RESUMEN
BACKGROUND: Pneumocystis jirovecii pneumonia (PJP) can be challenging to diagnose, often requiring bronchoscopy. Since most patients suspected of PJP undergo imaging, we hypothesized that the findings of these studies could help estimate the probability of disease prior to invasive testing. METHODS: We created a cohort of patients who underwent bronchoscopy specifically to diagnose PJP and conducted a nested case-control study to compare the radiographic features between patients with (n = 72) and without (n = 288) pathologically proven PJP. We used multivariable logistic regression to identify radiographic features independently associated with PJP. RESULTS: Chest x-ray findings poorly predicted the diagnosis of PJP. However, multivariable analysis of CT scan findings found that "increased interstitial markings" (OR 4.3; 95%CI 2.2-8.2), "ground glass opacities" (OR 3.3; 95%CI 1.2-9.1) and the radiologist's impression of PJP being "possible" (OR 2.0; 95%CI 1.0-4.1) or "likely" (OR 9.3; 95%CI 3.4-25.3) were independently associated with the final diagnosis (c-statistic 0.75). CONCLUSIONS: Where there is clinical suspicion of PJP, the use of CT scan can help determine the probability of PJP. Identifying patients at low risk of PJP may enable better use of non-invasive testing to avoid bronchoscopy while higher probability patients could be prioritized.
Asunto(s)
Neumonía por Pneumocystis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Estudios de Casos y Controles , Estudios de Cohortes , Humanos , Modelos Logísticos , Persona de Mediana Edad , Neumonía por Pneumocystis/patología , RadiografíaRESUMEN
PURPOSE: Traditionally, indications for imaging studies of women are considered to be related to screening for and evaluation of disease of the female breast and pelvis. However, a number of chest diseases and associated intrathoracic imaging findings are unique to women and should be recognized by general radiologists, as well as chest and women-imaging specialists. CONCLUSIONS: The sex-specific findings unique to women include normal anatomical variants, primary lung disease, complications of breast and gynaecological disease, and pregnancy-related conditions. Classification, description, and illustration of gender-specific chest imaging findings are the objective of this article.
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Diagnóstico por Imagen , Enfermedades Torácicas/diagnóstico , Puntos Anatómicos de Referencia , Diagnóstico Diferencial , Femenino , Enfermedades de los Genitales Femeninos/diagnóstico , Humanos , Embarazo , Complicaciones del Embarazo/diagnósticoRESUMEN
CONTEXT.: In the early 1900s, it was common practice to retain, prepare, and display instructive pathologic specimens to teach pathology to medical trainees and practitioners; these collections were called medical museums. Maude Abbott, MD, established her reputation by developing expertise in all aspects of medical museum work. She was a founder of the International Association of Medical Museums (later renamed the International Academy of Pathology) and became an internationally renowned expert on congenital heart disease. Her involvement in the Canadian Medical War Museum (CMWM) is less well known. OBJECTIVE.: To explore Abbott's role in the development of the CMWM during and after World War I and to trace its history. DESIGN.: Available primary and secondary historical sources were reviewed. RESULTS.: Instructive pathologic specimens derived from Canadian soldiers dying during World War I were shipped to the Royal College of Surgeons in London, which served as a clearinghouse for museum specimens from Dominion forces. The Canadian specimens were repatriated to Canada, prepared by Abbott, and displayed at several medical meetings. Abbott, because she was a woman, could not enlist and so she reported to a series of enlisted physicians with no expertise in museology. Plans for a permanent CMWM building in Ottawa eventually failed and Abbott maintained the collection at McGill (Montreal, Quebec, Canada) until her death in 1940. We trace the CMWM after her death. CONCLUSIONS.: Sadly, after Abbott had meticulously prepared these precious teaching specimens so that their previous owners' ultimate sacrifice would continue to help their military brethren, the relics were bureaucratically lost.
