Gleason's Grading of Prostatic Adenocarcinoma: Inter-Observer Variation Among Seven Pathologists at a Tertiary Care Center in Oman

Prostatic adenocarcinoma is the commonest solid malignancy seen in Omani elderly males 60-80 years of age. The Gleason grade is the most widely used grading system for prostatic carcinoma and is recommended by the World Health Organization. A peer review was carried out at the Pathology Department of Sultan Qaboos University Hospital (SQUH), Oman, to assess the quality of reporting at the center. The aim of this study was to determine inter-observer variation among 7 pathologists working at a tertiary care center in Oman. A total of 47 consecutive prostatic biopsies were interdependently reviewed by seven pathologists and the results obtained were compared with each other and the original diagnosis. This peer review indicated a fair inter-observer agreement (0.482) among 7 pathologists in the department, with fair to moderate agreement when the results were compared to the reported diagnosis, comparable to the published literature. Dual and sub-specialty reporting are being instituted to improve the performance in this vital aspect of pathology.

Histomorphological Spectrum of Papillary Carcinoma of Thyroid in Oman.

Thyroid cancer is the commonest endocrine malignancy and is the second most common cancer affecting young females in Oman. The diagnosis of Papillary Thyroid Carcinoma (PTC) is based primarily on histologic architecture and nuclear morphology in routine Haematoxilin and Eosin (H & E) stained slides. Whenever in doubt, immunohistochemistry may be helpful. This retrospective study included 115 cases of PTC diagnosed at a tertiary care center in Oman over 10 years period, from 2001 to 2010. Slides and blocks of these cases were retrieved from the pathology laboratory. Ninety five (95) were females and 20 were males. Papillary Thyroid Carcinoma (PTC) was most commonly seen in the 20 - 50 years of age. The commonest morphologic variant seen in this population was classical papillary variant in 44/115 (38%) followed by papillary micro-carcinoma (n=30/115, 26%) and follicular variant of papillary carcinoma (n=18/115, 15.6%). Out of the 30 micro-carcinoma cases, 18 were diagnosed incidentally in thyroids operated for multi-nodular goiter. Immunohistochemical marker CK-19 was positive in 29/31, HBME-1 and HMW-CK in 15/15 cases; CEA was in one case where it was reported negative. Immunohistochemical stains were useful in cases with atypical /doubtful morphology.

Inter-observer agreement in reporting HER 2 Neu protein over expression by immunohistochemistry.

INTRODUCTION: HER 2 Neu protein overexpression and its detection by immunohistochemistry (IHC) has become quiet critical because of its relevance in regards to Herceptin treatment. This peer review was done at a tertiary care center, which aimed at determining the inter-observer variation among five pathologists and evaluating the degree of agreement between them. AIMS: The aim of our study was to determine the reproducibility of HER 2 Neu system of reporting in breast cancer cases and determine inter-observer variability among five pathologists at a tertiary care center. To compare the results with similar studies done at other centers. SETTINGS AND DESIGN: Retrospective descriptive study. MATERIALS AND METHODS: Hematoxylin and Eosin (H and E) and IHC stained slides of 104 cases of carcinoma breast, on which HER 2 Neu status had been reported were reviewed. The time period for selection was from January 2010 to December 2011 (2 year period). Five pathologists reviewed the H and E and IHC slides independently and scored the results on a specially designed work sheet. Kappa values for inter-observer variation and Cornbach's alpha for internal consistency were calculated. STATISTICAL ANALYSIS USED: SPSS 20.0 (IBM). not known. RESULTS: Complete agreement was seen between all five pathologists in 70 cases (70/104) = 67%. Agreement between four pathologists was seen in 78 cases (78/104) = 75%. Agreement between three pathologists was seen in 92 cases (92/104) = 88%. The global value for kappa co efficient for agreement between two pathologists was 0.706 and Cornbach alpha for internal consistency of reporting in the department was 0.987. CONCLUSION/KEY MESSAGES: Our departmental peer review indicated that there is good inter-observer concordance (agreement between two pathologists) and there is strong overall internal consistency of reporting for HER 2 Neu reporting by IHC. Our results are comparable to International reported data of similar studies.

Malignant neuroendocrine tumour of the gallbladder with elevated carcinoembryonic antigen: case report and literature review.

A 58-year-old woman presented to a tertiary care centre with signs and symptoms of acute cholecystitis, cholelithiasis and diagnoses of a high-grade neuroendocrine tumour of the gallbladder primarily with peritoneal and liver metastases. She had a liver abscess secondary to Salmonella and Enterococcus fecalis that was drained and treated with appropriate antibiotics. Interestingly, the serum chromogranin A levels were within normal limits, but carcinoembryonic antigen was elevated, which helped evaluate responses and pick progression. She was treated with 10 cycles of palliative chemotherapy when malignancy associated complications started to recur, that is, cholangitis, worsening pain, cachexia, intestinal obstruction, etc leading to chemotherapy delays. Her disease progressed during these times with rapid deterioration of performance status. She died of septic complications postlaparotomy for intestinal obstruction. Her progression-free survival remained for 8 months with subjective and objective improvements, and her overall survival remained at 13 months. We describe the course of her illness and give a brief review of the literature.