[Experiences with telepathology in northern Afghanistan : A 10-year success story]. / Erfahrungen mit Telepathologie in Nordafghanistan : Eine 10-jährige Erfolgsgeschichte.

Afghanistan is in a military conflict lasting more than 20 years and according to recent political development, in a downhill spiral towards a failed society. This scenario faces the question of the usefulness of international medical aid, especially morphological diagnostics in crisis situations. On the basis of ten years of experience from a telemedicine project, need, feasibility and results in Afghanistan will be discussed. General and country-specific problems and the sustainability of an international partnership are discussed. In summary our experience is: (1) Telemedicine is possible and necessary even in countries with high conflict potential. It is integrated into routine care by local medical care taker, (2) Accompanying video conferences are a significant improvement in telemedical diagnostics, (3) "High level" consultations can bridge the gap between sophisticated western diagnostics and medicine in the partner country in selected cases and (4) Scientific work is possible on the basis of the medical data collected on site and the image material generated.

Clinicopathological analysis of malignant pleural effusion cell masses from 105 cases / 中国基层医药

Objective:To analyze the pathological types, tissue sources and clinical features of malignant pleural effusion.Methods:Cell masses were collected from 105 cases of malignant pleural effusion diagnosed by immunohistochemical examination after liquid-based cytology between May 2017 and October 2019 in Qidong People's Hospital, China. The pathological, morphological, immunohistochemical and clinical characteristics of the cell masses were analyzed.Results:Immunohistochemistry results showed that pleural effusion malignant cells were from lung adenocarcinoma tissue in 94 (89.52%) cases because they were positive for thyroid transcription factor-1, Napsin A and carcinoembryonic antigen, from small cell lung cancer tissue in one (0.95%) case because they were positive for neural cell adhesion molecule 1 and synaptophysin,from lung squamous cell carcinoma tissue in 2 (1.90%) cases because they were positive for cytokeratin 5/6 and P40, from ovarian adenocarcinoma tissue in 1 (0.95%) case because they were positive for CA125, from breast adenocarcinoma tissue in 4 (3.81%) cases because they were positive for estrogen receptor, progesterone receptor and gross cystic disease fluid protein 15, from the gastrointestinal tract adenocarcinoma tissue in 2 (1.90%) case because they were positive for caudal-type homeobox 2, and from the pancreatic adenocarcinoma tissue in 1 (0.95%) case because they were positive for cancer antigen 19-9 (CA199).Conclusion:Lung adenocarcinoma is the most common cause of malignant pleural effusion. Lung adenocarcinoma cells are positive for thyroid transcription factor-1, Napsin A and carcinoembryonic antigen. The combined use of the three markers can help the diagnosis of lung adenocarcinoma. In addition, lung adenocarcinoma should be differentiated from other types of lung cancer and the tumors from other regions.

[A summary of 70 years' development of diagnostic techniques of ophthalmic pathology in China].

With the development of medical science, new techniques and methods of ophthalmic pathology are constantly emerging, which has greatly promoted the advancement of ophthalmology. The Chinese Journal of Ophthalmology has witnessed the growth of ophthalmic pathology in China since its founding 70 years ago. This article reviews the development of diagnostic techniques of ophthalmic pathology in China and speculates their future direction.（ Chin J Ophthalmol， 2020， 56: 641-645）.

Number of levels required to assess Breslow thickness in cutaneous invasive melanoma: An observational study.

BACKGROUND: Melanoma is a globally significant and highly prevalent disease, with Breslow thickness widely recognized as the most important histologic indicator of prognosis. In the newest edition of the AJCC Cancer Staging Manual, changes have been made to the definition of stages based on Breslow thickness. It is therefore imperative we accurately measure the Breslow thickness in a standardized fashion. METHODS: Our study aimed to identify the optimal number of levels required to measure Breslow thickness. We reviewed archived cases of previously diagnosed invasive melanomas and assessed whether there was a change of T stage with the greater number of levels examined. RESULTS: In our series of 54 cases, 10 (18.5%) cases were upgraded as additional levels were examined, statistically significant at the threshold of three levels. CONCLUSIONS: Our data suggests the optimal number of levels to examine is 3, with no benefit seen in further levels up to 10.

