Managing Formaldehyde indoor pollution in anatomy pathology departments.

BACKGROUND: Nearly eleven years have passed since the International Agency for Research on Cancer classified Formaldehyde (FA) as a known human carcinogen (group 1), yet the safety of anatomy pathology workers who are currently exposed to FA is still a matter of concern. OBJECTIVE: The purpose of this study was to evaluate the literature to discover which topics have been focused on and what the latest developments are in managing FA indoor pollution in anatomy pathology departments. which topics have been focused on and what the latest developments in managing FA indoor pollution in anatomy pathology departments. METHODS: For the purpose of this review, we searched for publications in PubMed and Web of Science using selected keywords. The articles were reviewed and categorized into one or more of the following three categories based on subject matter: exposure levels exposure controls and alternatives. RESULTS: Our search resulted in a total of 31 publications that matched our inclusion criteria. The topics discussed, in order of frequency (from highest to lowest), were: "exposure controls", "exposure levels" and "alternatives". The most frequently suggested intervention was to improve local exhaust ventilation systems to minimize FA levels in gross anatomy laboratories. CONCLUSIONS: We found a lack of evidence-based improvement interventions that aimed to control exposure to FA. According to this finding, and pending a valid chemical substitute for FA, we suggest the need for more in-depth studies targeting measures to minimize exposures to FA in pathology departments.

Discordance in pathology report after central pathology review: Implications for breast cancer adjuvant treatment.

AIM: Pathological predictive factors are the most important markers when selecting early breast cancer adjuvant therapy. In randomized clinical trials the variability in pathology report after central pathology review is noteworthy. We evaluated the discordance rate (DR) and inter-rater agreement between local and central histopathological report and the clinical implication on treatment decision. METHODS: A retrospective analysis was conducted in a series of consecutive early breast cancer tumors diagnosed by local pathologists and subsequently reviewed at the Pathology Division of European Institute of Oncology. The inter-rater agreement (k) between local and central pathology was calculated for Ki-67, grading, hormone receptors (ER/PgR) and HER2/neu. The Bland-Altman plots were derived to determine discrepancies in Ki-67, ER and PgR. DR was calculated for ER/PgR and HER2. RESULTS: From 2007 to 2013, 187 pathology specimens from 10 Cancer Centers were reviewed. Substantial agreement was observed for ER (k0.612; 95% CI, 0538-0.686), PgR (k0.659; 95% CI, 0580-0.737), Ki-67 (k0.609; 95% CI, 0.534-0.684) and grading (k0.669; 95% CI, 0.569-0.769). Moderate agreement was found for HER2 (k0.546; 95% CI, 0444-0.649). DR was 9.5% (negativity to positivity) and 31.7% (positivity to negativity) for HER2 and 26.2% (negativity to positivity) and 12.5% (positivity to negativity) for ER/PgR. According to changes in Her2 and ER/PgR status, 23 (12.2%) and 33 (17.6%) systemic prescription were respectively modified. CONCLUSIONS: In our retrospective analysis, central pathological review has a significant impact in the decision-making process in early breast cancer, as shown in clinical trials. Further studies are warranted to confirm these provocative results.

A vinyl chloride-exposed worker with an adrenal gland angiosarcoma: a case report.

Adrenal epithelioidangiosarcoma (AEA) is a rare neoplasm that accounts for less than 1% of sarcomas. Due to its rarity, it can easily be misdiagnosed, both by the clinician and the pathologist. Data on the patient's occupational history was collected and analyzed. The bibliographic data was found on the PUBMED bibliographic search site after entering the word "extrahepaticangiosarcoma". We report a case of adrenal epithelioidangiosarcoma (AEA) in a 68 yr-old Caucasian male factory worker exposed to Vinyl Chloride (VC) for 15 yr. He underwent surgery, chemotherapy and radiotherapy. Hepatic angiosarcoma is a known consequence of VC exposure, but occupational causality of extra-hepatic angiosarcoma is controversial. Extra-hepatic angiosarcomas have been reported in VC workers, but never AEA. Cancerogenic effects of VC involve all endothelial areas of the body and extra-hepatic endothelial tumors may also be caused by this substance. This is the first published report of AEA diagnosed in a worker exposed to VC.

Early dynamic changes in pulse oximetry signals in preterm newborns with histologic chorioamnionitis.

