Multiple primary malignancies are defined as two or three malignant neoplasms arising in different organ systems. Several cases of multiple primary malignancies are emerging in recent years due to the advancement in medical therapy and diagnostics. Multiple primary malignancies are not uncommon occurring at 0.7-16% of cancer patients, however, reported cases of multiple primary sarcomas are sparse. Presented in this report is a pediatric patient diagnosed with primary metachronous cerebral rhabdomyosarcoma after being treated for primitive neuroectodermal tumor/Ewing’s sarcoma of the oral cavity. Despite limited cases addressing multiple primary sarcomas, this entity must not be overlooked as it is associated with a meager outcome compared to an index case of sarcoma alone.
{"title":"Metachronous Primary Cerebral Rhabdomyosarcoma After Treatment of Oral Primitive Neuroectodermal Tumor/ Ewing’s Sarcoma in a School-Aged Girl: A Case Report","authors":"Danielle Anne Gonong, M. Madrid","doi":"10.21141/pjp.2020.13","DOIUrl":"https://doi.org/10.21141/pjp.2020.13","url":null,"abstract":"Multiple primary malignancies are defined as two or three malignant neoplasms arising in different organ systems. Several cases of multiple primary malignancies are emerging in recent years due to the advancement in medical therapy and diagnostics. Multiple primary malignancies are not uncommon occurring at 0.7-16% of cancer patients, however, reported cases of multiple primary sarcomas are sparse. Presented in this report is a pediatric patient diagnosed with primary metachronous cerebral rhabdomyosarcoma after being treated for primitive neuroectodermal tumor/Ewing’s sarcoma of the oral cavity. Despite limited cases addressing multiple primary sarcomas, this entity must not be overlooked as it is associated with a meager outcome compared to an index case of sarcoma alone.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130639317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sonia B. Sia, Agnettah Olorsoa, Marilyn T. Limas, Manuel Jamoralin Jr., P. K. Macaranas, Holly Grace Espiritu, June M. Gayeta, M. Masim, Ferissa B. Ablola, C. Carlos
Background. Salmonella enterica ser. Typhi and Salmonella enterica ser. Paratyphi are agents of typhoid fever, a severe systemic disease, which remains to be a public health concern in the Philippines. Infection due to non-typhoidal Salmonella (NTS), on the other hand, most often results in a self-limiting acute gastroenteritis but may result in invasive disease in some cases. There is scarcity of information on the Salmonella serotypes in the Philippines which limits understanding of the distribution, transmission and antimicrobial resistance of these bacteria. Objective. This study describes the serotype distribution and antimicrobial resistance of Salmonella in the Philippines over a 15-year period. Methodology. Salmonella isolates were collected through the Philippine Department of Health-Antimicrobial Resistance Surveillance Program (DOH-ARSP) from January 1, 2004 to December 31, 2018. The isolates were serotyped using Sven Gard method for slide agglutination using antigens from Denka Seiken (Japan), and S and A serotest (Thailand). Antigenic formula obtained were classified according to White-KauffmannLeMinor scheme. Antimicrobial susceptibility testing for ampicillin, ceftriaxone, cefotaxime, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole, were performed using both automated and conventional methods (Kirby Bauer disk diffusion and gradient diffusion method). Antimicrobial susceptibility results were interpreted using Clinical and Laboratory Standards Institute (CLSI) 2018 interpretive criteria (M100Ed28E). Results. A total of 2,387 isolates were collected from human specimens during the 15-year study period. There were 69 serotypes of Salmonella identified with the most common being Salmonella enterica ser. Typhi: n=1895 (79.39%), Salmonella enterica ser. Enteritidis: n=182 (7.62%), Salmonella enterica ser. Typhimurium: n=87 (3.64%), Salmonella enterica ser. Weltevreden: n=24 (1.00%), Salmonella enterica ser. Paratyphi A: n=17 (0.71%), Salmonella enterica ser. Stanley: n=17 (0.71%), Salmonella enterica ser. Anatum: n=13 (0.54%), Salmonella enterica ser. Heidelberg: n=12 (0.50%), Salmonella enterica ser. Choleraesuis var. Kunzendorf: n=9 (0.38%). The multidrug resistant Salmonella serotypes reported in this study were mostly resistant to ampicillin, cefotaxime, ciprofloxacin combinations. Conclusion. This present study showed that prevailing Salmonella serotypes in the Philippines were similar with Salmonella serotypes reported from other Asian countries. Typhoidal isolates were high among 6-17 years old and were mostly from males. The antimicrobial resistance rates for typhoidal Salmonella isolates to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, ceftriaxone and cefotaxime were lower compared with the antimicrobial resistance rates for non-typhoidal Salmonella isolates. Multidrug resistance for both Salmonella Typhi and NTS were relatively low. Continued and enhanced surveillance is needed to
