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PubMed1999

Tympanic membrane/middle ear pathologic correlates in chronic otitis media.

OBJECTIVE: To correlate pathologic findings of the tympanic membrane with pathologic changes in the middle ear cleft in chronic otitis media. STUDY DESIGN: Retrospective. MATERIAL AND METHODS: One hundred-fifty temporal bones from 97 subjects with chronic otitis media (defined as middle ear pathologic changes including granulation tissue, fluid, cholesteatoma, cholesterol granuloma, tympanosclerosis, and ossicular changes) were selected to correlate the presence of these middle ear pathologies with histopathologic changes of the tympanic membrane. The tympanic membrane pathologies included perforation, myringosclerosis, retraction, hemorrhage, fluid-filled cystic spaces, or dilated vessels. Temporal bones were also assessed for atelectasis. Fifty-six normal temporal bones were taken as controls for measurements. RESULTS: Significant correlations between tympanic membrane and middle ear pathology included myringosclerosis and granulation tissue, myringosclerosis and ossicular pathology, retraction and cholesterol granuloma, retraction and cholesteatoma, retraction and ossicular pathology, perforation and ossicular pathology, and hemorrhage and granulation tissue. Additive effects of some pathologies were also observed. Almost half the bones with middle ear pathology had no associated tympanic membrane pathology, whereas multiple pathologic changes in the tympanic membrane generally showed underlying multiple pathologic changes in the middle ear. CONCLUSION: When tympanic membrane pathology is detected otoscopically, its presence, alone or in combination, can be a strong indicator of underlying middle ear pathology. However, a normal-appearing tympanic membrane does not exclude the possibility of middle ear pathology. These findings suggest the need for other diagnostic tools such as multifrequency tympanometry and otoacoustic emissions to complement otoscopy for diagnosis of middle ear pathology, especially in a tympanic membrane that appears "normal."

Adolescent↗
PubMed1998

Histopathologic review of prostate biopsies from patients referred to a comprehensive cancer center: correlation of pathologic findings, analysis of cost, and impact on treatment.

BACKGROUND: Clinicians at the Fox Chase Cancer Center (FCCC) base prostate carcinoma treatment decisions regarding need to treat, field size, total dose, and adjuvant hormonal therapy on known prognostic factors including clinical stage, Gleason score (GS), perineural invasion (PNI), and pretreatment prostate specific antigen levels. The pathology of every patient is reviewed at FCCC to confirm a diagnosis of malignancy. The objective of this study was to define differences between pathologic reviews and their impact on treatment between outside institutions and FCCC. METHODS: The authors reviewed 538 pathology reports of prostate biopsies performed at both outside pathology departments and FCCC on patients evaluated between January 1993 and December 1996. The outside pathology reviews represented 107 community hospitals, academic institutions, and private pathology laboratories. Patients who had received hormonal therapy, cryosurgery, or radical prostatectomy prior to prostate biopsy were excluded from analysis. Final FCCC pathology determinations were compared with pathology reports from outside institutions. Reports then were analyzed to determine whether differences in interpretation would have resulted in different treatment strategies. Differences in percentages according to institutional type were evaluated using the chi-square statistic. The cost was assessed and cost per change in treatment estimated. RESULTS: The 538 pathology reviews identified a nearly 40% change in GS and a 13% change in > or =2 GS between the FCCC pathology review and 107 outside academic institutions. The results of this study showed that 22% of community hospitals, 10% of private laboratories, and 8% of academic institutions demonstrated at least 2 GS changes compared with the FCCC pathology review (p = 0.001). There was no significant difference observed between types of institutions in the incidence of PNI. CONCLUSIONS: This analysis provides evidence of a significant difference in the pathologic reviews of prostate biopsies conducted at FCCC and outside pathology departments. There was a nearly 40% change in GS and a 13% change in > or =2 GS between the FCCC pathology review and 107 outside institutions. The second pathology review added approximately $104 per case for a total of $55,952 to review all 538 cases. Overall, the savings in health care dollars resulting from the second pathologic review totaled $12,997. This second review of outside pathology in prostate cancer appears to be justified based on the treatment changes and on cost.

Adenocarcinoma↗
PubMed2003

Age-associated prevalence and risk factors of Lewy body pathology in a general population: the Hisayama study.