Diagnostic utility of immunohistochemical analysis and Epstein-Barr virus-encoded small RNAs in situ hybridisation of cell block sections obtained using fine-needle aspiration in nasopharyngeal carcinoma with lymph node metastasis.

OBJECTIVE: This study aimed to investigate the diagnostic utility of immunohistochemistry (IHC) analysis (FNA) and Epstein-Barr virus- (EBV) encoded small RNAs (EBERs) in situ hybridisation analyses of cell block (CB) sections obtained using fine needle aspiration in nasopharyngeal carcinoma (NPC) with lymph node metastasis. METHODS: A total of 38 FNA biopsies were collected using a Youyi aspirator. The cytomorphology, CB-based histomorphology, IHC, and EBERs in situ hybridisation were observed and the sensitivity/final diagnostic rates were compared with those of simple smears and a combination of smears and CBs. RESULTS: The 38 cases of metastatic lymph nodes from NPC displayed the morphological characteristics of non-keratinising carcinoma in cell smears and CB sections. The tumour cells showed high expression of CK5/6, P63, Ki-67, and EBERs (94.7%, 36/38 cases) in the CB sections. The sensitivity and the final diagnostic rates were lowest with the simple cell smears (86.8%, 33/38 and 71.1%, 27/38 cases), moderate with the smears combined with CB sections (92.1%, 35/38 cases and 81.6%, 31/38 cases), and the highest with IHC and EBERs in situ hybridisation (94.7%, 36/38 and 94.7%, 36/38 cases). CONCLUSIONS: FNA has great value in the diagnosis of NPC with lymph node metastases, and using cell smears combined with IHC and EBERs in situ hybridisation of CB sections could help clinical doctors promptly identify the primary lesions.

[Consistency of diagnosis between cervical cytology and colposcopic biopsy diagnosis].

Objective: To identify underlying reasons for discrepant cases of positive cytology but negative histology. Methods: Cases with positive cytology and negative histology from 2008 to 2016 were retrieved from Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University. Low grade squamous intraepithelial lesion or higher grade lesions were considered as positive cytology test in the study. Consecutive follow-up biopsies and as well as sites of biopsy were documented for analysis. Results: Overall positive rate of biopsy followed positive cytology was 74.3%(8 990/12 097). Of the negative biopsies, 675 cases were followed-up with multiple biopsy. Two-hundred and eighty-seven cases (42.5%, 287/675) were confirmed to have lesions. Comparing with those with initial positive biopsiews, patients of the latter group were significantly older and had other specimen types including vaginal biopsy, cone biopsy and hysterectomy. The final histological diagnoses were well correlated with cytological results (Kappa=0.505, P<0.01). Conclusions: Qualified cervical cytology is complimentary to histological diagnosis. Clinicians should not ignore the positive cytological result prior to a normal histological diagnosis. In contradictory cases, repeated colposcopy and biopsy at extended anatomic sites may reveal additional lesions.

The Relationship between Neurite Density Measured with Confocal Microscopy in a Cleared Mouse Brain and Metrics Obtained from Diffusion Tensor and Diffusion Kurtosis Imaging.

PURPOSE: Diffusional kurtosis imaging (DKI) enables sensitive measurement of tissue microstructure by quantifying the non-Gaussian diffusion of water. Although DKI is widely applied in many situations, histological correlation with DKI analysis is lacking. The purpose of this study was to determine the relationship between DKI metrics and neurite density measured using confocal microscopy of a cleared mouse brain. METHODS: One thy-1 yellow fluorescent protein 16 mouse was deeply anesthetized and perfusion fixation was performed. The brain was carefully dissected out and whole-brain MRI was performed using a 7T animal MRI system. DKI and diffusion tensor imaging (DTI) data were obtained. After the MRI scan, brain sections were prepared and then cleared using aminoalcohols (CUBIC). Confocal microscopy was performed using a two-photon confocal microscope with a laser. Forty-eight ROIs were set on the caudate putamen, seven ROIs on the anterior commissure, and seven ROIs on the ventral hippocampal commissure on the confocal microscopic image and a corresponding MR image. In each ROI, histological neurite density and the metrics of DKI and DTI were calculated. The correlations between diffusion metrics and neurite density were analyzed using Pearson correlation coefficient analysis. RESULTS: Mean kurtosis (MK) (P = 5.2 × 10-9, r = 0.73) and radial kurtosis (P = 2.3 × 10-9, r = 0.74) strongly correlated with neurite density in the caudate putamen. The correlation between fractional anisotropy (FA) and neurite density was moderate (P = 0.0030, r = 0.42). In the anterior commissure and the ventral hippocampal commissure, neurite density and FA are very strongly correlated (P = 1.3 × 10-5, r = 0.90). MK in these areas were very high value and showed no significant correlation (P = 0.48). CONCLUSION: DKI accurately reflected neurite density in the area with crossing fibers, potentially allowing evaluation of complex microstructures.

