The International Society of Urological Pathology (ISUP) is the international professional organization dedicated to the subspecialty of urological pathology. [...] In 2011 the Society undertook to review all aspects of the pathology of adult renal malignancy through an international consensus conference [...]. The detailed decisions relating to the consensus conference are presented in 4 reports, included this issue of the journal.
Many have wondered what might have become of the totalitarian state Lenin founded on merciless terror, had he not died so young. He was 52 and at the height of his power when he had his first stroke. Six months later he had another and then a third stroke three months after that. He died 3 months shy of his 54th birthday with cerebral arteries so calcified that when tapped with tweezers at the time of his autopsy, they sounded like stone. The reason for his premature atherosclerosis has yet to be explained. He had a family history of cardiovascular disease and, therefore, is suspected of having had an inherited lipid disorder. Stress too might have had a role in the progression of his atherosclerosis. However, neither would explain the extent of the calcification of his cerebral arteries identified at post mortem examination. A recently described variant of the NT5E mutation might explain such calcification, as well as Lenin's family history of cardiovascular disease, and his premature cerebrovascular attacks.Vinters H, Lurie L, Mackowiak PA. Vessels of Stone: Lenin's "Circulatory Disturbance of the Brain". Hum Pathol. 2013 Feb 18.
In the new classification of adenocarcinomas, the term lepidic is defined as tumor cells proliferating along the surface of intact alveolar walls without stromal or vascular invasion.[...] This word is a neologism, a new word invented in Canada in the early 1900s [by] John George Adami, MD. [...] After studying in Manchester, Cambridge, Breslau, and Paris, Dr Adami arrived at McGill University in Montreal, Canada, in 1892. Adami was a prolific writer, and he first used the term lepidic in an address to the Toronto Pathological Society on January 4, 1902. In his lecture titled ‘‘Original Communication on the Classification of Tumors,’’ he proposed 2 new terms that would be used to classify all neoplasms. The term lepidic (from greek meaning a rind, skin, or membrane) was applied to tumors that appeared to be derived from surface-lining cells. The term hylic (from greek meaning crude undifferentiated material) was applied to tumors that appeared to be derived from connective tissues. [...]
[...] The terms lepidic and hylic underwent a subtle change in meaning. In Herbert Spencer’s Pathology of the Lung,6 published in 1962, he stated that tumors may grow into the surrounding alveoli ‘‘either filling them with a solid mass of malignant cells (a hilic [sic] growth) or lining their walls (a lepidic growth).’’ This is a minor alteration in definition; however, this is where the modern definition of tumor growth along intact alveolar septa arose. [...]
In the early 1990s the erroneous belief that the term lepidic came from the etymologic origin ‘‘butterfly’’ became prevalent. [...] Soon the term was stated to mean, ‘‘like a butterfly resting on a branch,’’ ‘‘resembling butterflies sitting on a fence,’’ ‘‘butterflies alighting on shrubbery,’’ ‘‘vague resemblance in cross-section to a butterfly,’’ and a reference ‘‘to the scales of the butterfly wing.’’ While these colorful and useful metaphors evoked both the microscopic morphologic appearance and the possible aerogenous mode of dissemination, they were unrelated to the source of the term. Lepidic did not have an entomologic etymology.
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Thomas Hodgkin (1798–1865) was one of the leading physicians and scientists of the nineteenth century. His outstanding contributions transcend many fields, medical and non-medical. A renowned diagnostician, he carried out pioneering work in public health and epidemiology, but devoted the greater part of his career to the study of pathology. Among his many interests were anthropology, geology, geography, and ethnography. He helped found the University of London. [...] His most important legacy to medical science was the recognition of the condition called “Hodgkin’s disease,” now known as “Hodgkin lymphoma”. Hodgkin did not fully appreciate the importance of this work and, indeed, it was not recalled as being a particularly noteworthy contribution at the time of his death.
