Usefulness of WhatsApp for Discussing Difficult Cases in Pathology Practice: A Moroccan Experience.

OBJECTIVE: The primary aim of the study was to evaluate whether the WhatsApp application can be used for obtaining a quick second opinion on histopathological and cytological diagnosis and also for discussing difficult cases in pathology practice. MATERIAL AND METHOD: A WhatsApp group named "FESPATH" was created with total of 17 pathologists (the authors of this manuscript as group administrators and 15 general pathologists from 7 different cities in Morocco, working in 12 different institutions as members). The group was used to discuss difficult routine sign out cases, to obtain a second opinion. Pathology-related academic files, books and links were also shared. At the end of 20 months, members were asked to complete a feedback questionnaire. RESULTS: Over a 20-month period, 86 cases were discussed with 515 posted pictures. 78 cases were related to histopathology, and 8 cases to cytopathology. Twenty-one links regarding educational materials and books were also shared. A total of 14 participants out of 17 were active participants, and the majority of them found the discussions very useful for overcoming challenging cases. CONCLUSION: Sharing microphotographs of histopathological or cytological cases via WhatsApp is a very easy and fast method to obtain a second opinion in pathology practice and also to discuss difficult cases.

Planos conjugados y sistema de iluminación de Köhler en microscopía óptica / Conjugate planes and Köhler illumination in optical microscopy

Un adecuado conocimiento y comprensión del concepto de planos conjugados es de capital importancia en la utilización del microscopio por cuanto que desde hace ya bastante tiempo el diseño de los microscopios se basa en la correcta situación de sus dos conjuntos de planos conjugados. En 1893 August Köhler publicó el trabajo «Un nuevo sistema de iluminación en microfotografía» donde dio a conocer los fundamentos básicos de una técnica de iluminación que actualmente lleva su nombre. El conocimiento y aplicación de los principios del sistema de iluminación de Köhler constituye el elemento de mayor importancia en el correcto manejo de un microscopio. Dichos principios no siempre son bien conocidos y comprendidos por los usuarios del microscopio constituyendo una fuente frecuente de errores en microscopía, particularmente en microfotografía. En este artículo revisamos los principios básicos del concepto de planos conjugados y del sistema de iluminación de Köhler (AU)

Adequate knowledge and understanding of the concept of conjugate planes is of paramount importance in the use of the microscope and for a long time microscope design was based on the correct location of the two sets of conjugate planes. In 1893 August Köhler published the article «A new illumination system in microphotography» in which he introduced the basics of an illumination technique that now bears his name. The knowledge and application of the principles of the Köhler illumination system is the most important element in the proper handling of a microscope. These principles are not always well known or understood by the users of microscopes, frequently leading to errors in microscopy, particularly in photomicrography. This article reviews the basic principles of the concept of conjugate planes and Köhler illumination system (AU)

Células madre de la piel: en la frontera entre el laboratorio y la clínica. Parte I: células madre epidérmicas / Skin Stem Cells: At the Frontier Between the Laboratory and Clinical Practice. Part 1: Epidermal Stem Cells

Las células madre son células que se caracterizan por su capacidad para autorrenovarse y diferenciarse hacia células de todos los linajes que constituyen su tejido de origen. El descubrimiento de las células madre en un organismo adulto, y la descripción de los marcadores que han permitido aislar de forma específica estas células, han abierto nuevas perspectivas y nuevos horizontes en la investigación biomédica y también nuevas esperanzas en el tratamiento de muchas enfermedades. En este artículo se revisan de forma detallada las principales características de las células madre que dan origen a las distintas células de la piel humana, incluyendo las células madre epidérmicas, mesenquimales y melanocíticas, y sus potenciales implicaciones y aplicaciones en las enfermedades cutáneas. La primera parte de este artículo revisa las células madre epidérmicas, con sus principales características y sus potenciales aplicaciones en dermatología

Stem cells are characterized by their ability to self-renew and differentiate into the different cell lineages of their tissue of origin. The discovery of stem cells in adult tissues, together with the description of specific markers for their isolation, has opened up new lines of investigation, expanding the horizons of biomedical research and raising new hope in the treatment of many diseases. In this article, we review in detail the main characteristics of the stem cells that produce the specialized cells of the skin (epidermal, mesenchymal, and melanocyte stem cells) and their potential implications and applications in diseases affecting the skin. Part I deals with the principal characteristics and potential applications of epidermal stem cells in dermatology

Microscopic Image Photography Techniques of the Past, Present, and Future.

