Calcinose idiopática escrotal: uma inabitual desordem de pele / Idiopathic scrotal calcinosis: an unusual skin disorder

A calcinose escrotal idiopática é uma entidade rara, benigna. Não costuma ter outros sintomas associados. O caso reportado se trata de um paciente de 30 anos com diversos nódulos calcificados em bolsa escrotal, com 15 anos de evolução. Como medida terapêutica, foi realizada excisão cirúrgica completa dos nódulos, apresentando boa evolução cirúrgica e resultados estético e funcional satisfatórios.

Idiopathic scrotal calcinosis is a rare benign entity. Patients affected by scrotal calcinosis usually do not have other associated symptoms. We report the case of a 30-yearold man with several calcified nodules in the scrotal sac with onset at age 15 years. A complete surgical excision of the nodules was performed, and the patient recovered well with satisfactory aesthetic and functional results.

Comparing touch imprint cytology, frozen section analysis, and cytokeratin immunostaining for intraoperative evaluation of axillary sentinel lymph nodes in breast cancer.

Background: Sentinel lymph node (SLN) biopsy has been applied to the management of breast carcinoma inorder to decrease postoperative complication and morbidity. Touch imprint cytology (TIC), frozen section (FS), scrape cytology, or combination of these methods are used as intraoperative diagnostic methods. However, the sensitivity of these intraoperative modalities for detecting metastatic disease in SLNs is not equivalent to permanent histopathologic examination as a gold standard method. Objectives: The aim of this study was to review our department's results with SLN biopsy using touch imprint and frozen section for intraoperative diagnosis of breast cancer metastasis. Immunohistochemistry for cytokeratin was used on permanent sections. The sensitivities and specificities of TIC with those of FS analysis and IHC were also compared. Materials and Methods: A total of 100 consecutive SLN biopsies from 49 patients performed. The TIC and subsequently frozen were stained using hematoxylin and eosin. The cytological and frozen findings were compared and results were reported to the surgeon during operation. Final pathologic evaluation was performed on the formalin-fixed, paraffin-embedded tissue sections. Analysis of the permanent tissue included evaluation of three-step sections of the lymph node by H&E and immunohistochemical (IHC) staining. The sensitivities, specificities, positive and negative predictive values of TIC, FS and IHC for the detection of metastatic tumor in the SLNs were determined with the corresponding 95% confidence intervals (CIs). Results: One hundred SLNs were examined from 49 patients with invasive breast carcinoma with mean age of 45.29 ° 10.6 years. Intraoperative TIC and FS failed to show metastatic involvement in 10 examined lymph nodes from three patients. No false positive results for TIC and FS was identified. The sensitivity of TIC compared with the final histopathological result, considered the gold standard, was 90% (CI, 68.49-98.81%). Similarly, the sensitivities of frozen sections and permanent were the same respectively. The specificities of TIC, FS, and permanent were 100% (CI, 94.95-100.00). The sensitivity of touch imprint cytology compared with the final histopathological result, considered the gold standard, was 90% (CI, 68.49--98.81%). Similarly, the sensitivities of frozen sections and permanent were the same respectively. The specificities of TIC, FS, and permanent were 100% (CI, 94.95-100.00). Conclusions: Our experience with TI and FS for the intraoperative evaluation of SLNs is similar to the findings from previously reported studies. We detected the same sensitivities for these two methods; however lower sensitivity of TI in detecting metastasis with higher false-negative rate has been addressed in the published literature. The 90% sensitivity of TI and FS with permanent histopathologic examination as the gold standard falls within the range of reported sensitivities: 33-96% for TI and 44-100% for FS. However, variations in patient selection criteria, experience of the pathologist, skill of the technician submitting specimen for intraoperative evaluation, and tumor size are important variables that influence the results.

Study of parameters to ensure quality control in histopathology reporting: A meta-analysis at a tertiary care center.

