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Mucosa-associated lymphoid tissue (MALT) lymphoma: a practical guide for pathologists.

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is the third most common non-Hodgkin lymphoma subtype, accounting for around 6-8% of all non-Hodgkin lymphomas in the Western hemisphere. Although MALT lymphomas are clinically indolent, the disease is typically chronic, requiring long-term clinical surveillance and, often, repeated biopsies. Pathologists thus play a central role in the diagnosis and management of these patients. The optimal diagnosis and management of a MALT lymphoma requires careful integration of morphological, immunohistochemical and molecular information, together with close cooperation with the clinician treating the patient. This review discusses recent developments in the molecular pathogenesis of MALT lymphoma and provides strategies for integrating this information into daily pathological practice.

Algorithms↗

Training of pathologists in countries belonging to the European Economic Community.

The regulations and procedures for the training and assessment of pathologists engaged in morbid anatomy and histology, medical microbiology, haematology, and clinical chemistry in the countries of the European Economic Community are reviewed. Differences in the terminology used in the description of pathological disciplines are noted. Suggestions are made by which harmonisation of training, which is an EEC objective, could be achieved.

Chemistry, Clinical↗

On-call service: the role of chemical pathologists.

The workload of the chemical pathology advisory on-call service was investigated. Over three years 317 calls were recorded, giving a mean of nine calls a month. Seasonal variation in the number of calls was observed, with an increase in calls during December, January, and February. Requests for the arrangement of analysis accounted for 231 calls, while there were 98 requests for advice. Authorization of a request for analysis was the outcome of 156 calls. Advice with respect to investigation, treatment, or interpretation of results was offered during 173 calls. The acute medical and surgical wards, the accident and emergency department, renal unit and intensive care unit accounted for 198 of the calls. The two analyses most frequently requested, through the advisory on-call service, were serum digoxin and blood ethanol, with 51 and 33 requests, respectively. The "acute" wards and accident and emergency department had the greatest request rate, accounting for 35 of the requests for digoxin and 26 of the requests for blood ethanol. The acute care areas were responsible for the major part of the workload, and a clinical requirement for the services of chemical pathologists out of hours, was observed.

Blood Chemical Analysis↗

Royal College of Pathologists' accreditation pilot study: a year later. The College Audit Steering Committee.

Twenty one heads of departments who participated in the Royal College of Pathologists' pilot study of laboratory accreditation were questioned a year after the event to discover if the process had produced any lasting effect. All but one responded. Eighteen (90%) felt that there had been lasting and tangible benefit from their inspection. Of 10 departments with deficiencies relating to resources (and where no plans to upgrade existed before the study), five (50%) had obtained improvements as a direct result of the inspector's report. Overall, 16 (80%) of respondents were in support of the development of an accreditation scheme of the type attempted, and none were opposed. The envisaged scheme seems to have the potential to produce lasting improvements in service and commands the support of the departments involved so far.

Accreditation↗

Pathologists dislike sound? Evaluation of a computerised training microscope.

AIM: To evaluate the use of multimedia enhancements, using a computerised microscope, in the training of microscope skills. METHODS: The HOME microscope provides facilities to highlight features of interest in conjunction with either text display or aural presentation. A pilot study was carried out with 10 individuals, eight of whom were at different stages of pathology training. A tutorial was implemented employing sound or text, and each individual tested each version. Both the subjective impressions of users and objective measurement of their patterns of use were recorded. RESULTS: Although both versions improved learning, users took longer to work through the aural than the text version; 90% of users preferred the text only version, including all eight individuals involved in pathology training. CONCLUSIONS: Pathologists appear to prefer visual rather than aural input when using teaching systems such as the HOME microscope and sound does not give added value to the training experience.

Attitude of Health Personnel↗

The role of the pathologist in human rights abuses.

The objective and unbiased statement is much valued in international work against human rights abuses. Pathologists play an increasingly important role. In this article, this role is illustrated by examples and the international set of rules is described. It is emphasised that under no circumstances should physicians assist in procedures, such as torture, which can weaken a human being. There is ongoing research into the sequelae of torture, both by gross and microscopic examination and in the living and dead victims.

Autopsy↗

Proactive management of histopathology workloads: analysis of the UK Royal College of Pathologists' recommendations on specimens of limited or no clinical value on the workload of a teaching hospital gastrointestinal pathology service.

AIMS: To investigate the effect on the workload of a gastrointestinal pathology service of implementing the recommendations of the Royal College of Pathologists' (RCPath) working party on specimens of limited or no clinical value (LONCV). METHODS: All endoscopic gastrointestinal pathology reports for the first three months of 2001 at a large teaching hospital were reviewed against the RCPath recommendations. Specimens in the category of LONCV were recorded and the final histopathology diagnosis noted. RESULTS: The biopsies in the LONCV category were 30% of oesophageal, 61% of gastric, 0.5% of duodenal, and 7% of colorectal origin. CONCLUSIONS: Implementing the RCPath recommendations would reduce the number of requests for the examination of gastrointestinal endoscopic specimens by 3500 specimens each year in this department. None of the specimens in the LONCV category showed an abnormality that could not have been detected by a more efficient and less invasive method. In the UK, where there is a severe shortage of trained histopathologists, the implementation of these recommendations would ensure that these scarce resources are not misused.