Follicular dendritic cells (FDCs) are a specialized type of antigen-presenting dendritic cells that are largely restricted to lymphoid follicles. They form dense three-dimensional meshwork patterns within benign follicles, which maintain the follicular architecture. The FDC function is to bind and retain antigens by linking to complement and immune complexes and then present these antigens to germinal center B cells that start the secondary immune response. FDCs aid in the rescue of bound B cells from apoptosis, and induce the differentiation of B cells into long-term memory B cell clones or plasma cells. We will discuss the different patterns of the FDC meshwork observed in different types of reactive and neoplastic disorders, which may be due to underlying different roles that FDCs may play in these disorders and whether changes in the architecture of the FDC meshwork can be useful in routine diagnostic practice or have a prognostic value.Rezk SA, Nathwani BN, Zhao X, Weiss LM. Follicular dendritic cells: origin,function, and different disease-associated patterns. Hum Pathol. 2013Jun;44(6):937-50.
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| FDC patterns in reactive and neoplastic disorders highlighted by CD21 immunostaining, from Rezk et al, 2013. |
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The placenta does not respond in a single way to hypoxia, and various placental hypoxic features should be explained within a clinical context. Because the placenta has a large reserve capacity, hypoxic lesions may not result in poor fetal condition or outcome. On the other hand, very acute, in utero, hypoxic events, followed by prompt delivery, may not be associated with placental pathology, and many poor perinatal outcomes can be explained by an etiology other than hypoxia. Nevertheless, assessment of placental hypoxic lesions is helpful for retrospective explanations of complications in pregnancy and in medicolegal investigation.
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| Histopathologic features of placental hypoxia da Stanek J. 2013 |
The pathology community is aware of, and has not been idle on, the issue of resident deficiencies. [...] As residency progresses, “[t]he successful trainee develops a very keen sense of dedication, honesty, commitment, intellectual fortitude, integrity, and respect for both patients and colleagues.”Unlike non-pathology residents, who quickly “break the mold formed [in medical school] by being handed a large syllabus containing all of the information that they need to know for an exam and the world of multiple choice questions”… “[i]n contrast, pathology residents may fall into a passive learning style with little or no clinical responsibilities, clinical contact, or accountability…,”leading to “significant deficiencies in confidence, expertise, professionalism, and lifelong learning skills.”
“[a]s the resident progresses over time, the resident may predictate and then give the case to the attending to sign out without sitting with the attending again for sign out. This allows upper level residents to gain additional autonomy”.
Program directors will need “a clear framework within which to ensure that residents have appropriate opportunities to take responsibility for diagnostic decisions with progressively less oversight.” [...] Program directors will be especially challenged. “[I]t takes a particular combination of high standards, creative thinking, and hard work to manage a training program”; and “time and workload management are critical.” Importantly, “competency-based learning must allow time for remediation for those trainees having inadequate performance…” and “structuring individualized programs for residents in need of remediation falls squarely on the already often overworked residency program director.”
We pathologists have long understood the significance of misdiagnoses and the value of second opinions. Second opinions of pathology diagnoses are routinely used intradepartmentally not only for immediate patient diagnostic accuracy, but also as a tool for peer review, quality assurance, and quality improvement. These may occur as consensus conferences or mandatory second opinions of initial diagnoses of cancers. These measures to assure accuracy of diagnosis are well established in many pathology departments, both private and academic. And directed peer review—selecting specific disease types or particular sites of origin—provides added benefit by targeting latent factors that contribute to diagnostic error.Da Allen TC. Second Opinions: Pathologists' Preventive Medicine.
Caro PATHfinder,se può essere utile, voglio passarti un piccolo contributo sul cancro del colon.Ti allego alcuni articoli di Quirke molto didattici che spiegano qual è il metodo e l'obiettivo del patologo nella diagnosi dei tumori del retto. Due articoli spiegano molto chiaramente tutte le possibili lesioni che vanno diagnosticate; un articolo guida nel report macroscopico e microscopico, un altro spiega bene qual è il significato del margine radiale nelle resezioni del retto e come va valutato.Penso possa essere molto d'aiuto per tutti.CiaoSevero Campione, MD.