In dementia with Lewy bodies (DLB), the Lewy bodies (LBs) are an essential substrate. Although LB pathology has gained increasing attention as one of the major causes of dementia, little is known about the exact prevalence of LB pathology in the general population. In addition, the pathology of Alzheimer-type dementia (ATD) is frequently associated with DLB. To investigate the prevalence of LB pathology in a community-based population and to evaluate the relationship between LB and ATD pathology, we performed an analysis of 102 consecutive autopsy cases. The survey extended over 2.5 years and autopsy rate was 70.5%. LB pathology was detected using alpha-synuclein immunohistochemistry and was assessed based on consensus guidelines for DLB. ATD pathology was evaluated by both CERAD and NIA-RI criteria. Twenty-nine subjects were clinically demented. LB pathology was present in 23 (22.5%) of 102 cases, and in 12 (41.4%) of the demented subjects. The LB score was not significantly different between DLB cases and non-demented subjects with LB pathology (nd-LB), while the Braak stages were significantly different between the two groups. Prevalence of LB pathology constantly increased with age. DLB cases accompanying severe ATD pathology showed more rapid increase of LB scores than did DLB cases without severe ATD pathology. Moreover, DLB cases with severe ATD pathology had poorer prognoses than those without severe ATD pathology. Our results suggested that aging and severe ATD pathology have a strong effect on the evolution of LB pathology.

Age of Onset↗
PubMed2004

Pathological entity of dementia with Lewy bodies and its differentiation from Alzheimer's disease.

We reclassified the pathological subtypes of dementia with Lewy bodies (DLB), based on both Lewy pathology and Alzheimer pathology, to clarify the pathological entity of DLB and the boundary between DLB and Alzheimer's disease (AD) in autopsied cases, using both pathological and immunohistochemical methods. DLB was classified as either limbic type or neocortical type according to the degree of Lewy pathology including Lewy bodies (LB) and LB-related neurites by our staging, and was classified as pure form, common form or AD form according to the degree of Alzheimer pathology including neurofibrillary tangles (NFT) and amyloid deposits by Braak staging. These combined subtypes were lined up on a spectrum, not only with Lewy pathology but also with other DLB-related pathologies including Alzheimer pathology, neuronal loss in the substantia nigra, spongiform change in the transentorhinal cortex and LB-related neurites in the CA2-3 region. In contrast, the Lewy pathology of AD did not meet the stages of Lewy pathology in DLB, and there were scarcely any similarities in other DLB-related pathologies between AD and DLB. In addition, the Lewy pathology of AD had characteristics different from that of DLB, including the coexistence rate of LB with NFT, and the immunohistochemical and immunoelectron microscopic findings of LB and LB-related neurites. These findings suggest that DLB is a distinctive pathological entity that can be differentiated from AD, although it shows some pathological subtypes.

Aged↗
PubMed1999

Introduction and development of pathology.

If one defines pathology as gross and microscopic examination of abnormal tissue there was no comparable discipline in traditional medicine of Korea until the introduction of Western medicine in Korea. However, when one widens the scope of pathology to include pathogenesis and etiology, there were some pathology-related descriptions in Oriental medicine long before this period. The pathology based on Virchow's cellular pathology was introduced to Korea through two tracks independently in 1910s. One was academic pathology, through Japanese pathologists, namely Dr. Inamoto and Dr. Tokumitzu, and the other track was hospital pathology through Western missionaries who introduced the American system of laboratory medicine (clinical pathology). It was Japanese who dominated the introduction and development in Korea. The Koreans played a minor role in the development of pathology from the introduction period until 1945, when the Korea was liberated from Japan. Pathology teaching, research and hospital service had been consistently carried out through three medical schools, namely Severance Medical School and two government medical schools until 1945. After independence, the Korean Society of Pathologists was quickly organized and made a rapid promotion. The Korean war provided opportunities to experience and adopt the American pathology system in Korea. The hospital pathology system has been established, together with the pathology specialty system in Korea. Balanced promotion of research pathology and service pathology is expected in Korea.

History, 19th Century↗
PubMed2002

Relationship of clinical and pathologic response to neoadjuvant chemotherapy and outcome of locally advanced breast cancer.

BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy in locally advanced breast cancers produces histologically evaluable changes and frequently reduces the size of the primary tumor. Local clinical response to neoadjuvant chemotherapy may correlate with response of distant metastases. Therefore, clinical or pathological factors, which predict or assess response to treatment, may predict outcome after consideration for initial extent of disease. METHODS: To identify pretreatment characteristics of locally advanced breast cancers which predict clinical and pathologic response to neoadjuvant chemotherapy as well as survival and to assess the utility of postoperative histologic changes, we retrospectively studied one hundred forty-four patients with locally advanced breast cancer treated with neoadjuvant chemotherapy between January 1975 and July 1996. Patients were identified through pathology records of the Mount Sinai Medical Center and via one of the author's clinical databases. Pathologic and clinical responses to neoadjuvant chemotherapy were correlated with survival. Stepwise logistic regression was used to identify variables most significantly related to clinical response and pathologic axillary lymph node involvement. RESULTS: Complete clinical response with no palpable tumor was noted in 7/86 patients (8%) and complete pathologic response was achieved in 18/138 patients (13%). Both clinical (P = 0.038) and pathologic response (P = 0.011) were related to tumor size at the time of diagnosis: smaller tumors were more likely to respond to chemotherapy than larger tumors. Histologic evidence of chemotherapeutic effect, i.e., cytoplasmic vacuolization, change in the number of mitoses and localized fibrosis in lymph nodes did not correlate with clinical or pathologically measured response. Clinical and pathologic response was not associated with age, histology, differentiation, or type of chemotherapy. No residual tumor was found in the axillary nodes of 27% (37) of the patients. Age and complete pathologic response were the only variables significantly related to pathologic nodal status. Eighty-four percent of the 61 patients under 50 years of age had nodal involvement compared to 65% of older patients (P = 0.014). Fifty percent of complete pathologic responders had positive axillary lymph nodes compared to 76% of patients who did not have a complete pathologic response (P = 0.020). Distant disease-free (P = 0.039) and overall survival (P = 0.035) were related to the number of involved axillary lymph nodes. After consideration for pathologic lymph node status, no other variable was significantly related to distant disease-free or overall survival in multivariate analysis. No variable was significantly related to local disease-free survival. Age, clinical tumor size, clinical lymph node status, clinical response, type of chemotherapy, histology, differentiation, chemotherapy effects on primary tumor and lymph nodes, decline in the number of mitoses, and degree of fibrosis in nodes were not predictive of distant recurrence or overall survival. CONCLUSIONS: This study of patients treated with neoadjuvant chemotherapy for locally advanced breast cancers found little evidence that measurable clinical or pathologic changes attributable to chemotherapy predicted survival. Axillary lymph node status, associated with young age, was the most important prognostic indicator in these patients.

Adult↗
PubMed2003

APOE E4 is a determinant for Alzheimer type pathology in progressive supranuclear palsy.

OBJECTIVE: To assess demographic and genetic determinants of Alzheimer type pathology in progressive supranuclear palsy (PSP). METHODS: From a total of 173 pathologically proven cases of PSP in the Society for PSP Brain Bank, 143 patients (mean age = 74.4 years, ranging from 42 to 98 years) were suitable for genetic and pathologic study. Senile plaques (SPs) and neurofibrillary tangles (NFTs) were counted in five cortical areas, Braak stage was given, and APOE genotype was determined from DNA isolated from frozen brain tissue. The APOE allele frequency in PSP with varying degrees of concomitant Alzheimer type pathology was compared with pure PSP and autopsy controls. The relationship of APOE epsilon4 to quantitative pathologic measures was also assessed. RESULTS: Most patients with PSP (103 cases) had either minimal or no Alzheimer type pathology (Braak stage III or less), but 14 patients had many SPs (>20 per low power field) and a Braak stage of IV or higher consistent with pathologic criteria for AD, and 26 patients had many diffuse plaques with minimal neurofibrillary degeneration (Braak stage III or less) consistent with pathologic aging. Alzheimer type pathology was more frequent in women and older individuals with PSP, and 19 of the 40 patients with PSP with Alzheimer type pathology carried at least one APOE epsilon4 allele. The epsilon4 allele frequency was significantly higher in PSP with AD or pathologic aging than in pure PSP, and APOE epsilon4 correlated with the average maximal density of both neocortical SPs and NFTs. CONCLUSION: APOE epsilon4 is a risk factor for Alzheimer type pathology in PSP. Alzheimer type pathology is an independent process unrelated to PSP in cases with both types of pathologies.

