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International Journal of Surgery Case... May 2024Paraneoplastic leukemoid reactions (PLRs) in the context of sarcomas represent a unique clinical entity that poses significant diagnostic challenges and adds valuable...
INTRODUCTION
Paraneoplastic leukemoid reactions (PLRs) in the context of sarcomas represent a unique clinical entity that poses significant diagnostic challenges and adds valuable insights to the surgical literature. Characterized by an abnormal elevation of white blood cell count, these reactions are often associated with aggressive tumor biology and poor prognosis, emphasizing the need for heightened awareness among clinicians.
CASE PRESENTATION
A 48-year-old male presented with a rapidly growing, ulcerated tumor on his thigh. Lab tests revealed an extreme leukocytosis with a white blood cell count of 92,860/mm3. Imaging and biopsy confirmed a high-grade spindle cell sarcoma.
CLINICAL DISCUSSION
After excluding other causes of leukocytosis, a PLR secondary to sarcoma was diagnosed. Despite initial antibiotic treatment, leukocytosis persisted, prompting a decision for surgical intervention. The patient underwent successful tumor resection, resulting in a significant decrease in leukocyte count and subsequent stable recovery, supported by adjuvant radiotherapy.
CONCLUSION
This case underscores the importance of recognizing PLRs in sarcoma patients as they can significantly impact clinical management and prognosis. It highlights the necessity of a multidisciplinary approach for accurate diagnosis and effective treatment. The case contributes to the surgical literature by detailing the diagnostic process and therapeutic interventions in managing such complex presentations, thereby providing key "take-away" lessons on the importance of considering PLRs in the differential diagnosis of leukocytosis in patients with malignancies.
PubMed: 38875823
DOI: 10.1016/j.ijscr.2024.109819 -
Frontiers in Pediatrics 2024Primary ciliary dyskinesia (PCD) is considered a rare cause of chronic rhinosinusitis with nasal polyposis (CRSwNP), which is reported in 6% of children with PCD. The...
BACKGROUND
Primary ciliary dyskinesia (PCD) is considered a rare cause of chronic rhinosinusitis with nasal polyposis (CRSwNP), which is reported in 6% of children with PCD. The forms of PCD associated with the variants of the GAS8 gene identified so far seem to be linked to recurrent respiratory infections (sinusitis, otitis, and bronchiectasis) without situs inversus.
CASE PRESENTATION
We report a case of an 11-year-old girl with recurrent otitis media, productive cough, and chronic rhinosinusitis with nasal polyposis with homozygosity for a novel nonsense mutation in the GAS8.
CONCLUSION
Children with CRSwNP should be treated in a multidisciplinary manner (ENT, pulmonologist, allergist, pathologist, pediatrician, and geneticist) because nasal polyposis often hides etiologies that must be recognized.
PubMed: 38873586
DOI: 10.3389/fped.2024.1345265 -
Frontiers in Digital Health 2024Digital pathology (DP) has become a part of the cancer healthcare system, creating additional value for cancer patients. DP implementation in clinical practice provides... (Review)
Review
Digital pathology (DP) has become a part of the cancer healthcare system, creating additional value for cancer patients. DP implementation in clinical practice provides plenty of benefits but also harbors hidden ethical challenges affecting physician-patient relationships. This paper addresses the ethical obligation to transform the physician-patient relationship for informed and responsible decision-making when using artificial intelligence (AI)-based tools for cancer diagnostics. DP application allows to improve the performance of the Human-AI Team shifting focus from AI challenges towards the Augmented Human Intelligence (AHI) benefits. AHI enhances analytical sensitivity and empowers pathologists to deliver accurate diagnoses and assess predictive biomarkers for further personalized treatment of cancer patients. At the same time, patients' right to know about using AI tools, their accuracy, strengths and limitations, measures for privacy protection, acceptance of privacy concerns and legal protection defines the duty of physicians to provide the relevant information about AHI-based solutions to patients and the community for building transparency, understanding and trust, respecting patients' autonomy and empowering informed decision-making in oncology.
PubMed: 38873358
DOI: 10.3389/fdgth.2024.1358305 -
Pathology Oncology Research : POR 2024Gastric epithelial neoplasm of the fundic-gland mucosa lineages (GEN-FGMLs) are rare forms of gastric tumors that encompass oxyntic gland adenoma (OGA), gastric...