Biopsy↗

Role of the pathologist in the diagnosis of hereditary non-polyposis colorectal cancer.

The aim of this paper is to indicate how the pathologist may suspect a diagnosis of hereditary non-polyposis colorectal cancer (HNPCC) on the basis of histological criteria and patient age alone. A single morphological feature, namely the presence of intra-epithelial lymphocytes (tumor infiltrating lymphocytes), identifies the majority of colorectal cancers (CRC) with the DNA microsatellite instability-high phenotype. A number of pathological criteria can help to distinguish HNPCC from sporadic MSI-H CRC, though age below 60 years is an important pointer towards HNPCC. Immunohistochemistry to demonstrate loss of expression of DNA mismatch repair genes serves as a highly reliable test of mismatch repair deficiency if antibodies to hMLH1, hMSH2, hMSH6 and hPMS2 are employed.

Adaptor Proteins, Signal Transducing↗

Educational issues in teaching dysphagia to speech pathologists.

This paper examines current practices in teaching speech pathology students dysphagia theory and practice in Australia, with comment and contrast from speech pathology courses in the UK. There is wide diversity in terms of the time allocated to this subject on undergraduate courses, in ways of teaching and achieving clinical practicum in these areas and in evaluating the learning outcomes and competence of students. Against the background of changing work experience in the health sector, where dysphagia increasingly forms a significant proportion of a speech pathologist's caseload, the challenge for educators is to provide a dynamic, integrated, modern curriculum where dysphagia forms a significant component of the course. This paper examines some of the current educational issues and discusses teaching and learning paradigms in this area.

Australia↗

Educating speech-language pathologists for a multicultural world.

This paper presents critical elements and current needs in educating speech-language pathologists for a multicultural world. A proposed paradigm shift in clinical teaching using the UK model is also introduced. In addition, a case study on the American Speech Language Hearing Association's efforts in implementing the Multicultural Action Agenda by networking with the Asian Pacific Islander caucus is described. A survey of multicultural elements in programs in Australia and New Zealand is included. Finally, suggestions for collaboration with those in established professional bodies to meet the increasing needs of a multicultural world are provided.

Cultural Diversity↗

Education of speech-language pathologists and audiologists in Brazil.

The field of speech-language pathology (SLP) in Brazil, named 'fonoaudiologia', comprises both a therapeutic approach to communication disorders and audiology and was officially recognized on December 9, 1981 (law No. 6965). University programs exist since the 1960s. The undergraduate level is a 4-year honors Bachelor of Science program and requires at least a 3,700 h of coursework. Since 1996 four areas of specialization were established: language, audiology, voice and oral myology, requiring a minimum of 500 h of course. Graduate programs in the narrower sense,master's degree and doctorate, exist since the 1970s. Brazil is a 180-million inhabitant country with approximately 25,000 speech-language pathologists, of which 2,700 are specialists, 800 masters and 210 doctors. There are almost 100 undergraduate programs and 70 specialization courses; however, for master's degree and doctorate purposes there are only 8.

Audiology↗

Preparation of speech-language pathologists in the United States: The Master's degree.

In order to become credentialed as a speech-language pathologist in the United States, a masters's degree is required. This degree integrates course work with clinical practica. Course work covers normal anatomy and physiology involved in human communication and swallowing, disorders affecting these functions and methods of evaluation and treatment across the life span. Generally this master's degree education requires 1(1/2) to 2 years for students with some background course work on the undergraduate level.

Clinical Competence↗

"Early" cancer of the larynx: the concept as defined by clinicians, pathologists, and biologists.

Since a great deal of confusion surrounds the different uses made by clinicians, pathologists, and biologists of the term, this paper clarifies the concept of "early" cancer of the larynx. Clinically, this is usually a glottic neoplasm in which full cordal mobility is still present; early supraglottic cancer is infrequent, and usually a chance finding. Whatever the site, early laryngeal cancer is a minimally invasive neoplastic lesion that does not invade the muscle or cartilage, but is still capable of metastasis. Being confined to the lamina propria, it is more than a carcinoma in situ but less than a deeply infiltrating carcinoma. Superficial extending carcinoma is therefore an early cancer. Biologically, early cancer belongs to stage II.

Carcinoma in Situ↗

Comparative and correlative neuroanatomy for the toxicologic pathologist.