CONTEXT: The field of pathology is driven by microscopic images. Educational activities for trainees and practicing pathologists alike are conducted through exposure to images of a variety of pathologic entities in textbooks, publications, online tutorials, national and international conferences, and interdepartmental conferences. During the past century and a half, photographic technology has progressed from primitive and bulky, glass-lantern projector slides to static and/or whole slide digital-image formats that can now be transferred around the world in a matter of moments via the Internet. OBJECTIVE: To provide a historic and technologic overview of the evolution of microscopic-image photographic tools and techniques. DATA SOURCES: Primary historic methods of microscopic image capture were delineated through interviews conducted with senior staff members in the Emory University Department of Pathology. Searches for the historic image-capturing methods were conducted using the Google search engine. Google Scholar and PubMed databases were used to research methods of digital photography, whole slide scanning, and smart phone cameras for microscopic image capture in a pathology practice setting. CONCLUSIONS: Although film-based cameras dominated for much of the time, the rise of digital cameras outside of pathology generated a shift toward digital-image capturing methods, including mounted digital cameras and whole slide digital-slide scanning. Digital image capture techniques have ushered in new applications for slide sharing and second-opinion consultations of unusual or difficult cases in pathology. With their recent surge in popularity, we suspect that smart phone cameras are poised to become a widespread, cost-effective method for pathology image acquisition.

Evaluación sistemática de la biopsia de médula ósea en casos de sospecha de mielofibrosis primaria. Propuesta de informe diagnóstico estandarizado. Consenso de expertos de las SEAP/SEHH / Systematic evaluation and standardised reporting of cases with suspicion of primary myelofibrosis. Consensus of SEAP/SEHH hematopathology experts

Se ha elaborado un consenso aplicando la metodología Delphi para acordar cuál debe ser la sistemática de evaluación e información de las biopsias de médula ósea en las neoplasias mieloproliferativas crónicas, especialmente en casos de mielofibrosis primaria (MFP). Un panel de 10 expertos hematopatólogos ha elaborado un cuestionario que se ha remitido a 37 hematopatólogos con preguntas acerca de los datos clínicos, analíticos y moleculares a conocer en la fase pre-analítica, parámetros histopatológicos a evaluar y contenido del informe diagnóstico final. Se realizaron 2 rondas buscando un consenso mínimo del 70% para los parámetros imprescindibles y recomendables. A partir de los resultados del consenso se elabora y propone un prototipo de informe histopatológico para informar de manera homogénea y reproducible los casos de MFP (AU)

A consensus based on Delphi methodology was developed to produce a guide for the evaluation and reporting of bone marrow biopsies in patients with a clinical suspicion of myeloproliferative neoplasm with fibrosis. Ten expert haematopathologists formulated a questionnaire including: clinical and laboratory data required before regarding a biopsy suspicious for primary myelofibrosis (PMF), descriptive aspects to be reported and the main histopathological differential diagnoses to be considered. It was circulated among 37 hematopathologists and consensus was defined when more than 70% of the experts "strongly agreed" or "agreed" after two rounds. The recommendations gave rise to a proposal for a standardized diagnostic report form to aid in the diagnostic workup and homogeneous reporting of cases with a clinical suspicion of PMF (AU)

Carcinoma epitelial-mioepitelial de glándula salival menor. Diagnóstico inesperado ante sospecha de patología benigna / No disponible

No disponible

Solución del caso 34. Adenoma hepático / Solution to case 34. Adenoma of the liver

No disponible

[Imaging of single molecules in live cells]. / Microscopies cellulaires à l'échelle de la molécule individuelle.

