Morphometry in surgical pathology

The potential role of morphometry in surgical pathology is discussed. Specific areas in which morphometry could be helpful are in (1) identifying malignant cells in lesions that are largely composed of benign-appearing cells (e.g., follicular thyroid neoplasms), (2) defining reference points in apparent continua (e.g., in the progression from normal colon to adenoma to adenocarcinoma), (3) distinguishing between benign and malignant lesions with similar appearances (e.g., fibromatosis and fibrosarcoma of the soft tissue) and (4) distinguishing between similar-appearing types of malignant neoplasms (e.g., between small-cell carcinoma of the lung and small-cell lymphoma). Morphometric techniques are already being used in DNA ploidy determinations, which frequently bear prognostic information. The measurement of other nuclear and cellular parameters has been used for both diagnostic and prognostic ends; one example is the relation of nuclear roundness to metastatic potential in prostatic carcinomas. Morphometry is now being increasingly applied to histologic sections, as in the prognostic study of lesion thickness in malignant melanoma and the diagnostic study of glandular architecture in colonic adenoma. The use of morphometry can enhance the observation and interpretation of morphologic features, which, combined with the clinical data and the experience of the pathologist, can lead to greater accuracy and precision in surgical pathology diagnoses.     

The principles and advances of quantitative pathology

This article gives an overview of the quantitative pathologic techniques used today, with special emphasis on interactive morphometry and its application in the clinical setting. At present, stereologic calculations may be necessary, but in a diagnostic setting have only rarely proved to be essential. The reproducibility of the measurements is discussed in relation to the definition of the particles and staining methods. A number of technical factors that cause random errors are mentioned, such as quality of the slides, magnification, definition of the particles to be measured and measuring protocol. Large-scale experiments have revealed that the means of nuclear morphometric and certain stereologic features are reproducible, such as in the volume percentage of epithelium, the surface densities of glands and the mitotic activity index. The diagnostic applications of the standard deviation and shape factors of nuclear quantitative features require additional precautions, however. Having quantified cell and tissue features, multivariate analysis may result in a better discrimination of two or more groups under study. The quantitative pathologic examination of cells and tissues can provide important diagnostic and prognostic information. Quantitation in pathology is especially useful in so-called continuous lesions, in which interobserver and intraobserver disagreement is considerable. An important requirement of diagnostic morphometry is object selection by a skilled pathologist; the use of morphometry as a black box can result in dramatic errors. The criteria used for a morphometric classification rule that can be used for clinical applications are summarized. Quality control of the whole measuring system is essential. Application of these techniques for more than six years in diagnostic pathology has repeatedly corrected previous qualitative diagnoses.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fine needle aspiration diagnosis of osteitis fibrosa cystica (brown tumor of bone): a case report

BACKGROUND: Fine needle aspiration (FNA) cytologic diagnosis of bone lesions is controversial; opponents cite its low sensitivity and proponents emphasize its cost-effectiveness, specificity and rapid turnaround time. The focus of FNA cytology is most often to exclude malignancy, which may contribute to incomplete information sharing on the part of the health care team and the published low sensitivity of diagnostic cytology of osseous lesions. It is therefore incumbent upon cytopathologists to formulate a complete differential diagnosis of osseous lesions. CASE: A 72-year-old man, admitted for severe abdominal pain, underwent diagnostic computed tomography (CT) examination that incidentally revealed multiple abdominal and pelvic lytic bone lesions. CT-guided FNA of a lesion revealed bland histiocytic and spindled cells, prominent hemosiderin pigment and scattered multinucleated cells, findings consistent with osteitis fibrosa cystica. Subsequent consultation with the medical team revealed the patient's underlying secondary hyperparathyroidism. CONCLUSION: This case emphasizes the importance of correlating clinical history and radiologic findings to the accurate cytologic diagnosis of bone lesions. The benign cytomorphologic features of brown tumor should not be overlooked or be considered nondiagnostic in the hunt for suspected malignancy. FNA allowed confident exclusion of a malignant process and prevented unnecessary surgery and its inherent risks.     

