Concept: Gross examination
Aims: To demonstrate the feasibility of the Leaflex™ Catheter System, a novel percutaneous device for fracturing valve calcification using mechanical impact in order to regain leaflet mobility. Methods and results: Radiographic analysis of calcium patterns in 90 ex vivo human aortic valve leaflets demonstrated that 82% of leaflets had a typical “bridge” or “half-bridge” pattern, which formed the basis for the catheter design. The therapeutic effect was quantified in 13 leaflets showing a reduction of 49±16% in leaflet resistance to folding after treatment. A pulsatile flow simulator was then used with 11 ex vivo valves demonstrating an increase in aortic valve area of 35±12%. Using gross pathology and histology on fresh calcified leaflets, we then verified that mechanical impacts do not entail excessive risk of embolisation. In vivo safety and usability were then confirmed in the ovine model. Conclusions: We demonstrated preclinically that it is feasible to improve valve function using the Leaflex™ technology. Once demonstrated clinically, such an approach may have an important role as preparation for or bridging to TAVI, as destination treatment for patients where TAVI is clinically or economically questionable and, in the future, maybe even as a means to slow disease progression in asymptomatic patients.
Mortality of seabirds due to anthropogenic causes, especially entrapment in fishing gear, is a matter of increasing international concern. This study aimed at characterising the gross pathology of seabirds that drowned in fishing nets and comparing it with that in other common causes of mortality.
Changes in the field of pathology and resident education necessitate ongoing evaluation of residency training. Evolutionary change is particularly important for surgical pathology rotations, which form the core of anatomic pathology training programs. In the past, we organized this rotation based on subjective insight. When faced with the recent need to restructure the rotation, we strove for a more evidence-based process. Our approach involved 2 primary sources of data. We quantified the number of cases and blocks submitted per case type to estimate workload and surveyed residents about the time required to gross specimens in all organ systems. A multidisciplinary committee including faculty, residents, and staff evaluated the results and used the data to model how various changes to the rotation would affect resident workload, turnaround time, and other variables. Finally, we identified rotation structures that equally distributed work and created a point-based system that capped grossing time for residents of different experience. Following implementation, we retrospectively compared turnaround time and duty hour violations before and after these changes and surveyed residents about their experiences with both systems. We evaluated the accuracy of the point-based system by examining grossing times and comparing them to the assigned point values. We found overall improvement in the rotation following the implementation. As there is essentially no literature on the subject of surgical pathology rotation organization, we hope that our experience will provide a road map to improve pathology resident education at other institutions.
-Medication resins, including Kayexalate, sevelamer, and bile acid sequestrants, can be encountered in gastrointestinal tract specimens. Their classic histologic appearances have been well documented, but pathologist recognition of the resins is 75%, patient history is not always available, and atypical morphologic findings are sometimes present.
The practice of anatomic pathology, and of gastrointestinal pathology in particular, has been dramatically transformed in the past decade. In addition to the multitude of diseases, syndromes, and clinical entities encountered in daily clinical practice, the increasing integration of new technologic and molecular advances into the field of gastroenterology is occurring at a fast pace. Application of these advances has challenged pathologists to correlate newer methodologies with existing morphologic criteria, which in many instances still provide the gold standard for diagnosis. This review describes the impact of new technologic and molecular advances on the daily practice of gastrointestinal and hepatobiliary pathology. We discuss new drugs that can affect the gastrointestinal tract and liver, new endoluminal techniques, new molecular tests that are often performed reflexively, new imaging techniques for evaluating hepatocellular carcinoma, and modified approaches to the gross and histologic assessment of tissues that have been exposed to neoadjuvant therapies.
Paratesticular seminoma: echographic features and histological diagnosis with review of the literature
- APMIS : acta pathologica, microbiologica, et immunologica Scandinavica
- Published 11 days ago
Primary extratesticular seminomas exceptionally occur in the epididymis or in the paratesticular region/spermatic cord. Some old papers included poor histological description or insufficient photographic documentation, reducing the number of faithful cases: an up-to-date systematic review is lacking. We report the 4th primary seminoma of the paratesticular region/spermatic cord in a 35-year-old man, including the first echographic description. We provide review of the literature and etiopathogenetic discussion. Ultrasound examination showed a right paratesticular, solid, heterogeneous mass (iso-hypoechoic with hyperechoic striae; peri- and intra-lesional vascular signals) with no testicular involvement: the paratesticular origin was confirmed by pathological examination. Despite careful gross examination and extensive sampling, the 6.5-cm extratesticular tumor revealed only one microscopic focus with minimal invasion (<2 mm) of the atrophic testicular parenchyma. Intratubular germ cell neoplasia or morphologic features of a regressed testicular tumor (fibrosis/scar, necrosis, hyalinization, calcification, inflammation) were not found. Primary seminomas of the paratesticular region/spermatic cord occurred at an older mean age and presented as bigger lesions if compared to the 9 primary epididymal seminomas reported in literature. Clinical-pathological correlation and accurate sampling are mandatory for a correct diagnosis.
