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PubMedDate not supplied

Digital microscopy imaging and new approaches in toxicologic pathology.

Digital microscopy, a comprehensive integration of digital imaging and light microscopy, can assist the pathologist to observe, acquire, record, share, analyze, and manage pathology image data. To lead the activity for establishing new generation digital microscopy capacity, novel concepts and strategies of digital pathology information flow and digital pathology platform were designed to integrate personal digital pathology microscopy workstations and other pathology imaging modalities with centralized data storage/management. In addition, a strategy for Web-enabled interactive telepathology that would permit global capacity was designed. A novel concept of high content pathology was also created to develop an automated tissue microscopy imaging and screening approach. These new concepts, strategies, and approaches guided the development and implementation of a digital pathology platform, a telepathology platform, and automated tissue slide imaging capacity. Digital microscopy photography is now able to replace photographic film in toxicologic pathology. Digital pathology and telepathology platforms can provide a networked environment for multisite, global team participation. Our practice also ascertained the central value of digital microscopy which can provide innovative quantitative pathology information and data mining capability with various imaging biomarkers via advanced digital image processing and pathology informatics; these are now the focus of ongoing development.

Image Enhancement↗
PubMed2000

Informed evaluation of pathology residency programs.

OBJECTIVES: To identify resources and summarize important issues in anatomic and clinical pathology training and to assist the pathology resident candidate in evaluating potential training programs. DATA SOURCES: Published guides for medical residency applicants, recent literature discussing pathology education, and World Wide Web sites. STUDY SELECTION: Resources perceived by the author as valuable for the pathology resident candidate. DATA EXTRACTION: Key issues in pathology education are identified. DATA SYNTHESIS: Issues are discussed from the perspective of a pathology resident candidate, and resources for further information are provided. CONCLUSIONS: The pathology residency candidate faces unique challenges in the residency search process because of the breadth of pathology training and the limited exposure to the practice of pathology in medical school. General guides for residency applicants include little discussion of pathology-specific issues. Recent literature discussing pathology education is fragmented but provides invaluable insights for resident candidates. This review seeks to identify a wide variety of issues and resources as a starting point for evaluating potential training programs.

Anatomy↗
PubMed2003

Training in pathology informatics: implementation at the University of Pittsburgh.

CONTEXT: Pathology informatics is generally recognized as an important component of pathology training, but the scope, form, and goals of informatics training vary substantially between pathology residency programs. The Training and Education Committee of the Association for Pathology Informatics (API TEC) has developed a standard set of knowledge and skills objectives that are recommended for inclusion in pathology informatics training and may serve to standardize and formalize training programs in this area. OBJECTIVE: The University of Pittsburgh (Pittsburgh, Pa) core rotation in pathology informatics includes most of these goals and is offered as an implementation model for pathology informatics training. DESIGN: The core rotation in pathology informatics is a 3-week, full-time rotation including didactic sessions and hands-on laboratories. Topics include general desktop computing and the Internet, but the primary focus of the rotation is vocabulary and concepts related to enterprise and pathology information systems, pathology practice, and research. The total contact time is 63 hours, and a total of 19 faculty and staff contribute. Pretests and posttests are given at the start and end of the rotation. Performance and course evaluation data were collected for 3 years (a total of 21 residents). RESULTS: The rotation implements 84% of the knowledge objectives and 94% of the skills objectives recommended by the API TEC. Residents scored an average of about 20% on the pretest and about 70% on the posttest for an average increase during the course of 50%. Posttest scores did not correlate with pretest scores or self-assessed computer skill level. The size of the pretest/posttest difference correlated negatively with the pretest scores and self-assessed computing skill level. CONCLUSIONS: Pretest scores were generally low regardless of whether residents were familiar with desktop computing and productivity applications, indicating that even residents who are computer "savvy" have limited knowledge of pathology informatics topics. Posttest scores showed that all residents' knowledge increased substantially during the course and that residents who were computing novices were not disadvantaged. In fact, novices tended to have higher pretest/posttest differences, indicating that the rotation effectively supported initially less knowledgeable residents in "catching up" to their peers and achieving an appropriate competency level. This rotation provides a formal training model that implements the API TEC recommendations with demonstrated success.