BACKGROUND
Gastric epithelial neoplasm of the fundic-gland mucosa lineages (GEN-FGMLs) are rare forms of gastric tumors that encompass oxyntic gland adenoma (OGA), gastric adenocarcinoma of the fundic-gland type (GA-FG), and gastric adenocarcinoma of the fundic-gland mucosa type (GA-FGM). There is no consensus on the cause, classification, and clinicopathological features of GEN-FGMLs, and misdiagnosis is common because of similarities in symptoms.
METHODS
37 cases diagnosed with GEN-FGMLs were included in this study. H&E-stained slides were reviewed and clinicopathological parameters were recorded. Immunohistochemical staining was conducted for MUC2, MUC5AC, MUC6, CD10, CD56, synaptophysin, chromograninA, p53, Ki67, pepsinogen-I, H/K-ATPase and Desmin.
RESULTS
The patients' ages ranged from 42 to 79 years, with a median age of 60. 17 were male and 20 were female. Morphologically, 19 OGAs, 16 GA-FGs, and two GA-FGMs were identified. Histopathological similarities exist between OGA, GA-FG, and GA-FGM. The tumors demonstrated well-formed glands, expanding with dense growth patterns comprising pale, blue-grey columnar cells with mild nuclear atypia. These cells resembled fundic gland cells. None of the OGA invaded the submucosal layer. The normal gastric pit epithelium covered the entire surface of the OGA and GA-FG, but the dysplasia pit epithelium covered the GA-FGM. Non-atrophic gastritis was observed in more than half of the background mucosa. All cases were diffusely positive for MUC6 and pepsinogen-I on immunohistochemistry. H/K-ATPase staining was negative or showed a scattered pattern in most cases. MUC5AC was expressed on the surface of GA-FGMs. p53 was focally expressed and the Ki67 index was low (1%-20%). Compared with OGA, GA-FG and GA-FGM were more prominent in the macroscopic view ( < 0.05) and had larger sizes ( < 0.0001). Additionally, GA-FG and GA-FGM exhibited higher Ki67 indices than OGA ( < 0.0001). Specimens with Ki-67 proliferation indices >2.5% and size >4.5 mm are more likely to be diagnosed with GA-FG and GA-FGM than OGA.
CONCLUSION
GEN-FGMLs are group of well-differentiated gastric tumors with favourable biological behaviours, low cellular atypia, and low proliferation. Immunohistochemistry is critical for confirming diagnosis. Compared with OGA, GA-FG and GA-FGM have larger sizes and higher Ki67 proliferation indices, indicating that they play a critical role in the identification of GEN-FGML. Pathologists and endoscopists should be cautious to prevent misdiagnosis and overtreatment, especially in biopsy specimens.
Topics: Humans; Stomach Neoplasms; Male; Female; Middle Aged; Aged; Adult; Ki-67 Antigen; Gastric Mucosa; Biomarkers, Tumor; Adenocarcinoma; Gastric Fundus; Adenoma; Prognosis
PubMed: 38873175
DOI: 10.3389/pore.2024.1611734 -
Archives of Pathology & Laboratory... Jun 2024The College of American Pathologists (CAP) accreditation requirements for clinical laboratory testing help ensure laboratories implement and maintain systems and...
General Applicability of Existing College of American Pathologists Accreditation Requirements to Clinical Implementation of Machine Learning-Based Methods in Molecular Oncology Testing.
CONTEXT.—
The College of American Pathologists (CAP) accreditation requirements for clinical laboratory testing help ensure laboratories implement and maintain systems and processes that are associated with quality. Machine learning (ML)-based models share some features of conventional laboratory testing methods. Accreditation requirements that specifically address clinical laboratories' use of ML remain in the early stages of development.
OBJECTIVE.—
To identify relevant CAP accreditation requirements that may be applied to the clinical adoption of ML-based molecular oncology assays, and to provide examples of current and emerging ML applications in molecular oncology testing.
DESIGN.—
CAP accreditation checklists related to molecular pathology and general laboratory practices (Molecular Pathology, All Common and Laboratory General) were reviewed. Examples of checklist requirements that are generally applicable to validation, revalidation, quality management, infrastructure, and analytical procedures of ML-based molecular oncology assays were summarized. Instances of ML use in molecular oncology testing were assessed from literature review.
RESULTS.—
Components of the general CAP accreditation framework that exist for traditional molecular oncology assay validation and maintenance are also relevant for implementing ML-based tests in a clinical laboratory. Current and emerging applications of ML in molecular oncology testing include DNA methylation profiling for central nervous system tumor classification, variant calling, microsatellite instability testing, mutational signature analysis, and variant prediction from histopathology images.
