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The prospect of forming a joint venture need not be frightening. Three years into the operation of one such venture, a pathologist explains why and how the formation of a marketing organization enhanced this laboratory's ability to provide broad-based community laboratory services while working within the hospital environment.
There will be increasing competition in hospitals for access to and control of the hospital clinical database, and one of the major causes of this competition, the author suggests, is that administrators and physicians have a different set of goals and objectives. To maintain the integrity of the lab database, pathologists must lobby vigorously for a partly decentralized system with the lab's information system operating semi-autonomously.
In the 15 years between 1975 and 1989 approximately 5,000 infants succumbed to SIDS in the Nordic countries. Denmark and Norway were most seriously hit, with SIDS rates amounting to 2 and 2.5 per 1,000 live births in 1989. During the 1970's and 1980's especially Denmark and Norway experienced a significant increase in SIDS rates. In 1990 a co-operative study was initiated by Nordic Council of Ministers. Part of the study consisted of forensic pathologists examining SIDS victims. They showed that neither the increase during the 1980's nor the decrease during the 1990's was due to changes in the classification or diagnostic practise. A correlation between prone sleeping position and SIDS rates is now well recognised. However, neither an explanation for the great discrepancy in SIDS rates between the Nordic countries nor a possible explanation for the risk of prone sleeping position has been achieved.
Acute self-limited colitis encompasses several diagnostic possibilities such as infectious colitis, post-antibiotic colitis, drug-induced colitis and should be differentiated from acute forms of inflammatory bowel disease. Diverticular disease in the elderly patient with colonic ischaemia may also give symptoms of acute bloody mucoid rectal discharge and should be recognised, although the clinical picture is usually completely different. Recognition of the causative agent--if possible--is particularly important in the patient with a foudroyant colitis (e.g. toxic megacolon), when the clinician has to decide, whether antibiotics or corticosteroids should be given or even a resection should be performed. A short history usually indicates towards infection, but a long-standing history of inflammatory bowel disease may be complicated by a superinfection. Faecal cultures, endoscopy with colonic biopsy should be performed and results be discussed. New techniques for the assessment and follow up of difficult cases are: white cell scintigraphy, computerized tomography scanning and magnetic resonance imaging scanning. Acute self-limited colitis can usually be classified properly and treated accordingly. This review discusses the role to be played by the clinician, microbiologist and pathologist and is illustrated by several clinical examples, in which patients presented with unusual forms of acute self-limited colitis.
OBJECTIVE: Patients scheduled for prostatectomy often receive androgen deprivation therapy to make malignant tumors more amenable to resection and improve the postoperative course. These hormonal therapies may significantly alter the histomorphology of carcinoma of the prostate detected on subsequent needle biopsies. METHODS: Needle specimens were obtained from resected prostates harboring biopsy-proven carcinoma previously treated with leuprolide. The tissue was examined by light microscopy to note architectural and cytologic characteristics. RESULTS: A high proportion of treated carcinomas had an atrophic, infiltrative appearance. Nuclear and nucleolar enlargement were consistently observed. Macronucleoli, blue-tinged mucin, and intraluminal pink amorphous material was frequently identified. CONCLUSIONS: The markedly atrophic nature of the cells and glands may result in either overgrading of prostate carcinoma or failure to recognize the more subtle patterns of this malignant neoplasm. It is imperative that clinicians convey a history of hormone treatment to pathologists when core biopsies of the prostate are submitted for histologic evaluation.
Important criteria for histopathological evaluation in breast carcinoma are described. Of major importance is macroscopical evaluation. It is mainly the evaluation of the resection margins which still remains a clinically relevant problem for pathologists. New trends for intraductal carcinoma and evaluation of axillary lymph nodes are reported. An overview for prognostic factors is given.
The general level of histotechnology in this country is alarmingly low. Surgical pathology, a difficult field, is made doubly so by poorly prepared sections. The blame for this must rest in part on the pathologist because of his ignorance of histologic procedures, his acceptance of shoddy work, and his lack of interest in seeing that bright young people are enticed into the field and that adequate training facilities and career opportunities are available to them. Today we are asked to perform increasingly complex procedures, and if we are to meet this challenge, as well as perform our duties in pathologic anatomy to the best of our ability, it is essential that we rapidly change our attitude.
The endoscopy era made it possible to see many of the diseases that were being treated by clinicians. The use of endoscopic biopsy further enhanced that ability. This article illustrates how gastrointestinal biopsy and other practices can be improved so that patients benefit more than they might otherwise. This article focuses on pinch biopsy forceps technique and on dialogue with the pathologist.
Health care work should be one of the important roles of the clinical pathologist. However, we do not have specific health care programs yet. I would like to propose that the Japan Society of Clinical Pathology should become involved in the region of health care programs. In the health care programs that we discuss here, target values appropriate for healthy people to maintain their health are determined. Laboratory medicine is expected to make great contributions in this respect. I hope this session will be helpful in promoting an understanding of the importance of health care programs among our members.