{"title":"A Fifteen-Year Report of Serotype Distribution and Antimicrobial Resistance of Salmonella in the Philippines","authors":"Sonia B. Sia, Agnettah Olorsoa, Marilyn T. Limas, Manuel Jamoralin Jr., P. K. Macaranas, Holly Grace Espiritu, June M. Gayeta, M. Masim, Ferissa B. Ablola, C. Carlos","doi":"10.21141/pjp.2020.04","DOIUrl":"https://doi.org/10.21141/pjp.2020.04","url":null,"abstract":"Background. Salmonella enterica ser. Typhi and Salmonella enterica ser. Paratyphi are agents of typhoid fever, a severe systemic disease, which remains to be a public health concern in the Philippines. Infection due to non-typhoidal Salmonella (NTS), on the other hand, most often results in a self-limiting acute gastroenteritis but may result in invasive disease in some cases. There is scarcity of information on the Salmonella serotypes in the Philippines which limits understanding of the distribution, transmission and antimicrobial resistance of these bacteria. Objective. This study describes the serotype distribution and antimicrobial resistance of Salmonella in the Philippines over a 15-year period. Methodology. Salmonella isolates were collected through the Philippine Department of Health-Antimicrobial Resistance Surveillance Program (DOH-ARSP) from January 1, 2004 to December 31, 2018. The isolates were serotyped using Sven Gard method for slide agglutination using antigens from Denka Seiken (Japan), and S and A serotest (Thailand). Antigenic formula obtained were classified according to White-KauffmannLeMinor scheme. Antimicrobial susceptibility testing for ampicillin, ceftriaxone, cefotaxime, chloramphenicol, ciprofloxacin, and trimethoprim-sulfamethoxazole, were performed using both automated and conventional methods (Kirby Bauer disk diffusion and gradient diffusion method). Antimicrobial susceptibility results were interpreted using Clinical and Laboratory Standards Institute (CLSI) 2018 interpretive criteria (M100Ed28E). Results. A total of 2,387 isolates were collected from human specimens during the 15-year study period. There were 69 serotypes of Salmonella identified with the most common being Salmonella enterica ser. Typhi: n=1895 (79.39%), Salmonella enterica ser. Enteritidis: n=182 (7.62%), Salmonella enterica ser. Typhimurium: n=87 (3.64%), Salmonella enterica ser. Weltevreden: n=24 (1.00%), Salmonella enterica ser. Paratyphi A: n=17 (0.71%), Salmonella enterica ser. Stanley: n=17 (0.71%), Salmonella enterica ser. Anatum: n=13 (0.54%), Salmonella enterica ser. Heidelberg: n=12 (0.50%), Salmonella enterica ser. Choleraesuis var. Kunzendorf: n=9 (0.38%). The multidrug resistant Salmonella serotypes reported in this study were mostly resistant to ampicillin, cefotaxime, ciprofloxacin combinations. Conclusion. This present study showed that prevailing Salmonella serotypes in the Philippines were similar with Salmonella serotypes reported from other Asian countries. Typhoidal isolates were high among 6-17 years old and were mostly from males. The antimicrobial resistance rates for typhoidal Salmonella isolates to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, ceftriaxone and cefotaxime were lower compared with the antimicrobial resistance rates for non-typhoidal Salmonella isolates. Multidrug resistance for both Salmonella Typhi and NTS were relatively low. Continued and enhanced surveillance is needed to","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126979591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erick Martin Yturralde, Karen Bulseco-Damian, N. Geraldino
