Concordance between digital pathology and light microscopy in general surgical pathology: a pilot study of 100 cases.

AIM: (1) A pilot study to determine the accuracy of interpretation of whole slide digital images in a broad range of general histopathology cases of graded complexity. (2) To survey the participating histopathologists with regard to acceptability of digital pathology. MATERIALS AND METHODS: Glass slides of 100 biopsies and minor resections were digitally scanned in their entirety, producing digital slides. These cases had been diagnosed by light microscopy at least 1 year previously and were subsequently reassessed by the original reporting pathologist (who was blinded to their original diagnosis) using digital pathology. The digital pathology-based diagnosis was compared with the original glass slide diagnosis and classified as concordant, slightly discordant (without clinical consequence) or discordant. The participants were surveyed at the end of the study. RESULTS: There was concordance between the original light microscopy diagnosis and digital pathology-based diagnosis in 95 of the 100 cases while the remaining 5 cases showed only slight discordance (with no clinical consequence). None of the cases were categorised as discordant. Participants had mixed experiences using digital pathology technology. CONCLUSIONS: In the broad range of cases we examined, digital pathology is a safe and viable method of making a primary histopathological diagnosis.

Kikuchi-Fugimoto disease (Cervical Subacute Necrotising Lymphadenitis): an important benign disease often masquerading as lymphoma.

OBJECTIVES: We describe a rare cause of posterior triangle cervical lymphadenopathy in a third decade female, outline the clinical and histopathological features and discuss excision biopsy as the investigation of choice in this age group, with lymphoma as the diagnosis of exclusion. CASE REPORT: A thirty-four year old female was referred to our Head and Neck clinic with a one-month history of left posterior triangle lymphadenopathy. She reported no other symptoms and haematological investigations were normal. She was "Red Flagged" as a possible lymphoma. Excision biopsy revealed extensive histiocytic necrotising lymphadenitis providing a diagnosis of Kikuchi-Fujimoto disease. CONCLUSIONS: Persistent posterior triangle lymphadenopathy in the 16-40 year old age group warrants "Red Flag" referral to rule out serious pathology such as HIV, metastatic cancer or lymphoma. When the ENT examination and haematological work up is negative, we advocate proceeding straight to excision biopsy as the quickest way to obtain a diagnosis, which sometimes comes up with the unexpected as in this rare case of Kikuchi-Fujimoto disease.

Natural history of potentially malignant oral lesions and conditions: an overview of the literature.

At a workshop coordinated by the WHO Collaborating Centre for Oral Cancer and Pre-cancer in the UK issues related to potentially malignant disorders of the oral cavity were discussed by an expert group. The consensus views of the Working Group are presented in a series of papers. In this report we review the literature on the epidemiology and natural history of potentially malignant disorders (PMD), detailing those characteristics of the patients and lesions thought to be associated with future development of oral squamous cell carcinoma (OSCC). Older patients, particularly females are more at risk than younger patients; the duration of PMD may be important. Those who have never used tobacco seem at greater risk than smokers. OSCC is more likely with PMD on the lateral and ventral tongue, floor of mouth and retromolar/soft palate complex than with those elsewhere. The vast majority of PMD in which OSCC develop are non-homogenous although 5% of homogenous PMD will develop carcinoma. Large lesions covering several intraoral subsites also appear more at risk.

Histopathology of the teeth in segmental odontomaxillary dysplasia: new findings.

Histological examination of the deciduous teeth in two cases of segmental odontomaxillary dysplasia (SOMD) showed fibrous enlargement of the pulps, an irregular pulp/dentine interface displaying many pseudoinclusions and pulp stones. There were tubular defects in the coronal dentine from pulp horn to cusp tip, an irregular tubular structure to the circumpulpal dentine of the apical half, a focally deficient odontoblast layer and widespread external resorption. Together with the clinical features of unilateral maxillary enlargement, upper alveolar expansion in the distal segment, increased spacing and delayed eruption of the deciduous molars and absence of premolar teeth, these histological appearances allow distinction of this condition from fibrous dysplasia (FD), segmental hemifacial hypertrophy (SHH) and regional odontodysplasia (ROD).

Identification and overexpression of human neutrophil alpha-defensins (human neutrophil peptides 1, 2 and 3) in squamous cell carcinomas of the human tongue.

To date, little attention has been paid to the possible role of alpha-defensins (human neutrophil peptides 1-3), HNP-1, HNP-2 and HNP-3 in innate host defence against tumour invasion. In the current study, using a single-dimensional high pressure liquid chromatography (HPLC) method for peptide separation, followed by mass spectrometry and amino acid sequencing for identification and quantitation, we report the overexpression of HNP-1, HNP-2 and HNP-3 in squamous cell carcinomas of the human tongue compared with autogenous non-tumour tissue. Using a specific antibody we show that the defensins are abundant in neutrophils infiltrating human oral squamous cell carcinoma tissue. In the context of their previously reported oncolytic activity, our results may imply a role for alpha-defensins in host defence against oral squamous cell carcinoma.

Case report: Oral pemphigus vulgaris with multiple oral polyps in a young patient.

A rare case of oral pemphigus vulgaris is presented, which developed initially in a 9-year old Jordanian male. The disease was not well controlled with immunosuppressive therapy and was complicated by the development of multiple oral polyps approximately one year after the onset of symptoms. These lesions were smooth, painless and located particularly on the upper labial gingiva, the labial and buccal mucosae and the tongue. Disease activity continued for approximately nine years until the patient was referred to an oral medicine specialist. Histological examination of the polyps revealed exuberant granulation tissue. Adjustment of the steroid dosage lead to resolution of the oral symptoms and the polyps reduced in number and in size. This case highlights the occurrence of pemphigus vulgaris in young patients, illustrates a rare complication of persistent ulcero-inflammatory disease and emphasises the importance of specialist referral in the management of oral disease.

Invasive front grading: reliability and usefulness in the management of oral squamous cell carcinoma.

BACKGROUND: The value of histological grading was examined with emphasis on reliability of assessment in 102 cases of intraoral squamous cell carcinoma from Northern Ireland with known outcome. METHODS: Two pathologists independently graded the invasive tumour front blinded to the stage and outcome. RESULTS: Intraobserver agreement was acceptable but interobserver agreement was not satisfactory. The degree of keratinisation was assessed most consistently while nuclear polymorphism was the least reliable feature. Multivariate survival analysis showed that the total grading score was associated with overall survival while the pattern of tumour invasion was the most valuable feature in estimating regional lymph node involvement. The number of positive lymph nodes was strongly associated with regional relapse, while the treatment modality and status of the surgical margins correlated with local relapse. CONCLUSIONS: Grading of selected features in OSCC is reliable and can facilitate treatment planning.

Unifocal Langerhans' cell histocytosis and frontal sinus agenesis: report of a rare case.

Unifocal Langerhans' cell histiocytosis of the frontal bone is rare. We report a most unusual case of Langerhans' cell histiocytosis of the frontal bone in a patient who had been affected by frontal sinus agenesis. We believe this is the first reported case of its kind. We also review previously reported cases of solitary eosinophilic granuloma of the frontal bone and we discuss its clinical, radiologic, and histopathologic features.