Accuracy of magnetic resonance imaging to identify pseudocapsule invasion in renal tumors

Purpose: To evaluate accuracy of MRI in detecting renal tumor pseudocapsule (PC) invasion and to propose a classification based on imaging of PC status in patients with renal cell carcinoma. Methods: From January 2017 to June 2018, 58 consecutive patients with localized renal cell carcinoma were prospectively enrolled. MRI was performed preoperatively and PC was classified, according to its features, as follows: MRI-Cap 0 (absence of PC), MRI-Cap 1 (presence of a clearly identifiable PC), MRI-Cap 2 (focally interrupted PC), and MRI-Cap 3 (clearly interrupted and infiltrated PC). A 3D image reconstruction showing MRI-Cap score was provided to both surgeon and pathologist to obtain complete preoperative evaluation and to compare imaging and pathology reports. All patients underwent laparoscopic partial nephrectomy. In surgical specimens, PC was classified according to the renal tumor capsule invasion scoring system (i-Cap). Results: A concordance between MRI-Cap and i-Cap was found in 50/58 (86%) cases. ρ coefficient for each MRI-cap and iCap categories was: MRI-Cap 0: 0.89 (p < 0.0001), MRI-Cap1: 0.75 (p < 0.0001), MRI-Cap 2: 0.76 (p < 0.0001), and MRI-Cap3: 0.87 (p < 0.0001). Sensitivity, specificity, positive predictive value, negative predictive value, and AUC were: MRI-Cap 0: Se 97.87% Spec 83.3%, PPV 95.8%, NPV 90.9%, and AUC 90.9; MRI-Cap 1: Se 77% Spec 95.5%, PPV 83.3%, NPV 93.5%, and AUC 0.86; MRI-Cap 2- iCap 2: Se 88% Spec 90%, PPV 79%, NPV 95%, and AUC 0.89; MRI-Cap 3: Se 94% Spec 95%, PPV 88%, NPV 97%, and AUC 0.94. Conclusions: MRI-Cap classification is accurate in evaluating renal tumor PC features. PC features can provide an imaging-guided landmark to figure out where a minimal margin could be preferable during nephron-sparing surgery

Matthew Baillie's specimens and engravings

In 1799, Matthew Baillie, William Hunter's nephew, published his famous atlas of pathology. It was entitled A Series of Engravings Accompanied with Explanations which are Intended to Illustrate the Morbid Anatomy of Some of the Most Important Parts of the Human Body. The present study aims to match the illustrations to extant specimens in the collections of William and John Hunter, preserved at the University of Glasgow and at the Royal College of Surgeons of England respectively. Baillie's book contains 10 fasciculi, consisting of 73 plates and 206 figures. The specimens Baillie illustrated came from his own collection and those of ten others, including his uncles, William and John Hunter. The book was illustrated by William Clift and engraved by James Basire, William Skelton and James Heath. Excluding eight illustrations of intestinal worms where the provenance of the specimens is uncertain, a total of 98 specimens from William Hunter's collection were illustrated in 104 figures. Eight of the specimens were calculi impossible to identify specifically. Excluding worms and calculi, 72 of William Hunter's specimens illustrated by Baillie are extant in the Hunterian Collection at the University of Glasgow. All but one of the 20 specimens illustrated that had belonged to John Hunter were identified in the on-line catalogue of the Royal College of Surgeons of England. Baillie's own collection was destroyed when the Royal College of Surgeons of England was bombed in 1941. Baillie is credited with being the first to produce an illustrated systematic textbook of morbid anatomy and probably the first to illustrate emphysema and transposition of the great vessels. His book, however, was not comprehensive. It did not cover a number of topics such as muscles and bones and there is little coverage of the nervous system. Baillie's book, however, was an original concept as an atlas of morbid anatomy and showed his deep insight into pathology

Errors in Surgical Pathology Laboratory

Pathology must aim at a correct and complete diagnosis for the patient, which is timely, useful, and understandable to the physician assistant. However, in daily practice, there are multiple possibilities of errors in the pathology laboratory, with several impacts on patient care and prognosis. In this chapter, we discuss the different concepts of error and diagnostic concordances in pathology, at which point in the diagnostic process the errors are more frequent, and propose solutions to minimize the chance of their occurrence