CONCLUSIONS.—
Currently, much of the ML activity in molecular oncology is within early clinical implementation. Despite specific considerations that apply to the adoption of ML-based methods, existing CAP requirements can serve as general guidelines for the clinical implementation of ML-based assays in molecular oncology testing.
PubMed: 38871357
DOI: 10.5858/arpa.2024-0037-CP -
Archives of Pathology & Laboratory... Jun 2024The blood bank is often consulted for transfusion support of patients with suspected platelet transfusion refractoriness (PTR). The workup is complex because testing...
CONTEXT.—
The blood bank is often consulted for transfusion support of patients with suspected platelet transfusion refractoriness (PTR). The workup is complex because testing includes specialized assays that are uncommonly ordered with limited availability. Add to this the variety of possible products-crossmatched platelets, human leukocyte antigen (HLA)-matched platelets, HLA antigen-negative platelets-and the approach to PTR can be overwhelming. Moreover, most literature on the subject is published in transfusion medicine journals aimed at transfusion medicine physicians and blood bank specialists in academic settings. Resources tailored to community hospital blood banks are lacking.
OBJECTIVE.—
To provide pathologists who may not have subspecialized training in transfusion medicine and who direct blood banks algorithmic workflows based on clinical scenario and test availability to provide appropriate transfusion support for patients with PTR.
DATA SOURCES.—
This review is a comprehensive overview of terminology, HLA testing procedures, interpretations, and practical recommendations for managing PTR in various scenarios based on expert opinion as well as relevant medical literature published from 2007 to 2022.
CONCLUSIONS.—
Consultation on PTR is complicated and encompasses many clinical and laboratory aspects. The lack of guidelines derived from high-quality prospective studies poses challenges in the workup and management of PTR. Hindering the process further are limited test availability, unfamiliarity with the technical assays, and the various specialized platelet products. The clinical evaluation algorithm presented herein along with the workflow pathways offer pathologists user-friendly and best-practice guidelines with different options based on the clinical scenario and the tests available.
PubMed: 38871350
DOI: 10.5858/arpa.2023-0484-RA -
Archives of Pathology & Laboratory... Jun 2024Computational pathology combines clinical pathology with computational analysis, aiming to enhance diagnostic capabilities and improve clinical productivity. However,...
CONTEXT.—
Computational pathology combines clinical pathology with computational analysis, aiming to enhance diagnostic capabilities and improve clinical productivity. However, communication barriers between pathologists and developers often hinder the full realization of this potential.
OBJECTIVE.—
To propose a standardized framework that improves mutual understanding of clinical objectives and computational methodologies. The goal is to enhance the development and application of computer-aided diagnostic (CAD) tools.
DESIGN.—
The article suggests pivotal roles for pathologists and computer scientists in the CAD development process. It calls for increased understanding of computational terminologies, processes, and limitations among pathologists. Similarly, it argues that computer scientists should better comprehend the true use cases of the developed algorithms to avoid clinically meaningless metrics.
RESULTS.—
CAD tools improve pathology practice significantly. Some tools have even received US Food and Drug Administration approval. However, improved understanding of machine learning models among pathologists is essential to prevent misuse and misinterpretation. There is also a need for a more accurate representation of the algorithms' performance compared to that of pathologists.
CONCLUSIONS.—
A comprehensive understanding of computational and clinical paradigms is crucial for overcoming the translational gap in computational pathology. This mutual comprehension will improve patient care through more accurate and efficient disease diagnosis.