Background and Objectives. The use of conventional microscopy still forms the basis for the morphologic evaluation of erythrocytes despite widespread use of automated tests in the hematology laboratory. This requires a considerable length of time and expertise, and have the potential of becoming a source of errors and delay in reporting. Advances in image processing and machine learning in recent years have shown acceptable performance characteristics and have promising applications in the diagnostic laboratory. Use of these newly-developed technologies can address the stated problems and provide an alternative approach in the microscopic analysis of erythrocytes. Methodology. This prospective validation study compared digital image analysis using a machine-learning based image recognition algorithm with conventional microscopy performed by a trained microscopist, which served as the reference standard. Random deidentified anticoagulated peripheral blood samples submitted to the hematology laboratory were assessed. Results. A total of 956 erythrocytes were evaluated after image processing using support vector machine and routine microscopy as classifiers of erythrocytes into three categories: size, central pallor, and shape. The tested software was able to achieve a strong level of agreement compared to conventional microscopy, having kappa values ranging from 0.81 to 0.86. Accuracy for size, central pallor and shape were 89.88%, 93.72% and 87.89%, respectively. Conclusion. The validated image recognition software is an acceptable diagnostic test in determining erythrocyte morphology in peripheral blood smears. Its integration can potentially minimize hands-on time and improve the diagnostic laboratory workflow. Registration. Philippine Health Research Registry (PHRR) ID: PHRR191211-002348; University of the Philippines Manila Research Ethics Board (UPMREB): 2019-356-01 Keywords: erythrocyte morphology, digital imaging, microscopy
{"title":"Comparison of Digital Image Analysis and Conventional Microscopy in Evaluating Erythrocyte Morphology in Peripheral Blood Smears","authors":"Erick Martin Yturralde, Karen Bulseco-Damian, N. Geraldino","doi":"10.21141/PJP.2020.03","DOIUrl":"https://doi.org/10.21141/PJP.2020.03","url":null,"abstract":"Background and Objectives. The use of conventional microscopy still forms the basis for the morphologic evaluation of erythrocytes despite widespread use of automated tests in the hematology laboratory. This requires a considerable length of time and expertise, and have the potential of becoming a source of errors and delay in reporting. Advances in image processing and machine learning in recent years have shown acceptable performance characteristics and have promising applications in the diagnostic laboratory. Use of these newly-developed technologies can address the stated problems and provide an alternative approach in the microscopic analysis of erythrocytes. \u0000Methodology. This prospective validation study compared digital image analysis using a machine-learning based image recognition algorithm with conventional microscopy performed by a trained microscopist, which served as the reference standard. Random deidentified anticoagulated peripheral blood samples submitted to the hematology laboratory were assessed. \u0000Results. A total of 956 erythrocytes were evaluated after image processing using support vector machine and routine microscopy as classifiers of erythrocytes into three categories: size, central pallor, and shape. The tested software was able to achieve a strong level of agreement compared to conventional microscopy, having kappa values ranging from 0.81 to 0.86. Accuracy for size, central pallor and shape were 89.88%, 93.72% and 87.89%, respectively. \u0000Conclusion. The validated image recognition software is an acceptable diagnostic test in determining erythrocyte morphology in peripheral blood smears. Its integration can potentially minimize hands-on time and improve the diagnostic laboratory workflow. \u0000Registration. Philippine Health Research Registry (PHRR) ID: PHRR191211-002348; University of the Philippines Manila Research Ethics Board (UPMREB): 2019-356-01 \u0000Keywords: erythrocyte morphology, digital imaging, microscopy","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132711306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pier Angeli Medina, J. Matibag, Sarah Jane Datay-Lim, Elizabeth Arcellana-Nuqui
Introduction Six sigma has been used over the years, initially in manufacturing industries to improve quality by reducing the number of wastes and defects. In the laboratory, it can also provide measurement of quality using the sigma scale. Objectives The main objective of the study is to evaluate the performance of tests in two chemistry analyzers using the six sigma scale. Methodology A total of twenty (28) tests were evaluated on two Abbott Architect c8000 chemistry analyzers from September 2014 to July 2019 using results of quality control mean, coefficient of variation, bias and total allowable error to compute for the six sigma value. Both level one and level two third party quality controls were included in the evaluation. Results OResults of the study showed the tests that were >6 sigma for both levels 1 and 2 throughout the 5 years. Di-Bil, CK, HLD, TG and UA were consistently >6 sigma for one machine while CK, Di-Bil, HDL, Mg, TG and UA were consistently >6 sigma for the other. Level 1 and Level 2 sigma scores were noted to be incongruent in some analytes as follows: ALB, ALT, K, TP for one instrument and ALB, ALP and AST for the other instrument. Electrolytes Ca, Cl, and Na were generally low ( Conclusion Using six sigma metrics allowed the laboratory to evaluate the performance of the chemistry tests objectively. Tests that are >6.0 sigma signifies world class performance and entail application of fewer Westgard rules with fewer number of runs while those that are