Context : When surgical pathology reports are dispatched to patients and clinicians, sometimes they are discovered to have errors, and it is a common practice for the pathologists to issue amended reports. Measuring the rate at which surgical pathology reports are amended can be used as a tool for assuring quality control in histopathology. Aim : The aim of this study was determine the parameters that can be used as an assessment tool to minimize errors in histopathology. Materials and Methods : This study was carried out at a major histopathology center. The duration of this study was from January 2001 through January 2011(ten years). Following parameters were looked for: Interpretational errors, permanent and frozen section correlation, intradepartmental consultation and cases sent for second opinion, cases brought in tissue committee meetings, audits, and cases discussed in hospital meetings. Results : A total of 28,1931 surgical pathology cases were signed out during the ten-year period. On these, addendums were issued on 5730 cases (2.0%). Additional report issued on 3521 (1.3%). Addendum/corrected report issued for 2209 cases, which was 0.7%, representing the true interpretational error. And out of this number, a second opinion was taken for 5980 cases, and 78 were sent abroad for second opinion. Conclusion : Review by a second pathologist is a strong tool to minimize errors in surgical pathology reporting. This may be done prior to or after the report is dispatched and the case is discussed in the hospital for treatment purposes. This analysis concludes that true interpretational error occurred only in 0.7% of cases, which is an attribute to the strong peer review in the department.

In search of the rainbow: Colored inks in surgical pathology.

Introduction: Although surgical pathologists are aware of the multiple advantages that coloured inks contribute to surgical pathology practice, these coloured inks are not available in India and importing them is not a viable proposition. A systematic search for locally available coloring agents was done, and resulted in identifying specific shades within a popular set of children's hobby colors of a particular brand. They retain their bright distinct colors on paraffin blocks and sections. These paints are available all over India, and are cheap, safe, and easy to use. Coloring gross specimen excision margins with different colors, adds precision to margin examination. It allows three-dimensional microscopic reconstruction of the tumor vis-a-vis its various neighboring anatomic structures. It allows postoperative comparison of tissue planes predicted by preoperative imaging. It maintains orientation of grossed and dissected specimens, enabling the pathologist to re-visit the grossed specimen, if required, and confidently allows further sampling if necessary. Aim: A systematic search for indigenous coloring agents was carried out, which included the dyes used in the histopathology laboratory, gelatin, commercially available paints, including acrylic paints and inks. Results: The study identified specific shades within a brand of acrylic colors that are easily available and simple to use, with good results on microscopic examination. Conclusion: Colored inks lend precision to margin examination. A set of easily procurable colors are available in our country, which are easy to use, with distinct bright colors, safe, and reliable.

Visión panorámica de la patología quirúrgica cardiovascular actual / Panoramic vision of the present cardiovascular surgical pathology

La evaluación de las biopsias cardiovasculares proporciona una visión panorámica actual sobre el avance de la cirugía y patología cardiovascular en nuestro país, especialmente en la Gran Caracas donde se concentran los mayores centros hospitalarios. Evaluar el material de patología quirúrgica cardiovascular y su relación con la situación médica y socioeconómica de nuestro medio. Se analizaron las biopsias cardiovasculares de los últimos 7 años (2001-2007) diagnosticados en la sección de patología cardiovascular del instituto Anatomopatológico (UCV). Se compararon con los 7 años anteriores (1994-2000). Se obtuvo las frecuencias del número total de las biopsias por año (2001-2007) y de los tipos de biopsias según su naturaleza. Se describió los protocolos del estudio anatomopatológico según el tipo de patología y los criterios de diagnóstico. Se demostró un aumento progresivo de las biopsias en los últimos 7 años (n =1550) vs. (n = 669). La distribución del material (2001-2007) según su naturaleza reveló: biopsias vasculares (51,0%), biopsias vasculares (35,0%), tumores cardíacos (5,0%) biopsia pericárdicas (4,0%) y las biopsias endomiocárdicas, congénitos y misceláneas (2,0% c/uno). Este trabajo proporcionó una visión panorámica de algunas enfermedades cardiovasculares quirúrgicas. Se comprobó un predominio de valvulopatías especialmente de las estenosis aórticas y valvulopatías reumáticas así como de los tumores cardíacos y un aumento importante de traumas vasculares por armas de fuego y blancas, así como descenso de las biopsias endomiocárdicas. Estas evidencias apuntan a algunos problemas de salud en relación con la situación socioeconómica de nuestro medio.

