Sjögren's syndrome-like illness associated with the acquired immunodeficiency syndrome-related complex.

Three cases of Sjögren's syndrome-like illness occurring in patients with the acquired immunodeficiency syndrome (AIDS)-related complex (ARC) are described. All three patients were male. Positive serologic tests for the human immunodeficiency virus (HIV) were documented in two; the third patient was a prison inmate with a history of drug abuse. The lymphoid infiltrate seen in these cases resembled morphologically the features of persistent generalized lymphadenopathy. One patient complained of dry eyes and arthralgias. Autoimmune phenomena including lupus-like anticoagulant, immune thrombocytopenic purpura, and others have been reported in patients with AIDS and ARC. The occurrence of Sjögren's syndrome in ARC provides further evidence for autoimmune phenomena arising in the severely damaged immune system of ARC patients. Atypical Sjögren's syndrome now requires evaluation for ARC. Proposed criteria for identifying these patients are as follows: 1) young age (less than 40 years); 2) male sex (less than 10 per cent of non-ARC patients are male); 3) homosexuality or bisexuality, or other high-risk groups for AIDS; 4) generalized lymphadenopathy (also seen in rheumatoid arthritis); 5) negative test for rheumatoid factor despite generalized lymphadenopathy; 6) salivary gland lymphoid infiltrate showing features of persistent generalized lymphadenopathy. Patients with such features should be studied for HIV antibodies and other evidence of autoimmune phenomena in order to define more precisely the nature of this new Sjögren's-like illness.

Quality assurance of histopathologic diagnoses: a prospective audit of three thousand cases.

The purpose of this study was to examine a system of quality assurance in which microscopic slides from all surgical cases were subject to peer review before completion of the final pathology report. Three thousand surgical pathology cases were evaluated and the diagnoses entered on preliminary diagnosis sheets. Microscopic slides were reviewed and coded reviewer opinions entered on photostatic copies of preliminary diagnosis sheets. Reviewer comments were incorporated into the final pathology reports at the discretion of the responsible pathologist. Two hundred thirty-three (7.8%) cases were identified in which at least one reviewer disagreed with the preliminary diagnosis; in 67 of the 233 cases (2.2%) the final diagnosis was modified as a result of the review process. Changes in final diagnoses were judged to be significant in 29 (0.96%) cases. These results suggest that systematic review of surgical pathology diagnoses prior to preparation of final pathology reports may be a useful tool in assuring quality and consistency in diagnoses.

Renal oncocytoma followed for eighteen years without resection.

The natural history of unresected renal oncocytomas is unknown. We report a renal oncocytoma which was mistakenly diagnosed as benign renal cyst and followed up for eighteen years. We are unable to find other oncocytomas without resection which were followed up. The apparent lack of change in size over eighteen years supports the concept of slow growth. Malignant histologic characteristics confirm the potential for malignant degeneration in what is generally considered to be a benign lesion.

Status of anatomic pathology data management systems.

Criteria are presented for selecting and evaluating anatomic pathology computer systems, along with a definition of critical performance areas. Also included are a review of factors in computer technology and coding of diagnoses that are leading to increasing use of computers in anatomic pathology and a list of current systems, some of which are available commercially. A suggested outline of pathologists' data management requirements to facilitate communication with computer marketing personnel and systems developers, and a classification of anatomic pathology data management systems are also presented.

Security in the clinical laboratory. Guidelines for managing the information resource.

The principal product produced by the clinical laboratory is information. This is true whether or not an automated system is used to organize and retrieve this information. It follows that great care must be exercised in ensuring that the stored data are accurate in the sense that they truly and always represent those data that were meant to be recorded. Various forces may act to compromise this information including (1) accidents, such as fire, floods, or earthquakes; (2) human error; and (3) deliberate acts, such as sabotage or theft of information. An organized plan for systematically managing the "information resource" has become critical. To safeguard against the potential catastrophic loss of information, a formal information resource management policy must be adopted within the clinical laboratory and directed by a specific individual, under the guidance of the director of pathology.