{"title":"A Pilot Study on the Evaluation of Clinical Chemistry Laboratory Test Performance using Six Sigma Metrics","authors":"Pier Angeli Medina, J. Matibag, Sarah Jane Datay-Lim, Elizabeth Arcellana-Nuqui","doi":"10.21141/pjp.2019.13","DOIUrl":"https://doi.org/10.21141/pjp.2019.13","url":null,"abstract":"Introduction Six sigma has been used over the years, initially in manufacturing industries to improve quality by reducing the number of wastes and defects. In the laboratory, it can also provide measurement of quality using the sigma scale. Objectives The main objective of the study is to evaluate the performance of tests in two chemistry analyzers using the six sigma scale. Methodology A total of twenty (28) tests were evaluated on two Abbott Architect c8000 chemistry analyzers from September 2014 to July 2019 using results of quality control mean, coefficient of variation, bias and total allowable error to compute for the six sigma value. Both level one and level two third party quality controls were included in the evaluation. Results OResults of the study showed the tests that were >6 sigma for both levels 1 and 2 throughout the 5 years. Di-Bil, CK, HLD, TG and UA were consistently >6 sigma for one machine while CK, Di-Bil, HDL, Mg, TG and UA were consistently >6 sigma for the other. Level 1 and Level 2 sigma scores were noted to be incongruent in some analytes as follows: ALB, ALT, K, TP for one instrument and ALB, ALP and AST for the other instrument. Electrolytes Ca, Cl, and Na were generally low ( Conclusion Using six sigma metrics allowed the laboratory to evaluate the performance of the chemistry tests objectively. Tests that are >6.0 sigma signifies world class performance and entail application of fewer Westgard rules with fewer number of runs while those that are","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"1245 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132317264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Badrick, J. Habijanic, Sam Yew Mah, Elizabeth Arcellana-Nuqui
Introduction To ensure continuous quality improvement, laboratories need to obtain data about best practice from peers. Data about analytical EQA is available but far less is available about other important aspects of laboratory performance. There is a Roche Diagnostics Survey of laboratories which provides benchmarking in key areas of laboratory performance. Methodology The Roche Diagnostics Survey included 1058 laboratories from 14 countries in the Asia Pacific Region with both developing and developed nations. The data were collected in 2017 but the survey has been collecting data each second year since 2011. Data was collected in the areas of quality, speed and cost. Results The results for the Philippines was compared with other countries in the Asia Pacific Region. Broadly it was found that 42% of all laboratories in the Region were accredited to ISO 15189 or ISO 9001 and that 50% of laboratories were in an External Quality Assurance (EQA) program. Compared to other countries in the survey, the Philippines laboratories had fewer sites with ISO 15189 and with Lean Six Sigma improvement deployment. There are six laboratories in the Philippines that are accredited to ISO 15189. There was a greater emphasis on customer satisfaction related Key Performance Indicators (KPIs) such as turnaround time monitoring, cost reduction and employee productivity. Conclusion Benchmarking can highlight the differences in the apparent quality of laboratory services compared to their peers and may lead to improvement. The benchmarking comparison has identified opportunities for Philippine laboratories to improve including obtaining ISO 15189 accreditation, implementing laboratory information systems and concentrating on Lean practices to improve productivity. The Roche scheme provides an ongoing (growing) large sample of benchmarks that can be used by participants to improve their performance and the performance of individual countries.
