Chronic Endometritis: Diagnostic Considerations in Patients With Infertility
Chronic endometritis (CE) is a controversial clinical and pathological entity. Although the presence of plasma cells (PCs) is the most frequently used diagnostic criterion for CE, the minimal diagnostic criteria remain controversial and undefined. The clinical setting of CE (asymptomatic, pelvic inflammatory disease, infertility) is an important consideration regarding the clinical significance of endometrial PCs. In the setting of infertility, specifically recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL), CE may have a negative impact on endometrial receptivity, resulting in higher rates of implanta...
Source: Pathology Case Reviews - September 1, 2022 Category: Pathology Tags: Reviews Source Type: research
Carcinomas With Concurrent Involvement of the Endometrium and Uterine Adnexa—Implications for Pathological Diagnosis and Clinical Management in Current Practice
A proportion of endometrial and adnexal carcinomas have concurrent involvement of the other site. In the case of high-grade serous carcinomas involving the tubal epithelium as well as endometrium, distinction of tubo-ovarian high-grade serous from endometrial serous carcinoma can have implications for surgical as well as nonsurgical treatment approaches, including targeted therapies and referral to clinical genetics services. The other situation is involvement of the endometrium and ovary by low-grade endometrioid carcinoma; here separation of high-stage endometrial carcinoma from 2 low-stage, low-grade tumors determines a...
Source: Pathology Case Reviews - September 1, 2022 Category: Pathology Tags: Reviews Source Type: research
Undifferentiated Endometrial Carcinoma—Diagnostic and Therapeutic Challenges
We report here the case of a 37-year-old woman who presented with menorrhagia and the subsequent pathologic and clinical workup showed an advanced-stage ARID1A/ARID1B-deficient mismatch repair–proficient undifferentiated endometrial carcinoma. Despite pelvic external beam radiation and platinum/taxane-based chemotherapy (4 of 6 planned cycles), the patient experienced disease progression with osseous metastasis to her left elbow and died of her disease 7 months after clinical presentation. This case highlights the diagnostic and treatment challenges associated with such undifferentiated/dedifferentiated cancer types of t...
Source: Pathology Case Reviews - September 1, 2022 Category: Pathology Tags: Case Review Source Type: research
Mesonephric-Like Adenocarcinoma of the Endometrium: Review of the Literature and Practical Diagnostic Recommendations
Mesonephric-like adenocarcinomas are endometrial and ovarian neoplasms of müllerian origin with morphologic, immunophenotypic, and molecular evidence of mesonephric-type transdifferentiation, as well as considerable homology with endometrioid tumors. First described in 2016, mesonephric-like adenocarcinomas are morphologically indistinguishable from “true” mesonephric adenocarcinomas of the uterine cervix, but the latter are distinguished by (1) primary localization to the cervical wall, (2) frequent association with mesonephric remnants, and (3) in some cases, lack of mucosal involvement. Despite an overall low-grade...
Source: Pathology Case Reviews - September 1, 2022 Category: Pathology Tags: Reviews Source Type: research
Counterpoint: Integration of Molecular Subtype and Histotype/Grade Into One Classification System for Endometrial Carcinoma
The establishment of 4 endometrial carcinoma molecular subtypes by The Cancer Genome Atlas project and their surrogates (POLE mutated, mismatch repair–deficient, p53 abnormal, and no specific molecular profile) invigorated a debate on how to integrate these within the traditional histotype/grade classification. Specific issues of contradicting histotype/grade and molecular subtype diagnoses will be discussed with illustrated examples. The hierarchy of histotype/grade and molecular subtype is interdependent. Pathologists should aim to integrate histotypes/grades and molecular subtypes to provide one consistent and clinica...
Source: Pathology Case Reviews - September 1, 2022 Category: Pathology Tags: Reviews Source Type: research
The Best of Both Worlds: Combining the Molecular and Traditional (Histotype/Grade) Endometrial Cancer Classification
The discovery of 4 distinct molecular endometrial cancer subgroups by The Cancer Genome Atlas has fundamentally changed the way we look at endometrial carcinoma today. The proven robustness of surrogate markers in a diagnostic algorithm endorsed by the World Health Organization classification of female genital tumors 2020 has opened the gates for worldwide implementation. This advance delivers a reproducible classification system with improved prognostication and a biological basis for future targeted treatments. Although we all embrace this exciting development, we now struggle how to position the traditional histology-ba...