The evaluation of the material of cardiovascular biopsies provides a present panoramic vision on the advance of the surgery and cardiovascular pathology in our country, specially in the Great Caracas where the greater centers hospitals are concentrated in which this surgical subspecialty works. It is to evaluate the material of present cardiovascular surgical pathology and its relation with the medical and socioeconomic situation of our means. The annual information of the cardiovascular biopsies of last the 7 years (2001-2007) diagnosed in the Section of Cardiovascular Pathology of Institute of Pathology was analyzed (UCV). They were compared with the numbers of the 7 previous years. (1994-2000). One obtained the frequencies of the total number of the biopsies per year (2001-2007) and of the types of biopsies according to his nature. The protocols of the pathologic study of the material were described according to the type of pathology and the criteria talked about of the diagnostic. One in the last demonstrated to a progressive increase of the biopsies 7 years (n = 1550). The distribution of the material according to its nature revealed: valvular biopsies (51,0%), vascular biopsies (35,0%), cardiac' tumours (5,0%) Pericardial biopsies (4,0%) and the endomycardial biopsies, congenital and miscellaneous material (2,0% c/one). This work provided a panoramic vision of some surgical cardiovascular diseases. A predominance of valvulopathy of the aortic stenosis and rheumatic valvulopathy was verified especially as well as of cardiovascular tumours. A real reduction of the endomiocardicas biopsies was observed and an important increase of injuries you will tilt by gunshot wound and white. These evidences indicate to some problems of health in relation to our socioeconomic situation.

Correlation of intra-operative frozen section consultation with the final diagnosis at a referral center in Karachi, Pakistan.

BACKGROUND: The correlation of intra-operative frozen section diagnosis with final diagnosis on permanent sections is an integral part of quality assurance in surgical pathology laboratories. However, there is scant data on this topic from Pakistan. Similarly, no local study has looked at frozen section turnaround times. AIMS AND OBJECTIVES: To analyze indications, discrepancies and deferrals for all frozen sections performed or received at our institution over a 1-year period and to determine the turnaround time for frozen section diagnoses in our cases. DESIGN: A retrospective study, was undertaken, of all frozen sections reported at our institution between 1 st January 2006 and 31 st December 2006. The records of these cases were reviewed. The number and types of discrepancies, including sampling and interpretation errors were determined. The deferred cases and causes for deferral were also determined. The turnaround times of all cases were recorded. Agreement rates were calculated as percent agreement, sensitivity/specificity and positive and negative predictive values. RESULTS: A total of 356 specimens were received. Out of these, 14 cases (3.93%) were deferred to permanent sections. Of the remaining 342 cases, the discordant diagnostic frequency was 2.92% while the concordant diagnostic frequency was 97.08%. The most common pathological processes encountered were presence/typing of neoplasm (51.12%) and assessment of surgical margins (27.53%). The average turn-around time for frozen section diagnosis was 23 minutes; 60% of the cases were reported in 20 minutes or less. CONCLUSIONS: The accuracy of frozen section diagnosis at AKUH pathology department can be interpreted as comparable with most international quality control statistics for frozen sections. The overall error and deferral rates are within the range of previously published errors in pathology. Deferrals and errors in some sub-specialties were higher than in others. The results suggest specific measures should be taken to reduce the number of discrepancies. The overall goal is to reduce errors, reduce the number of deferrals and improve frozen section diagnosis turnaround times.

Calidad del manejo de las muestras quirúrgicas enviadas al departamento de patología del HEODRA durante los años 2005 al 2007 / Quality of the handling of the samples surgical correspondents to the department of pathology of the HEODRA during the years 2005 at the 2007

