Real-Time Telepathology Is Substantially Equivalent to In-Person Intraoperative Frozen Section Diagnosis.

CONTEXT.­: Intraoperative diagnosis by frozen section is a mainstay of surgical pathology practice, providing immediate feedback to the surgical team. Despite good accuracy with modern methods, access to intraoperative surgical pathology with an appropriate turnaround time (TAT) has been a limiting factor for small or remote surgical centers, with negative impacts on cost and patient care. Telepathology offers immediate expert anatomic pathology consultation to sites without an in-house or subspecialized pathologist. OBJECTIVE.­: To assess the utility of live telepathology in frozen section practice. DESIGN.­: Frozen section diagnoses by telemicroscopy from 2 tertiary care centers with a combined 3 satellite hospitals were queried for anatomic site, TAT per block, pathologist, and concordance with paraffin diagnosis. TAT and concordance were compared to glass diagnoses in the same period. RESULTS.­: For 748 intraoperative diagnoses by telemicroscopy, 694 had TATs with a mean of 18 minutes 56 seconds ± 8 minutes 45 seconds, which was slower than on glass (14 minutes 25 seconds ± 7 minutes 8 seconds, P < .001). Twenty-two (2.89% of available) were discordant, which was not significantly different from the on-glass rate (P = .44) or categorical distribution (P = .31). Two cases (0.27%) had technical failures. CONCLUSIONS.­: Although in-person diagnoses were statistically faster, the great majority of telemicroscopic diagnoses were returned in less than 20 minutes. This remained true through numerous pathologists, pathology assistants and/or technicians, different hospitals, and during a combined 6 years. The concentration of discordant diagnoses among relatively few pathologists suggests individual comfort with telepathology and/or frozen section diagnosis. In rare cases, technical issues prevented telemicroscopic diagnosis. Overall, this justifies continued use and expansion of telemicroscopic services in primary intraoperative diagnoses.

Successful integration of thyroid cytopathology and surgical pathology education in an E-module format.

Context: The shift to digital learning in medicine is well underway and in fact spurred by the COVID-19 pandemic. The didactic portion of our institution's cytotechnology (CT) education program is online and delivered to learners across the nation. With CT education elevating to the master's degree level, there is a need to expand cytologic correlation with surgical resection specimens. We also wanted to afford pathology residents the same. Methods: We developed an online cytologic-histologic correlation digital learning module (e-module) addressing thyroid fine needle aspirations (FNAs) and surgical thyroidectomy specimens which was administered as part of coursework in the CT education and pathology residency programs. The module was 35 min long and consisted of guided narration with both formative and summative interactive quizzes. After completion of the module, participants were invited to fill a brief survey comprised of multiple choice, Likert, and free response questions. This study was approved by the institutional review board. Results: The 29 respondents were comprised of 22 CT students and 7 residents. CT students had minimal experience thyroid pathology prior to the module; residents were mixed. Twenty-three (79.3%) ranked the highest tiers for learning cytopathology through this module, 24 (82.8%) for learning thyroid surgical pathology, and 25 (86.2%) for cytologic-histologic correlation. All respondents stated they would like similar activities in the future. Conclusions: Teaching cytology-histology correlation for thyroid in an electronic format was effective and well-received by participants. There is a demand for these activities among current learners, suggesting that expanding the available repertoire will be beneficial.

Pulmonary Hypertensive Changes Secondary to COVID-19 Pneumonia in a Chronically SARS-CoV-2-Infected Bilateral Lung Explant.

