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1.
Hum Pathol ; 29(12): 1367-71, 1998 Dec.
Article in English | MEDLINE | ID: mdl-9865821

ABSTRACT

Neuroendocrine tumors occur in many sites of the body and can present significant diagnostic problems when poorly differentiated. To identify a tumor as neuroendocrine, pathologists commonly use either immunocytochemistry or electron microscopy. In this report, the various immunocytochemical reagents are reviewed along with the ultrastructural features of neuroendocrine tumors. Site-specific variations in neuroendocrine tumors are discussed. A cost-effectiveness evaluation was performed on tumors from one laboratory which showed that electron microscopy was a less expensive diagnostic modality if more than three antibodies were necessary to arrive at the correct pathological diagnosis.


Subject(s)
Carcinoma, Neuroendocrine/diagnosis , Immunohistochemistry , Microscopy, Electron , Neoplasms/diagnosis , Antibodies, Neoplasm/analysis , Biomarkers, Tumor/metabolism , Carcinoma, Neuroendocrine/metabolism , Carcinoma, Neuroendocrine/ultrastructure , Diagnosis, Differential , Humans , Immunohistochemistry/economics , Male , Microscopy, Electron/economics , Neoplasms/metabolism , Neoplasms/ultrastructure
2.
Arch Pathol Lab Med ; 121(11): 1171-5, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9372744

ABSTRACT

OBJECTIVE: Breast cancer reports form an important part of the basis of clinical decision making for patients. Our objectives were to improve breast cancer reporting in the Urban Central Region in Utah of Intermountain Health Care in a clinically relevant manner and to show that the method chosen actually improved information transfer among physicians of breast cancer patients and led to durable changes in pathologist behavior. METHODS/INTERVENTION: Pathologists designed a synoptic report based on interviews with oncologists about what data were meaningful. The report format was piloted with one hospital pathology group, modified, and implemented in three hospitals. A report evaluation of missing information was done before, immediately after, and 2 years after the intervention. Oncologists were surveyed after 2 years to evaluate satisfaction with report format. RESULTS: Changing breast cancer reporting to a synoptic format significantly decreased information missing from pathology reports. Prior to implementation, 32 of 365 reports lacked some item(s) of pathology information desirable to clinicians; after the intervention, 8 of 250 reports contained missing information. After 2 years, 1 in 190 reports contained missing data elements. Synoptic breast cancer reports continued to be used by pathologists throughout the reporting period. Oncologists responding to a survey reported uniform satisfaction with the new reporting format. SUMMARY: Pathologists are important members of the clinical oncology team. They provide patient-specific information crucial to patient care. Activities designed to improve the quality of reporting processes should use clinically relevant indicators of process improvement, such as measurement of missing information and satisfaction of clinical colleagues with format/quality of information.


Subject(s)
Breast Neoplasms/pathology , Medical Records, Problem-Oriented , Outcome Assessment, Health Care/methods , Pathology, Clinical/methods , Data Collection , Humans , Outcome Assessment, Health Care/standards , Pathology, Clinical/standards , Practice Patterns, Physicians' , Registries
4.
Ultrastruct Pathol ; 15(4-5): 419-38, 1991.
Article in English | MEDLINE | ID: mdl-1755103

ABSTRACT

Thymoma is the most common tumor of the anterior-superior mediastinum, especially in middle-aged or older adults. Microscopically, thymomas can be differentiated from other tumors with which they can be confused by the finding of a mixed population of cells, including neoplastic thymic epithelial cells with numerous processes surrounding activated-appearing lymphocytes. Thymomas can be classified as benign or malignant, and the majority of those that are malignant appear cytologically benign and are locally invasive. Cytologically benign thymomas have been classified as being lymphocyte rich, epithelial cell rich, or spindle cell type. This classification has not been found to be prognostically useful. A new method classifies these tumors as being cortical, medullary, or mixed. This new classification appears to have prognostic significance. Malignant thymomas that are cytologically malignant are uncommon. Such tumors usually are squamous cell carcinomas. Other types include sarcomatoid carcinoma, clear cell carcinoma, basaloid carcinoma, and mucoepidermoid carcinoma. Because other tumors can occur in the anterior mediastinum, electron microscopy and/or immunocytochemistry is helpful in making the distinction. The differential features by ultrastructural and immunocytochemical analysis are reviewed.


Subject(s)
Thymoma/diagnosis , Thymus Neoplasms/diagnosis , Humans , Microscopy, Electron , Thymoma/pathology , Thymoma/ultrastructure , Thymus Neoplasms/pathology , Thymus Neoplasms/ultrastructure
5.
Ultrastruct Pathol ; 15(4-5): 503-7, 1991.
Article in English | MEDLINE | ID: mdl-1755108

ABSTRACT

The report describes a malignant gastrointestinal stromal tumor occurring in the duodenum in a 71-year-old woman. The neoplasm showed both epithelioid and spindle cell patterns by light microscopy. The ultrastructural features were diagnostic of nerve sheath origin. The tumor had numerous wrapping processes joined by junctions and surrounded by axons. No features of smooth muscle differentiation were identified. Immunocytochemistry was inconclusive. The differential diagnosis of such neoplasms is discussed.


Subject(s)
Duodenal Neoplasms/pathology , Aged , Cell Nucleus/chemistry , Cell Nucleus/ultrastructure , Diagnosis, Differential , Duodenal Neoplasms/diagnosis , Duodenal Neoplasms/ultrastructure , Duodenum/chemistry , Duodenum/pathology , Duodenum/ultrastructure , Female , Humans , Immunohistochemistry , Microscopy, Electron , S100 Proteins/analysis , Tomography, X-Ray Computed
6.
Diagn Cytopathol ; 7(2): 150-4, 1991.
Article in English | MEDLINE | ID: mdl-2065569

ABSTRACT

Thyrolipoma, or adenolipoma of the thyroid gland, is an uncommon neoplasm and thus not recognized by many cytopathologists. This is the first article to describe the fine-needle aspirate findings of a histologically confirmed thyrolipoma. The gross morphologic and computerized tomographic features of this entity are also discussed, and the literature is reviewed.


Subject(s)
Lipoma/pathology , Thyroid Neoplasms/pathology , Aged , Biopsy, Needle , Humans , Lipoma/diagnosis , Male , Thyroid Neoplasms/diagnosis
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