Se realizó investigación para conocer los principales problemas en el manejo de las muestras quirúrgicas que son enviadas al Departamento de patología del HEODRA, determinar los niveles de conocimientos en manejo de muestras quirúrgicas del personal involucrado en a misma y realizar intervenciones para controlar los errores encontrados. Se diseñó en tres fases, la primera correspondió al diagnóstico inicial a través de encuesta de calidad de manejo de las biopsias que son enviadas al Departamento de Patología y encuesta de conocimientos al personas que realiza el manejo de dichas muestras, en la segunda fase se realizaron intervenciones mediante charlas y distribución de material didáctico impreso para disminuir los errores encontrados, posteriormente, en la última fase se volvieron a realizar encuestas de calidad de manejo de biopsias así como de conocimientos del mismo personal encuestado en la primera tase. Se encontraron deficiencias en el manejo de las muestras tales como falta de datos en las hojas de solicitud de biopsias, volúmenes inadecuados de liquido fijador en las muestras, capacidad inferior y boca inadecuada en los frascos que transportan la muestra, tapas sin cierre hermético y falta de concordancia entre los datos de la solicitud y la muestra recibida, todas estas deficiencias disminuyeron después de la intervención. Inicialmente los trabajadores encuestados respondieron de forma adecuada aproximadamente un tercio de las preguntas, al finalizar este trabajo cerca de las tres cuartas partes de las respuestas fueron correctas. Se concluye que se encontraron errores en el manejo de las muestras quirúrgicas y en los conocimientos básicos referentes al tema, pero después de la intervención estas deficiencias disminuyeron notablemente...

Immunohistochemistry in surgical pathology practice: a current perspective of a simple, powerful, yet complex, tool.

Immunohistochemistry (IHC) is a powerful tool in the surgical pathologists' armamentarium. The requests for IHC and the list of monoclonal antibodies have increased tremendously in the past decade. Issues concerning technical reproducibility, uniformity of interpretation, inter-laboratory comparability, and quality assurance are assuming greater importance due to the increased availability of IHC and its impact on diagnosis and therapy. An attempt has been made to give a current perspective of this simple and yet, in some aspects, a complex tool.

Uso prático da imuno-histoquímica em patologia cirúrgica / Practical use of immunohistochemistry in surgical pathology

OBJETIVO: avaliar o motivo para indicação e analisar o grau de auxílio da imuno-histoquímica (IHQ) para o diagnóstico de neoplasias e lesões pseudoneoplásicas. MATERIAL E MÉTODO: avaliação retrospectiva observacional e descritiva de 4.459 casos submetidos a análise no laboratório de IHQ do Departamento de Patologia do Jackson Memorial Hospital, Universidade de Miami, Estados Unidos, em 1999. RESULTADOS: 3.706 casos possuíam dados suficientes para o desenvolvimento dos objetivos propostos. Em 19 por cento dos casos a IHQ foi utilizada para determinar fatores prognósticos ou índices proliferativos; em 17 por cento dos casos teve como objetivo identificar microrganismos, células, estruturas ou materiais; e em 64 por cento dos casos teve aplicação diagnóstica propriamente dita. Em 835 casos desta última categoria a IHQ contribuiu para um diagnóstico específico em 83 por cento das vezes e diminuiu o número de diagnósticos diferenciais em 12 por cento. Em 5 por cento das vezes a IHQ não auxiliou o patologista devido a exigüidade de algumas amostras, presença de necrose extensa ou indiferenciação extrema de algumas neoplasias. Os principais problemas de diagnóstico diferencial para os quais a IHQ foi utilizada foram: determinar o local de origem de carcinomas e adenocarcinomas e diferenciar entre hiperplasia mesotelial reacional, mesotelioma e adenocarcinoma, entre outros. Foram utilizados 4,1 anticorpos por caso, em média. CONCLUSÕES: Quando bem indicada e aplicada, a imuno-histoquímica é um método diagnóstico complementar útil em 95 por cento dos casos e muitas vezes contribui fundamentalmente para as condutas cirúrgica e terapêutica. Amostras muito exíguas ou necróticas e neoplasias extremamente indiferenciadas são situações que comprometem o exame imuno-histoquímico e seus resultados. Quando utilizada de maneira direcionada aos principais diagnósticos diferenciais, a técnica apresenta uma relação custo/benefício alta.