Management of complex acute surgical pathology in austere environments necessitates rapid evaluation and resource appropriate management to avoid time-associated morbidity and potentially mortality. Obstructive upper gastrointestinal (UGI) pathologies can be particularly challenging and associated with significant morbidity. Herein, we present six patients with UGI obstructions encountered over the course of an 8-mo deployment onboard a US Navy Aircraft Carrier. Each patient presented to our medical department with signs and symptoms of obstructive UGI pathology including one gastric volvulus requiring operative management at sea, one with a new diagnosis of achalasia requiring transportation and continental United States outpatient evaluation, and four patients with food impaction requiring urgent endoscopic management. Although UGI pathology is seldom encountered at sea, definitive surgical interventions, including prompt evaluation and management of these acute pathologies, can be performed in an austere environment. We wish to call attention to these potential encounters in order that underway deployed medical units and supporting resources ashore are prepared and equipped to intervene on acute UGI obstructive pathology.
The objective of this study was to evaluate the safety of 25-OH-D3 addition to the diet of bovine calves. The investigation was conducted as a feeding experiment for 90 days. 40 calves were allotted to four groups: T1 - control group which received 30 IU vitamin D3/kg feed, and three experimental groups, which received 25-OH-D3 in increasing dosages: T2 - 25-OH-D3 at 1.7 μg/kg, T3 - 25-OH-D3 at 5.1 μg/kg and T4 - 25-OH-D3 at 8.5 μg/kg. All calves in the four groups gained weight continually: no growth depression was observed. No adverse effects of 25- OH-D3 were observed for any of the hematology and serum chemistry parameters measured or during the routine clinical examinations. Plasma 25-OH-D3 concentration was higher (p<0.05) in groups T2, T3 and T4 compared to that observed in group T1. Tissues content of 25-OH-D3 was significantly higher in in groups T2, T3 and T4 than in group T1. In the post-mortem evaluation, no adverse effects of the different 25-OH-D3 doses were observed, neither during the gross pathology nor in the histological examination. The results of this study show explicitly that there were no adverse effects of 25-OH-D3 compared to the control group, supplemented with vitamin D3.
Grossing pathologies, otherwise known as macroscopic cutup for diagnostic information, is a vital laboratory step as it impacts the patient treatment and prognosis. However, it is a challenging skill acquired with keen observation, experience, and correlation between macroscopy and microscopy. Before we make an attempt to gross, it is imperative to have sound knowledge about its general principles and its applications as it differs among different lesions. Thereby, we have made an attempt to enhance the guidelines for gross description and also updated on the general principles. A practical insight has been provided with respect to grossing of oral mucosal biopsies, pathology of malignancies, odontogenic cysts, cystic odontogenic tumors, salivary gland pathologies, and lymph nodes along with the brief history of gross pathology.
We have investigated gross pathology, physiological (steroid precursors) and toxicological responses (oxidative stress and phase II biotransformation) in relation to tissue contaminant burden in Tilapia species along the entire length (320 km) of Ogun River, Nigeria. The Ogun River is the longest and largest river in Southwestern Nigeria located along heavily industrialized cities and receives complex mixtures of effluents. A total of 1074 tilapias were collected from three sampling points (Abeokuta, Isheri and Ikorodu) and from an upstream control point (Igboho) and evaluated for gross pathological changes, hepatic transcript levels for oxidative stress and phase II biotransformation responses. Trace metal concentrations and POPs in muscle samples were analyzed using ICP-MS and GC-MS respectively. Evaluation of gross pathological changes showed a 50-, 33-, 17 and 0% prevalence of hepatic tumors at the Ikorodu, Abeokuta, Isheri and Igboho sites, respectively. Plasma concentrations of cholesterol and pregnenolone showed apparent significant decreases at downstream sites of the control point in both male and female fish (except for pregnenolone levels of male fish at Ikorodu). Inversely, gst, ugt-1, ZuCu-sod and sod significantly increased in fish collected from downstream sites, compared with the control site and these increases paralleled the significant increase in trace metal and POPs concentrations at these sites. PCA revealed a site related association between measured toxicological responses and contaminant burden, indicating a potential cause-and-effect relationship. Thus, the possible adaptation of Ogun River Tilapia species to contaminants may have significant consequences on cellular, physiological and biochemical processes regulating metabolism, growth, development and reproduction, and also have serious human health consequences, since the Ogun River is used for fisheries and domestic water supply for surrounding neighborhoods.