Clinical Competence↗
PubMed2006

Critical values in anatomic pathology.

Similar to critical values (CVs) in clinical pathology, occasional diagnoses in surgical pathology and cytology could require immediate notification of the physician to rapidly initiate treatment. However, there are no established CV guidelines in anatomic pathology. A retrospective review of surgical pathology reports was recently conducted to study the incidence of CVs in surgical pathology and to survey the perceptions of pathologists and clinicians about CVs in surgical pathology, with a similar analysis of CVs performed in cytology. The results indicated that CVs in surgical pathology and cytology are uncommon but not rare and that there is a wide range of opinion among pathologists and between pathologists and clinicians about the need for an immediate telephone call and about the degree of urgency. It was obvious from the study that there is a lack of consensus in identifying what constitutes surgical pathology and cytology CV cases. Since the Institute of Medicine's report on medical errors, there has been an increasing number of initiatives to improve patient safety. Having guidelines for anatomic pathology CVs could enhance patient safety, in contrast to the current practice in which CV cases are managed based on common sense and on personal experience. Therefore, a discussion involving the pathology community might prove useful in an attempt to establish anatomic pathology CV guidelines that could represent a practice improvement.

Diagnostic Errors↗
PubMed2001

Impact of second opinion pathology in the definitive management of patients with bladder carcinoma.

BACKGROUND: The accurate diagnosis, staging, and grading of bladder neoplasms depend heavily on the interpretation of biopsies and transurethral resection (TUR) specimens. Although many centers require review of outside pathologic material before definitive treatment such as radical cystectomy, the authors are unaware of data supporting the utility of this approach in urothelial (transitional cell) carcinoma. The authors therefore examined the clinical and cost impact of pathologic review on patients referred to an academic urology department for treatment of bladder neoplasia. METHODS: The pathologic material from 97 patients referred to an academic center for evaluation of urothelial carcinoma of the bladder from July 1996 to July 1999 was reviewed. This material was received from 30 community hospitals and 4 academic centers. The 97 patients had undergone 131 (mean, 1.35; range, 1-10) biopsies or TUR procedures before referral. Surgical pathologists at the authors' institution reviewed all outside patient material, and discordant cases were rereviewed by one of the authors (S.E.M), an experienced genitourinary pathologist. Follow-up chart review was performed in discordant cases to determine clinical and pathologic outcomes. RESULTS: Upon review at the authors' institution, 24 of 131 (18%) specimens with a referring diagnosis of urothelial carcinoma exhibited significant discrepancies with regard to the diagnosis, stage, grade, or tumor histologic type made at the outside institution. Four tumors (3%) were found to be nonurothelial neoplasms. Five specimens (4%) were judged inadequate for staging because they contained no muscularis propria. Three patients were upstaged, including two patients shown to have muscle invasive disease. Eight patients were downstaged, including two patients referred with purported muscle invasive disease who were determined to have only superficial disease on pathology review. Two patients initially thought to have carcinoma in situ (tumor in situ [Tis]) showed no evidence of Tis on pathology review. One patient with purported muscle invasive disease was shown to have only metaplasia, and one patient had a highly significant change in tumor grade. As a result of the pathology review, five radical cystectomies were avoided, whereas five repeat TUR procedures were recommended for inadequate staging. One patient shown to have muscle invasion on pathology review proceeded directly to cystectomy, avoiding a planned repeat TUR. A cystectomy also was recommended to a second patient who was shown to have invasive disease by the pathology review. Pathology review of 131 specimens resulted in net savings of $86,176 or $658 per TUR reviewed. CONCLUSIONS: The review of bladder pathologic materials before definitive therapy can impact clinical decisions significantly and can reduce overall expenditures for the management of this cohort of bladder carcinoma patients.

Biopsy↗
PubMed1986

[60 years in pathologic anatomy].

