Antithrombotic therapy-A simple algorithm for the interventional pathologist: A case series.

We can safely manage patients on antithrombotic therapy in the interventional pathology practice with this practical algorithm based on the new Antithrombotic Therapy Management Guidelines. This new algorithm helps ensure safe care for patients on antithrombotic therapy undergoing interventional pathology procedures. #interventionalpathology.

Resident training in interventional pathology: Ultrasound-guided fine-needle aspiration and rapid on site evaluation-5 years of teaching experience in a single university hospital.

INTRODUCTION: Despite the established role of the interventional pathologist, their diagnostic performance is difficult to establish. At least in Spain training of pathology residents in ultrasound-guided interventional procedures for specimen collection is limited or absent in most institutions. We present our teaching experience in the instruction of ultrasound-guided fine-needle aspiration (FNA) to pathology residents in a tertiary-level hospital. MATERIALS AND METHODS: The training of pathology residents who rotated through the interventional unit of the pathology department and the application of ultrasound-guided FNA and rapid on-site evaluation (U-ROSE) was documented over 5 years. The training period was broken down into learning phases and included the number of ultrasound-guided FNA performed, anatomical location, and their diagnostic performance, among other aspects. RESULTS: Nineteen (19) pathology residents were trained in U-ROSE, and performed a total of 4003 procedures, with a mean of 211 per resident. In 53% of cases only one pass was required for an adequated sample. The specimen was diagnostic in more than 97% of cases. The most frequently sampled anatomical sites were the thyroid gland (n = 2347), followed by lymph node (n = 667), soft tissues (n = 663) and salivary glands (n = 322). CONCLUSION: The results support the training programme followed by pathology residents in learning U-ROSE, which is essential to lay the foundations for the future interventional pathologist.

Digital Examination of LYmph node CYtopathology Using the Sydney system (DELYCYUS): An international, multi-institutional study.

BACKGROUND: After a series of standardized reporting systems in cytopathology, the Sydney system was recently introduced to address the need for reproducibility and standardization in lymph node cytopathology. Since then, the risk of malignancy for the categories of the Sydney system has been explored by several studies, but no studies have yet examined the interobserver reproducibility of the Sydney system. METHODS: The authors assessed interobserver reproducibility of the Sydney system on 85 lymph node fine-needle aspiration cytology cases reviewed by 15 cytopathologists from 12 institutions in eight different countries, resulting in 1275 diagnoses. In total, 186 slides stained with Diff-Quik, Papanicolaou, and immunocytochemistry were scanned. A subset of the cases included clinical data and results from ultrasound examinations, flow cytometry immunophenotyping, and fluorescence in situ hybridization analysis. The study participants assessed the cases digitally using whole-slide images. RESULTS: Overall, the authors observed an almost perfect agreement of cytopathologists with the ground truth (median weighted Cohen κ = 0.887; interquartile range, κ = 0.210) and moderate overall interobserver concordance (Fleiss κ = 0.476). There was substantial agreement for the inadequate and malignant categories (κ = 0.794 and κ = 0.729, respectively), moderate agreement for the benign category (κ = 0.490), and very slight agreement for the suspicious (κ = 0.104) and atypical (κ = 0.075) categories. CONCLUSIONS: The Sydney system for reporting lymph node cytopathology shows adequate interobserver concordance. Digital microscopy is an adequate means to assess lymph node cytopathology specimens.

Fatal sclerosing mesenteritis: a 7-year-old male autopsy case report.

Sclerosing Mesenteritis (SM) is a rare diagnosis, particularly in pediatric patients, and is typically non-fatal when appropriately treated. Although molecular and immunohistochemical alterations have been described, no pathognomonic signature has been identified for this entity. This report presents a case of a seven-year-old boy who suffered sudden cardiorespiratory arrest. Upon autopsy, he was found to have multicentric SM on the upper mesentery, which led to bowel wall thinning and abdominal bleeding with bacterial translocation. We performed comprehensive morphological, immunohistochemical, and molecular analyses. SM is an atypical disorder with diverse clinical manifestations, including a rare but potentially fatal course. Early diagnosis is critical, given its potential severity. To our knowledge, this is the first case report of pediatric mortality linked to SM. Our findings emphasize the importance of increased awareness and early detection of SM in pediatric patients.