{"title":"Philippines Diagnostic Pathology Laboratory Benchmarking","authors":"T. Badrick, J. Habijanic, Sam Yew Mah, Elizabeth Arcellana-Nuqui","doi":"10.21141/pjp.2019.11","DOIUrl":"https://doi.org/10.21141/pjp.2019.11","url":null,"abstract":"Introduction To ensure continuous quality improvement, laboratories need to obtain data about best practice from peers. Data about analytical EQA is available but far less is available about other important aspects of laboratory performance. There is a Roche Diagnostics Survey of laboratories which provides benchmarking in key areas of laboratory performance. Methodology The Roche Diagnostics Survey included 1058 laboratories from 14 countries in the Asia Pacific Region with both developing and developed nations. The data were collected in 2017 but the survey has been collecting data each second year since 2011. Data was collected in the areas of quality, speed and cost. Results The results for the Philippines was compared with other countries in the Asia Pacific Region. Broadly it was found that 42% of all laboratories in the Region were accredited to ISO 15189 or ISO 9001 and that 50% of laboratories were in an External Quality Assurance (EQA) program. Compared to other countries in the survey, the Philippines laboratories had fewer sites with ISO 15189 and with Lean Six Sigma improvement deployment. There are six laboratories in the Philippines that are accredited to ISO 15189. There was a greater emphasis on customer satisfaction related Key Performance Indicators (KPIs) such as turnaround time monitoring, cost reduction and employee productivity. Conclusion Benchmarking can highlight the differences in the apparent quality of laboratory services compared to their peers and may lead to improvement. The benchmarking comparison has identified opportunities for Philippine laboratories to improve including obtaining ISO 15189 accreditation, implementing laboratory information systems and concentrating on Lean practices to improve productivity. The Roche scheme provides an ongoing (growing) large sample of benchmarks that can be used by participants to improve their performance and the performance of individual countries.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115676365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Flora Mae Sta. Ines, Anna Louise Anceno, Rachelle Arah Salamat, N. Navarro, G. Pua, J. Andal, D. Ang
Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) of the gallbladder is a rare tumor that is defined in the World Health Organization (WHO) 2019 digestive system tumor classification as the presence of a neuroendocrine neoplasm admixed with a non-neuroendocrine carcinoma, each component constituting at least 30% of the neoplasm. The exact pathogenesis of MiNENs remains unclear. We present a case of a 74-year-old Filipino woman who presented with nonspecific clinical and radiologic findings and subsequently underwent cholecystectomy. Histopathologic and immunohistochemical evaluation of the gallbladder confirmed the diagnosis of a mixed well-differentiated adenocarcinoma (30%) and large cell neuroendocrine carcinoma (70%). The adenocarcinoma and neuroendocrine carcinoma components were separately microdissected and submitted for targeted 15-gene sequencing using the Illumina Trusight Tumor 15 (TST15) panel. NGS identified a TP53 missense mutation leading to a stop codon in both components. The finding of similar molecular signatures in the two morphologically distinct components supports the hypothesis that MiNEN arises from a common precursor stem cell capable of divergent phenotypic differentiation.
{"title":"Targeted Sequencing of Mixed Neuroendocrine- Non-neuroendocrine Neoplasm of the Gallbladder Suggests a Monoclonal Origin: A Case Report","authors":"Flora Mae Sta. Ines, Anna Louise Anceno, Rachelle Arah Salamat, N. Navarro, G. Pua, J. Andal, D. Ang","doi":"10.21141/PJP.2019.16","DOIUrl":"https://doi.org/10.21141/PJP.2019.16","url":null,"abstract":"Mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) of the gallbladder is a rare tumor that is defined in the World Health Organization (WHO) 2019 digestive system tumor classification as the presence of a neuroendocrine neoplasm admixed with a non-neuroendocrine carcinoma, each component constituting at least 30% of the neoplasm. The exact pathogenesis of MiNENs remains unclear. We present a case of a 74-year-old Filipino woman who presented with nonspecific clinical and radiologic findings and subsequently underwent cholecystectomy. Histopathologic and immunohistochemical evaluation of the gallbladder confirmed the diagnosis of a mixed well-differentiated adenocarcinoma (30%) and large cell neuroendocrine carcinoma (70%). The adenocarcinoma and neuroendocrine carcinoma components were separately microdissected and submitted for targeted 15-gene sequencing using the Illumina Trusight Tumor 15 (TST15) panel. NGS identified a TP53 missense mutation leading to a stop codon in both components. The finding of similar molecular signatures in the two morphologically distinct components supports the hypothesis that MiNEN arises from a common precursor stem cell capable of divergent phenotypic differentiation.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"91 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126210637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steffanie Charlyne Tamayo, J. Balolong-Garcia, M. Alcantara, Rubi K. Li, D. Ang, J. Andal, R. M. Santiago