Adult↗
PubMed1987

A survey of first-year pathology residents: factors in career choice.

Pathology has become less attractive to US medical graduates by every measure available to us. In 1981, 2.3 per cent of US medical school seniors planned a pathology career; by 1986, a steady decline had reached 1.6 per cent. In absolute numbers, adjusted for the response rate to the AAMC questionnaire, this means that the 290 seniors entering pathology in 1981 had fallen to 205 by 1986. FMGs enter pathology through the matching program in greater numbers than any other specialty. Our data show that slightly less than a third of current first-year pathology residents are FMGs, mainly from Caribbean and Mexican medical schools. The decline in US graduates entering pathology has resulted almost entirely from a drop in the number of men choosing the field. In 1984, 286 male US graduates matched in pathology, but this number dropped to 150 in 1985 and 149 in 1986. The group entering in 1985 was the first who will need 5 years to be eligible for certification in the anatomic pathology/clinical pathology programs. During the same years, the 116 women who matched in 1984 were followed by 111 in 1985 and 100 in 1986. The effect of the American Board of Pathology's change in requirements is not easily analyzed. The figures for residents entering, given above, would suggest that the requirements discouraged men, especially, from entering the field. This hypothesis is supported by our questionnaire data and by anecdote concerning the pressure felt by graduating seniors to finish their postgraduate training as fast as they can and start paying off their average debt of $33,650. Pathology still seems to attract people who like to teach, study interesting case material, and do research. The percentage of PhD/MDs entering pathology is almost 10 times as high as their percentage among graduating seniors. Discouragement against entering pathology came from a perceived shortage of job openings, negative statements from other physicians (including pathologists), the addition of a fifth-year requirement, and lack of patient contact. The last is hard to account for because pathology would obviously not offer the opportunities to see patients that exist in the clinical specialties, but it was prominent in the concerns of residents answering our questionnaire. The picture that emerges from our data is one of a specialty passing through a difficult period in attracting new talent into its ranks. The first step in dealing with the problem would seem to be recognizing its existence.(ABSTRACT TRUNCATED AT 400 WORDS)

Career Choice↗
PubMed1987

[Seventy years of the Great October Socialist Revolution and the development of Soviet pathology].

In reviewing briefly the changes that have taken place during the past decade (1977-86) in the theory and practice of pathology and, in the theory and practice of pathology and, more particularly, in the Pathology Service within the overall Soviet Health care system, it should be noted first of all that this period has been productive with regard to both the practical work of the pathology departments in hospitals and the research activities of scientific institutions. Pathology is gaining importance as a basic biomedical discipline. Considerable successes have been scored in fundamental research not only by the central scientific institutions but also by laboratories for morphologic research and departments of pathology at educational establishments in most of the Union Republics. Many of such laboratories and departments are well equipped and conduct work at a high technological and methodological level in areas of high priority. The number of interdisciplinary research projects has increased. A series of monographs has been published, devoted to various aspects of methodology on medicine, to the relationship between form and function, or to a critique of erroneous theories. Scientific cooperation with pathologists of other Socialist countries has been expanding, as has the participation of Soviet pathologists at international congresses, symposia, and other meetings. An important achievement has been the establishment of a network of pathology departments of hospitals and of pathologic service bureaus. There is little doubt that these bureaus which have so far been set up on a pilot basis, will become an important component of the Pathology Service on which this will rely for research progress and for keeping abreast of technological developments. They are also called upon to promote better services in rural areas. The construction of new buildings for hospital pathology departments has been expanded, but the rate and magnitude of this activity cannot yet be regarded as satisfactory. Over the past decade, pathology laboratories at hospitals have become important diagnostic centers indispensable for accurate diagnosis of many diseases through examination of biopsy specimens, and they are now better equipped than before, although the improvements have been less spectacular than expected. The quality of postmortem and clinicopathologic analysis has improved. A notable event was the session of the Collegium of the USSR Ministry of Health devoted to the Pathology Service development.(ABSTRACT TRUNCATED AT 400 WORDS)

Armenia↗
PubMed2006

Discrepancy between clinical and pathologic stage: impact on prognosis after radical cystectomy.