Pleural metastasis from pulmonary primary signet-ring squamous cell carcinoma. Case report and literature review.

Signet-ring cells are morphologically defined by the presence of a large intracytoplasmic vacuole that compresses and displaces the nucleus to the periphery. In most cases, these cells are associated with adenocarcinomas of various locations, and with non-epithelial neoplasms. To date, less than 20 cases of squamous cell carcinoma with signet-ring morphology have been described, mainly located on the skin. We present the case of a 73-year-old male with pleural effusion and a left lower lobe mass. The cytological study of the pleural effusion allowed the diagnosis of metastasis of squamous cell carcinoma, signet-ring cell variant. The treatment of lung cancer in advanced stages requires a precise diagnosis that allows the best therapy to be offered to the patient, depending on the clinical stage and the positivity of the biomarkers, among others. Our patient died 18 months after the initial diagnosis.

Fatal sclerosing mesenteritis: a 7-year-old male autopsy case report

ABSTRACT Sclerosing Mesenteritis (SM) is a rare diagnosis, particularly in pediatric patients, and is typically non-fatal when appropriately treated. Although molecular and immunohistochemical alterations have been described, no pathognomonic signature has been identified for this entity. This report presents a case of a seven-year-old boy who suffered sudden cardiorespiratory arrest. Upon autopsy, he was found to have multicentric SM on the upper mesentery, which led to bowel wall thinning and abdominal bleeding with bacterial translocation. We performed comprehensive morphological, immunohistochemical, and molecular analyses. SM is an atypical disorder with diverse clinical manifestations, including a rare but potentially fatal course. Early diagnosis is critical, given its potential severity. To our knowledge, this is the first case report of pediatric mortality linked to SM. Our findings emphasize the importance of increased awareness and early detection of SM in pediatric patients.

[Lung clear cell tumor «sugar tumor¼. Unusual diagnostic neoplasm]. / Tumor de células claras «sugar tumor¼ pulmonar. Neoplasia de diagnóstico inusual.

Clear Cell «sugar tumor¼ of the lung is a rare nosological entity of which around 60 cases have been published in the scientific literature. Considered to be of mesenchymal origin, it presents a typical histochemical - immunohistochemical profile, positive PAS and melanic markers, which allows it to be differentiated from other more frequent neoplasms with worse prognosis. We present the case of a 56-year-old man with a clear cell lung tumor. Radiological, macro-microscopic and histochemistry - immunohistochemical characterization, as well as a brief review of the literature.

Classification of follicular-patterned thyroid lesions using a minimal set of epigenetic biomarkers.