A. I. Strukov--Hero of Socialist Labour, Lenin prize winner, Honoured Scientist, Academician of the USSR Academy of Medical Sciences has been involved in a pathological anatomy for 60 years. He started studying this discipline when a student, and his first teacher was Professor V. A. Afanasyev. After a short period of work as an assistant of a Chair of Pathological Anatomy in Voronezh A. I. Strukov became a chief of a department of pathology in N. A. Semashko City Hospital in Tula. Simultaneously he attended, by correspondence, a postgraduate course in a Chair of Pathological Anatomy headed by Prof. A. I. Abrikosov at the First Moscow University. Later A. I. Strukov moved to Moscow where he started working in a laboratory of pathology of the Central Institute of Tuberculosis of the USSR Ministry of Health, headed by Prof. V. G. Stefko. He inherited from his chiefs the interest to the problem of tuberculosis and, for many years, he has been studying, together with his students, the details of morpho- and pathogenesis and pathomorphosis of this disease. The results of these studies were published in a number of monographs and journals and were included into candidate and doctor theses. A. I. Strukov developed a clinico-morphological classification of tuberculosis recognised by pathologists and clinicians of the USSR. Since 1933 A. I. Strukov worked as an assistant of A. I. Abrikosov's chair and was elected a chief of the Pathological Anatomy Chair of the First Kharkov Medical Institute. He spent the Great Patriotic War (1941-1945) in Orenburg where the Kharkov Medical Institute was evacuated. Here on the basis of local civil and military hospitals, teaching, clinical and scientific work of the institute chairs, including that of pathological anatomy, was developed. A. I. Strukov returned to Moscow in 1944, worked in Prof. V. G. Shtefko's laboratory, then was elected a Professor of a Chair of Pathological Anatomy in the First Moscow Medical Institute. In 1953, after A. I. Abrikosov has retired, A. I. Strukov became the chief of this most prominent chair of pathological anatomy in the country. Continuing the traditions of A. I. Abrikosov's school, A. I. Strukov investigates with his students various problems of pathology (tuberculosis, rheumatic diseases), develops a concept of systemic and progressing disorganisation of connective tissue in rheumatic diseases, continues studying the pathology of broncho-pulmonary lesions, cardio-vascular diseases.(ABSTRACT TRUNCATED AT 400 WORDS)

History, 20th Century↗
PubMed2003

A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision.

PURPOSE: Preoperative chemoradiation reduces tumor size and nodal metastasis in patients with rectal cancer. Tumor downstaging has been associated with an increased probability of a sphincter-saving procedure and with improved local control. However, pathologic complete response to chemoradiation has not been correlated with local control and patient survival. We studied the prognostic value of pathologic complete response to preoperative chemoradiation in rectal cancer patients. METHODS: We have prospectively followed up 168 consecutive patients with ultrasound Stages II (46) and III (122) rectal cancer treated by preoperative chemoradiation followed by radical resection with mesorectal excision; 161 had a curative resection. Recurrence and survival were compared with tumor characteristics and pathologic complete response. Average follow-up was 37 months. RESULTS: Tumor downstaging occurred in 97 (58 percent) patients, including 21 (13 percent) patients who had a pathologic complete response. None of the clinical or pathologic variables was associated with pathologic complete response. The estimated 5-year rate of local recurrence was 5 percent; of distant metastasis, 14 percent. None of the patients with pathologic complete response has developed disease recurrence. We found no difference in survival among patients with pathologic Stages I, II, or III tumors. CONCLUSIONS: A pathologic complete response to preoperative chemoradiation is associated with improved local control and patient survival. For patients without pathologic complete response, the pathology stage does not have prognostic significance.

Adult↗
PubMed2005

Clinical multiple sclerosis occurs at one end of a spectrum of CNS pathology: a modified threshold liability model leads to new ways of thinking about the cause of clinical multiple sclerosis.