Frecuencia de la patología quirúrgica tiroidea / Frequency of the thyroid pathology

Introducción: Una pieza importante en el diagnóstico, tratamiento, pronóstico y prevención de la patología quirúrgica tiroidea es conocer la frecuencia de la misma. Objetivo: Determinar la frecuencia actual de la patología quirúrgica tiroidea. Material y métodos: Estudio descriptivo, transversal no comparativo en 1,038 pacientes intervenidos quirúrgicamente por patología tiroidea de 1992 a 1996. Fueron recopilados los siguientes datos: diagnóstico histopatológico (variable dependiente), así como sexo, edad y presentación clínica (variables independientes); los cuales fueron analizados por medidas de tendencia central. Resultados: El predomino del sexo femenino fue de 15:1 y edad promedio de 39.9 años. El cáncer representó el 20.1 por ciento, siendo el más frecuente el papilar (85.2 por ciento), seguido por el medular (6.7 por ciento). El bocio eutiroideo representó el 39.1 por ciento, siendo el nodular el más común 87.1 por ciento. Los adenomas representaron el 6.2 por ciento, el más frecuente folicular (86 por ciento). Los padecimientos autoinmunes que requirieron cirugía para diagnóstico y tratamiento representaron el 34.6 por ciento. La presentación clínica más frecuente fue el nódulo tiroideo con 60.7 por ciento y, de éstos, el cáncer representó el 33 por ciento. Conclusiones: 1) El predomino femenino se ha incrementado. 2) La presentación clínica más frecuente es nódulo tiroideo. 3) La frecuencia de cáncer en nódulo tiroideo es de 33 por ciento. 4) El cáncer medular tiene un incremento en su frecuencia.

Angiostrongilose abdominal: patologia cirúrgica de importância regional / Abdominal angiostrongylosis: surgical pathology of reginal importance

Os autores revisaram 18.361 biópsias e peças cirúrgicas de patologia digestiva não-tumoral. Em 1.064 peças cirúrgicas do trato digestivo inferior foram observados 19 casos de angiostrongilose abdominal (AA). Relacionando estes casos com as intervenções cirúrgicas por complicações secundárias da doença de Crohn (DC), colite ulcerativa (CU) e tuberculose intestinal (TI), observou-se que a freqüência de AA em relação às patologias cirúrgicas citadas pode ser considerada como parasitose de importância cirúrgica regional

Estudio histopatológico en piezas de amigdalectomía y adenoidectomía: análisis costo-beneficio / Pathology examination of tonsillectomy and adenoidectomy material: cost-benefit analysis

Pocos estudios analizan la relación costo-beneficio del estudio patológico rutinario de las piezas producto de adenoidectomía y/o amigdalectomía. Objetivo: Determinar en que casos deberíamos pedir el estudio patológico, basados en síntomas y signos de cada paciente en particular, y determinar el beneficio del costo del estudio. Métodos: Estudiamos todos los pacientes en que se hizo adenoidectomía, amigdalectomía o ambas, efectuadas desde Enero 1, 1994 a Diciembre 31, 1998, investigando la causa de la indicación de la cirugía y el resultado patológico. Resultados: En 1161 archivos clínicos y patológicos, en 99.3 por ciento de ellos, el informe fue "hipertrofia reactiva o reticular". Seis casos (0.51 por ciento) se informaron como actinomicosis, en que la cirugía es tratamiento curativo. Dos casos (0.17 por ciento) se informaron como "linfomas"; en ambos casos se sospechó neoplasia desde la primera consulta. Conclusión: La investigación patológica de las amígdalas y los adenoides tiene costo-beneficio negativo, y está únicamente indicada en pacientes que la historia clínica orienta hacia una enfermedad neoplásica.

Análisis de factores de riesgo para morbilidad y mortalidad en pacientes mayores de 60 años, tratados por patología quirúrgica electiva y de urgencia / Analysis of risk factors for morbility and mortality in patients older than 60 years submitted to elective or emergency surgery