Objective: The minimally invasive fine-needle aspiration cytology (FNAC) is the current gold standard for the diagnosis of thyroid nodule malignancy. However, the correct discrimination of follicular neoplasia often requires more invasive diagnostic techniques. The lack of suitable immunohistochemical markers to distinguish between follicular thyroid carcinoma and other types of follicular-derived lesions complicates diagnosis, and despite most of these tumours being surgically resected, only a small number will test positive for malignancy. As such, the development of new orthogonal diagnostic approaches may improve the accuracy of diagnosing thyroid nodules. Design: This study includes a retrospective, multi-centre training cohort including 54 fresh-frozen follicular-patterned thyroid samples and two independent, multi-centre validation cohorts of 103 snap-frozen biopsies and 33 FNAC samples, respectively. Methods: We performed a genome-wide genetic and epigenetic profiling of 54 fresh-frozen follicular-patterned thyroid samples using exome sequencing and the Illumina Human DNA Methylation EPIC platform. An extensive validation was performed using the bisulfite pyrosequencing technique. Results: Using a random forest approach, we developed a three-CpG marker-based diagnostic model that was subsequently validated using bisulfite pyrosequencing experiments. According to the validation cohort, this cost-effective method discriminates between benign and malignant nodules with a sensitivity and specificity of 97 and 88%, respectively (positive predictive value (PPV): 0.85, negative predictive value (NPV): 0.98). Conclusions: Our classification system based on a minimal set of epigenetic biomarkers can complement the potential of the diagnostic techniques currently available and would prioritize a considerable number of surgical interventions that are often performed due to uncertain cytology. Significance statement: In recent years, there has been a significant increase in the number of people diagnosed with thyroid nodules. The current challenge is their etiological diagnosis to discount malignancy without resorting to thyroidectomy. The method proposed here, based on DNA pyrosequencing assays, has high sensitivity (0.97) and specificity (0.88) for the identification of malignant thyroid nodules. This simple and cost-effective approach can complement expert pathologist evaluation to prioritize the classification of difficult-to-diagnose follicular-patterned thyroid lesions and track tumor evolution, including real-time monitoring of treatment efficacy, thereby stimulating adherence to health promotion programs.

[Unusual presentation of metastasis of prostate carcinoma as a mediastinal mass: A case report and a brief review of the literature.] / Presentación inusual de metástasis de carcinoma prostático como masa mediastínica: descripción de un caso y breve revisión de la literatura.

OBJECTIVE: To assess the metastasic prostatecancer in the differenctial diagnosis of mediastinal masses. METHODS: To report a case. RESULTS: We present the case of a 78-year-old male patientwith a diagnosis of prostate cancer with a mediastinalmass compatible with prostate metastasis. CONCLUSION: Mediastinum is a very rare site for prostatecancer metastasis, but it must be considered in thedifferential diagnosis of mediastinal masses. Treatment isthe usual for metastatic prostate cancer.

OBJETIVO: Considerar el cáncer de próstatametastásico en el diagnóstico diferencial de masas mediastínicas. MÉTODOS: Presentación de un caso clínico. RESULTADOS: Se presenta el caso de un paciente varónde 78 años con diagnóstico de cáncer de próstata en elque se objetiva una masa mediastínica compatible conmetástasis prostática. CONCLUSIÓN: El mediastino es un lugar muy infrecuentede metástasis de cáncer de próstata, pero hay que considerarloen el diagnóstico diferencial de masas mediastínicas.El tratamiento es el estándar del cáncer de próstatametastásico.

Presentación inusual de metástasis de carcinoma prostático como masa mediastínica: descripción de un caso y breve revisión de la literatura / Unusual presentation of prostate carcinoma metastases as a mediastinal mass: description of a case and brief review of the literature

Objetivo: Considerar el cáncer de próstatametastásico en el diagnóstico diferencial de masas mediastínicas. Métodos: Presentación de un caso clínico.Resultados: Se presenta el caso de un paciente varónde 78 años con diagnóstico de cáncer de próstata en elque se objetiva una masa mediastínica compatible conmetástasis prostática. Conclusion: El mediastino es un lugar muy infrecuentede metástasis de cáncer de próstata, pero hay que considerarlo en el diagnóstico diferencial de masas mediastínicas. El tratamiento es el estándar del cáncer de próstatametastásico.(AU)

Objetive: To assess the metastasic prostatecancer in the differenctial diagnosis of mediastinal masses. Methods: To report a case. Results: We present the case of a 78-year-old male patient with a diagnosis of prostate cancer with a mediastinalmass compatible with prostate metastasis. Conclusion: Mediastinum is a very rare site for prostate cancer metastasis, but it must be considered in thedifferential diagnosis of mediastinal masses. Treatment isthe usual for metastatic prostate cancer.(AU)

Ultrasound-Guided Fine-Needle Aspiration of Superficial Lymphadenopathy Performed by Interventional Pathologists: The Applicability of the Sydney System from 2 Years of Experience and 363 Cases.