Multiple sclerosis (MS) is a complex trait, the causes of which are elusive. A threshold liability model influences thinking about the causes of this disorder. According to this model, a population has a normal distribution of genetic liability to MS. In addition, a threshold exists, so that MS begins when an individual's liability exceeds the MS threshold; environmental and other causative factors may increase or decrease an individual's MS liability. It is argued here, however, that this model is misleading, as it is based on the incorrect assumption that MS is a disorder that one either has or does not have. This paper hypothesizes, instead, that patients with a diagnosis of MS share identical CNS pathology, termed MS pathology, with some individuals who have a diagnosis of possible MS and with some apparently healthy individuals, who may never have a diagnosis of MS. In order to accommodate this hypothesis, the current threshold liability model is modified as follows. (1) In addition to a normal distribution of MS liability within a population, a spectrum of MS pathology occurs in some who have a high MS liability. (2) A clinical MS threshold exists at a point on this liability distribution, where the burden and distribution of MS pathology permits a diagnosis of clinical MS. (3) Additional thresholds exist that correspond to a lower MS liability and a lesser burden of MS pathology than occur at the clinical MS threshold. This modified threshold model leads to the postulate that causes act at various time points to increase MS liability and induce MS pathology. The accumulation of MS pathology sometimes leads to a diagnosis of clinical MS. One implication of this model is that the MS pathology in clinical MS and in some with possible MS differs only in the extent but not in the type of CNS injury. Thus, it may be possible to obtain insight into the causative environmental factors that increase MS liability and induce MS pathology by focusing on patients who have clinical MS; some environmental factors that induce new lesions in patients with clinical MS may be identical to those that induce MS pathology in genetically susceptible individuals who do not have clinical MS. Identification of these causative factors has importance, as specific treatment may prevent the accumulation of MS pathology that leads to the significant CNS damage associated with clinical MS.

Central Nervous System Diseases↗
PubMed2006

How does the radiographic size of a renal mass compare with the pathologic size?

OBJECTIVES: To investigate the relationship between the radiographic size on computed tomography and the pathologic size of renal tumors. METHODS: The records of 126 patients with a renal lesion suspicious for malignancy and with preoperative computed tomography performed 60 days or less before surgery at our institution were reviewed. The clinical size was defined as the largest diameter of the tumor seen on computed tomography and the pathologic size was defined as the largest diameter seen at pathology. The clinical and pathologic sizes were compared by size range and primary tumor stage. RESULTS: A total of 133 tumors from 126 patients were identified. Of the 133 tumors, 120 (90.2%) were renal carcinoma. The clinical and pathologic size for all 133 tumors was not significantly different (4.5 versus 4.1 cm, P = 0.35). The average clinical tumor size was larger than the pathologic tumor size for all sizes, except for 7 cm and greater. The difference reached statistical significance in all ranges from 1 to 5 cm. The largest size difference was seen for tumors 4 to 5 cm, for which the average clinical size was 0.87 cm larger than the average pathologic size (P = 0.025). CONCLUSIONS: Preoperative computed tomography imaging may slightly overestimate the pathologic size of renal tumors in certain size ranges. In pathologic Stage T1a tumors, the clinical tumor size was significantly larger than the pathologic stage (P = 0.009). The difference between the clinical and pathologic tumor size was greatest for tumors 4 to 5 cm. These results may affect decisions to perform nephron-sparing surgery in certain patients.

Adult↗
PubMed2002

Prognostic significance of a complete pathological response after induction chemotherapy in operable breast cancer.

Only a few papers have been published concerning the incidence and outcome of patients with a pathological complete response after cytotoxic treatment in breast cancer. The purpose of this retrospective study was to assess the outcome of patients found to have a pathological complete response in both the breast and axillary lymph nodes after neoadjuvant chemotherapy for operable breast cancer. Our goal was also to determine whether the residual pathological size of the tumour in breast could be correlated with pathological node status. Between 1982 and 2000, 451 consecutive patients were registered into five prospective phase II trials. After six cycles, 396 patients underwent surgery with axillary dissection for 277 patients (69.9%). Pathological response was evaluated according to the Chevallier's classification. At a median follow-up of 8 years, survival was analysed as a function of pathological response. A pathological complete response rate was obtained in 60 patients (15.2%) after induction chemotherapy. Breast tumour persistence was significantly related to positive axillary nodes (P=5.10(-6)). At 15 years, overall survival and disease-free survival rates were significantly higher in the group who had a pathological complete response than in the group who had less than a pathological complete response (P=0.047 and P=0.024, respectively). In the absence of pathological complete response and furthermore when there is a notable remaining pathological disease, axillary dissection is still important to determine a major prognostic factor and subsequently, a second non cross resistant adjuvant regimen or high dose chemotherapy could lead to a survival benefit.