We report a case of a 64-year-old Filipino male who initially presented with chronic cough, easy fatigability, and weight loss. Work-ups lead to a diagnosis of lung adenocarcinoma with epidermal growth factor receptor (EGFR) exon 19 deletion. Patient was placed on targeted therapy with Afatinib. He was able to complete 17 months of targeted therapy with relatively stable disease before experiencing recurrence of easy fatigability. Work-ups then lead to a diagnosis of a high-grade neuroendocrine tumor consistent with small cell lung carcinoma (SCLC). Afatinib was then discontinued and the patient was started on Carboplatin and Etoposide. However, after only one cycle, the patient’s symptoms progressed and the patient eventually expired. Histological transformation of EGFR-mutant adenocarcinoma to SCLC as a mechanism of resistance to targeted therapy has been documented in literature since 2006. However, to our knowledge, this is the first fully-documented case of histologic transformation occurring in a Filipino patient. As molecular targeted therapy and immunotherapy become standard-of-care in our country, it is of paramount importance that clinicians and pathologists are aware of the various mechanisms of resistance that can occur as a result of these treatments.
{"title":"Histologic Transformation in an EGFR-Mutant Lung Cancer in a Filipino Patient treated with Afatinib: A Case Report and Review of Literature","authors":"Steffanie Charlyne Tamayo, J. Balolong-Garcia, M. Alcantara, Rubi K. Li, D. Ang, J. Andal, R. M. Santiago","doi":"10.21141/PJP.2019.15","DOIUrl":"https://doi.org/10.21141/PJP.2019.15","url":null,"abstract":"We report a case of a 64-year-old Filipino male who initially presented with chronic cough, easy fatigability, and weight loss. Work-ups lead to a diagnosis of lung adenocarcinoma with epidermal growth factor receptor (EGFR) exon 19 deletion. Patient was placed on targeted therapy with Afatinib. He was able to complete 17 months of targeted therapy with relatively stable disease before experiencing recurrence of easy fatigability. Work-ups then lead to a diagnosis of a high-grade neuroendocrine tumor consistent with small cell lung carcinoma (SCLC). Afatinib was then discontinued and the patient was started on Carboplatin and Etoposide. However, after only one cycle, the patient’s symptoms progressed and the patient eventually expired. Histological transformation of EGFR-mutant adenocarcinoma to SCLC as a mechanism of resistance to targeted therapy has been documented in literature since 2006. However, to our knowledge, this is the first fully-documented case of histologic transformation occurring in a Filipino patient. As molecular targeted therapy and immunotherapy become standard-of-care in our country, it is of paramount importance that clinicians and pathologists are aware of the various mechanisms of resistance that can occur as a result of these treatments.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"180 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116313808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pyloric gland adenoma (PGA) is a rare neoplasm with definite malignant potential that is difficult to recognize because of its characteristically bland histology. We present a case of a 74-year old female with chronic, intermittent symptoms referable to gastroesophageal reflux, bloatedness, and frequent flatus, with family history of gastric cancer. Initial endoscopy was done and biopsy revealed an inflammatory pseudopolyp. After six months, repeat endoscopy showed multiple polyps at the cardia, and biopsy of one of the visualized polyps was done. Microscopic sections of the polyp show a neoplasm composed of discrete glands lined by simple cuboidal to columnar epithelial cells with amphophilic to eosinophilic cytoplasm without apical mucin caps, and mild nuclear atypia. Mild epithelial stratification is noted in some of the glands. PAS staining showed granular, cytoplasmic staining in tumor cells. Immunohistochemical staining with P53 showed focal, weak, nuclear staining in tumor cells. Staining with Ki67, MUC2, MUC5AC, and MUC6 were not done because the tissue had already been exhausted. The diagnosis of PGA with low-grade dysplasia has been made. The patient is apparently well, and is advised surveillance endoscopy at six-month intervals. PGA may be diagnosed in a limited resource setting, through thorough histologic examination, and use of special histochemical stains.