INTRODUCTION: The Sydney system proposal for the study and reporting of lymphadenopathy by fine-needle aspiration (FNA) constitutes one of the first attempts to standardize this procedure. Here, we review its applicability. MATERIALS AND METHODS: A retrospective study in which all ultrasound-guided FNAs (USFNAs) of superficial lymphadenopathy (palpable or not) performed by interventional pathologists in 2 specialized hospital centers were quantified over 2 years. The procedure was systematized, and the diagnoses were reclassified according to the Sydney system categories. RESULTS: We analyzed 363 USFNAs of lymphadenopathies. The distribution of cases by categories was as follows: insufficient (n = 13; 3.58%), benign (n = 208; 57.30%), atypia of uncertain significance (n = 7; 1.93%), suspicious (n = 21; 5.79), and malignant (n = 114; 31.40%). The risks of malignancy calculated for categories I, II, III, IV, and V were 27%, 3%, 50%, 100%, and 100%, respectively. CONCLUSION: The implementation of the Sydney system allows the systematization and standardization of the lymph node FNA methodology, with increased efficacy and efficiency. Assimilating the recommendations enables the qualification of the diagnostic procedure.

[Minimally invasive percutaneous musculoskeletal biopsy performed by Interventional Pathologist for myopathy study. Twenty years of experience]. / Biopsia percutánea muscular mínimamente invasiva realizada por patólogo intervencionista en el estudio de miopatías. Veinte años de experiencia.

INTRODUCTION: Muscle biopsy plays a major role in the final diagnosis of myopathies. Open muscle biopsy is the benchmark procedure, although minimally invasive percutaneous muscle biopsy (MIPMB) has demonstrated comparable diagnostic performance at a lower cost and can be carried out by interventional pathologists. MATERIALS AND METHODS: Muscle biopsies performed from 1997 to 2017 were reviewed and classified according to the type of procedure, whether carried out by an interventional pathologist or another specialist, the diagnosis and the effectiveness of the procedure. RESULTS: 738 muscle biopsies were performed; 32% were open biopsies and 68% MIPMB carried out by pathologist. The muscle most often biopsied was the femoral quadriceps and the most frequent diagnosis was inflammatory myopathies. In only 39 cases (20 open biopsies and 19 MIPMB) was there insufficient tissue for diagnosis. CONCLUSIONS: Muscle biopsy proved highly effective as a diagnostic tool as 90% yielded adequate tissue samples. The results obtained with MIPMB performed by interventionist pathologists were comparable to those of open muscle biopsy.

Biopsy of Intrapulmonary Lesions in Lungs with Atelectasis and Pleural Effusion / Biopsia de lesiones intrapulmonares en pulmones con atelectasia y derrame pleural

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Amyloid goiter diagnosis by ultrasound-guided fine needle aspiration performed by interventional pathologist.

Amyloid goiter (AG) (primary or secondary) is extremely rare. An abdominal fat pad core needle biopsy (CNB) is the diagnostic gold standard for secondary amyloidosis. Although CNB is useful to detect amyloid infiltration of a specific organ, fine-needle aspiration (FNA) is proven to be the best diagnostic method for thyroid disorders. Guidelines recommend an ultrasound-guided FNA (US-FNA) whenever possible. This procedure is usually performed by various interventional specialists, including pathologists, who perform the procedure in addition to validating the adequacy of the sample. We report a rare case of AG diagnosed using US-FNA performed by a pathologist in a 39-year-old patient with systemic amyloidosis. US-FNA performed by pathologists is a proven, less-invasive, and cost-effective tool that ensures acquisition of adequate specimens and reduces nondiagnostic rates of this procedure to ensure timely cytological diagnosis.