Role of fine needle aspiration cytology in the diagnosis of soft tissue tumours

Fine needle aspiration cytology (FNAC) is a widely accepted safe, simple and rapid diagnostic procedure used in the examination of neoplastic and non‐neoplastic lesions of various locations. Since its introduction, FNAC has developed into an effective diagnostic tool practiced in a large majority of medical centres evaluating and treating oncological patients. The role of FNAC has been limited in the examination of primary soft tissue lesions, however, as many physicians working in this area recommended against using FNAC. An increasing use of minimally invasive diagnostic procedures in the last decade has resulted in a better acceptance of FNAC as a first‐line approach or as a complementary tool to core needle biopsy in the diagnosis of musculoskeletal lesions. This review discusses the role and value of FNAC in the evaluation and treatment of soft tissue tumours based on the experience gathered over the course of 48 years at the Sarcoma Center in Lund, Sweden. FNAC reports most often provide diagnostic information allowing the initiation of treatment or, when definitive diagnosis cannot be rendered from a cytological examination, guiding the continued diagnostic investigation. The main advantages of soft tissue FNAC are good sensitivity and specificity, low morbidity, speed of diagnosis, and low cost/benefit ratio. The most important disadvantages stem from limited experience in cytological diagnosis of soft tissue tumours and a lack of standardised and uniform reporting system for soft tissue FNAC.     

Síndrome fronto-subcortical: cuando la red falla,a propósito de un caso

Depression and parkinsonism are direct consequences of a lesion, usually vascular, that affects some structure of the frontal-subcortical circuit. Their detection represents a diagnostic challenge and has important repercussions in therapeutic management. The case is presented of a 79-year-old male patient with good overall baseline status, who was admitted to a Psychogeriatric Unit after an autolytic attempt. Initially, a non-psychotic frank depression is observed, and an increase in the base of support for walking and bradykinesia is noted. After adjustment of antidepressant treatment, a notable improvement in affective symptoms is evidenced but not in motor symptoms, so it is decided to request a magnetic resonance imaging that shows ischemic lesions in the basal ganglia. This case provides clear support for the frontal-subcortical circuit model, in which the clinical presentation, neuropsychiatric evaluation, neuroimaging data and therapeutic response contribute to understanding the deficits following these types of lesions.We believe that this article will provide brief and accurate information on the pathophysiological mechanisms, evaluation, diagnostic approach, and treatment of the frontal-subcortical syndrome.     

Diagnostic value of unusual gross appearance of aspirated material from endoscopic ultrasound-guided fine needle aspiration of pancreatic and peripancreatic cystic lesions

OBJECTIVE: To evaluate the diagnostic value of the gross appearance of aspirated material from endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic orperipancreatic cystic lesions. STUDY DESIGN: This study focuses on nonneoplastic (peri)-pancreatic cystic lesions on EUS-FNA. Eight cases were identified with distinct gross appearances of aspirated material by the authors' experience and by computerized review. Gross observations are evaluated together with clinical data, radiologic findings, laboratory markers and cytologic and surgical microscopy findings. RESULTS: Aspiration of cystic lesions often results in nonspecific cytologic findings. Gross and microscopic appearance of aspirated material can provide valuable information. We divide findings of 8 cystic lesions into 3 different patterns according to their gross appearance at on-site EUS-FNA: Pattern 1, 2 cases of biloma; Pattern 2, 1 case of lymphoepithelial cyst with sebaceous differentiation; Pattern 3, 3 cases of regular lymphoepithelial cysts and 2 cases ofpancreatic pseudocyst. CONCLUSION: The full value of FNA is achieved only with the integrated approach, including the gross appearance of the cytology specimens. Certain unusual gross appearances of the aspirated material can add valuable information toward a pathologic diagnosis.     

Liver tumors in wild flatfish: a histopathological, proteomic, and metabolomic study

Fish play host to viral, bacterial, and parasitic diseases in addition to non-infectious conditions such as cancer. The National Marine Monitoring Programme (NMMP) provides information to the U.K. Government on the health status of marine fish stocks. An aspect of this work relates to the presence of tumors and other pathologies in the liver of the offshore sentinel flatfish species, dab (Limanda limanda). Using internationally agreed quality assurance criteria, tumors and pre-tumors are diagnosed using histopathology. The current study has expanded upon this work by integrating these traditional diagnostic approaches with ones utilizing modern technologies for analysis of proteomic and metabolomic profiles of selected lesions. We have applied SELDI and FT-ICR technologies (for proteomic and metabolomic analyses, respectively) to tumor and non-tumor samples resected from the liver of dab. This combined approach has demonstrated how these technologies are able to identify protein and metabolite profiles that are specific to liver tumors. Using histopathology to classify "analysis groups" is key to the success of such an approach since it allows for elimination of spurious samples (e.g., those containing parasite infections) that may confuse interpretation of "omic" data. As such, the pathology laboratory plays a central role in collating information relating to particular specimens and in establishing sampling groups relative to specific diagnostic questions. In this study, we present pilot data, which illustrates that proteomics and metabolomics can be used to discriminate fish liver tumors and suggest future directions for work of this type.     