The study of the feasibility of detecting EGFR,KRAS and PIK3CA genes by ROSE cytological slides in non-small cell lung cancer / 天津医药

Objective To explore the feasibility of EGFR, KRAS and PIK3CA mutation analysis on rapid on-site evaluation (ROSE)cytological slides in patients with non-small cell lung cancer and its clinical value. Methods Seventy-five cases of ROSE cytological slides and paired histological specimens were collected in Tianjin Medical University General Hospital. xTAG70plex liquidchip technology was used to analyze the gene mutations of the samples.Results The KRAS mutation was found in histological specimen but not in ROSE cytological slides in one case. The mutation results were the same in histological specimen and ROSE cytological slides in other cases.The consistent rates of the EGFR mutation and KRAS mutation were 100% and 98.7%,respectively. Conclusion Our study demonstrates that xTAG70plex liquidchip technology can be used for the mutation analysis of EGFR,KRAS and PIK3CA genes in non-small cell lung cancer on ROSE cytological slides.

Consistency of diagnosis between cervical cytology and colposcopic biopsy diagnosis / 中华病理学杂志

Objective@#To identify underlying reasons for discrepant cases of positive cytology but negative histology.@*Methods@#Cases with positive cytology and negative histology from 2008 to 2016 were retrieved from Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University. Low grade squamous intraepithelial lesion or higher grade lesions were considered as positive cytology test in the study. Consecutive follow-up biopsies and as well as sites of biopsy were documented for analysis.@*Results@#Overall positive rate of biopsy followed positive cytology was 74.3%(8 990/12 097). Of the negative biopsies, 675 cases were followed-up with multiple biopsy. Two-hundred and eighty-seven cases (42.5%, 287/675) were confirmed to have lesions. Comparing with those with initial positive biopsiews, patients of the latter group were significantly older and had other specimen types including vaginal biopsy, cone biopsy and hysterectomy. The final histological diagnoses were well correlated with cytological results (Kappa=0.505, P<0.01).@*Conclusions@#Qualified cervical cytology is complimentary to histological diagnosis. Clinicians should not ignore the positive cytological result prior to a normal histological diagnosis. In contradictory cases, repeated colposcopy and biopsy at extended anatomic sites may reveal additional lesions.

Intranodal Palisaded Myofibroblastoma: Radiological and Cytological Overview.

BACKGROUND: Intranodal palisaded myofibroblastoma is a benign and very rare mesenchymal neoplasm of the lymph nodes originating from differentiated smooth muscle cells and myofibroblasts. CASE REPORT: We report a case of intranodal palisaded myofibroblastoma in an 84-year-old woman with Parkinson's disease that presented as a left inguinal mass. The diagnosis was made using ultrasound-guided fine needle aspiration biopsy and consequent cytopathological examination that included immunohistochemical analysis. Herein, we discuss the presentation of a rare intranodal palisaded myofibroblastoma with emphasis on its ultrasonographic and cytopathologic features. CONCLUSIONS: Intranodal palisaded myofibroblastoma should be considered in the differential diagnosis of inguinal lymphadenopathy and the diagnosis is possible with cytopathologic exam and immunohistochemical analysis using ultrasound-guided FNA biopsy, guiding the clinician to nodal excision rather than aggressive measures.