Progress in optical microscopy, combined to the emergence of new fluorescent probes and advanced instrumentation, now permits the imaging of single molecules in fixed and live cells. This extreme detection sensitivity has opened new modalities in cellular imaging. On the one hand, optical images with an unprecedented resolution in the 10-50 nm range, well below the diffraction limit of light, can be recorded. These super-resolution images give new insights into the properties of cellular structures. On the other hand, proteins, either in the membrane or intracellular, can be tracked in live cells and in physiological conditions. Their individual trajectories provide invaluable information on the molecular interactions that control their dynamics and their spatial organization. Single molecule imaging is rapidly becoming a unique tool to understand the biochemical and biophysical processes that determine the properties of molecular assemblies in a cellular context.

El "cúmulo sarcoideo". Un nuevo signo en tomografía computarizada de tórax de alta resolución / The "sarcoid cluster sign". A new sign in high resolution chest CT

Objetivos: Valorar la presencia de múltiples nodulillos puntiformes formando un grupo en el pulmón periférico en pacientes con sarcoidosis y describir este hallazgo como el nuevo "signo del cúmulo sarcoideo" en tomografía computarizada de alta resolución (TCAR).Material y métodos: Estudio retrospectivo de las TCAR de 91 pacientes diagnosticados de sarcoidosis torácica en el Hospital de León. Se valoró la presencia de grupos de múltiples nodulillos puntiformes en el pulmón periférico ("signo del cúmulo sarcoideo"), su morfología redonda o alargada y su distribución en los campos pulmonares. Se utilizaron reconstrucciones de máxima intensidad de proyección. Se realizó correlación radiopatológica en 3 pacientes. Material y métodos: Posteriormente, se valoró la presencia de este signo en TCAR en 120 pacientes consecutivos estudiados por sospecha de enfermedad pulmonar infiltrativa difusa (EPID). Resultados: De los 91 pacientes con sarcoidosis, 9 (6 varones y 3 mujeres, con edad media de 29 años) presentaban el "signo del cúmulo sarcoideo" en TCAR. La mayoría de los cúmulos mostraban morfología redondeada y su distribución fue predominante en la zona periférica no subpleural de los campos pulmonares superiores y medios; cuando los cúmulos tenían distribución periférica subpleural, nodulillos subpleurales formaban parte del cúmulo. Los cúmulos correspondían a granulomas no caseosos, no coalescentes, con predominio de linfocitos CD4+, sin fibrosis y con distribución linfangítica. Resultados: Únicamente 2 de los 120 pacientes con sospecha de EPID mostraban grupos periféricos de múltiples nodulillos puntiformes ("signo del cúmulo sarcoideo"); los 2 correspondían a sarcoidosis. El total de sarcoidosis diagnosticadas en este grupo fue de 1. Conclusión: El nuevo “signo del cúmulo sarcoideo” en TCAR solamente se ha observado en pacientes jóvenes con sarcoidosis pulmonar. Puede ser un hallazgo radiológico útil en el diagnóstico de esta enfermedad (AU)

Objectives: To evaluate the presence of clusters of multiple small punctiform nodules in the peripheral regions of the lung in patients with sarcoidosis, and to report this finding as a new sign "the sarcoid cluster sign" in high-resolution chest CT (HRCT). Material and methods: This is a retrospective study of the HRCT findings in 91 patients diagnosed with lung sarcoidosis at our hospital. We evaluated the presence of clusters of multiple small punctiform nodules in the periphery of the lungs (the "sarcoid cluster sign"), whether these were rounded or long in shape, and their distribution in the lung fields. We used reconstructions of maximum intensity projections (MIP). We correlated the imaging and histopathological results in three patients. Material and methods: Afterward, we evaluated the presence of the “sarcoid cluster sign” on high resolution CT findings in 120 consecutive patients studied for suspected diffuse lung disease. Results The "sarcoid cluster sign" was present at HRCT in 9 of the 91 patients with sarcoidosis (6 men and 3 women; mean age 29 years). Most clusters were rounded and most were located in the non-subpleural peripheral regions of the upper and middle fields of the lungs. When the clusters were located in the subpleural peripheral regions, the clusters contained small subpleural nodules. The correlation between the imaging and histopathological results revealed that the clusters corresponded to non caseous, noncoalescing granulomas with a predominance of CD4+ lymphocytes, without fibrosis, that were distributed in the lymph vessels. Results Only 2 of the 120 patients with suspected diffuse lung disease had peripheral clusters of multiple small punctiform nodules (the "sarcoid cluster sign"); these two patients had sarcoidosis, and a total of 21 cases of sarcoidosis were diagnosed in this group. Conclusion: The "sarcoid cluster sign" on HRCT has been observed only in young patients with lung sarcoidosis. This finding could be useful in the diagnosis in the diagnosis of this disease (AU)