Xenobiotic-induced neuroanatomic alterations are always regarded as adverse and are commonly used to define reference doses to manage neurotoxic risk. Thus, the neuropathologist plays an essential role in evaluating potential neurotoxicants. The pathologist must be able to recognize the morphologic differences that exist among species, strains, and ages or between genders (comparative neuroanatomy) and to grasp the impact of structural damage on neural function (correlative neuroanatomy). Brain anatomy and function may be used to group the mammals used in neurotoxicity bioassays into 3 classes: rodent, carnivore, and primate. Neural function may or may not be affected by the structural divergence. Rodents are preferred for neurotoxicity assays because their reduced body size allows optimal perfusion at little cost and their smaller brain size permits screening of multiple regions using few sections. However, care must be exercised when interpreting rodent neuropathology data because the rodent paleocortex does not recapitulate the sophisticated neocortical circuitry and functions of carnivores and primates. Knowledge of the neuroanatomic variations that exist among test species assists the neuropathologist in defining the relevance of structural alterations, the potential clinical sequelae of such findings, and the possible significance of similar changes in humans.

Animals↗

Pathologist's responsibility in the diagnosis of oncogenesis.

In recent years with all sophisticated incoming data, it has become obvious that "cancer" is indeed a cellular disease. This level of biological organization is extremely pivotal, because it is at this level that the interactive control mechanisms have failed, rendering excessive proliferation and uncoordinated growth, which persists after cessation of the stimuli which evoked it. Although we are extremely interested in identifying and describing the stimuli (etiology), presently as toxicologic pathologists, we are called upon in rendering a diagnosis as to whether given findings are "cancer", and by extension whether an administered substance has caused these findings in laboratory animal species. For some time now the etiology has been confused with the diagnosis and the identification of the causative stimuli with the manifested effects. Although we don't know yet the entire story about the etiology of the oncogenic process we can say that we know a lot about its manifestations and therefore we are capable of making the diagnosis. By virtue of our training, we are capable of identifying, classifying and describing all oncogenic manifestations, no matter whether they are in mice or men. In the course of this pursuit we need some order. Oncogenesis is a multistep, multistage process. We must therefore have a design capable of describing and differentiating initiation, potentiation, promotion, modification, and autonomy in our laboratory animal studies. We must also address the status of the biological resistance of the animal organism through pertinent comparative correlations. Furthermore, since "cancer" is a disease, and a syndrome, we must not limit ourselves in studying only the incidence of a single manifestation in an animal, especially if we intend to use it in extrapolation, but the entire multiplicity of manifestations. In biology, in order to effectively extrapolate, we need appropriate changes in the orders of magnitude. The new chemical entity should be compared structurally to the known human and rodent oncogenic substances. The interspecies differences in toxicokinetics and metabolism compared and the type and location of target cell, as well as, the extent of genetic distortions should be established. By implementing all these it is possible not only to render an accurate diagnosis but also estimate the human "cancer" risk.

Adult↗

The pathologist in litigation: a scientist's perspective.

Escalation of myriad litigious facets of our society can be found in almost any large city newspaper, especially in the United States, and, in particular, in the Yellow Pages of the telephone directory listing of personal injury (toxic tort) lawyers--many with full-page advertisements offering a cornucopia of services replete with free consultation and contingency "no-fee" offers if litigation proceedings are undertaken and fail to be financially productive. With such inducements, it is little wonder that such an environment essentially guarantees that many pathologists such as yourselves will be increasingly drawn into litigation at some stage in his/her career, especially in the area of product (toxic tort) liability.

Expert Testimony↗

Fine Needle Aspiration Biopsies of the Head and Neck: The Surgical Pathologist's Perspective.

Masses of the head and neck comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgical pathologist and surgeon. Fine needle aspiration cytology is an increasingly popular technique in the initial evaluation of such lesions. The high diagnostic accuracy of this technique makes it generally preferable to traditional surgical biopsy. It is particularly useful in the sampling of histologically uniform neoplasms of the salivary glands, identification of classical papillary carcinoma and medullary carcinoma of the thyroid, separation of colloid goiter from follicular neoplasms, and confirmation of clinically suspicious lymph node metastases in cases with already documented malignant diseases. Despite its usefulness, aspiration cytology of head and neck lesions has certain inherent pitfalls, and these are briefly examined in this review. Int J Surg Pathol 8(1):17-28, 2000

Journal Article↗

Modern management of colorectal cancer--a pathologist's view.

Colorectal cancer is an increasingly significant cause of both mortality and morbidity due to wider adoption of the Western lifestyle and a progressively ageing population. Recently steps forward have been made both in surgical and chemoradiotherapeutic management of this disease. Well performed total mesorectal excision surgery has now become the gold standard for rectal cancer resection. Several prognostic markers, both clinicopathological and molecular, have been identified allowing better patient counselling and targeting of treatment. The rationale for patient selection, timing and dose of radiotherapy has been further elucidated. New chemotherapy agents are under trial and predictive factors allowing selection of those patients most likely to respond to them have been identified. Many of these factors will increase in importance as colorectal cancer becomes a chronic disease with lengthening survival times. As we will discuss the pathologist has important roles in all of these developments and at all stages of colorectal cancer management.

Colorectal Neoplasms↗