BACKGROUND AND OBJECTIVES: The REAL/WHO classification constitutes a new tool for the better understanding and treatment of malignant lymphomas. The authors focus on the key features of B-cell lymphomas with an indolent behavior, aiming to contribute to the cross-talk between pathologists and clinicians. DATA SOURCES AND METHODS: Each lymphoma entity is analyzed on the basis of the most representative contributions in the literature and the authors' experience gained in studying more than 20,000 lymphoid tumors over a 20-year period. RESULTS: Guidelines for diagnosis and areas of interest for future clinico-pathologic studies are identified and discussed. Within this context, selected data obtained by the application of novel markers are presented. INTERPRETATION AND CONCLUSIONS: The present know- ledge and organization of malignant lymphomas now make the development of tailored therapies a feasible goal.
BACKGROUND AND OBJECTIVES: The REAL/WHO classification constitutes a new tool for the better understanding and treatment of malignant lymphomas. The authors focus on the key features of aggressive B- and T-cell lymphomas, aiming to contribute to the cross-talk between pathologists and clinicians. DATA SOURCES AND METHODS: Each lymphoma entity is analyzed on the basis of the most representative contributions in the literature and the authors' experience gained in studying more than 20,000 lymphoid tumors over a 20-year period. RESULTS: Guidelines for diagnosis and areas of interest for future clinico-pathologic studies are identified and discussed. Within this context, selected data obtained by the application of novel markers are presented. INTERPRETATION AND CONCLUSIONS: The present know- ledge and organization of malignant lymphomas now make the development of tailored therapies a feasible goal.
The surgical management of malignant breast tumours has considerably changed in the last decade, and breast conservation is often favoured over mastectomy. As a consequence of screening and use of preoperative diagnostic tools some unequivocal lesions are removed for diagnostic purposes. In the present study, the author addressed some of the quality control issues of breast operations that pathologists could monitor. Breast specimens from patients operated on in 1999 formed the basis of this work. The benign to malignant ratio of the 187 assessed cases (0.6) was favourable, and the diagnostic intraoperative frozen section rate (25%) also showed a favourable decrease when compared with previous years. The weight of breast tissue (mean: 31.9 grams) removed during surgery for benign conditions was high. Possibilities for (further) decreasing the three monitored parameters are highlighted. It seems that the parameter than can be improved the most is the mass of benign breast tissue removed for diagnostic purposes. This could be achieved with a better segregation between diagnostic and therapeutic indications of operations. As benign tissue is generally removed from patients who are young, cosmetic results should particularly be taken into consideration in this group.
Soft tissue masses are common in both children and adults. Clinicians must evaluate patients carefully to avoid management errors. The most effective management decisions are made when a working group composed of clinicians, radiologists, and pathologists participates in the interpretation of the imaging studies. Plain-film radiographs and MR imaging scans are the two main imaging modalities used in patients with soft tissue masses. The working group assimilates the clinical and radiographic data to determine if they can identify the nature of the soft tissue mass. When the group can assign a definitive diagnosis, the lesion is designated as a determinate lesion. Determinate lesions include lipomas, ganglions, hemangiomas, neurofibromas, diabetic myonecrosis, muscle tears, myositis ossificans (heterotopic ossification), and pigmented villonodular synovitis. When the process cannot be identified, the lesion is classified as indeterminate. All soft tissue sarcomas are indeterminate lesions. Many benign lesions are also indeterminate. Common examples include schwannomas, myxomas, and giant cell tumor of tendon sheath. Based on the clinical and radiologic features, these diagnoses may be suspected, but because of the inability to distinguish them from sarcomas based on the MR imaging features, they are usually classified as indeterminate. When lesions are judged to be determinate, observation or excisional biopsy are the two major treatment choices. When lesions cannot be identified on the imaging studies, incisional or needle biopsy is performed to establish a diagnosis. Once a diagnosis is made, the proper management choice can be selected. Inappropriate excisional biopsy is the major treatment error in the management of soft tissue tumors. When a high-grade soft tissue sarcoma is resected with multiple positive margins, the risk of local failure after definitive resection is much higher than if the patient had been treated initially with only a needle or incisional biopsy. Also, if a major complication, such as an infection, a major wound-healing problem, or contamination of the major neurovascular structures, occurs at the time of incisional biopsy, amputation of the limb may be necessary. Inappropriate excisional biopsy can occur when a surgeon is not familiar with the features of sarcomas or when a radiologist mistakenly interprets the signal features as a benign lesion.
