An Assessment of Pathology Resident Access to and Use of Technology: A Nationwide Survey.

CONTEXT: - Current technologies including digital slide scanners and handheld devices can revolutionize clinical practice and pathology graduate medical education (GME). The extent to which these technologies are used in pathology GME is unknown. OBJECTIVES: - To determine the types of technologies used, usage amount, and how they are integrated into pathology residency/fellowship programs nationwide. DESIGN: - A 40-question online survey for residents/fellows was developed and administered via the Research Electronic Data Capture System after institutional review board approval. RESULTS: - Fifty-two program directors (37%) gave permission for participation. One-hundred seventy-one responses were received (18% response rate). Most respondents have access to personal technology (laptop = 78% [134 of 171]), smartphone = 81% [139 of 171], tablet = 49% [84 of 171]), and Web-based digital slide collections (82%, 141 of 171). Few residents are provided electronic devices by their programs (laptop = 22% [38 of 171], smartphone = 0.5% [1 of 171], and tablet = 12% [21 of 171]). Fifty-nine percent have access to digital slide scanners, 33% have access to a program-created database of digitized slides, and 52% use telepathology. Fifteen percent have access to asynchronous learning. Of those with access to video-recorded conferences, 89% review them. Program size was significantly positively correlated with resident access to program-provided laptops (P = .02) and tablets (P < .001), digital slide scanners (P = .01), and telepathology (P = .001). Of all devices, program-provided laptops are used most for professional work (60.5% use this device for more than 5 hours per day). CONCLUSIONS: - Most residents report access to multiple types of innovative technology, but incorporation of these tools within pathology training programs is highly variable. Opportunities for incorporating innovative technologies exist and could be further explored.

Improved detection of diffuse large B-cell lymphoma by flow cytometric immunophenotyping-Effect of tissue disaggregation method.

BACKGROUND: Flow cytometric immunophenotyping (FCI) is recognized as a rapid, sensitive, and accurate method for diagnosis of B-cell lymphomas. We observed that FCI failed to identify the clonal B-cell population in several cases of large B-cell lymphoma (DLBCL) when tissue samples were prepared by a commercially available mechanical tissue disaggregation method. We tested a manual tissue disaggregation method and compared it with the mechanical method. METHODS: FCI findings from 51 cases of DLBCL processed with the mechanical tissue disaggregation method, 27 cases processed using the manual method, and 15 cases processed using a combination of both methods were compared. The histological and immunohistochemical findings in each case were reviewed. RESULTS: FCI detected a clonal B-cell population in 88.9% of cases processed by the manual tissue disaggregation method, 66.7% of cases processed by a combination of the manual and mechanical disaggregation methods, and in 62.7% of cases processed solely by the mechanical tissue disaggregation method (P < 0.01 Fisher exact). Manual processing yielded positive FCI results in 81.8% of the nodal tissue samples and 93.8% of the extra-nodal tissue samples, whereas mechanical disaggregation was particularly inefficient in preserving large lymphoma cells from extra-nodal tissue: 71.4% of the nodal and 56.8% of the extra-nodal tissue samples processed by the mechanical method showed clonal B-cells by flow cytometry (P < 0.006, Fisher exact). CONCLUSIONS: The diagnostic yield of FCI in DLBCL can be significantly improved by utilizing a manual disaggregation method, particularly in extra-nodal tissue samples. © 2015 International Clinical Cytometry Society.

Macroscopic sertoli cell nodule: a study of 6 cases that presented as testicular masses.

Sertoli cell nodules are almost always incidental microscopic lesions found in both cryptorchid and normally descended testes. Sertoli cell nodules, when present as masses or ultrasonographic lesions, may create diagnostic confusion. Herein, we report 6 cases of macroscopic Sertoli cell nodules that were received in consultation. The referral diagnoses included Sertoli cell tumor (2 cases), sex cord tumor with annular tubules (1 case), and gonadoblastoma (1 case). The patients were 19 to 36 years old: 3 patients presented with palpable testicular masses and 3 with lesions that were worrisome for neoplasms in ultrasonographic examinations conducted for pain (2 cases) or infertility (1 case). All were phenotypically normal male patients who lacked endocrine symptoms. The Sertoli cell nodules ranged from 6 to 10 mm in diameter and on microscopic examination consisted of circumscribed proliferations of immature Sertoli cells, globules and trabeculae of basement membrane, and spermatogonia in varying proportions. In 2 cases the lesion was distinctly intratubular, consisting of closely packed tubules containing various components; in the other cases there was confluent growth of the tubules. Immunostains for α-inhibin highlighted the Sertoli cells (5 of 5 cases), with the germ cells appearing in negative relief. An antibody for testis-specific protein, Y-encoded (TSPY), stained the spermatogonia (2 of 2 cases), whereas OCT 3/4 was negative in all the cases (5 of 5 cases). We conclude that Sertoli cell nodules may present clinically as mass lesions, and that it is important to distinguish them from true neoplasms to avoid unnecessary procedures.