Adult↗
PubMed2003

VEGF164-mediated inflammation is required for pathological, but not physiological, ischemia-induced retinal neovascularization.

Hypoxia-induced VEGF governs both physiological retinal vascular development and pathological retinal neovascularization. In the current paper, the mechanisms of physiological and pathological neovascularization are compared and contrasted. During pathological neovascularization, both the absolute and relative expression levels for VEGF164 increased to a greater degree than during physiological neovascularization. Furthermore, extensive leukocyte adhesion was observed at the leading edge of pathological, but not physiological, neovascularization. When a VEGF164-specific neutralizing aptamer was administered, it potently suppressed the leukocyte adhesion and pathological neovascularization, whereas it had little or no effect on physiological neovascularization. In parallel experiments, genetically altered VEGF164-deficient (VEGF120/188) mice exhibited no difference in physiological neovascularization when compared with wild-type (VEGF+/+) controls. In contrast, administration of a VEGFR-1/Fc fusion protein, which blocks all VEGF isoforms, led to significant suppression of both pathological and physiological neovascularization. In addition, the targeted inactivation of monocyte lineage cells with clodronate-liposomes led to the suppression of pathological neovascularization. Conversely, the blockade of T lymphocyte-mediated immune responses with an anti-CD2 antibody exacerbated pathological neovascularization. These data highlight important molecular and cellular differences between physiological and pathological retinal neovascularization. During pathological neovascularization, VEGF164 selectively induces inflammation and cellular immunity. These processes provide positive and negative angiogenic regulation, respectively. Together, new therapeutic approaches for selectively targeting pathological, but not physiological, retinal neovascularization are outlined.

Animals↗
PubMed2005

Pathological stage does not alter the prognosis for renal lesions determined to be stage T1 by computerized tomography.

PURPOSE: Pathological stage has been the most widely used prognosticator for evaluating surgically managed cases of renal cell carcinoma. Minimally invasive surgical approaches are being increasingly used to treat small masses for which traditionally pathological information is lacking (morcellation) or absent (radio frequency ablation or cryoablation). Preoperative cross-sectional imaging by computerized tomography (CT) or magnetic resonance imaging has been used to stage renal tumors clinically but it can lead to variances with traditional pathological staging systems, particularly with respect to microscopic invasion beyond the renal capsule. In this study we assessed whether radiographically staged clinical T1 lesions that were pathological T1 behave differently than those that were clinical stage T1 and up staged to pT3a. MATERIALS AND METHODS: The records of 296 patients who underwent surgical treatment for renal cell carcinoma at The Johns Hopkins Hospital between 1990 and 1999 were retrospectively reviewed. All patients had undergone preoperative CT or magnetic resonance imaging, which was used to assign a clinical stage and size (largest diameter) to each tumor in accordance with the 1997 TNM staging system. Following surgical resection pathological stage, size and tumor grade were determined. Only the 186 patients with clinical T1 tumors were included in this analysis. RESULTS: Of the 186 patients who were clinically found to have T1 lesions 125 (67%) had pathological T1 and 57 (31%) had pathological T3a lesions. All surgical margins and lymph nodes were negative at surgical resection. Mean tumor size +/- SD was 3.9 +/- 1.5 cm for pT1 lesions and 3.8 +/- 1.5 cm for pT3a lesions. When comparing these pathological groups using Kaplan-Meier analysis, 5-year recurrence-free survival was not statistically different in patients with pT1 and pT3a lesions (90.6 and 97.5%, respectively). CONCLUSIONS: Patients in whom the initial classification of T1 renal cell carcinoma by CT was up graded to T3a on pathological analysis (invasion of fat within Gerota's fascia) showed the same recurrence-free survival rate as patients with pathologically confirmed T1 lesions. Thus, smaller tumors (less than 7 cm) that are up graded to T3a based on capsule invasion behave much like T1 tumors and exact pathological T staging does not appear to impact overall survival.

Carcinoma, Renal Cell↗
PubMed1996

Direct speech feature estimation using an iterative EM algorithm for vocal fold pathology detection.