Source: Pathology Case Reviews - September 1, 2022 Category: Pathology Tags: Reviews Source Type: research
Perspectives in Endometrial Pathology
No abstract available (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - September 1, 2022 Category: Pathology Tags: Editorial Source Type: research
Surviving a Cyberattack in Anatomic Pathology: Disaster Response and Creation of an Incident Command System
Laboratories are increasingly reliant on networked electronic health information systems and therefore especially vulnerable to prolonged downtimes for a variety of reasons, which can be planned or unanticipated events. Our hospital was the victim of a cyberattack causing a complete shutdown of all computer systems, a downtime that lasted 25 days. The effects were devastating for patients, hospital employees, financials, public opinion, and hospital operations. After a week of downtime in the anatomic pathology laboratory, it became evident that our laboratory needed to rethink our organizational structure in order to rega...
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Case Reviews Source Type: research
Reporting Critical/Urgent/Significant Results in Anatomic Pathology: The Devil Is in the Details
We report a case of an incidentally detected and unexpected finding of tumor cells in a routine hip arthroplasty, in a patient under surgical management for a variety of chronic issues including peripheral arterial disease and traumatic fall. The abnormal result proved to be the first presentation of a widely disseminated metastatic melanoma. Although multiple associated health care providers were successfully contacted with the unexpected finding and acknowledged awareness of the concern for metastatic melanoma, one provider was not successfully contacted with the pathology result, leading to frustrations among multiple p...
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Case Reviews Source Type: research
Compatible With Confusion: Phrasing Pitfalls in Anatomic Pathology Reports
We present a case that shows how uncertainty phrasing in a final diagnosis contributed to confusion surrounding patient care and resulted in sending the case for outside consultation. In addition, we review the literature surrounding uncertainty phrasing and discuss reporting of altered or amended reports. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Reviews Source Type: research
Data-Driven Decision-Making in Support of Managing Pathology Laboratories
Pathology laboratories generate large amounts of patient and operational data, usually housed in laboratory information systems. Linking that information to other data sources for data mining and analytics is essential to inform decision-making by multiple stakeholders to effectively manage the pathology laboratory. We review and illustrate examples of how data-driven decision-making can support laboratory operations, resource management, personnel performance and productivity, quality assurance, and business activities. The application of dashboards and informatics tools for data-driven decision-making in pathology is hig...
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Reviews Source Type: research
Quality Metrics to Assess Cytopathology Practice Patterns: Focus on Thyroid Fine-Needle Aspiration Cytology
Quality assurance measures in the cytology laboratory help ensure accurate and consistent diagnoses. For thyroid fine-needle aspirations (FNAs), various cytologist performance metrics have been proposed to help monitor and explain cytologist practice patterns. Thoughtful implementation of metrics such as diagnostic category utilization rates, ratios of key diagnostic categories, surgical outcome data, and correlation with ancillary molecular testing results have been proposed to help minimize the use of indeterminate diagnostic categories in thyroid FNAs, such as atypia of undetermined significance. Development of laborato...
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Reviews Source Type: research
The Value and Challenges of Internal Error Tracking in Anatomic Pathology Quality Management
A case of a sudden increase in reports of a specific error in the anatomic pathology laboratory is evaluated, yielding insights into the value, challenges, and limitations of using error reports as a quality management tool. The discussion considers the utility of a robust error-reporting system for anatomic pathology laboratories and identifies key factors at each step to improve success. Initial reporting must be easy and rewarding to reporters, and they must have confidence that reporting will not result in adverse impacts on coworkers. Categorization of common errors simplifies reporting, investigation, tracking, and d...
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Reviews Source Type: research
A Framework for Utilization of Turnaround Time as a Quality Metric in Surgical Pathology
Timeliness of surgical pathology result reporting is a critical quality metric for patients and treating clinicians. Over the past several decades, studies have sought to define laboratory turnaround time (TAT) in the context of the surgical pathology workflow, investigate the various factors that influence TAT, and develop a framework to monitor, measure, and track TAT within and across laboratories. However, the complexity of health care delivery and health information technology creates barriers to tracking TAT that should be considered in the context of local environments. We seek to provide background and context as w...
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Reviews Source Type: research
Successful Identification of a Neoplastic Tissue Contaminant in Surgical Pathology
We report a case of tissue contamination within a paraffin block and describe our subsequent investigation, which was successful in identifying the source of contamination. (Source: Pathology Case Reviews)
Source: Pathology Case Reviews - July 1, 2022 Category: Pathology Tags: Case Review Source Type: research