We are observing a gradual and important change in the pathologist's profession because a new character has appeared in our daily practice: we can define this character as the “interventional pathologist.” Every day, we now spend most of our time outside of the pathology department: we help nonpathologist physicians and radiologists to solve difficult clinical cases, we aid oncologists in selecting medical procedures, and we verify the adequacy of gastrointestinal biopsies in the endoscopy room. We also discuss the best procedure for molecular characterization of neoplasms. Broadly speaking, we give an effective, direct, and crucial contribution to the patients' diagnostic and therapeutic workup. Moreover, in our hospitals, pathologists personally perform cytologic biopsies, such as thyroid or lymph node fine-needle aspiration biopsy, and histologic sampling, such as breast core needle biopsy. Therefore, we have to interact with radiologists for correct localization of target lesions. [...] This expanded approach to the practice of pathology requires a unique multidisciplinary knowledge. For example, we believe that the pathologist should have a basic knowledge of imaging, and be able to interpret radiography and ultrasound images. [...] The interventional pathologist becomes a modern and all-encompassing figure in the diagnostic process. Are we ready for this cultural revolution?
As pathology is a visual specialty, it would seem that to optimize training, an understanding of how visual perception skills develop and change as a function of experience would be beneficial.
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Nello scorcio d’un malinconico ottobre, una mattina, tra le otto e le nove, mi avviavo lentamente alla lezione d’anatomia, su per le scale di Sant’Aniello a Caponapoli. Pioviccicava; era una pioggerella diaccia e sottile che penetrava le ossa, una di quelle tristezze lagrimose con cui il cielo diventato grigio principia a piangere l’estate che se ne va. La scala era deserta e muta; [...]. Con le mani in saccoccia, il sigaro inumidito tra le labbra, soffrendo orribilmente a cagione d’uno stivalino troppo stretto, io salivo quel calvario dei miei diciott’ anni e pigliavo per l’ anfiteatro anatomico, col buon volere che avrebbe mosso un condannato a far la via del patibolo. Non so bene se ancora esista quell' indegna cantina della morte, dove i cadaveri degli Incurabili si sciorinavano in tutta la miseria delle loro carni. [...]. I morti arrivati di fresco dormono in quella stanzetta a man destra, nudi, stesi supini, in una sacrilega confusione di sesso. [...]. Mettete l’ occhio all' inferriata d’un finestrino; ecco là, sulla panca bruttata di sangue, un cadavere giovanile, con le braccia penzoloni, la testa rasa, rovesciata. [...] Se avete coraggio, spingete ancora un usciolino in fondo: questa che segue è la bottega delle ossa; gli studenti vi possono comperare un paio di stinchi, un lucido cranio, una mandibola, una rotella, l’ umano bambù d 'una spina dorsale..Non so come, non so perché io scesi, in quella mattina, assalito da un indefinibile presentimento, la scala del deposito. Entrai, di mala voglia, nella sala in cui il professore anatomizzava, e mi posi in mezzo ai compagni miei, che guardavano, con attenzione grande il cadavere d'un vecchio. Poco prima, seppi, uno di loro s'era svenuto. Era un novizio, un abruzzese, gentile e non forte. Ma come il professore aveva conciato quel vecchio morto!... [...]. Al meglio della lezione, uscii dalla sala. Non ne potevo più; mi si rivoltava lo stomaco. Senza guardarmi attorno, senza salutare nessuno, infilai il corridoio e feci per ascendere, in fretta e furia, la scaletta. In cima un bidello si preparava a discendere, con in capo una tinozza di membra umane. I gradini della scaletta, su per i quali erano passate centinaia di scarpe goccianti, parevano insaponati. Il bidello scivolò, la tinozza - Dio mio! - la tinozza rovesciata sparse per la scala il suo contenuto, e, in un attimo, tre o quattro teste mazze, inseguite da gambe sanguinanti, saltarono per la scala fino a' miei piedi! Di sopra il bidello urlava e sacramentava, raggomitolato in un angolo, aferrandosi una gamba lussata...Quell’ inserviente, dalla faccia butterata e cinico, dall’ aria insolente, dalla voce sempre rauca, com' egli era sempre oscenamente avvinazzato, si chiamava Ferdinando. Per la faccia sua, cincischiata a quel modo, i compagni lo chiamavano, napoletanamente, Setaccio. lo devo la mia salvazione a Setaccio, perché da quel giorno la cantina dei cadaveri non mi vide più e nemmanco l’ Università, dove compivo il terzo anno di medicina.
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| Dissection at the Yale School of Medicine around 1910. From the book Dissection. |
