers can be trained to recognize specific histopathological tumor and tissue elements with high interobserver agreement with experienced observers. Nevertheless, supervision by experienced pathologists remains necessary. Results of this study can be used to facilitate more rapid progress for supervised machine learning-based algorithm development in pediatric pathology and beyond.

Free Vascularized Fibular Graft

Background: Free Vascularized Fibular Grafts (FVFGs) are currently a mainstay for extreme case reconstruction mainly due to their anatomical characteristics, reliability, and versatility in managing all bone defects cases. Method: This paper is a review article of the journal found by the author suitable for our reference in search engines with the keywords "Free Vascularized Fibular Graft" "surgery" "postoperative" and "complications". Results: FVFG can be used as management of bone defects such as post-trauma, infection or tumor, treatment of congenital abnormalities, avascular necrosis (AVN), arthrodesis, and pediatric pathology. Position Placement, Intercalary Resection, Bone Tumor Resection, Fibula Flap Retrieval, Allograft Preparation, Reconstruction at Recipient Site, and Intra-articular Resection need to be considered in the surgical procedure. Postoperative Monitoring in the ICU is necessary to evaluate Vital signs, flap viability, axle well as complications in patients. Conclusion: FVFG is a choice of bone defect reconstruction techniques with good results to be considered by orthopedic surgeons. Keywords: Free Vascularized Fibular Grafts, FVFG, Surgery post-operative, complication.

Sonographic Detection of Congenital Intestinal Malrotation: A Case Report

Intestinal malrotation is a rare fetal anomaly resulting from the failure of midgut rotation and fixation. Sonography is typically the first modality of choice for assessing pediatric pathology due to its high sensitivity, portability, real-time imaging capability, and non-ionizing technique; however, its role in diagnosing small bowel rotational anomalies remains limited and controversial. Fluoroscopic upper gastrointestinal imaging (UGI) is the primary diagnostic examination at most institutions. However, even on UGI, imaging findings may be equivocal. In such cases, sonography may provide additional information at facilities where it is not used as a primary diagnostic tool. This case report represents the first reported case showing how patient position is important as the typical vascular sonographic features of rotation were normal in one position but abnormal in another. In addition, this case shows how congenital intestinal malrotation was decisively diagnosed using sonographic imaging.

A Practical Approach to the Evaluation and Diagnosis of Pediatric CNS Tumors

Tumor classification in neuropathology is a dynamic and complex topic, with many changes emerging in the past 5 years, up to and including the 2021 publication of the 5th edition of the World Health Organization Classification of Tumours of the Central Nervous System (CNS). For pediatric pathologists who will encounter brain tumors with varying frequency, it is important to understand the principles of these classification updates, particularly the inclusion of molecular genetic features and development of a layered, or integrated, diagnosis. This issue of Perspectives in Pediatric Pathology is dedicated to the examination of pediatric brain tumors, and features articles on intraoperative diagnosis and updated information on molecular-based classification for pediatric glial, glioneuronal, ependymal, and embryonal tumors of the CNS.

Proportion of children with cancer that have an indication for genetic counseling and testing based on the cancer type irrespective of other features

In children with cancer, specific clinical features such as physical anomalies, occurrence of cancer in young relatives, specific cancer histologies, and unique mutation/methylation signatures may indicate the presence of an underlying cancer predisposition syndrome (CPS). The proportion of children with a cancer type suggesting a CPS among all children with cancer is unknown. To determine the proportion of children with cancer types suggesting an underlying CPS among children with cancer. We evaluated the number of children with cancer types strongly associated with CPS diagnosed in Germany between 2007 and 2016. Data were obtained from various sources including two national pediatric pathology reference laboratories for brain and solid tumors, respectively, various childhood cancer trial offices as well as the German Childhood Cancer Registry. Among 21,127 children diagnosed with cancer between 2007 and 2016, 2554 (12.1%) had a cancer type strongly associated with a CPS. The most common diagnoses were myelodysplastic syndrome and juvenile myelomonocytic leukemia, retinoblastoma, malignant peripheral nerve sheath tumor, infantile myofibromatosis, medulloblastomaSHH, rhabdoid tumor as well as atypical teratoid/rhabdoid tumor. Based on cancer type only, 12.1% of all children with cancer have an indication for a genetic evaluation. Pediatric oncology patients require access to genetic counselling and testing.