Objetivo: Evaluar en un grupo de pacientes de más de 60 años, sometidos a cirugía mayor, los factores de riesgo que pudieran incidir en la morbi-mortalidad. Diseño: Estudio retrolectivo, observacional y transversal. Sede: Departamento de cirugía general del hospital de Especialidades del Centro Médico Nacional de Occidente, del Instituto Mexicano del Seguro Social, Guadalajara, Jal. México. Pacientes y métodos: Revisión de expedientes clínicos de los pacientes de 60 años o más que fueron operados en forma electiva o urgente. Se evaluaron las sigueientes variables: Edad y sexo, tipo de cirugía, estado físico (clasificación de la ASA), estimación general del índice de riesgo cradiaco (clasificación de Goldman), estado nutricional apoyo nutricional, problemas médicos asociados, tiempo de ingreso a quirófano, condiciones hemodinámicas pre-operatorias y complicaciones post-operatorias (médicas y quirúrgicas), mortalidad. Análisis estadístico: Se usaron pruebas de Chi cuadrada, prueba exacta de Fisher de dos colas, riesgo relativo (RR) e intervalo de confianza (IC)al 95 por ciento. Resultados: Se encontró que: la cirugía de urgencia (P < 0.0001, RR 18.5 e IC 2.2-178), el retardo en el ingreso al quirófano (P < 0.01, RR 8.8 e IC 1.5-39.3), el riesgo anestésico (ASA) III, IV o V (P < 0.0001, RR 20 e IC 4-114), una clasificación de Goldman 3, 4 ó 5 (P < 0.001, RR 9.6 e IC 2.1-46), la presencia de hipoalbuminemia (P < 0.05, RR 4.1 e IC 1.2-15), los procedimientos quirúrgicos prolongados (P < 0.05, RR 13.5 e IC 1.5-103) y la hemorragia (P < 0.001, RR 10 e IC 2.2-48) fueron los factores que afectaron directamente la morbilidad. Para mortalidad los factores identificados fueron: ASA (P < 0.01) Goldman (P < 0.01), hipoalbuminemia (P < 0.01) e hipotensión transoperatoria (P < 0.001, RR 25.0 e IC 2.8-122). La frecuencia de complicaciones fue del 58 por ciento y la mortalidad del 18 por ciento, siendo la causa más frecuente de ésta, la falla cardiopulmonar. Conclusión: Es necesario identificar, en los pacientes mayores de 60 años, aquellos factores de riesgo susceptibles de corrección preoperatoria; en los pacientes con cuadros agudos, asumir su presencia y evitar tiempos quirúrgicos prolongados y la hipotensión transoperatoria

Indicadores de riesgo de recidiva local en el tratamiento conservador del cáncer de mama / Risk indicators of local relapse in the conservative treatment of the breast cancer

Fueron evaluados los posibles factores de riesgo para recidiva mamaria en pacientes con estadio I y II de adenocarcinoma ductal invasor, sometidas a tratamiento conservador. Luego de un seguimiento promedio de 60 meses, se registraron 20 recidivas en 211 pacientes con tratamiento conservador. Sobre un total de 152 pacientes se realizó un análisis estadístico, uni y multivariado, para hallar los factores de significación respecto al riesgo de recidiva. Igual metodología de análisis fue implementada en pacientes pre y postmenopáusicas por separado. Se identificaron dos tipos de factores, aquellos asociados con la agresividad tumoral y los relacionados con la enfermedad residual. Tanto para pacientes premenopáusicas como postmenopáusicas, el factor de riesgo más significativo del primer tipo, fue la invasión vascular. Entre los factores asociados a enfermedad residual. Tanto para pacientes premenopáusicas como postmenopáusicas, el factor de riesgo más significativo del primer tipo, fue la invasión vascular. Entre los factores asociados a enfermedad residual, resultó significativo la presencia de componente intraductal extenso. Los bordes quirúrgicos comprometidos resultaron estadísticamente significativos sólo en pacientes postmenopáusicas.

Intraoperative frozen section consultation: an analysis of accuracy in a teaching hospital

This is a retrospective quality assurance study of all frozen sections done at The Aga Khan University Hospital during a six year period [1986 to 1991]. There were 1,031 frozen sections out of a cumulative total of 42,985 surgical specimens [2.39%]. Nine hundred and seventy-six [94.66%] were concordant. In 92 [8.9%] fresh specimens were brought from other hospitals of Karachi, in 37 cases [3.58%] the diagnosis was deferred till the evaluation of permanent paraffin sections and 18 [1.74%] were discordant with 7 [0.67%] false positive and 11 [1.06%] false negative. Among the discordant cases, 9 were attributed to misinterpretation, 7 due to sampling errors and 2 due to technical reasons. Some of these errors might have been avoided, but appear to be an irreducible minimum