Fredrik Georg Gade (1855-1933) was born in Bergen as the eldest son of a merchant and politician. He graduated from the University of Oslo in 1880. After clinical residency and training in anatomy and pathology at the National Hospital in Oslo, he worked in several of the most outstanding medical research institutions in Continental Europe, including the institutes of Robert Koch and Carl Friedländer in Berlin, Carl Weigert in Frankfurt, the pathologists and anatomists Victor Cornil, Louis-Antoine Ranvier and Louis Charles Malassez in Paris. Gade was associate professor (prosector) of anatomy in Oslo from 1897 to 1906 and also the editor of the Norwegian Medical Journal (Norsk Magazin for Laegevidenskaben). He was also one of the pioneers of cancer statistics in Norway. In addition to his scientific publications, he wrote extensively on political and cultural issues. Struck by serious illness he donated most of his family fortune to establish an institute for pathology in his home town Bergen, which opened in 1912 under the name Dr. med. F.G. Gades Pathologiske institutt. It later became one of the pillars of the Medical Faculty when the University of Bergen was established in 1946 (now: The Gade Institute, University of Bergen).
The development of cancer screening has led to the discovery of smaller tumours and less frequent dissemination to lymph nodes and organs that requires special techniques for detection. Numerous papers on micrometastases reflect a considerable amount of work devoted to detection methods, technical problems and the prognostic value of these lesions. Apart from cytological techniques, the pathologist can rely on two methods for the detection of micrometastases: serial slicing of paraffin-embedded blocks and immunohistochemistry. When these methods are combined, the detection rate is similar to that of biological methods and can attain levels as high as 60% for the sentinel node with the added vantage of being able to visualise cells. Despite an impressive body of studies, major disparities are found in detection rates and the prognostic value of micrometastases is not firmly established. In order to facilitate comparisons and analyses, it is essential to adopt a common terminology with precise definitions. The UICC advocates the use of the term micrometastasis which denotes a metastasis smaller than or equal to 2 mm in size. The potential aggressiveness of micrometastases is dependent on other poorly explored parameters such as the number of cells detected in the bone marrow or lymph node and the location of micrometastases. The new pTNM classification takes into account this latter parameter and distinguishes two categories of micrometastases: "isolated tumor cells" located in the lumen of vessels or sinuses and "micrometastasis" which has already invaded an organ. This classification warrants further analysis to determine the prognostic value of these categories. The next challenging problem consists in determining the key biological properties that account for distant dissemination.
Camillo Golgi confirmed, in 1885, Marchiafava's and Celli's discoveries about malaria, following a clinical-pathologic research pattern and studying the patient directly. In 1889 he associated the naturalistic-biological point of view and the clinical-pathologic one so that he made possible a differential diagnosis between tertian and quartan fever, independently from the clinical observation; he supplied useful laboratory data for clinical diagnosis and, in doing so, he created the new figure of the clinical pathologist; he distinguished three different kinds of intermittent fevers and, in 1888, he specified the useful time for quinine administration. The article analyzes, also, his methodological and scientific principles.
The authors discuss basic problems of pathology in district institutes of national health as well as social aspects of the work of pathologtsts. Social activity and correctly conceived health education are an essential part of the activities of pathologists.
OBJECTIVE: To assess the adequacy of reporting gross and microscopic pathologic findings of resected lung carcinoma. DESIGN: Q-Probes study following the College of American Pathologists format. SETTING: Pathology laboratories, 1991. PARTICIPANTS: Four hundred sixty-four institutions. MAIN OUTCOME MEASURES: Rate of reporting gross and microscopic features. RESULTS: Information provided in over 8300 surgical pathology reports of resected primary lung carcinomas from 464 institutions was reviewed. Descriptors included gross and microscopic findings. The rate of reporting the descriptors from the aggregate sample is listed as follows (the corrected rate for those descriptors in which evaluation was not applicable are listed in parentheses for each descriptor where appropriate): general findings, standard report or checklist used 20.8%, type of procedure stated 89.6%, and lobe or lung of origin stated 99.1% (99.5%); gross findings, distance of neoplasm from nearest visceral pleura 61.1%, involvement or lack of involvement of bronchus 68.7%, presence or absence of involvement of veins 18.3%, parenchyma not involved by neoplasm described 80.1% (81.4%), visceral pleural surface described 83.0%, tumor size stated 97.2%, and description of regional lymph nodes attached to specimen 74.7% (82.7%); and microscopic findings, microscopic description 77.6%, histologic type of tumor stated 99.3%, grade of carcinoma stated 80.9% (88.7%), presence or absence of lymphatic vascular invasion 24.3%, status of lymph nodes stated 89.0% (95.9%), presence or absence of venous invasion 22.6%, presence or absence of neoplasm at bronchial margin 90.8%, presence or absence of neoplasm at vascular margin 30.9%, presence or absence of carcinoma in the visceral pleura 64.6% (66.9%), and presence or absence of abnormality in nonneoplastic parenchyma 72.8% (74.1%). CONCLUSION: The rate of reporting gross and microscopic features varies; recommendations for reporting are made and include the use of a standard report form or checklist.