{"title":"Gastric Pyloric Gland Adenoma: A Case Report, Review of Literature, and Diagnostic Challenges in the Philippine Setting","authors":"Kevin Elomina, Ignacio de Guzman","doi":"10.21141/PJP.2019.14","DOIUrl":"https://doi.org/10.21141/PJP.2019.14","url":null,"abstract":"Pyloric gland adenoma (PGA) is a rare neoplasm with definite malignant potential that is difficult to recognize because of its characteristically bland histology. We present a case of a 74-year old female with chronic, intermittent symptoms referable to gastroesophageal reflux, bloatedness, and frequent flatus, with family history of gastric cancer. Initial endoscopy was done and biopsy revealed an inflammatory pseudopolyp. After six months, repeat endoscopy showed multiple polyps at the cardia, and biopsy of one of the visualized polyps was done. Microscopic sections of the polyp show a neoplasm composed of discrete glands lined by simple cuboidal to columnar epithelial cells with amphophilic to eosinophilic cytoplasm without apical mucin caps, and mild nuclear atypia. Mild epithelial stratification is noted in some of the glands. PAS staining showed granular, cytoplasmic staining in tumor cells. Immunohistochemical staining with P53 showed focal, weak, nuclear staining in tumor cells. Staining with Ki67, MUC2, MUC5AC, and MUC6 were not done because the tissue had already been exhausted. The diagnosis of PGA with low-grade dysplasia has been made. The patient is apparently well, and is advised surveillance endoscopy at six-month intervals. PGA may be diagnosed in a limited resource setting, through thorough histologic examination, and use of special histochemical stains.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123629903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kenneth Aristotle Punzalan, Rhoda Yu, Iza Mae Chamen
External Quality Assessment Scheme (EQAS) is an important and vital component of a quality system to which a retrospective and periodic assessment of quality can be undertaken by an independent external agency. The Transfusion Transmissible Infections–National Reference Laboratory (TTI-NRL) annually provides an EQAS program for transfusion transmissible infections to all blood service facilities in the Philippines as a requirement for the renewal of their license to operate and raise the quality standards of testing for infectious diseases. A total of 188 participants registered in the 2018 test event and were given an EQAS panel comprised of a serology program (HVHT4120) and malaria program (MLRA415). Results from the participants were submitted through an online informatics system managed by OneWorld Accuracy Canada using the ISO 13528:2008 Robust Statistics method (Huber’s Method). Results were analyzed and evaluated with the reference result from the TTI-NRL. The HVHT4120 program generated 15,330 results and the MLRA415 generated 940 results. 97 results (0.63%) and 80 results (8.51%) were reported as aberrant from each program respectively and were either due to random or systematic errors. The data generated from this test event are used for the improvement of the quality processes of each participant and the subsequent renewal of their license to operate as required by local health regulations.
{"title":"External Quality Assessment Scheme for Transfusion Transmissible Infections Among Blood Service Facilities in the Philippines, 2018","authors":"Kenneth Aristotle Punzalan, Rhoda Yu, Iza Mae Chamen","doi":"10.21141/PJP.2019.17","DOIUrl":"https://doi.org/10.21141/PJP.2019.17","url":null,"abstract":"External Quality Assessment Scheme (EQAS) is an important and vital component of a quality system to which a retrospective and periodic assessment of quality can be undertaken by an independent external agency. The Transfusion Transmissible Infections–National Reference Laboratory (TTI-NRL) annually provides an EQAS program for transfusion transmissible infections to all blood service facilities in the Philippines as a requirement for the renewal of their license to operate and raise the quality standards of testing for infectious diseases. A total of 188 participants registered in the 2018 test event and were given an EQAS panel comprised of a serology program (HVHT4120) and malaria program (MLRA415). Results from the participants were submitted through an online informatics system managed by OneWorld Accuracy Canada using the ISO 13528:2008 Robust Statistics method (Huber’s Method). Results were analyzed and evaluated with the reference result from the TTI-NRL. The HVHT4120 program generated 15,330 results and the MLRA415 generated 940 results. 97 results (0.63%) and 80 results (8.51%) were reported as aberrant from each program respectively and were either due to random or systematic errors. The data generated from this test event are used for the improvement of the quality processes of each participant and the subsequent renewal of their license to operate as required by local health regulations.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126201343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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