Macroscopic features of scurvy in human skeletal remains: A literature synthesis and diagnostic guide

The past two decades have seen a proliferation in bioarchaeological literature on the identification of scurvy, a disease caused by chronic vitamin C deficiency, in ancient human remains. This condition is one of the few nutritional deficiencies that can result in diagnostic osseous lesions. Scurvy is associated with low dietary diversity and its identification in human skeletal remains can provide important contextual information on subsistence strategy, resource allocation, and human-environmental interactions in past populations. A large and robust methodological body of work on the paleopathology of scurvy exists. However, the diagnostic criteria for this disease employed by bioarchaeologists have not always been uniform. Here we draw from previous research on the skeletal manifestations of scurvy in adult and juvenile human skeletal remains and propose a weighted diagnostic system for its identification that takes into account the pathophysiology of the disease, soft tissue anatomy, and clinical research. Using a sample of individuals from the prehistoric Atacama Desert in Northern Chile, we also provide a practical example of how diagnostic value might be assigned to skeletal lesions of the disease that have not been previously described in the literature.     

Use of cytomorphometry and cytology in the diagnosis of transitional-cell carcinoma of the upper urinary tract

Because of the rise in incidence of upper urinary tract tumors, there is a need for a simple and reliable method for diagnosing these tumors, especially in people in a "high-risk" group. This retrospective study showed the usefulness of cytology and cytomorphometry in making the diagnosis of transitional-cell carcinoma of the upper urinary tract. The study also emphasized that the methods of collection and processing are of the utmost importance: the cytologic evaluation of ureteral catheterized urine specimens gave 100% accuracy as compared with a 40% false-negative rate in the cytologic diagnosis of voided urine specimens. A higher accuracy of urinary cytology for the diagnosis of upper urinary tract lesions clearly requires selective catheterization of the ureter. Objective cytomorphologic grading of the urinary cytology specimens was shown to compare favorably with histologic grading. Cytomorphologic grading not only can offer important information in determining the prognosis and in planning treatment but can also assist in quality control of other diagnostic methods and can help to resolve apparent diagnostic discrepancies.     

Assessing diagnostic certainty for scurvy and rickets in human skeletal remains

Objectives

Identifying scurvy and rickets has important implications for understanding adaptations and variability among past communities, and bioarchaeologists now regularly evaluate these conditions. Due to the increased number of studies, cases with less clear-cut lesions and variable preservation are now frequently reported. Despite an improved understanding of the biological mechanisms for disease expression, there is a lack of consensus on the language used to express diagnostic certainty, limiting comparability. This article aims to address these issues and provide recommendations on more consistent diagnostic terminology using widely accepted diagnostic methodology based on biological mechanisms.

Materials and Methods

We review diagnostic terms used in bioarchaeology by considering published cases of rickets, scurvy and co-occurrence alongside M.B.B.'s past project notes. We also consider differences in the diagnosis of rickets and scurvy in living and archeological individuals.

Results

We provide recommendations on a framework that can be used to show diagnostic certainty in cases of rickets, scurvy, and co-occurrence. Core lesions of rickets and scurvy are used alongside a limited lexicon of diagnostic terminology based on the Istanbul protocol.

Discussion

It is not the number of lesions that determines whether an individual is assigned to a particular diagnosis category, but rather the range and expression of lesions present. Avoiding a “tick-list” approach to core lesions of these diseases will be critical to ensure that identifying rickets and scurvy continues to contribute to understanding adaptations and variability among past communities. The framework allows more consistency in diagnostic certainty, facilitating greater comparability in research.     

Percutaneous Aspiration Lung Biopsy

A total of 182 percutaneous trans-thoracic aspiration biopsies were performed in 164 patients over a three-year period. In malignant neoplasms arising in the lung the diagnostic accuracy rate was 84%. In the non-malignant localized parenchymal lesions the accuracy drops considerably unless the lesion is cystic or cavitary. Some patients with non-parenchymal lesions were selected to assess further the value of this procedure. It proved much less rewarding in lesions of the chest wall, diaphragm and also in diffuse parenchymal disease. These lesions may be more accurately identified by other methods of biopsy. Lesions presenting as a mediastinal mass are an intermediate group and in selected cases helpful information can often be obtained by small-bore needle aspiration, particularly if a pericardial, bronchogenic or thymic cyst is suspected. Recent reports have shown that the aspiration of pulmonary lesions can be utilized to obtain viable tumour cells for chemosensitivity testing. The aspiration of nodular pulmonary lesions should be considered when a diagnosis is not forthcoming from the usual investigative means, since there has been little morbidity and no mortality in the series.     

