Current diagnostic pathology最新文献

The diagnosis of minimal prostatic adenocarcinoma can be challenging in prostate needle biopsy tissues, and immunohistochemistry may be needed to substantiate the diagnosis of prostatic adenocarcinoma and/or exclude one of its benign mimickers. Basal cell markers, such as those targeted by the 34βE12 antibody, and antibodies directed against cytokeratin (CK) 5/6 or p63, are very useful for demonstrating basal cells as their presence argues against a diagnosis of invasive carcinoma. The detection of α-methylacyl-coenzyme-A racemase in the appropriate histological context, and with the concurrent use of basal cell markers, can be very useful in confirming an impression of adenocarcinoma. It is important to be aware of the different caveats associated with the use of these markers. Cutting and saving interval sections and performing immunohistochemistry on destained haematoxylin and eosin-stained sections are methods that can be used to increase the diagnostic yield of immunohistochemistry in the assessment of prostatic lesions.

Microscopic colitis is an inflammatory condition of the large bowel that is distinct from inflammatory bowel disease and infection. Several histological patterns of inflammation have been described. The classification of microscopic colitis needs to evolve to take into account newly described patterns. We suggest an approach to analysing biopsies in cases of suspected microscopic colitis and propose a new classification system. We divide microscopic colitis into classical (collagenous colitis, lymphocytic colitis) and non-classical (granulomatous colitis, giant-cell microscopic colitis, pseudomembranous microscopic colitis). We also propose that minimal-change colitis should not be considered under the heading of microscopic colitis.

Many drugs can cause pathology in the large intestine. Major classes include antibiotics, non-steroidal anti-inflammatory drugs, laxatives, anticancer drugs and immunosuppressive agents. The pathogenesis of the lesions caused by drugs is highly variable. Toxic injury and vascular insufficiency are probably the most important mechanisms. The microscopic pattern of such lesions is generally non-specific. They may produce histological patterns that resemble acute infectious-type colitis, microscopic colitis, ischaemic colitis and even chronic idiopathic inflammatory bowel disease. Specific features, such as the presence of crystals (Kayexalate), pigment and diaphragms, indicating a specific diagnosis are less common. The precise incidence of drug-induced damage to the large intestine is not known, but the importance of the phenomenon is probably underestimated. A correct histopathological diagnosis is difficult and requires a careful clinical history and the consideration of the possibility of a drug-related aetiology.

Intracranial haemorrhages are important causes of morbidity and mortality in infancy. They can affect the extradural and subdural spaces, subarachnoid space and intracerebral/intracerebellar compartments. Although the actual diagnosis of a haemorrhage may not be difficult to make, it is important to be able to correlate the findings to the appropriate clinical setting. This is particularly important in the medicolegal setting, in which interpretation of the presence of intracranial haemorrhage can be controversial. This review will describe the causes and appearances of the various haemorrhages, and will discuss some of the important practical points in their diagnosis.

Stillbirth is an absolute indication for pathological examination of the placenta. Placental histopathology can shed light on the cause of the stillbirth and help in the management of future pregnancies and in the resolution of medicolegal issues. Placental lesions that are likely causes of stillbirth are discussed. They can be broadly classified into umbilical cord lesions, fetal vascular lesions, maternal uteroplacental insufficiency and placental inflammation. In some of these lesions, the direct contribution to the stillbirth may be obvious; in others, it may be debatable. Medicolegal questions that are frequently posed in placental examination in stillbirths are the timing of fetal demise and whether there was fetal distress.

The accurate dissection of resection specimens forms a very important part of colorectal cancer patient management in that important prognostic data, gleaned from the resection specimen, strongly influence postoperative management, including being the most important determinant of the decision to institute adjuvant therapy, influencing decisions on patient follow-up and assessing likely prognosis and survival. Furthermore, pathological assessment is being increasingly used as a tool to make judgements on the quality of colorectal cancer surgery. Sadly, the task of dissecting the gross specimen has been seen as an unwanted and less than skilful chore and has, in the past, been the task of the most junior member of staff, who is often ill prepared and untrained for such an important role. The past few years have seen a dramatic change in this practice, in the UK and many Western European countries, such that it is now accepted that no amount of sophisticated microscopic analysis can redeem a case that has not been dissected and sampled for histology appropriately. The introduction of Royal College of Pathologists (RCPath) minimum datasets and protocols, for the accurate pathological assessment of specimens, has done much to improve the situation. However, although pathologists can now diligently record all pathological data of importance as part of such datasets, question marks still remain about the overall quality of such data. For instance, there are now compelling data to indicate the importance of adequate lymph node harvests. Yet recent audits have still demonstrated that lymph node harvests remain low in some centres, and this has an important influence on management decisions for individual patients. In this treatise, we discuss optimal macroscopic assessment practice for colorectal cancer resections and also consider the changes in the newly updated Royal College of Pathologists colorectal cancer minimum dataset and proforma.

The investigation of a case of sudden unexpected death in infancy (SUDI) is a multidisciplinary process requiring a death scene investigation, a review of the relevant clinical history and a detailed autopsy examination. Autopsy examinations should be performed by pathologists with experience in paediatric pathology and follow a detailed protocol with specific ancillary investigations including skeletal radiology, a full histological examination of all major organs and microbiological, biochemical and metabolic studies. On completion of all the investigations, the final autopsy findings should be discussed at a multidisciplinary case review involving paediatric and primary care input. It is essential that the family of the deceased infant are supported by the local SUDI paediatrician throughout the investigation and that they are kept fully informed of progress and the final conclusion, which should be determined after completion of the case review.

Malformations of the lung are an important cause of morbidity and mortality, particularly in the neonatal period, and are a common finding at perinatal post-mortem examinations. This review relates the malformations to the underlying developmental processes and highlights recent literature.

Renal tumours in early life are not frequent, and they differ significantly in incidence from those seen later in childhood. Therefore, the patient's age may be a very useful clue in reaching an accurate diagnosis of renal tumours, which is critical for administering the most appropriate treatment as some of these tumours are cured only by complete surgical resection. The most common renal tumours in early life include mesoblastic nephroma, Wilms’ tumour, rhabdoid tumour of the kidney and clear cell sarcoma of the kidney, whereas metanephric stromal tumours and ossifying renal tumour of infancy are very rare. This review presents the main clinicopathological features of these tumours.