Asunto(s)
Museos/historia , Patología/historia , Médicos Mujeres/historia , Canadá , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Primera Guerra MundialRESUMEN
BACKGROUND: The objectives of this study were: 1) to determine the diagnostic concordance of non-small cell lung carcinoma (NSCLC) subtypes in cytology and biopsy specimens taken during the same procedure and evaluate the causes of discordance; and 2) to determine the frequency of immunohistochemistry (IHC) use for subtyping NSCLC. METHODS: Biopsy and cytology specimens that were obtained at the same procedure and diagnosed as NSCLC between January 2011 and December 2014 at the McGill University Health Center were identified (n = 226 pairs). The diagnostic concordance between the 2 methods was evaluated. The slides from discordant cases were reviewed, and final diagnoses were made based on IHC, resection specimens, or pathologist discussion. RESULTS: Concordance in subtype diagnosis was perfect (adeno-adeno or squamous-squamous) in 66.2% of cases and was partial (adeno or squamous vs non-small cell) in 23%; discordance (adeno vs squamous) was observed in 7.8%. Although subtyping was not possible (ie, the final diagnosis was NSCLC, not otherwise specified) in 12.8% of biopsy specimens and 16.3% of cytology specimens, specific subtyping was not achieved in only 3% of cases when both modalities were considered. IHC was used in 47% of biopsy cases and 13% of cytology cases. CONCLUSIONS: Subtyping of NSCLC can be achieved in most cases (97%) by considering findings in both biopsy and cytology specimens, and concordance in subtyping between cytology and biopsy specimens can be reached in a high percentage of cases (89.2%). Cancer Cytopathol 2016;124:737-43. © 2016 American Cancer Society.
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Biopsia con Aguja Fina/métodos , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/patología , Citodiagnóstico/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , HumanosRESUMEN
Cardiac inflammatory myofibroblastic tumor (IMT) is a rare entity affecting predominantly infants, children, and young adults. Although most tumors have a benign clinical course after complete surgical resection, some have significant clinical effects. We report the case of a 9-year-old girl who had sudden cardiac death as a result of occlusion of the left circumflex coronary artery. A review of 57 cases of cardiac IMTs reported in the literature in terms of epidemiology, clinical presentation, histologic and immunohistologic features, and outcome is presented. Recognition of this rare abnormality is important in order to initiate prompt surgical intervention.
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Muerte Súbita Cardíaca/etiología , Granuloma de Células Plasmáticas/complicaciones , Cardiopatías Congénitas/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Válvula Aórtica/patología , Enfermedad de la Válvula Aórtica Bicúspide , Niño , Muerte Súbita Cardíaca/patología , Femenino , Granuloma de Células Plasmáticas/patología , Cardiopatías Congénitas/patología , Enfermedades de las Válvulas Cardíacas/patología , HumanosRESUMEN
INTRODUCTION: Fluorescence in situ hybridization (FISH) is currently the standard for diagnosing anaplastic lymphoma kinase (ALK)-rearranged (ALK+) lung cancers for ALK inhibitor therapies. ALK immunohistochemistry (IHC) may serve as a screening and alternative diagnostic method. The Canadian ALK (CALK) study was initiated to implement a multicenter optimization and standardization of laboratory developed ALK IHC and FISH tests across 14 hospitals. METHODS: Twenty-eight lung adenocarcinomas with known ALK status were used as blinded study samples. Thirteen laboratories performed IHC using locally developed staining protocols for 5A4, ALK1, or D5F3 antibodies; results were assessed by H-score. Twelve centers conducted FISH using protocols based on Vysis' ALK break-apart FISH kit. Initial IHC results were used to optimize local IHC protocols, followed by a repeat IHC study to assess the results of standardization. Three laboratories conducted a prospective parallel IHC and FISH analysis on 411 consecutive clinical samples using post-validation optimized assays. RESULTS: Among study samples, FISH demonstrated 22 consensus ALK+ and six ALK wild type tumors. Preoptimization IHC scores from 12 centers with 5A4 and the percent abnormal cells by FISH from 12 centers showed intraclass correlation coefficients of 0.83 and 0.68, respectively. IHC optimization improved the intraclass correlation coefficients to 0.94. Factors affecting FISH scoring and outliers were identified. Post-optimization concurrent IHC/FISH testing in 373 informative cases revealed 100% sensitivity and specificity for IHC versus FISH. CONCLUSIONS: Multicenter standardization study may accelerate the implementation of ALK testing protocols across a country/region. Our data support the use of an appropriately validated IHC assay to screen for ALK+ lung cancers.