OBJECTIVES: We compared clinical and pathologic staging in a large, contemporary, consecutive series of patients who were treated with radical cystectomy and pelvic lymphadenectomy, and determined the effect of stage discrepancy on outcomes. METHODS: We collected retrospective data from 778 consecutive patients with bladder transitional cell carcinoma who were treated with radical cystectomy and pelvic lymphadenectomy, and for whom the clinical and pathologic stage were available. RESULTS: Pathologic upstaging occurred in 42% of patients, and pathologic downstaging occurred in 22%. Forty percent of patients with non-muscle-invasive clinical stage had muscle-invasive pathologic stage. Thirty-six percent of patients with organ-confined clinical stage had non-organ-confined pathologic stage (> or =pT3N0 or pTanyN-positive). Patients with higher clinical stage were more likely to be upstaged to non-organ-confined disease (p<0.001). Patients were stratified into three groups: pathologically upstaged, same clinical and pathologic stage, and pathologically downstaged. When adjusted for the effects of standard postoperative features, upstaged patients were at a significantly higher risk of disease recurrence and bladder cancer-specific death than patients who had the same pathologic and clinical stage, who in turn were at significantly higher risk than downstaged patients. This observation remained true within each clinical stage strata. Within each pathologic stage strata, clinical stage did not substratify into different risk groups. CONCLUSIONS: Clinical to pathologic stage discrepancy is a relatively common finding after extirpative surgery for bladder cancer. Clinical outcomes after radical cystectomy are largely driven by pathologic stage. Better clinical staging is necessary to improve patient evaluation and management.

Adult↗
PubMed1985

[Theoretical concepts of modern pathology (a critique of their medical philosophical foundations)].

Separation of theoretical pathology into an independent branch of science seems to be justified and creation of the Centre of Theoretical pathology in the Heidelberg Academy of Sciences is due and useful. As W. Doerr truly states, the theoretical pathology seems to be over the pathological physiology and general pathology, exerts additional functions, studies questions of the methodology in pathology, defines more exactly and analyzes the notion of disease, other concepts and terms, clarifies early preclinical and clinical disease manifestations, determines sociological and psychological factors of disease. However, we are not in full agreement with our colleagues from the FRG in the definition of "disease" and in the interpretation of such categories as "spirit", "soul", "psychic". K. Rotschuh' suggestion to consider the disease in terms of "body-soul" appears to be interesting but to be productive, it must be linked with the problems of medical psychology. W. Doerr and his colleagues support the dualistic concepts of human nature which is unacceptable for us; they claim that the understanding of the theoretical pathology essence is possible only on the basis of theleology and spirit (theology). As the highest commencenment on the way of the theoretical pathology recognition W. Doerr's categorical declaration that theoretical pathology based on the "gestalttheorie" returns scientists, as he writes" to their great delight, to the possibility of studying "spiritual essence of the disease". In W. Doerr's opinion, studying the concept of theoretical pathology "from the spiritual point of view" will ensure its brilliant future. Of course, we, Soviet pathologists and philosophers, do not reject the significance of the integrity theory in the meaning of the disease psycophysiological integrity, yet we decidedly reject any idealistic concepts. W. Doeer and his colleagues are right that the theoretical pathology stimulates the search of the approaches to the solution of complex biomedical problems, favours the creation of more precise definitions and terminology. Likewise, W. Doerr is right that he sharply condemns the attempts of some pathologists to substitute qualitative differences in pathological processes by quantitative ones; this may result, in his view, in one-sided erroneous conclusions.(ABSTRACT TRUNCATED AT 400 WORDS)

Communism↗
PubMed2003

Personality pathology and cognitive-behavioral treatment of fear of flying.