OBJECTIVE: No reliable clinical markers of histologic chorioamnionitis (HCA), a major and often subclinical cause of prematurity leading to high neonatal morbidity and mortality, are available to date. Increasing evidence indicates myocardial dysfunctions in affected fetuses and newborns. We sought to assess the value of nonlinear dynamics from pulse oximetry signals in identifying affected newborns. DESIGN: Prospective case-control study. SETTING: Tertiary level neonatal intensive care unit, Brindisi Hospital. PATIENTS AND INTERVENTION: Pulse oximetry-derived signals (pulse rate, oxygen saturation, and perfusion index), recorded within the first 1.5 hrs of life, were analyzed for 110 very low-birth-weight infants, of whom 54 had histopathological evidence of HCA. MEASUREMENTS AND MAIN RESULTS: Four different time series parameters were determined for nonlinear dynamical (NLD) analysis. Significantly decreased Lempel-Ziv, Lyapunov largest exponent, and correlation dimension, with significantly increased Hurst values for heart rate and perfusion index (p < .00001), were observed in newborns with HCA. Heart rate Lempel-Ziv

Igloo-like prepuce: a peculiar aspect of smooth-muscle hamartoma of the genitalia?

We report the case of a 16-year-old boy with 'igloo-like prepuce' and hypospadia, successfully treated by asymmetrical antero-posterior postectomy. Histopathological examination consisting of classical microscopy, immuno-histochemistry and electronmicroscopy of the surgical material provided insights into the etiopathogenesis of this rare disease.

Prolonged fetal bradycardia as the presenting clinical sign in Streptococcus agalactiae chorioamnionitis.

Group B Streptococcus remains a leading infectious cause of neonatal morbidity and mortality. We report a case of a 37 weeks' gestation infant with severe birth asphyxia, status epilepticus and GBS chorioamnionitis, in which a prolonged fetal bradycardia was the only prenatal clinical sign.

Early postnatal skin colour changes in term newborns with subclinical histological chorioamnionitis.

UNLABELLED: Chorioamnionitis, a known risk factor for fetal and neonatal morbidity both in preterm and term newborns, is often subclinical. Earlier observations have linked skin colourimetry to neonatal illness severity and adverse neonatal outcome. Here, we tested the hypothesis that subclinical histological chorioamnionitis is associated with early postnatal skin colour changes in term newborns. Skin colourimetry on ten body sites (forehead, cheek, forearm, palm, upper chest, abdomen, back, buttock, leg, and sole) was examined in 45 term infants with subclinical histological chorioamnionitis and 45 sex- and gestational age-matched controls, using a tristimulus portable colourimeter at 1, 5 and 10 min after birth. Infants with subclinical histological chorioamnionitis showed statistically significant early postnatal skin colourimetric differences, in nine and seven out of the ten body sites examined as compared to control newborns at 1 min (P< or =0.0092), 5 min (P< or =0.0081) and 10 min (P< or =0.0056) from birth, respectively. Skin colourimetry changes were associated with lower 1 min Apgar scores (P<0.0001), cord blood pH (P<0.0001), PaO2 (P<0.0001), and base excess (P<0.0001) values, together with higher cord blood PaCO2 (P=0.0001), NICU admissions (P=0.00076), endotracheal intubation in the delivery room (P=0.012), Neonatal Acute Physiology-Perinatal Extension (P<0.0001) and Neonatal Therapeutic Intervention Scoring System (P<0.0001) scores than the chorioamnionitis-negative infants. CONCLUSION: These findings, compatible with early peripheral microcirculatory changes, indicate skin vasoconstriction as an early neonatal manifestation of subclinical chorioamnionitis.

Human anisakiasis in Italy: a report of eleven new cases.

The authors report on eleven new human cases of anisakiasis occurring in Italy, and emphasize the importance of the infection in clinical medicine, histopathology and public health. For ten of these cases, the diagnosis was based on histological findings: an eosinophilic granuloma associated with a larva of Anisakis sp. For one of them, the larva was removed from the stomach by endoscopy. Nine of the subjects were from Apulia and two from Molise (regions of southern and central Italy, respectively). Ten of them were surgically treated, and in one case the endoscopical extraction of the parasite resolved the situation. In two cases, the gastric wall was affected, in three the intestinal wall, in a further three the omentum, in one the spleen, and in the final two the mesentery and the epiploic appendix. In all the cases, the parasite was discovered unexpectedly during surgical treatment of the patients for supposed illnesses, which had originally been misdiagnosed. In three cases, the patients were also affected by cancer. Human anisakiasis must be taken into account in the differential diagnosis of acute, abdominal synddromes in subjects who have ingested raw fish or squid a few hours to a few days before the onset of symptoms. Histopathologists should consider the possibility of this parasitic infection when confronted with an eosinophilic granuloma of the digestive tract, mesentery or peritoneum. The incidence of anisakiasis in Italy is probably higher than reported, as some cases might not be diagnosed and others might heal spontaneously.