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Adenocarcinoma/enzimología , Neoplasias Pulmonares/enzimología , Proteínas Tirosina Quinasas Receptoras/metabolismo , Adenocarcinoma/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma del Pulmón , Quinasa de Linfoma Anaplásico , Canadá , ADN de Neoplasias/genética , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Hibridación Fluorescente in Situ/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas Tirosina Quinasas Receptoras/genética , Reproducibilidad de los Resultados , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
El tórax normal. Métodos de investigación radiológica y patológica. Métodos de investigación clínica, de laboratorio y funcional. Signos radiológicos en el diagnóstico de enfermedades torácicas
Asunto(s)
Enfermedades Cardiovasculares/diagnóstico , Enfermedades Pulmonares/diagnóstico , Pulmón/anatomía & histología , Pruebas Respiratorias/instrumentación , Tórax/anatomía & histología , Corazón , Enfermedades Respiratorias , Enfermedades Respiratorias/diagnóstico , Mediastino , Mediastino/anatomía & histología , Pleura , Pleura/anatomía & histología , Pleura/fisiología , Pulmón , Pulmón/patología , Radiografía Torácica/clasificación , Radiografía Torácica/normas , Respiración/fisiología , Sistema Linfático/anatomía & histología , Sistema Linfático/fisiología , Pruebas Respiratorias/métodos , Tórax/fisiopatología , Tórax/patologíaRESUMEN
Enfermedades embólicas y trombóticas de los pulmones. Hipertensión y edema de pulmón. Enfermedades de las vías áereas. Enfermedades pleuropulmonares causadas por la inhalación de polvo inorgánico. Enfermedades pulmonares causadas por aspiración de cuerpos extraños
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Enfermedades Cardiovasculares/diagnóstico , Embolia Pulmonar/diagnóstico , Hipertensión Pulmonar/diagnóstico , Enfermedades Pulmonares/diagnóstico , Tórax/patología , Asma/diagnóstico , Bronquiectasia/diagnóstico , Bronquiolitis/diagnóstico , Calcinosis/diagnóstico , Disautonomía Familiar/diagnóstico , Enfermedades Cardiovasculares/terapia , Edema Pulmonar/diagnóstico , Edema Pulmonar/fisiopatología , Edema Pulmonar/patología , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/patología , Fibrosis Quística/diagnóstico , Neumoconiosis/diagnóstico , Neumoconiosis/fisiopatología , Neumonía por Aspiración/diagnóstico , Neumonía por Aspiración/fisiopatología , Enfermedades Pulmonares Obstructivas/diagnóstico , Enfermedades Pulmonares/terapiaRESUMEN
Enfermedades embólicas y trombóticas de los pulmones. Hipertensión y edema de pulmón. Enfermedades de las vías áereas. Enfermedades pleuropulmonares causadas por la inhalación de polvo inorgánico. Enfermedades pulmonares causadas por aspiración de cuerpos extraños
Asunto(s)
Tórax/patología , Enfermedades Pulmonares/diagnóstico , Enfermedades Cardiovasculares/diagnóstico , Embolia Pulmonar/diagnóstico , Hipertensión Pulmonar/diagnóstico , Enfermedades Pulmonares/terapia , Enfermedades Cardiovasculares/terapia , Embolia Pulmonar/fisiopatología , Embolia Pulmonar/patología , Edema Pulmonar/diagnóstico , Edema Pulmonar/fisiopatología , Edema Pulmonar/patología , Asma/diagnóstico , Enfermedades Pulmonares Obstructivas/diagnóstico , Bronquiectasia/diagnóstico , Bronquiolitis/diagnóstico , Calcinosis/diagnóstico , Disautonomía Familiar/diagnóstico , Fibrosis Quística/diagnóstico , Neumoconiosis/diagnóstico , Neumoconiosis/fisiopatología , Neumonía por Aspiración/diagnóstico , Neumonía por Aspiración/fisiopatologíaRESUMEN
Anormalidades pulmonares originadas en el desarrollo. Enfermedades infecciosas de los pulmones. Enfermedades por alteraciones de la actividad inmunológica. Enfermedad neoplásica de los pulmones
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Tórax/patología , Enfermedades Pulmonares/diagnóstico , Enfermedades Cardiovasculares/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Enfermedades del Sistema Inmune/diagnóstico , Neoplasias Pulmonares/diagnóstico , Enfermedades Pulmonares/terapia , Enfermedades Cardiovasculares/terapia , Pulmón/anomalías , Arteria Pulmonar/anomalías , Venas Pulmonares/anomalías , Pericardio/anomalías , Corazón , Aorta/anomalías , Infecciones del Sistema Respiratorio/fisiopatología , Enfermedades del Sistema Inmune/clasificación , Enfermedades del Sistema Inmune/fisiopatología , Neoplasias Pulmonares/clasificación , Neoplasias Pulmonares/patología , /diagnóstico , Metástasis de la Neoplasia/diagnóstico , Metástasis de la NeoplasiaRESUMEN
El tórax normal. Métodos de investigación radiológica y patológica. Métodos de investigación clínica, de laboratorio y funcional. Signos radiológicos en el diagnóstico de enfermedades torácicas