The focus of this study is to formulate a speech parameter estimation algorithm for analysis/detection of vocal fold pathology. The speech processing algorithm proposed estimates features necessary to formulate a stochastic model to characterize healthy and pathology conditions from speech recordings. The general idea is to separate speech components under healthy and assumed pathology conditions. This problem is addressed using an iterative maximum-likelihood (ML) estimation procedure, based on the estimation-maximization (EM) algorithm. A new feature for characterizing pathology, termed enhanced-spectral-pathology component (ESPC), is estimated and shown to vary consistently between healthy and pathology conditions. It is also shown that the mean-area-peak-value (MAPV) and the weighted-slope (WSLOPE) indexes, which are obtained from the ESPC estimate, are meaningful measures of speech pathology conditions. For classification purposes, a five-state hidden-Markov-model (HMM) recognizer was formulated, based on the MAPV, WSLOPE, and ESPC spectral features. A set of log Mel-frequency filter bank coefficients were used to parameterize the ESPC feature. An evaluation of the HMM-based classifier was performed using speech recordings from healthy and vocal fold cancer patients of sustained vowel sounds. It is shown that while both MAPV and WSLOPE are useful features for vocal fold pathology detection, superior performance was achieved using a finer spectral representation of ESPC (e.g., a detection rate of 88.7% for pathology and 92.8% for healthy condition). One main advantage of the proposed method is that it does not require direct estimation of the glottal flow waveform. Therefore, the limitation of the inability to characterize vocal fold pathology, due to incomplete glottal closure, is no longer an issue. The results suggest that general analysis of the ESPC feature can provide a quantitative, noninvasive approach for analysis, detection, and characterization of speech production under vocal fold pathology.

Algorithms↗
PubMedDate not supplied

Comparison of hydrosonography and transvaginal ultrasonography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

BACKGROUND: The aim of the study was to compare the accuracy of hydrosonography with that of transvaginal ultrasonography in detection of intracavitary pathologies in patients with history of abnormal uterine bleeding. STUDY DESIGN: Prospective, randomized, and unblinded study. MATERIAL AND METHODS: A total of 197 women (n = 130 premenopausal and n = 67 postmenopausal) aged between 23 and 71 years (mean age 45.7 +/- 8.9) presenting with a history of abnormal uterine bleeding were included into the study. Hydrosonography was carried out by experienced gynecologists, on the same setting in an outpatient clinic immediately after the performance of transvaginal sonography. The finally obtained surgical-pathologic findings were compared with the results obtained from transvaginal sonography and hydrosonography. Sensitivity, specificity, positive, and negative predictive values were calculated for each procedure. RESULTS: The surgical-pathologic examination confirmed normal physiologic endometrium in 50 (48%) of 104 women who were said to have normal endometrium on transvaginal sonography. Seventy (75%) of 93 women diagnosed of intracavitary pathologies on transvaginal sonography were confirmed by surgical-pathologic findings. The sensitivity, specificity, positive predictive value, and negative predictive value of transvaginal sonography in the detection of intracavitary pathology were 56, 68, 75, and 48%, respectively. Surgical-pathologic results revealed intracavitary pathologies in 23 (30%) of 76 women who were said to have normal endometrium on hydrosonography. Among 121 women diagnosed of intracavitary pathologies on hydrosonography, 101 (81%) women were confirmed after histological evaluation of the surgical specimens. The sensitivity, specificity, positive predictive value, and negative predictive value of hydrosonography in the detection of intracavitary pathology were 81, 73, 83, and 70%, respectively. Sensitivity and negative predictive value were significantly higher with hydrosonography. There were five cases of endometrial malignancy in which one of the case of malignancy was on polyp and two cases of endometrial hyperplasia with atypia which were not stated on sonographic results. CONCLUSION: Hydrosonography is more accurate than transvaginal ultrasography in the detection of intracavitary pathologies in women with abnormal uterine bleeding.

Adult↗
PubMed2001

Histo and cyto-pathologic diagnoses at a rural hospital in Kenya.

