FNA is the ideal tool to study and analyze tumor heterogeneity at metastatic sites

In routine practice, suspected metastases in patients with cancer are only occasionally biopsied, primarily because of the cost and invasiveness of the procedure. However, biopsies of metastatic lesions can be valuable, not only in confirming the presence of metastatic disease, but also in revealing unsuspected benign disease or secondary malignancies. In addition, such biopsies also allow the assessment of biomarkers that might differ from those on primary tumor cells, and can thereby facilitate selection of the optimal treatment. Because of the increasing recognition of clonal and phenotypic heterogeneity of tumors, we anticipate that in the near future, biopsying of metastatic lesions will constitute a standard-of-care practice, allowing assessment of molecular differences between the primary tumor and metastatic lesions. In our opinion, fine-needle aspiration is currently the best method for making repeated biopsies to monitor the tumor: it is minimally invasive, safe, and cost effective and can be coupled with modern ancillary techniques. Here we provide an up-to-date review of the clinical implications of tumor heterogeneity in metastatic disease and the ancillary molecular techniques used in cytology; we also discuss the role of modern cytology in contemporary diagnosis and management of metastatic cancer.

Beca F, Schmitt F. Growing indication for FNA to study and analyze tumor heterogeneity at metastatic sites. Cancer Cytopathol. 2014 Jan 29.

Getting Out From Behind the Paraffin Curtain

A must-to-read Editorial on pathologist's career with a focus on the political efforts needed  to achieve a good work quality and the consideration deserved among clinician colleagues and hospital administrators. To get out from behind the paraffin curtain.

Many pathologists, especially those who maintain contracts with hospitals and other providers, possess keen political skills. They have learned how to keep clinicians happy with the accuracy and alacrity of laboratory services, administrators satisfied with efficiency and financial performance, and technical personnel content with working conditions. [...] As pathologists' careers develop, they are often called on to be leaders. Some are uncomfortable in leadership positions, their careers to date having been founded mostly on individual achievement. The reluctant leader should not be dissuaded by lack of leadership experience. Often the best leaders are those who did not seek out the position but developed their own style as they adapted to the demands of the position. [...] Other challenges include learning to delegate (and follow up on delegated tasks), providing encouragement and inspiration to team members (some of whom may be quite hard-boiled and cynical), and occasionally standing up for the team when it is under assault by powerful factions, including clinicians and other clients. This last challenge takes no small measure of courage and equanimity. [...] The pathologist/politician/leader is commonly confronted by ethical issues. We typically serve multiple masters, including patients, administrators, clinicians, and regulatory agencies. We need to be sensitive to their conflicting agendas. Medical ethics is a complex field [...]  Nevertheless, building a reputation for incorruptibility does foster trust, and trust is fertile ground for opportunity.

Edward O. Uthman (2014) Getting Out From Behind the Paraffin Curtain. Archives of Pathology & Laboratory Medicine: January 2014, Vol. 138, No. 1, pp. 12-13.

Happy New Year 2014.

Landmarks in history of cancer

Una serie di articoli che descrive la storia del cancro in rapporto all' evoluzione delle conoscenze mediche.

Una lettura interessante, durante le ferie natalizie.

Bibliografia:

Hajdu SI. (et al.) A note from history: landmarks in history of cancer, part 1-6. Cancer.2011 Mar-2013 Dec

A large scapulohumeral tumor, most likely a sarcoma, was illustrated by Severino in his book, De Recondita, published in 1632. This the first clinical illustration of a tumor.

Hajdu SI. A note from history: landmarks in history of cancer, part 2

Ultrasound guided FNA: The new challenges and opportunities for cytopathologists

Numero monografico di Diagnostic Cytopathology dedicato alla categoria degli Interventional Pathologists (vedi post del 24 febbraio 2013). Perchè il patologo non è solo quello che campiona un reperto macroscopico e che legge i preparati al microscopio, ma è sempre più un professionista completo che fa in prima persona il prelievo, visita il paziente e discute la strategie diagnostiche e terapeutiche più appropriate con i colleghi. 

Masood S. Ultrasound guided fine needle aspiration biopsy: The new challenges and opportunities for cytopathologists. Diagn Cytopathol. 2013 Dec;41(12):1017-8.

Anatomy and Art --- Transforming Vesalius

Un numero monografico della Karger Gazette sul rapporto tra arte e medicina nella storia, in occasione della riedizione critica della Fabrica di Vesalio.

Bibliografia

Anatomy & Art Through the Ages, Karger Gazette, N. 73 2013

http://www.vesaliusfabrica.com/, accessed 17/11/2013

Fifth muscle man, displaying the rectus abdominis muscle as it is seen in dogs and caudate apes. Vesalius sometimes altered his woodcuts to show a feature that Galen had described but that does not exist in human anatomy.

50 ways to diagnose a tumor

Divertente video sulle più improbabili diagnosi differenziali che vengono in mente quando si osserva un caso difficile!

Help me! Help me! These things that I study, are things I'll never see. I've gotta think of every single thing, ' cause everything can look like anything!

Cineforum 18/11/2013 - Hysteria

La Scuola di Specializzazione in Anatomia Patologica presenta: 

Hysteria

di T. Wexler

con Hugh Dancy, Maggie Gyllenhaal, Felicity Jones, Rupert Everett e Jonathan Pryce.

La proiezione sarà preceduta da un intervento del dott. S. Orlando sull' evoluzione storica del concetto di isteria.

Nota: La proiezione sarà spostata a Lunedì 18 per motivi organizzativi.

Vi aspetto numerosi, ore 15, Auletta Seminari.