PubMed: 38871349
DOI: 10.5858/arpa.2023-0250-RA -
Journal of Pathology Informatics Dec 2024Eye tracking has been used for decades in attempt to understand the cognitive processes of individuals. From memory access to problem-solving to decision-making, such... (Review)
Review
Eye tracking has been used for decades in attempt to understand the cognitive processes of individuals. From memory access to problem-solving to decision-making, such insight has the potential to improve workflows and the education of students to become experts in relevant fields. Until recently, the traditional use of microscopes in pathology made eye tracking exceptionally difficult. However, the digital revolution of pathology from conventional microscopes to digital whole slide images allows for new research to be conducted and information to be learned with regards to pathologist visual search patterns and learning experiences. This has the promise to make pathology education more efficient and engaging, ultimately creating stronger and more proficient generations of pathologists to come. The goal of this review on eye tracking in pathology is to characterize and compare the visual search patterns of pathologists. The PubMed and Web of Science databases were searched using 'pathology' AND 'eye tracking' synonyms. A total of 22 relevant full-text articles published up to and including 2023 were identified and included in this review. Thematic analysis was conducted to organize each study into one or more of the 10 themes identified to characterize the visual search patterns of pathologists: (1) effect of experience, (2) fixations, (3) zooming, (4) panning, (5) saccades, (6) pupil diameter, (7) interpretation time, (8) strategies, (9) machine learning, and (10) education. Expert pathologists were found to have higher diagnostic accuracy, fewer fixations, and shorter interpretation times than pathologists with less experience. Further, literature on eye tracking in pathology indicates that there are several visual strategies for diagnostic interpretation of digital pathology images, but no evidence of a superior strategy exists. The educational implications of eye tracking in pathology have also been explored but the effect of teaching novices how to search as an expert remains unclear. In this article, the main challenges and prospects of eye tracking in pathology are briefly discussed along with their implications to the field.
PubMed: 38868488
DOI: 10.1016/j.jpi.2024.100383 -
Journal of Pathology Informatics Dec 2024Prostate cancer ranks as the most frequently diagnosed cancer in men in the USA, with significant mortality rates. Early detection is pivotal for optimal patient...
Validation and three years of clinical experience in using an artificial intelligence algorithm as a second read system for prostate cancer diagnosis-real-world experience.
BACKGROUND
Prostate cancer ranks as the most frequently diagnosed cancer in men in the USA, with significant mortality rates. Early detection is pivotal for optimal patient outcomes, providing increased treatment options and potentially less invasive interventions. There remain significant challenges in prostate cancer histopathology, including the potential for missed diagnoses due to pathologist variability and subjective interpretations.
METHODS
To address these challenges, this study investigates the ability of artificial intelligence (AI) to enhance diagnostic accuracy. The Galen™ Prostate AI algorithm was validated on a cohort of Puerto Rican men to demonstrate its efficacy in cancer detection and Gleason grading. Subsequently, the AI algorithm was integrated into routine clinical practice during a 3-year period at a CLIA certified precision pathology laboratory.
RESULTS
The Galen™ Prostate AI algorithm showed a 96.7% (95% CI 95.6-97.8) specificity and a 96.6% (95% CI 93.3-98.8) sensitivity for prostate cancer detection and 82.1% specificity (95% CI 73.9-88.5) and 81.1% sensitivity (95% CI 73.7-87.2) for distinction of Gleason Grade Group 1 from Grade Group 2+. The subsequent AI integration into routine clinical use examined prostate cancer diagnoses on >122,000 slides and 9200 cases over 3 years and had an overall AI Impact ™ factor of 1.8%.
CONCLUSIONS
The potential of AI to be a powerful, reliable, and effective diagnostic tool for pathologists is highlighted, while the AI Impact™ in a real-world setting demonstrates the ability of AI to standardize prostate cancer diagnosis at a high level of performance across pathologists.
PubMed: 38868487
DOI: 10.1016/j.jpi.2024.100378 -
Iranian Journal of Pathology 2024Breast sarcoma is a rare but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended....
Breast sarcoma is a rare but aggressive tumor. There are few case reports in the literature and several aspects of this disease are still not completely comprehended. Therefore, reporting new cases can help to enrich the literature. We report a patient with breast mass and pus secretion from her right breast, misdiagnosed as an abscess and mistreated by antibiotics. The patient was referred for an ultrasound examination and mammography, and a needle biopsy was performed that suggested an aggressive tumor. By the pathologist's suggestion, a total mastectomy of the right breast was performed with the excision of sentinel nodes. A pathological examination revealed a high-grade undifferentiated pleomorphic sarcoma (UPS) without vascular or lymph node invasion as the final diagnosis. The patient underwent postoperative chemotherapy and is currently in good condition. This case emphasizes considering this rare tumor when approaching a breast mass. Performing surgery with adequate resection margin can improve the patient's prognosis. Some suggested breast UPS cases with lung and brain metastasis would be more aggressive tumors than other breast sarcomas. Total mastectomy with negative margins and free-of-tumor lymph nodes may be the key to improve prognosis in such patients.
PubMed: 38864088
DOI: 10.30699/IJP.2023.2006411.3139