A History of Board Certification in Pediatric Pathology on Its 30th Anniversary

In 1983 under the leadership of Dr. Daria Haust, the Pediatric Pathology Club (PPC; forerunner of the Society for Pediatric Pathology [SPP]), promulgated bylaws that included recognition of the special expertise required in pediatric pathology. This standard followed formal discussion that began as early as 1970, suggesting that special certification should be pursued, and the idea was vetted by the PPC in 1980 following a special report by Dr. Benjamin Landing and a letter to PPC members. Under the leadership of Dr. William Donnelly in 1984, a relationship between the SPP and the American Board of Pathology (ABPath) began in order to receive recognition of pediatric pathology as a special discipline. As a result, a test committee chaired by Dr. Jerald Schenken began preparing question categories and examples for ABPath examination. These efforts culminated in the first pediatric pathology subspecialty examination, held in Atlanta, Georgia on November 20, 1990. With this article we wish to detail the history of ABPath pediatric pathology board certification from its beginnings to the current time.

TOPICAL ISSUES OF INFECTIOUS RESPIRATORY PATHOLOGY IN CHILDREN

Acute respiratory infections (ARI) are still topical, holding the first place in the structure of infectious pediatric pathology. The most common causative agents of ARI are viruses. Currently, about 200 respiratory viruses are known, among which the most significant are influenza and parainfluenza viruses, rhinoviruses, respiratory syncytial virus, adenoviruses. Relatively recently, previously unknown serotypes of coronaviruses (SARS-CoV, MERS-CoV, NL63 and HKU), bocaviruses and metapneumovirus were described, and at the end of 2019 a new coronavirus SARS-CoV-2 was discovered, which causes COVID-19 infection. Pneumotropic bacteria Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, etc. contributed to the incidence of respiratory infections. Pertussis remains a serious infection for young children, which in recent years, despite the typical clinical picture, presents certain difficulties for diagnosis. The ability of ARI to provoke the development of secondary bacterial complications (bronchitis, bronchiolitis and pneumonia) often dictates the unjustified prescription of antibiotic therapy, which has led in recent years to an increase in antibiotic resistance. Thus, the relevance of ARI at the present stage is not in doubt, and the above problems dictate the need for an individual approach to each patient.

Pediatric pathology all grown up – An interesting case of adult tethered spinal cord

Background: Cervical myelopathy in an adult is typically the result of degenerative disease or trauma. Dysraphism is rarely the cause. Case Description: The authors report the case of a 35-year-old male drywall installer who presented with 2 years of progressive left upper extremity weakness, numbness, and hand clumsiness. Only upon detailed questioning did he mention that he had neck surgery just after birth, but he did not know what was done. He then also reported that he routinely shaved a patch of lower back hair, but denied bowel, bladder, or lower extremity dysfunction. Magnetic resonance imaging of the cervical spine demonstrated T2 hyperintensity at C4-C5 with dorsal projection of the neural elements into the subcutaneous tissues concerning for a retethered cervical myelomeningocele. Lumbar imaging revealed a diastematomyelia at L4. He underwent surgical intervention for detethering and repaired of the cervical myelomeningocele. Four months postoperatively, he had almost complete resolution of symptoms, and imaging showed a satisfactory detethering. The diastematomyelia remained asymptomatic and is being observed. Conclusion: Tethered cervical cord is a rare cause for myelopathy in the adult patient. In the symptomatic patient, surgical repair with detethering is indicated to prevent disease progression and often results in clinical improvement.