Systematized protocol for interventional pathology reports. Pathology report paradigm for pathologist-performed Ultrasound Guided Fine Needle Aspiration (USFNA) and Ultrasound Guided Core Needle Biopsy (USCNB) / Protocolo sistematizado para informes de patología intervencionista. Informe de anatomía patológica para punción-aspiración con aguja fina con ecografía (EcoPAAF) y biopsia con aguja gruesa con ecografía (EcoBAG)

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Schwannoma pleural que simula metástasis pleural de un carcinoma de recto / Pleural Schwannoma Mimicking Metastatic Rectal Carcinoma

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El patólogo intervencionista. Punción aspiración con aguja fina «ecoguiada» realizada por citopatólogo. Una realidad en España / The interventional pathologist. Ultrasound guided fine needle aspiration performed by cytopathologists. Now a reality in Spain

Introducción. El desarrollo y perfeccionamiento de la ecografía a partir de los setenta supuso un gran avance en el ámbito de la punción aspiración con aguja fina (PAAF), posibilitando localizar lesiones no palpables y minimizar complicaciones. El uso de PAAF ecoguiada trajo como consecuencia que dicha técnica se desplazara por motivos logísticos de los servicios de anatomía patológica a los servicios de radiología. El «alejamiento del patólogo» trajo como consecuencia numerosos inconvenientes. Con la finalidad de recuperar el territorio perdido y optimizar el procedimiento se inició una experiencia pionera —y hasta donde sabemos única España— en el Servicio de Anatomía Patológica del Hospital Universitario Central de Asturias (HUCA) con la PAAF ecoguiada realizada por citopatólogo. Método. Se cuantificaron todas las PAAF realizadas en el HUCA desde el 1 de julio de 2015 hasta el 30 de junio de 2016. Se procedió a clasificarlas dependiendo de si fueron PAAF ecoguiadas realizadas por patólogo o PAAF no realizada por patólogo, teniendo como principal criterio si fueron valorables o insuficientes. Resultados. Casi la mitad de las PAAF efectuadas fueron realizadas por citopatólogo (923). Las PAAF ecoguiadas realizadas por patólogo superaron en rendimiento diagnóstico a las PAAF no realizadas por patólogo. En todas las localizaciones anatómicas comprables, la PAAF ecoguiada realizada por patólogo tuvo un menor porcentaje de muestras insuficientes (4,33%) en comparación con la PAAF no realizada por patólogo (12,05%). Conclusión. El citopatólogo adecuadamente adiestrado es capaz de realiza PAAF ecoguiada con excelentes resultados. Los buenos resultados obtenidos han traído como consecuencia el aumento progresivo del número de PAAF solicitadas para llevar a cabo en el Servicio de Anatomía Patológica (AU)

Introduction. The development and improvement of ultrasound from the seventies has caused a breakthrough in fine needle aspiration (FNA), allowing the location of non-palpable lesions and minimizing complications. For logistic reasons, ultrasound-guided-FNA (US-FNA) is carried out in the department of radiology. However, the distance from the pathologist has many disadvantages. In order to correct this and thus optimize the procedure, the Department of Pathology at the University Hospital of Asturias (Hospital Universitario Central de Asturias [HUCA]) has initiated, for the first time in Spain, the Ultrasound-Guided-FNA Performed by Cytopathologists programme. We present our experience so far. Method. FNA performed at HUCA were quantified from July 1st 2015 to June 30th 2016. FNA were classified as US-FNA-cytopathologists or US-FNA-without cytopathologists. Criteria of sufficient and insufficient samples were taken into account. Results. Almost half of the FNA were made by cytopathologists (923). The performance of US-FNA-cytopathologists was better than US-FNA-without cytopathologists. US-FNA-cytopathologists had a lower percentage of inadequate samples (4.33%) compared to FNA carried out by non cytopathologists (12.05%). Conclusion. Adequately trained cytopathologists can perform US-FNA with excellent results. Our positive experience has resulted in an increase in the number of requests for FNA to be carried out in the Department of Pathology (AU)