Studies have been inconclusive about the influence of personality pathology on treatment outcome in anxiety disorders. In general, it has been presumed that treatment outcome is negatively influenced by the presence of personality pathology. This is a study of the prevalence of personality pathology among persons who were seeking help for fear of flying. Moreover, the effects of personality pathology on the results of a multimodal, standardized, cognitive-behavioral fear of flying treatment program employed by an agency that specializes in treating people with fear of flying were studied. Personality pathology was determined with a self-report questionnaire, which provides ICD-10 diagnoses of personality disorders and dimensional severity scores for personality pathology. Treatment outcome was assessed with three different fear of flying questionnaires. Based on clinical judgment after individual-case conceptualization, participants (N=922) were assigned to a particular treatment for fear of flying. Self-report data for fear of flying were collected at pretreatment and at 3, 6 and 12-month follow-ups in 659 participants who followed the 2-day treatment program. Moreover, the number of flights made in the year following treatment was determined.The results of this study showed that participants with personality pathology, mainly from cluster C (anxiety), report greater fear of flying before treatment than participants without personality pathology. After treatment fear of flying was significantly reduced. Presence of personality pathology was not predictive of the number of flights after treatment and scores on the VAFAS scale at short or long term. Only on two questionnaires for fear of flying collected at short-term participants with personality pathology obtained significantly higher scores, although the size of the differences was relatively small. It was concluded that participants with personality pathology also benefited from fear of flying treatment and that the presence of personality pathology although cannot be regarded as a contra indication for a standardized, cognitive-behavioral group treatment.

Adolescent↗
PubMed2002

Low HER2/neu gene expression is associated with pathological response to concurrent paclitaxel and radiation therapy in locally advanced breast cancer.

PURPOSE: The objective of this study was twofold: first, to identify patients with locally advanced breast cancer (LABC) who will achieve a pathological response to a preoperative regimen of concurrent paclitaxel and radiation; and second, to explore associations between molecular markers from the original tumors and pathological response. METHODS AND MATERIALS: Patients with previously untreated LABC were eligible to receive a regimen of preoperative concurrent paclitaxel, 30 mg/m(2) twice a week for a total of 8 weeks, and radiation delivered Weeks 2--6, 45 Gy at 1.8 Gy per fraction to the breast, ipsilateral axilla, and supraclavicular nodes. At mastectomy, pathologic findings were classified as pathological complete response (pCR) = no residual invasive cells in the breast and axillary contents; pathological partial response (pPR) = presence of < or = 10 microscopic foci of invasive cells; no pathological response (pNR) = pathological persistence of tumor. For each patient, pretreatment breast cancer biopsies were prospectively analyzed by immunohistochemistry (IHC) for estrogen and progesterone (ER/PR) hormonal receptors, HER2/neu and p53 overexpression. Estrogen receptor (ER), HER2/neu, metablastin, beta-tubulin III and IV, microtubule-associated protein-4 (MAP-4), bcl-2, bax, and cyclooxygenase-2 (COX-2) gene expression were measured using real-time quantitative polymerase chain reaction (PCR). RESULTS: A total of 36 patients had pretreatment biopsies and were evaluable for the analysis of the association of molecular markers with pathological response. Pathological response in the mastectomy specimen was achieved in 12 of these 36 patients (33%). Only HER2/neu and ER gene expression were found to be significantly associated with the extent of pathological response to the regimen, i.e., tumors with low HER2/neu gene expression and negative estrogen receptors were more likely to respond to the tested regimen (p = 0.009 and p = 0.006, respectively). Conversely, p53 protein expression measured by IHC did not appear to be associated with pathological response (p = 0.67). CONCLUSION: Further studies in LABC should assess whether patient selection for treatment based on the original tumor molecular characteristics could affect their chance to achieve a pathological response.

Adult↗
PubMed1997

Original p53 status predicts for pathological response in locally advanced breast cancer patients treated preoperatively with continuous infusion 5-fluorouracil and radiation therapy.