放大内镜对结节性胃炎的诊断价值

随着内镜技术的发展,放大内镜在临床中的应用尤为受到重视,并越来越多运用于临床诊断。目前新型的放大内镜可清晰显示消化道粘膜腺管开口和微细血管等细微结构的变化,从而,发现和诊断普通内镜难以发现的一些早期病变,特别是早期恶性肿瘤及其癌前病变。近年来在放大内镜检查中加上染色对比技术及窄带成像等技术,使放大内镜的运用得到进一步拓展。本文就放大内镜对结节性胃炎及其相关病变的诊断价值作一综述。     

胃镜对咽喉部恶性病变诊断的临床应用价值

目的:探讨胃镜在对于咽喉部恶性疾病诊断的临床应用价值。方法:对2013年11月至2014年9月因声音嘶哑或咽部异物感或吞咽困难为主诉就诊的患者,给予电子喉镜或间接喉镜检查,以在喉镜下发现咽喉部肿物或喉镜下发现黏膜异常增生不能明确判定病灶性质的12例患者为研究对象。继而给予窄带成像(Narrow-band imaging,NBI)及放大胃镜检查,对病灶进行性质及病变范围的判定。病理结果作为金标准,比较喉镜及胃镜两种方式对咽喉恶性病灶的正确诊断率。结果:12例患者中共发现15处病灶,其中炎性反应5处,单纯性鳞状上皮增生3处,鳞状细胞癌6处,神经纤维瘤1处。喉镜对病灶的正确诊断率是40.0%(6/15),NBI放大胃镜对病灶的正确诊断率是93.3%(14/15),两者差异有统计学意义(x~2=9.60,P=0.005)。结论:NBI放大胃镜对咽喉部肿瘤诊断正确率高于普通喉镜,充分证明了胃镜在咽喉部恶性疾病的诊断方面的临床价值。在行胃镜检查时,同时对咽喉部进行仔细观察检查是十分必要的。     

Magnetic resonance imaging in the diagnosis of gastric cancer: X-ray versus MRI anatomic findings

The paper assesses the present-day role of MRI in the diagnosis of gastric cancer. The authors consider the major prerequisites for the main aim of their study to be: 1) a dramatic incidence of diffuse (endophytic) gastric carcinoma, which requires significant correction of today's approaches to its diagnosis and 2) a rather biased and, in the authors' opinion, present-day mainly negative attitude towards MRI of the stomach as a diagnostic method for its tumor lesions. By applying the X-ray-MRI anatomic principle to the comparative study of MRI findings in 50 patients with predominantly gastric intramural carcinoma and in 25 patients without gastric tumors (controls), the authors present their methods for gastric MRI, the MRI semiotics of gastric cancer by concurrently touching upon a variety of problems that characterize the potentialities of MRI of the stomach in the diagnosis of its tumor lesions, including their differential diagnosis. As a result, the authors highly appreciate gastric MRI and consider this method to be included into the diagnostic algorithm of radiation techniques used in the diagnosis of gastric cancer, which should occupy its definite diagnostic place.     

Contribution of trigeminal and facial reflexes to the localization of Vth, VIIth, and VIIIth cranial nerve dysfunction.

After a review of electrophysiological studies in 1,500 cases concerning different types of lesions of the trigeminal nerve, the acousticofacial complex, and the brain stem, one can conclude that beside the intensive clinical examination which most often allows a precise topographic diagnosis, study of trigeminofacial and facial reflexes appears to be an essential diagnostic method to determine the topography of the lesions. On the other hand, this study can sometimes contribute to the prognostic evaluation as well as the choice of the approach in some lesions concerning the acousticofacial complex.     

Diagnostic difficulties in the interpretation of fine needle aspirates of salivary gland lesions: the problem revisited

Diagnostic difficulties in the interpretation of he needle aspirates of salivary gland lesions: the problem revisited
Cases of salivary gland lesions ( n =325), mainly neoplastic but including a small number of non-neoplastic lesions, investigated by fine needle aspiration (FNA) and with histological correlation, are reviewed. The review identified a number of differential diagnostic problems which are discussed in some detail. One false-positive and eight false-negative diagnoses had been made resulting in a 99.5% specificity and a 85.5% sensitivity. If type-specific diagnoses are made only when all defined diagnostic criteria are present and if any uncertainty is clearly conveyed to the clinician, FNA is a safe and accurate tool in the investigation of salivary gland lesions.     

