The College of American Pathologists and National Society for Histotechnology workload study.

Limited data exist in regard to productivity and staffing in the anatomic pathology laboratory. In 2004, the National Society for Histotechnology (NSH) conducted a pilot study to examine productivity and staffing in the histology laboratory. After review of the data, The College of American Pathologists (CAP)/NSH Histotechnology Committee concluded that a larger survey was required to further address and expand on the pilot study findings. In 2007, a total of 2674 surveys were sent out to North American laboratories. From the responses, comparisons of laboratory demographics and productivity were examined by institution type and workload volume. Productivity was measured as the number of paraffin-embedded tissue blocks processed per full-time equivalent per year. This manuscript presents and discusses the data collected from the CAP/NSH Workload Study.

Chondroid metaplasia mimicking recurrent squamous cell carcinoma of the head and neck.

A 65-year-old woman presented with a "sore bump" on her tongue. She had a history of squamous cell carcinoma of the head and neck that had been treated with surgery and radiotherapy 11 years earlier. The tongue lesion was excised, and pathologic examination identified a submucosal focus of benign-appearing cartilage. No evidence of dysplasia or malignancy was seen. She was diagnosed with chondroid metaplasia. Chondroid metaplasia involving the head and neck is rare. When it has occurred, it has been seen in both reactive and neoplastic settings. To our knowledge, this is the first reported case of a chondroid metaplasia of the tongue.

Cutaneous malakoplakia.

Malakoplakia is an acquired granulomatous disorder first described by Michaelis and Gutmann in 1902. The pathogenesis of malakoplakia is poorly understood, but it is thought to be secondary to an acquired bacteriocidal defect in macrophages occurring mostly in immunosuppressed patients or in the setting of autoimmune disease. Malakoplakia has been described in numerous anatomic locations, most commonly in the genitourinary tract. Microscopically, malakoplakia consists predominantly of sheets of macrophages known as von Hansemann cells with scattered targetoid intracytoplasmic inclusions known as Michaelis-Gutmann bodies. Cutaneous malakoplakia is a rare entity with less than 50 cases reported in the literature. In this article, we review cutaneous malakoplakia including the clinical, gross, and microscopic features as well as the treatment and prognosis of 40 cases of cutaneous malakoplakia identified in the literature.

Tendon sheath fibroma of the medial canthus.

Isolated fibromas of the ocular adnexa are rare. Fibromas of the tendon sheath (FTS) are benign, collagenous, spindle cell neoplasms that typically present as an acquired, painless mass in the adult extremities. They infrequently involve the head and neck. We report a case of FTS presenting as a medial canthal mass. Like most FTS, the lesion in our patient was successfully treated by complete surgical excision. While the differential diagnosis contains a variety of mesenchymal tumors, the clinical and radiographic characteristics should lead to the correct diagnosis. To our knowledge, this is the first case of FTS reported to arise at this site.

Clinical significance of benign glands at surgical margins in robotic radical prostatectomy specimens.

OBJECTIVES: Completion of robotic radical prostatectomy compared with conventional open retropubic radical prostatectomy can result in different alterations in the prostatectomy specimens. One difference appears to be an increased incidence of benign glands at the margins, which has been associated with an increase in postoperative prostatic-specific antigen (PSA) levels. We compared the frequency and clinical significance of benign prostate glands at the surgical margins in radical prostatectomy specimens obtained by robotic versus open retropubic prostatectomy. METHODS: We reviewed 38 consecutive prostatectomy specimens from patients with biopsy-proven prostate cancer. Of these 38 specimens, 25 (65%) were obtained by robotic resection and 13 (35%) by open retropubic prostatectomy. Each case was analyzed for Gleason score, pathologic stage, including margin status, and the presence or absence of benign glands at the surgical margin. The study endpoint was the postoperative serum PSA level. RESULTS: A significantly greater incidence (P = 0.035) of benign glands at the surgical margins was found within the robotic group compared with the open retropubic prostatectomy group (54% versus 15%). With a median follow-up of 12.5 months for the robotic group and 24.5 months for the robotic prostatectomy group, only 2 patients, who also had had positive surgical margins, had a continued and persistent increase in the postoperative PSA level after an initial nadir. CONCLUSIONS: The early clinical follow-up data of our study have suggested that patients undergoing robotic radical prostatectomy with negative surgical margins achieve a PSA nadir of less than 0.1 ng/mL, irrespective of the presence or absence of benign prostatic tissue at the surgical margins.

Granulocytic sarcoma of the small intestine.

Granulocytic sarcoma is an extramedullary tumor of myeloblasts and/or immature myeloid cells, which can develop at any anatomic site and is often a forerunner to the development of acute myelogenous leukemia. Granulocytic sarcoma of the gastrointestinal tract most frequently involves the small intestine and most often presents with abdominal pain and obstruction. Pathologists must consider granulocytic sarcoma in any mass of unknown origin with a diffusely infiltrating population of tumor cells, as the diagnosis is often initially unrecognized, especially in nonleukemic patients. Multiple ancillary modalities are available to assist pathologists in making the correct diagnosis so that appropriate therapy can be initiated.