ABSTRACT
Eosinophilic fasciitis (EF) is a rare scleroderma-like syndrome. There has been no previous published report of EF in a Thai patient. We described a 41 year-old Thai man who presented with symmetric induration of the skin of forearms, arms, hands, fingers, lower aspects of the legs, and feet. Physical examination revealed bilateral symmetrical woody induration of the skin with peau d’orange appearance. A groove sign was positive on the flexural surface of both arms. Laboratory testing revealed a peripheral eosinophil count of 54%. The skin and superficial fascia biopsy specimen from the inner aspect of the left forearm was consistent with EF. He was treated with prednisolone, methotrexate, and colchicine. He experienced a gradual improvement within 4 months. A history of acute onset of scleroderma-like syndrome and careful physical examination can lead us to the diagnosis of EF.
ABSTRACT
Objective: The Modified Gleason Grading System was proposed by the 2005 International Society of Urological Pathology (ISUP) Consensus Conference. In Thailand, prostatic biopsies are mostly diagnosed by general pathologists. The accuracy of the Gleason grading on prostatic biopsies is still questioned. We assessed the accuracy of modified Gleason Grading on prostatic biopsies and detected pitfalls in the grading. Methods: Sixty-nine cases of prostatic biopsies which diagnosed adenocarcinoma were re-examined according to the modified Gleason grading system by an experienced pathologist, four general pathologists and two pathology residents. Results: The accuracy of modified Gleason scores on prostatic biopsies ranged from 79.7% to 98.6% with 68.3 to 100 of 95% CI. Most biopsies with more than one score of difference were missed from Gleason pattern 5. Gleason pattern 5 was found in 25 biopsies. Percents of Gleason pattern 5 were classified into <5% (12 biopsies), 5-10% (6 biopsies), 11-50% (5 biopsies), and >50% (3 biopsies) of the tumor volume. The mean of the number of the observers who fail to detect Gleason pattern 5 in each category was 4 (SD 1.2), 3.6 (SD 1.8), 1.3 (SD 0.95), and 0.33 (SD 0.5), respectively. We found a small amount of Gleason pattern 5 was significantly missed (p = 0.01). Conclusion: The accuracy of Gleason grading on prostate biopsies among general pathologists and pathology residents in this study was fairly good. The missed Gleason pattern 5 is the most common pitfall. Pathologists should be aware of Gleason pattern 5 because it might be present in a prostate biopsy of less than 5 % of the tumor volume.
ABSTRACT
Objective: The incidence of prostatic adenocarcinoma in Thailand has been increasing since 1989. Increased public awareness may have contributed to early detection of the disease. Findings of abnormal digital examination, elevated serum prostate-specific antigen (PSA) level and abnormal transrectal ultrasonography (TRUS) lead to more multiple core biopsies. The Gleason grading system is the most common histologic grading of prostate carcinoma as approved by the World Health Organization. The Gleason score, one of the prognostic predictors, thus plays an important part in the therapeutic decision. The correlation between Gleason scores in biopsies and subsequent prostatectomy specimens is the main purpose of this study. Associations of Gleason scores with organ confinement, perineural invasion and serum PSA levels before prostatectomy were also studied. Methods: The specimens from 100 patients, who underwent TRUS core biopsy and subsequent prostatectomy between January 2001 and June 2004, were included. Results: Gleason grade concordance was found in 35 cases. In TRUS core biopsy, 35, 9, and 1 cases were 1, 2, and 3 scores undergraded, respectively. Thirteen and 7 cases were 1 and 2 scores overgraded, respectively. Eighty three percent show a difference of not more than 1 score. Conclusion: We concluded that the Gleason scoring in prostatic biopsy remains a good predictor of the final Gleason grading of the radical prostatectomy specimen. However, the urologists and radiotherapists should keep in mind that undergrading and overgrading in TRUS core biopsies are both possible.
ABSTRACT
BACKGROUND: Although the WHO classification (2001) requires a great deal of morphologic, immunophenotypic, genetic, and clinical features for classifying lymphomas, it is still feasible to misdiagnose under limited resources, especially a limited panel of antibodies used for immunophenotyping. To identify pitfalls in classifying lymphomas among hematopathologist, general pathologists, and pathology residents under this situation. MATERIAL AND METHOD: Newly diagnosed lymphoma cases from 1 July 2002 to 30 June 2003 at Siriraj Hospital were included for two rounds of individually blinded review by a hematopathologist, two general pathologists, and three pathology residents. Final diagnoses were given by consensus. Pitfalls were determined from misdiagnosis, in each case analyzed in terms of frequency. RESULTS: One hundred and four lymphoma cases included 61 diffuse large B-cell lymphoma (DLBCL, 58.6%), 12 MALT lymphoma (11.5%), eight follicular lymphoma (FL, 7.7%), seven classical Hodgkin lymphoma (HL, 6.7%), four unspecified peripheral T-cell lymphoma (PTCL, 3.8%), three Burkitt lymphoma (BL, 2.9%), two subcutaneous panniculitis-like T-cell lymphoma (SPTCL, 1.9%), and seven other uncommon types (1% each). Pitfalls were low infrequency on diagnosis of DLBCL, nodular sclerosis HL, and SPTCL (8% each), but not different among the participants only in DLBCL. Pitfalls in diagnosis of MALT lymphoma, mixed cellularity HL, BL, unspecified PTCL, and FL were 60%, 50%, 33%, 29%, and 24%, respectively. However, considering hematopathologist and non-hematopathologist groups, pitfalls in the former were lower, especially in the uncommon types of lymphoma. CONCLUSION: Pitfalls in classifying lymphomas are common. Interest in hematopathology reduces misdiagnosis in lymphomas other than DLBCL.