BACKGROUND: Cancer has emerged as one of the common causes of morbidity and mortality in rural areas and as a major cause of premature deaths. OBJECTIVES: To provide histo-pathology and cyto-pathology data in a rural district hospital and highlight on the common malignancies seen in a rural setting in Kenya. DESIGN: Prospective study. SETTING: Histopathology Department, Machakos Provincial Hospital, Machakos district, Kenya. SUBJECTS: Two hundrend and sixty eight patients referred to Machakos laboratory for histopathology, fine needle aspirate or pap smear cyto-pathology were analysed. MAIN OUTCOME MEASURES: Staining with routine stains such Pap stain, Haeomatoxylin and Eosin was effective method of making a primary accurate and definitive histo-pathology and cyto-pathology diagnosis in a rural district hospital setting. RESULTS: Histo-pathology biopsies comprised 71.6% of the total slides seen. Pap smear cervical cytology comprised 13.8% while fine needle aspirate and post- mortem biopsies comprised 12.3%, 2.2% respectively. The commonest histo-pathology biopsies seen were breast comprising 24% of the total cases, followed by endometrium contributing 14.9%, then followed by skin 11.5%, lymph node 11.5%, cervical 11%, and gastrointestinal 6.3%. Most of pap smear cyto-pathology showed evidence of infection comprising 54% while fine needle aspirate infections and malignancy showed equal rate 24% of all cyto-pathology seen during this study. CONCLUSIONS: This is the first time histo-pathology and cyto-pathology data have been provided from a rural district hospital setting in Kenya. The malignant and pre-malignant pattern seen at Machakos General Hospital may be used to gain a broader picture of the common malignant conditions prevalent in any defined population in this country. This also serves as an important cancer epidemiological data in this region during the period of study.

Biopsy↗
PubMed2003

Pathological demography of native patients in a nephrology center in China.

OBJECTIVE: To analysis the pathological demography in Chinese patients undergoing renal biopsy from our nephrology center. METHODS: Between January 1979 and October 2000 in Jinling Hospital, Nanjing, China, 10,002 attempts of percutaneous renal were performed in patients with renal disease from 33 provinces of China. The pathological classifications were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995 by a panel of pathologists and nephrologists during routine clinical-pathological rounds. The pathological demography between those specimens collected from 1979 - 1989 and those from 1990 - 1999 was compared. RESULTS: The mean age of the 10,002 subjects undergoing renal biopsy was 31.4 +/- 13.0 years (ranging from 1 to 78 years), with a male to female ratio of 1.3:1; for the 592 renal transplant recipients, the mean age was 37.5 +/- 9.1 years (ranging from 16 to 66 years), with a male to female ratio of 2.36:1. Primary glomerular diseases (PGD) accounted for 71% of the total patients undergoing renal biopsies, secondary glomerular nephritis (SGN) 23%, tubular-interstitial diseases 3.2%, unclassified renal diseases 1.3%, hereditary and congenital renal diseases 1.0%, end stage renal diseases 0.96%, and recently realized or rare renal diseases 0.15%. IgA nephropathy (IgAN) was the most frequent pathological pattern (40%) of PGD, followed by mesangial proliferative lesion (MsPL) (30%), membranous nephropathy (MN) (10%), and focal segmental glomerulosclerosis (FSGS) (6%). Lupus nephritis (LN) was the most pathology common seen (74%) in SGN. During the 22 years of the study period, there was a steady increase in patients with SGN discovered during pathological evaluation of renal disorders. A rise in prevalence was found in IgA nephropathy, MN (both P < 0.001), crescentic glomerulonephritis (P < 0.0001), anti-GBM disease, and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura related renal damages (both P < 0.001). There was a decrease in endocapillary proliferative glomerulonephritis (P < 0.001) and IgM nephropathy (IgMN) (P < 0.01) from 1990 - 1999 as compared to 1979 - 1989. Infrequent renal pathological entities were also diagnosed in this group, including Niemann Pick disease, Fabry's disease, POEMS syndrome, and lipoprotein glomerulonephropathy. CONCLUSIONS: This is the largest series of renal biopsy data in China, and therefore may reflect the demographic picture of renal diseases in this country. Changes in prevalence of renal pathological entities were reflected in this group of patients over the last 22 years. In primary glomerular diseases, IgA nephropathy is still the most frequently observed pathological pattern. In SGN, LN appeared the most often. Increased prevalence was found in anti-GBM nephritis and HUS/TTP.