PURPOSE/OBJECTIVE: 1) To test feasibility of preoperative continuous infusion (c.i.) 5-Fluorouracil (5-FU) and radiation (RT) in locally advanced breast cancer. 2) To study clinical and pathological response rates of 5-FU and radiation. 3) To attempt preliminary correlations between biological probes and pathological response. METHODS AND MATERIALS: Previously untreated, locally advanced breast cancer patients were eligible: only patients who presented with T3/T4 tumors that could not be resected with primary wound closure were eligible, while inflammatory breast cancer patients were excluded. The protocol consisted of preoperative c.i. infusion 5-FU, 200 mg/m2/day with radiotherapy, 50 Gy at 2 Gy fractions to the breast and regional nodes. At mastectomy, pathological findings were classified based on persistence of invasive cancer: pathological complete response (pCR) = no residual invasive cells in the breast and axillary contents; pathological partial response (pPR) = presence of microscopic foci of invasive cells in either the breast or nodal specimens; no pathological response (pNR) = pathological persistence of tumor. For each patient pretreatment breast cancer biopsies were analyzed by immunohistochemistry for nuclear grade, ER/PR hormonal receptors, her2/neu and p53 overexpression. RESULTS: Thirty-five women have completed the protocol and are available for analysis. 5-FU was interrupted during radiation in 10 of 35 patients because of oral mucositis in 8 patients, cellulitis in 1, and patient choice in another. Objective clinical response rate before mastectomy was 71% (25 of 35 patients): 4 CR, 21 PR. However, in all 35 patients tumor response was sufficient to make them resectable with primary wound closure. Accordingly, all patients underwent modified radical mastectomy: primary wound closure was achieved in all patients. At mastectomy there were 7 pCR (20%), 5 pPR (14%) and the remaining 23 patients (66%) had pathological persistence of cancer (pNR). Variables analyzed as potential predictors for pathological response (pPR and pCR) were: initial TNM clinical stage, clinical response, nuclear grade, hormonal receptor status, p53 overexpression, and Her2/neu overexpression in the pretreatment tumor biopsy. Only initial p53 status (lack of overexpression at immunohistochemistry) significantly correlated with achievement of a pathological response to this regimen (p = 0.010). CONCLUSION: The combination of c.i. 5-FU and radiation was well tolerated and generated objective clinical responses in 71% of the patients. With the limitation of the small sample size, the complete pathological response achieved (20%) compares favorably with that reported in other series of neoadjuvant therapy for similar stage breast cancer. These preliminary data suggest that initial p53 status predicts for pathological response (pPR and pCR) to the combination of c.i. 5-FU and radiotherapy in locally advanced breast cancer.

Adult↗
PubMed2001

Treatment-induced pathologic necrosis: a predictor of local recurrence and survival in patients receiving neoadjuvant therapy for high-grade extremity soft tissue sarcomas.

PURPOSE: To determine whether treatment-induced pathologic necrosis correlates with local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas. PATIENTS AND METHODS: Four hundred ninety-six patients with intermediate- to high-grade extremity soft tissue sarcomas received protocol neoadjuvant therapy. All patients underwent surgical resection after neoadjuvant therapy and had pathologic assessment of tumor necrosis in the resected specimens. RESULTS: The 5- and 10-year local recurrence rates for patients with > or = 95% pathologic necrosis were significantly lower (6% and 11%, respectively) than the local recurrence rates for patients with less than 95% pathologic necrosis (17% and 23%, respectively). The 5- and 10-year survival rates for the patients with > or = 95% pathologic necrosis were significantly higher (80% and 71%, respectively) than the survival rates for the patients with less than 95% pathologic necrosis (62% and 55%, respectively). Patients with less than 95% pathologic necrosis were 2.51 times more likely to develop a local recurrence and 1.86 times more likely to die of their disease as compared with patients with > or = 95% pathologic necrosis. The percentage of patients who achieved > or /= 95% pathologic necrosis increased to 48% with the addition of ifosfamide as compared with 13% of the patients in all the other protocols combined. CONCLUSION: Treatment-induced pathologic necrosis is an independent predictor of both local recurrence and overall survival in patients who receive neoadjuvant therapy for high-grade extremity soft tissue sarcomas. A complete pathologic response (> or = 95% pathologic necrosis) correlated with a significantly lower rate of local recurrence and improved overall survival.

Adolescent↗
PubMed2000

[A quantitative analysis of renal pathology in the children with anaphylactoid purpura nephritis (APN)].

OBJECTIVE: To provide the theoretical value for the treatment and prognostic judgement of APN. METHODS: All cases were scored on the pathologic change of glomeruli and tubules. RESULTS: The pathologic scores of glomeruli in 30 cases were as follows: no one on Grade 0; 6(20%) on Grade 1; 17(56.7%) on Grade 2 and 7 (23.3%) on Grade 3. The pathologic scores of tubule were: Grade 0 was 2(6.7%); Grade 1 was 6(20%); Grade 2 was 14(46.7%); Grade 3 was 8(26.7%). There was positive correlation between glomerulus and tubule pathologic degree(r = 0.783, P < 0.01). The pathologic score of nephrotic syndrome in clinical manifestation was higher than that of non-nephrotic syndrome(P < 0.01). There was no significant difference in glomerular pathologic score between the simple urinary protein group and acute glomerulonephritis(AGN) group(P > 0.05), but tubular pathologic score in simple urinary proteins group was higher than that of AGN and essential hematuria group (P < 0.01, P < 0.05). The pathologic score of kidney(including glomerulus and tubule) was positively correlated with the disease course(r = 0.563, P < 0.01), but not with serum urea nitrogen and creatinine(r = 0.281, r = 0.236, P > 0.05). CONCLUSION: Serious tubular pathologic changes(not only glomerular pathologic change, but also tubular pathologic change in the APN children) were found in the patients with nephrotic syndrome and simple urinary proteins. Long-term urinary protein and the recurrence of the disease may be the important risk factor in kidney pathologic of APN.

