Histology of Cardiac Sarcoidosis with Novel Considerations Arranged upon a Pathologic Basis

Sarcoidosis is a rare disease of isolated or diffuse granulomatous inflammation. Although any organs can be affected by sarcoidosis, cardiac sarcoidosis is a fatal disorder, and it is crucial to accurately diagnose it to prevent sudden death due to dysrhythmia. Although endomyocardial biopsy is invasive and has limited sensitivity for identifying granulomas, it is the only modality that yields a definitive diagnosis of cardiac sarcoidosis. It is imperative to develop novel pathological approaches for the precise diagnosis of cardiac sarcoidosis. Here, we aimed to discuss commonly used diagnostic criteria for cardiac sarcoidosis and to summarize useful and novel histopathologic criteria of cardiac sarcoidosis. While classical histologic observations including noncaseating granulomas and multinucleated giant cells (typically Langhans type) are the most important findings, others such as microgranulomas, CD68+ CD163− pro-inflammatory (M1) macrophage accumulation, CD4/CD8 T-cell ratio, Cutibacterium acnes components, lymphangiogenesis, confluent fibrosis, and fatty infiltration may help to improve the sensitivity of endomyocardial biopsy for detecting cardiac sarcoidosis. These novel histologic findings are based on the pathology of cardiac sarcoidosis. We also discussed the principal histologic differential diagnoses of cardiac sarcoidosis, such as tuberculosis myocarditis, fungal myocarditis, giant cell myocarditis, and dilated cardiomyopathy.

Virtual Microscopy in Undergraduate Pathology Education

Objectives: Whole-slide imaging (WSI) and virtual microscopy (VM) have revolutionized teaching, diagnosis and research in histopathology. The aims of this study were to establish the feasibility of achieving early integration of clinical reasoning with undergraduate pathology teaching on a virtual microscopy platform and, to determine its student-centricity through student feedback. Methods: Thirty-eight VM-centered clinical cases were introduced to forty-nine students in an integrated undergraduate medical curriculum. The cases were aligned to curricular objectives, reinforced the pathologic basis of disease with critical thinking and were delivered across fifteen interactive small-group sessions. A simulated cross-disciplinary integration and judicious choice of pertinent diagnostic investigations was linked to principles of management. Feedback was obtained through a mixed-methods approach. Results: User-friendliness, gradual learning curve of VM and annotation-capacity were scored 4-5 on a Likert scale of 1-5 by 91.84%, 87.75% and 83.67% students respectively. Students agreed on content-match to the stage of learning (81.63%), theme of the week (91.84%) and development of a strong clinical foundation (77.5%). Integration (85.71%) and clinico-pathological correlation (83.67%) were strengths of this educational effort. High student attendance (~100%) and improved assessment scores on critical thinking (80%) were observed. Software lacunae included frequent logouts and lack of note-taking tools. Easy access was a significant student-centric advantage. Conclusion: A VM-centered approach with clinico-pathological correlation has been successfully introduced to inculcate integrated learning. Using the pathologic basis of disease as fulcrum and critical reasoning as anchor, a digitally-enabled generation of medical students have embraced this educational tool for tutor-guided, student-centered learning. Keywords: virtual, digital, pathology, microscopy, medical education

INTRODUCTION OF CASE BASED LEARNING IN UNDERGRADUATE PATHOLOGY TEACHING.

Pathology is a subject which bridges the basic medical sciences with clinical sciences in medical education. The undergraduate pathology classes in our Medical Colleges usually include didactic lectures, conventional practical and tutorial classes. The subject of Pathology can be made more interesting for the students by developing in them a proper understanding of the pathologic basis of disease at the 2nd MBBS level with clinical co-relation. One of the innovative method which can be used in this regard is case-based learning. I undertook this project to introduce case-based learning in undergraduate pathology teaching at Jorhat Medical College and Hospital, Jorhat for the second MBBS students. Both student's and teacher’s feedback were evaluated concerning their perceptions towards the method, its conduct and the various aspects of CBL.

Pathologic Basis for the Definition of Discordant Growth in Dichorionic Twins

<b><i>Objective:</i></b> The aim of the current study was to identify the optimal cutoff that should define discordance in dichorionic twin gestations through correlation with abnormal placental pathology as a specific measure of fetal growth restriction of the smaller twin. <b><i>Methods:</i></b> We performed a retrospective cohort study of all women with dichorionic twin pregnancies who gave birth in a single center between 2002 and 2015. We investigated the association between the level of growth discordance and maternal vascular malperfusion (MVM) pathology in the placenta of the smaller twin, with and without adjustment for whether the smaller twin is small for gestational age (SGA). <b><i>Results:</i></b> A total of 1,198 women with dichorionic twin gestation met the study criteria. The rate of MVM pathology in the placenta of the smaller twin increased with the level of discordance and was most obvious for discordance ≥25% (rate of MVM 12.0% compared with 2.8% in cases with discordance &#x3c;10%, adjusted relative risk [aRR] 3.71, 95% confidence interval [CI] 1.97–6.99). When the analysis was adjusted for SGA of the smaller twin, discordance was independently associated with MVM pathology only when growth discordance was ≥25% (aRR 2.18, 95%-CI 1.01–4.93), while SGA was strongly associated with MVM pathology irrespective of the level of discordance. <b><i>Conclusion:</i></b> Our findings suggest that discordant growth in dichorionic twins should raise the concern of fetal growth restriction of the smaller twin, irrespective of whether the smaller twin is SGA, only when the discordance s ≥25%. The association of lower levels of discordance with abnormal placental pathology is mainly driven by the confounding effect of SGA of the smaller twin.