Adolescent↗
PubMed2001

Curricular trends in instruction of pathology: a nationwide longitudinal study from 1993 to present.

Medical schools throughout the United States continue to respond to various external and internal challenges and make modifications in their curricula. Responses obtained from 66% (n = 83) of schools on a longitudinal survey conducted during the year 2000 to study trends in instruction of pathology over a 7-year period (ie, for classes entering 1993 to 1999) indicate the following. There have been steady shifts in instruction of systemic and clinical pathology from discipline-based courses to integrated formats from 1993 to 1999. The degree of integration with other disciplines varies among schools, and may take one or more of the following formats: joint course (pathology and another discipline); multidisciplinary systems course; a combination of pathology course and another integrated course; and completely integrated in the form of problem-based or case-based small group discussion. Presently, at least some degree of integration occurs in 51% of schools for instruction of systemic pathology and 65% for clinical pathology, up from 31% and 48%, respectively, in 1993. Although there has been an increased trend toward integration in instruction of general pathology as well, it is still taught predominantly in a discipline-based manner in the vast majority of schools. Although often difficult to identify with certainty, the best estimates indicate that the overall scheduled length of pathology instruction time has stabilized over the years; the mean total for the entering classes of 1999 was 196 hours versus 201 hours for the classes entering in 1993. However, internal rearrangements of time for various components of delivery of instruction continue. The lecture remains unchanged as an important mode comprising the largest component of pathology curriculum time (53% in 1999, 52.2% in 1993) during the 7-year period examined. The mean traditional laboratory instruction time has decreased slightly from 27% in 1993 to 24% in 1999. This decrease may be accounted for by a shift toward use of laboratory materials in various other formats and venues not included in the traditional laboratory instruction (eg, small group sessions, clinicopathologic correlation conferences, study of kodachrome slides, and computer programs). The use of electronic educational resources has increased remarkably, but for the most part it is not measurable because of the lack of any designated hours. Because pathology instruction occurs exclusively or primarily during year 2 in most schools, the classes entering in 1999 would have studied it during 2000 and 2001, which means the present study provides the most updated curricular trends at this time.

Computer-Assisted Instruction↗
PubMed2006

Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma.

BACKGROUND: Preoperative chemoradiation for localized gastric cancer can modify baseline stage, as determined by surgical pathology stage. Therefore, the authors hypothesized that surgical pathology stage would be a better prognosticator of overall survival (OS) than baseline stage. METHODS: Patient populations were combined from 2 prospectively conducted, preoperative chemoradiation trials that used the same therapeutic strategy. Patients must have had localized gastric adenocarcinoma and were staged extensively, including endoscopic ultrasonography and laparoscopy. Patients had to be fit for surgery medically with a technically resectable cancer. All patients provided written informed consent. Patients first received induction chemotherapy for up to 2 months followed by chemoradiation (45 grays) and an attempted surgery. OS was correlated with pretreatment and posttreatment parameters, including surgical pathology stage according to American Joint Commission on Cancer criteria. RESULTS: Of 74 patients who were registered, 69 patients (93%) had undergone surgery. Nineteen patients (26%) had a pathologic complete response (pathCR), and 55 patients (81%) had a curative (R0) resection. None of the pretreatment parameters correlated with OS; however, longer OS correlated with lower pathologic stage (P < .0001), R0 resection (P < .001), clinical response noted prior to surgery (P = .002), pathCR (P = .004), lower pathologic lymph node classification (P = .006), and lower pathologic tumor classification (P = .03). Pathologic stage and R0 resection were independent prognostic factors for OS (multivariate Cox model; both P = .05). CONCLUSIONS: When preoperative chemoradiation strategy was employed for gastric cancer, the surgical pathology stage, a reflection of cancer's biologic heterogeneity, was a better prognosticator of OS than the baseline clinical stage. Surgical pathology stage, in this setting, may serve as an intermediate endpoint for Phase II/III trials.

Adult↗