Clinicopathological study of thinprep cytologic test on 4234 patients with cervical lesion / 肿瘤研究与临床

Objective To estimate the clinical value of thinprep cytologic test (TCT) in screening cervical lesion. Methods 4234 TCT samples were interpreted according to the Besthesda System (TBS), 272positive cases (ASC-US or above) were taken colposcopic examination and biopsy. Results The coincidence of the results between TCT and biopsy in low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), squamous cell carcinoma (SCC), adenocarcinoma (AC) were 85.71%(12/14), 100 % (20/20), 75 % (3/4) and 100 % (2/2), respectively. The positive rates of over ASC-H by TCT and of over CIN Ⅰ by biopsy were 23.16 % (63/272) and 24.26 % (66/272), respectively. There is no difference between two positive rates (x2 = 0.868, P = 0.581). Conclusion TCT and histopathological diagnosis had a high coincidence, a combination of both can greatly enhance HSIL and cervical cancer and reduce the incidence of missed diagnosis. TCT would be a rapid and convenient method for screening cervical cancer.

The diagnosis value of morphology changes of pleomorphic megakaryocytes in bone marrow smears and bone marrow sections in chronic myeloproliferative disorders / 中华检验医学杂志

Objective To explore the diagnosis value of morphology changes of pleomorphic megakaryocytes in the bone marrow (BM) smears and BM sections in chronic MPD(CML-CP, ET,PV and PMF). Methods BM aspiration was taken in 182 patients of MPD aspiration and biopsy examination was performed synchronously to obtain the BM smears and BM sections samples. The BM smears were subjected to Wright/Giemsa stain and immunohistochemistry stain, while the BM sections were subjected to Haematoxylin-Giemsa-Fuchsin stain. The morphology of pleomorphic megakaryocytes was classified into five groups, which were Ⅰ type ( inclusion type), Ⅱtype ( hypolobulated muclei type), Ⅲ type ( giant hyperlobulated nuclei type), IV type (micro pyknotic type), and V type(extrusion type). The size of megakaryocytes clusters was recorded as no clusters(0) , predominantly small clusters of fewer than 6 cells (1) or predominantly large clusters of at least 6 cells (2) . The detection rates of various types of pleomorphic megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Results In CML-CP group, the detection rates were (3. 73±3. 84)% , (14.19 ±7. 62)% ,(5.99 ±4.67)%, (34. 37 ±10.79)%, (9.45 ±6. 87)%, (32. 28 ±7. 67)% and 3.13 ±2. 30)% ,(12.61 ± 9.28)%,(4.94±4.27)%,(35.26±9.63)%,(9.47 ±5.89)%,(34.58 ±6.81)% for I tⅠype,Ⅱ type,Ⅲ type, Ⅳtype and Ⅴ type pleomorphic megakaryocyte in BM smears and BM sections. There were no significantly differences between the BM smears and BM sections(t value were 0.524,0.510,0.645, 0.239,0.011,0. 869,all P>0.05). In ET group, the detection rate of I type [ (6.17 ±2. 89)% ] in BM smears was significantly higher than that in BM sections [ 2.42 ± 1. 28) % ] (t = 7. 183, P < 0. 01) , while the detection rate of V type [ (6. 28 ± 3. 34) % ] in BM smears was significantly lower than that in BM sections [ (10. 18± 4.03) % ] (t = 3.940, P < 0.01). Besides these, the detection rates of other types were not significantly different between the BM smears and BM sections(t value were 0.079,0. 122,1.643, 1. 638,all P>0. 05). In PV group, the detection rate of V type in BM smears [ (6. 55 ±4. 11)% ] was significantly lower than that in BM sections [ (10. 30±3. 34) % ] (t = 2. 351, P < 0.05 ). However, the detection rates of the other types were not significantly different between the BM smears and BM sections (t value were 1. 635,0. 301,0. 132,0. 704,0. 681 ,all P' >0. 05). In PMF group, the detection rate of IV type in BM smears [(13.05 ±5.24)%] was significantly lower than that in BM sections [(29.14± 8. 72) % ] (t = 5. 245, P < 0. 01). And the detection rate of normal type in BM smears [ ( 33. 58 ± 14.39)% ] was significantly higher than that in BM sections [(23. 01±7.96)%] (t =2. 132,P<0. 05). Besides these, the detection rates of the other types were not significantly different between BM smears and BM sections( t value were 0. 787,0.646,2.062,0. 869, P > 0. 05 ) . In CML-CP and PV groups, the detection rates of size of clusters were not significantly different between the BM smears and BM sections (x~2 = 2. 772, P > 0. 05 ). In ET group, the detection rate of small clusters (1) in BM smears was obviously higher than that in BM sections, however, the detection rate of larger clusters (2) in BM smears was obviously lower than that in BM sections (x~2 = 13. 748, P < 0.01). In PMF group, the detection rate of no clusters(0) in BM smears was obviously higher than that in BM sections, however, the detection rate of large clusters(2) in BM smears was obviously lowers than that in BM sections (x~2 =18.741 ,P<0. 01). Conclusions Both BM smears and BM sections can be applied to observe pleomorphic megakaryocytes. The morphology changes of pleomorphic megakaryocytes have certain reference values for identification of MPD subtypes and differential diagnosis.