A Fault Diagnosis Methodology for Gear Pump Based on EEMD and Bayesian Network

This paper proposes a fault diagnosis methodology for a gear pump based on the ensemble empirical mode decomposition (EEMD) method and the Bayesian network. Essentially, the presented scheme is a multi-source information fusion based methodology. Compared with the conventional fault diagnosis with only EEMD, the proposed method is able to take advantage of all useful information besides sensor signals. The presented diagnostic Bayesian network consists of a fault layer, a fault feature layer and a multi-source information layer. Vibration signals from sensor measurement are decomposed by the EEMD method and the energy of intrinsic mode functions (IMFs) are calculated as fault features. These features are added into the fault feature layer in the Bayesian network. The other sources of useful information are added to the information layer. The generalized three-layer Bayesian network can be developed by fully incorporating faults and fault symptoms as well as other useful information such as naked eye inspection and maintenance records. Therefore, diagnostic accuracy and capacity can be improved. The proposed methodology is applied to the fault diagnosis of a gear pump and the structure and parameters of the Bayesian network is established. Compared with artificial neural network and support vector machine classification algorithms, the proposed model has the best diagnostic performance when sensor data is used only. A case study has demonstrated that some information from human observation or system repair records is very helpful to the fault diagnosis. It is effective and efficient in diagnosing faults based on uncertain, incomplete information.     

A Simplified Technique for Postmortem Evaluation of Coronary Arteries

The growth of complex diagnostic and therapeutic technologies in the clinical management of cardiovascular diseases has mandated a more comprehensive and detailed analysis of cases which reach the pathology laboratory. This report describes in detail the relatively simple techniques and protocol which we have employed for postmortem evaluation of the coronary vascular bed and myocardium. The key elements include the use of a pigmented gelatin mass containing radiopaque material (Barosperse), proper injection technique with simultaneous filling of the main coronary vessels at identical pressures, postmortem arteriography, cardiac dissection, and histologic confirmation of coronary and myocardial lesions. Three cases with sharply differing cardiac diseases are presented to illustrate the kind of information which may be obtained with this approach. Our experience in terms of frequency and distribution of occlusive coronary vascular disease and the relationship to age and sex has been summarized. Significant disease (> 75% lumenal obstruction) was identified angiographically and confirmed by dissection in 46 of 57 cases of clinically suspected disease. None of six hearts from patients without clinical evidence for cardiovascular disease demonstrated actual or angiographically false-positive occlusive coronary disease. It is suggested that a more detailed analysis of the coronary vascular bed can be accomplished in the pathology laboratory with this relatively simple approach and that important information bearing on clinical management can be reliably obtained.     

THE APPLICATION AND EVALUATION OF PERITONEOSCOPY

Peritoneoscopic examination has now been accepted throughout the world as a safe diagnostic procedure in lieu of laparotomy in selected cases.Laparotomies for diagnostic purposes alone should be condemned.Peritoneoscopy should not be done without a definite purpose and the procedure should not be expected to accomplish more than the purpose for which it is done. Indications for the procedure are set forth in detail. Experience has established definite contraindications, which are reviewed.The procedure is especially indicated for patients who are aged, emaciated, anemic, or poor surgical risks for any reason.All patients having ascites of undetermined cause should be examined by peritoneoscopy.The method is especially indicated for examination of patients with liver disease of all types, for pelvic examinations, for use to determine existence of ectopic pregnancy, and for tumor localization.Considerable use was made of the procedure during World War II to determine the extent and site of intra-abdominal injuries caused by crushing, explosions, and falls from high places.The procedure permits early and correct diagnosis, early decision as to the advisability of operation, and determination as to operability in cases of malignant gastric lesions. It is a safe method for obtaining biopsy specimens from intra-abdominal tissue and organs.Accuracy of diagnosis in cases in which the method can be used is considerably greater with peritoneoscopic examination than with clinical information alone.     

The use of diagnostic radiology to detect shell irregularities in the New Zealand paua (abalone) Haliotis iris

A method is described for the non-destructive, non-invasive, detection of shell lesions in the New Zealand paua, a marine gastropod Haliotis iris using diagnostic radiology. The X-ray method reliably detected the presence of shell lesions in 96% of the cases examined once lesion dimensions exceeded 6.2 x 7.1 mm. The extent of lesions above this size can be reliably and accurately determined from X-ray images viewed on a video display unit (VDU). Biofouling on the outside of the shell can cause misdiagnoses. This method is a significant animal welfare refinement in the identification of marine gastropods with shell lesions, when compared with traditional techniques which kill the animals.