Embolismo pulmonar fatal tras la embolización con microsferas de un hepatocarcinoma / Fatal pulmonary embolism after embolization of a hepatocellular carcinoma using microspheres

El tratamiento intraarterial se ha convertido en una alternativa de primera línea en el arsenal terapéutico de los tumores hepáticos primarios y metastásicos. A pesar de su demostrada seguridad y eficacia, los tratamientos intraarteriales con lipiodol, quimioterápicos y partículas asocian el riesgo de complicaciones, algunas de ellas potencialmente letales. Presentamos el caso de una paciente de 32 años afecta de un hepatocarcinoma multifocal tratada mediante embolización con microsferas. La paciente falleció tras la segunda sesión de embolización como consecuencia de un embolismo pulmonar de partículas y células tumorales (AU)

Intra-arterial treatment has become a first-line alternative in the therapeutic arsenal against primary and metastatic hepatic tumors. Despite its proven safety and efficacy, intra-arterial treatment with lipiodol, chemotherapy, and particles carries the risk of complications, some of which can be lethal. We present the case of a 32-year-old woman with multifocal hepatocellular carcinoma treated with microsphere embolization. After the second session, the patient died of a pulmonary embolism composed of particles and tumor cells (AU)

Emulsiones líquida-cristalinas estabilizadas con estearato de trietanolamina y ácido esteárico: influencia del método de preparación en las propiedades y en la formación de gotas secundarias / Stabilized liquid-crystalline emulsions with triethanolamine stearate and stearic acid: preparation method influence in the properties and formation of secondary droplets

Se desarrolló una metodología que permite obtener emulsiones de vaselina líquida estabilizadas con estearato de trietanolamina y ácido esteárico con características líquida-cristalinas en las que las gotas se agrupan formando gotas secundarias de unos 15 mcrom de diámetro. La formación de estas gotas secundarias, que es una consecuencia de la presencia de cristales líquidos lioptrópicos en las emulsiones, trae como consecuencia una disminución de la viscosidad. El reemplazo de parte de la vaselina líquida de estas emulsiones por otros emolientes de mayor capacidad de penetración dérmica, tales como el miristato de isopropilo y el 2-octil-1-dodecanol, no disminuye las características líquida-cristalinas, lo que permite obtener otras emulsiones más adecuadas para usos farmacéutico y cosmético

It has been developed a methodology which allows obtaining mineral oil emulsions stabilized with triethanolamine stearate and stearic acid with liquid-crystalline characteristics where droplets cluster themselves forming secondary droplets of 15 microm diameter. The formation of the mentioned secondary droplets, which are a consequence of the presence of lyotropic liquid crystals in the emulsions, produces a diminution of the viscosity. The replacement of part of the mineral oil of these emulsions for others emollients with greater dermal penetration capacity, such as isopropyl myristate and 2-octyl-1-dodecanol, does not diminish the liquid-crystalline characteristics, granting the obtainment of more adequate emulsions for pharmaceutical and cosmetic usage

Photomicrography

Guía para el uso de equipamiento y sobre diversas técnicas de esta especialidad

Photomicrography

Guía para el uso de equipamiento y sobre diversas técnicas de esta especialidad