Bone marrow biopsy combined bone marrow smear for diagnosis of 86 MDS / 白血病·淋巴瘤

Objective To explore the clinical significance of the union between marrow smear and marrow biopsy in the myelodysplastic syndrome(MDS) diagnosis. Methods Bone marrow aspirate and smear were initially abtained, then bone tissues encircled drill and section at the same point which is called as. easy one-step technology to 86 MDS patients were analysed. Results In 86 cases of MDS patients, there were 30 cases of hyperplasia extreme degree of reduction by 34.88 %, 56 eases of active, obvious and extremely active active (65.12 %), 43 cases for red RCMD (50.00 %), 32 cases for the granulocyte dysplasia (37.21%), 22 cases for megakaryocyte RCMD (25.58 %) in bone marrow aspiration smears; compared with 15 cases of hyperplasia extreme degree of reduction and the reduction (17.44 %), 71 eases of active, obviously active and extremely active (82.56 %); 16 cases for red RCMD (18.61%), 52 cases for the granulocyte dysplasia (60.47 %), 56 cases for megakaryocyte RCMD (65.12 %) in bone marrow biopsy sections. 66 cases in 86 cases of bone marrow biopsy and bone marrow smear of WHO classification were in line with the rate of 76.74 %.Conclusion The biopsy slide and the puncture smear synchronization observation is more advantageous than the conventional puncture smear morphology observation and combining two method may increase the accuracy in the MDS diagnosis.

Combination of frozen section and touch imprint cytology for the intraoperative diagnosis of sentinel lymph node in breast cancer / 肿瘤研究与临床

Objective Frozen section(FS)and touch imprint cytology(TIC)were common methods for intraoperative evaluation of sentinel lymph node(SLN)biopsy in breast cancer,with low sensitivity when used separately.The purpose of this study was to evaluate the value of combination of these two techniques.Methotis This study included 400 sentinel nodes from 150 patients with breast cancer.352 sentinel nodes were bisected along the long axis.Each sectioned surface of SLN was imprinted onto the surface of a slide and was analyzed by cytologist;meanwhile SLN were analyzed with intraoperative FS.The other 48 SLN were only analyzed with intraoperative PS due to their small size.Results of intraoperative P3 and TIC were compared with final pathology.Results Eighty-nine positive SLN from 55 patients were identified by final pathology.The specificity of FS and TIC were both 100%.According to the number of SLN.the sensitivity of TIC and FS was 71.9%(64/89)and 83.1%(74/89),respectively(P＞0.05).The sensitivity of TIC compared with FS was 96.6%(86/89),significantly higher than that of TIC and FS separately(both P＜0.001).According to the number of patients,the sensitivities of TIC and FS were 80.0%(44/55)and 81.8%(45/55),respectively(P＞0.05).The sensitivity of TIC compared with FS was 94.5%(52/55).significantly higher than that of TIC and FS separately (both P＜0.001).Conclusion Combination of FS and TIC for the intraoperative diagnosis of SLN biopsy in breast cancer was reliable,with hish sensitivity and specificity,and could avoid the second axillary operation efficiently.