COVID-19, the syndrome caused by the novel coronavirus SARS-CoV-2, has spread throughout the world, causing the death of at least three million people. For the over 81 million who have recovered, however, the long-term effects are only beginning to manifest. We performed a bilateral lung transplant on a 31-year-old male patient for chronic hypoxic respiratory failure, severe pulmonary hypertension and radiographically identified pulmonary fibrosis five months after an acute COVID-19 infection. The explant demonstrated moderate pulmonary vascular remodeling with intimal thickening and medial hypertrophy throughout, consistent with pulmonary hypertension. The parenchyma demonstrated an organizing lung injury in the proliferative phase, with severe fibrosis, histiocytic proliferation, type II pneumocyte hyperplasia, and alveolar loss consistent with known COVID-19 pneumonia complications.This report highlights a novel histologic finding in severe, chronic COVID-19. Although the findings in acute COVID-19 pneumonia have been well-examined at autopsy, the chronic course of this complex disease is not yet understood. The case presented herein suggests that COVID-induced pulmonary hypertension may become more common as more patients survive severe SARS-CoV-2-related pneumonia. Pulmonologists and pulmonary pathologists should be aware of this possible association and look for the clinical, radiographic, and histologic criteria in the appropriate clinical setting.

Hb Gibbon [ß124(H2)Pro→Thr (HBB: c.373C>A, p.P125T)], an Asymptomatic Novel Hemoglobin Variant Detected by Newborn Screening.

We describe here a previously unreported hemoglobin (Hb) variant, Hb Gibbon [ß124(H2)Pro→Thr (HBB: c.373C>A, p.P125T)] detected by newborn Hb screening in a term male with no family history for hemoglobinopathy or other screening abnormalities. This missense mutation produces a ß-globin chain variant that was detected by high performance liquid chromatography (HPLC) methods, but is silent by capillary electrophoresis (CE). DNA sequencing studies revealed that his father was also a heterozygote for this mutation. Neither has abnormalities on complete blood count (CBC) or any symptomatology.

Utilization of Health Care Resources by the Amish of a Rural County in Nebraska.

The medical needs of the New Order Amish (NOA) remain poorly understood. The NOA community in Pawnee County, Nebraska was founded in 2011 by members from across the Midwest. Understanding what this community wants from their medical providers informs how rural hospitals may best serve the needs of growing NOA populations. To address this, the current utilization of the closest healthcare resource to community were assessed. Medical records data for Amish patients were obtained at Pawnee County Memorial Hospital and Rural Health Clinic from 2011 to 2016. Subjective data were obtained by surveys and interviews administered to Amish in Pawnee County. The 422 complete interactions in the medical record covered most primary care complaints. The fifteen survey respondents valued direct interaction with providers and expressed concerns about cost, emergencies, and access to obstetric practice. Surprisingly, though surveys indicated minimal use of health establishments for many common health complaints, medical records indicated frequent doctor visits for myriad reasons. Naturalistic books were the most utilized source of health information. The NOA utilize formal medicine, but may feel excluded in medical decision-making. They desire better access to obstetric care and culturally sensitive medical practice. Providers should ensure appropriate communication to increase healthcare-related comfort of this underserved population.

Teaching High School Students About Pathology: Development of a Secondary School-Focused Enrichment Course in Pathology and Physiology.

OBJECTIVES: Although pathology is a central discipline in medicine, many do not understand the role of pathologists and laboratory professionals. While there are efforts to educate the public, few focus on precollege students. METHODS: To define a curriculum exposing high school students to major concepts in health and disease, while introducing them to professions that employ this knowledge. A semester-long class was designed to meet for 2-hour sessions semiweekly. Each session included a lecture given by a pathologist followed by group activities including hands-on gross or virtual laboratory experiences and clinical simulations. Content included epidemiology, biostatistics, and the critical evaluation of health-related articles in the popular press. Students were evaluated by examination, group assignments, and a capstone research project presentation. RESULTS: Over 4 years (2011-2014), 114 of 122 students completed the course with a "B" or better. By course conclusion, students could articulate the link between tissue changes and clinical phenotypes. Surveys showed that 90% of students found the course appropriately challenging, 98% found the class appropriate for their learning style, and the teaching methods and course content received 99% approval. CONCLUSIONS: We present a pathology course geared toward high school students that taught the foundations of human disease that allowed students to fully understand and engage in the material. Students felt that the knowledge earned was valuable and helped them to understand human health as well as inform their future career choices. This course could serve as a model for public outreach programs and for secondary and postsecondary educators.