Adolescent↗
PubMed2003

Relationship between pathology curricular approaches and performance in the United States medical licensing examination (USMLE), step 1: a national cross-sectional study.

A collaborative multi-institutional study was conducted to study the relationship between characteristics of pathology instruction and student performance in the United States Medical Licensing Examination (USMLE), Step 1. Detailed descriptions of pathology instruction, such as curriculum format, style of instruction, and design of instruction of various areas of pathology for the 1996-1997 academic year were matched with Step 1 total scores and pathology subscores for 10,159 students from 88 schools who took the June 1997 examination. Hierarchical linear modeling was used for analysis while controlling for students' MCAT-bpv scores (Medical College Admission Test scores, average of biological and physical sciences and verbal reasoning). The Step 1 total scores correlate with Step 1 pathology subscores, and both correlate with students' MCAT-bpv scores. The MCAT-bpv scores account for most of the variation in Step 1 scores. Of all of the curricular variables analyzed, 2 possible factors that significantly influence the impact of MCAT-bpv scores on Step 1 scores are (1) multidisciplinary format of instruction and (2) discipline-based general pathology instruction in year 2. Overall, the multidisciplinary format reduced the impact of MCAT-bpv scores on both the Step 1 total score and the pathology subscore by 1 point per MCAT-bpv. Overall, the general pathology instruction in year-2 increased that impact on Step 1 total score by 1 point per MCAT-bpv. The slope became less steep with multidisciplinary format and more steep with year-2 general pathology instruction. As a result, students with higher MCAT-bpv scores tend to benefit from year-2 general pathology instruction, whereas those with lower MCAT-bpv scores appear to benefit from a multidisciplinary format. These differences become more apparent as the MCAT-bpv scores move away from the mean in either direction, indicating that scores of most students are not affected by curricular variables. Overall, there is no significant difference in the school means of Step 1 total scores and pathology subscores of schools with different curricular approaches. This is most likely due to the finding that the students' MCAT-bpv scores, and not curricular variables, are the major predictors of Step 1 scores, and all schools have a mix of students with various MCAT-bpv scores.

Analysis of Variance↗
PubMed2005

Resuscitating the teaching of anatomical pathology in undergraduate medical education: Web-based innovative clinicopathological cases.

AIMS: Medical education has undergone substantial change in recent years, resulting in shorter, more compact courses that often contain much less pathology than previously. There has also been a concurrent decrease in the academic pathologist workforce in Australia, such that medical schools struggle to deliver even this reduced pathology curriculum. This paper reports the development and evaluation of an innovative approach in an undergraduate medical school to supporting pathology lectures, through integrating pathology with clinical medicine. METHODS: A series of 32 clinical pathological cases (CPCs) was developed to replicate clinicopathological conferences in a small group format. The CPCs were based on the pathology lectures, developed by a multidisciplinary clinical team and delivered to the students by clinical tutors. Students had access to learning support resources on the School's Intranet in both the main campus and rural teaching sites. Digitised pathology images, Web-based delivery and semi-guided learning issues are the main characteristics of the pathology module. The module was evaluated by a ranking system by the medical students for two consecutive years. RESULTS: In both years, the CPC module achieved a high score when compared with other components of the pathology curriculum. Positive feedback and frequent inquiries were also received about the module. CONCLUSION: The Web-based CPC modules provide an important resource that can facilitate teaching of pathology to medical students in the main campus and rural teaching sites. The module provides an opportunity to improve the profile of pathology in the medical school, in a manner that is sustainable with only one academic pathologist. It has the potential to be used nationally and internationally because of its multidisciplinary nature and the flexibility in its mode of delivery.

Curriculum↗