Multilocular Cystic Nephroma – A Surgical and Radiological Dilemma

Multilocular cystic nephroma is a slow growing benign renal tumor. It has been identified as exclusive adult lesion, more common in females. It commonly occurs as an asymtomatic mass, occasionally with hematuria. Clinical presentation & radiological features puts urologist under dilemma. Only a few studies have correlated the Bosniak renal cyst classification with pathological findings; none of them has managed to recruit many patients, and all have case selection bias. Although new imaging techniques are available, surgical excision and histological analysis of the tumor are the only effective methods to distinguish benign from malignant cystic lesions of the kidney. Here in we present a case to highlight the need for proper diagnosis and designation of these tumors. These renal tumors are benign and carry an excellent prognosis

Procurement of human tissues for research banking in the surgical pathology laboratory: Prioritization practices at Washington University Medical Center

Academic hospitals and medical schools with research tissue repositories often derive many of their internal human specimen acquisitions from their site's surgical pathology service. Typically, such acquisitions come from appropriately consented tissue discards sampled from surgical resections. Because the practice of surgical pathology has patient care as its primary mission, competing needs for tissue inevitably arise, with the requirement to preserve adequate tissue for clinical diagnosis being paramount. A set of best-practice gross pathology guidelines are summarized here, focused on the decision for tissue banking at the time specimens are macroscopically evaluated. These reflect our collective experience at Washington University School of Medicine, and are written from the point of view of our site biorepository. The involvement of trained pathology personnel in such procurements is very important. These guidelines reflect both good surgical pathology practice (including the pathologic features characteristic of various anatomic sites) and the typical objectives of research biorepositories. The guidelines should be helpful to tissue bank directors, and others charged with the procurement of tissues for general research purposes. We believe that appreciation of these principles will facilitate the partnership between surgical pathologists and biorepository directors, and promote both good patient care and strategic, value-added banking procurements

Dataset for the reporting of carcinoma of renal tubular origin:recommendations from the International Collaboration on Cancer Reporting (ICCR)

AIMS The International Collaboration on Cancer Reporting (ICCR) has provided detailed datasets based upon the published reporting protocols of the Royal College of Pathologists, The Royal College of Pathologists of Australasia and the College of American Pathologists. METHODS AND RESULTS The dataset for carcinomas of renal tubular origin treated by nephrectomy was developed to provide a minimum structured reporting template suitable for international use and incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology and the fourth edition of the World Health Organization Bluebook on tumours of the urinary and male genital systems published in 2016. Reporting elements were divided into those, which are Required and Recommended components of the report. Required elements are; specimen laterality, operative procedure, attached structures, tumour focality, tumour dimension, tumour type, WHO/ISUP grade, sarcomatoid/rhabdoid morphology, tumour necrosis, extent of invasion, lymph node status, surgical margin status, AJCC TNM staging and co-existing pathology. Recommended reporting elements are; pre-operative treatment, details of tissue removed for experimental purposes prior to submission, site of tumour(s) block identification key, extent of sarcomatoid and/or rhabdoid component, extent of necrosis, presence of tumour in renal vein wall, lymphovascular invasion and lymph node status (size of largest focus and extranodal extension). CONCLUSIONS It is anticipated that the implementation of this dataset in routine clinical practise will inform patient treatment as well as provide standardized information relating to outcome prediction. The harmonisation of data reporting should also facilitate international research collaborations. This article is protected by copyright. All rights reserved

The Diagnostic Accuracy of Chest CT in the Detection of Tumor and Nodal Status in Non Small Cell Lung Carcinoma

At this time there is an increasing demand for an accurate pre operative staging in non small cell lung cancer. Chest Computed Tomography (CT) is one of the imaging modality of choice used for this purpose. This study evaluated the accuracy of the chest CT to determine the status of the tumor and nodules in non small cell lung cancer. During the years 1998 and 1999, a descriptive prospective study of 32 patients undergoing a contrast enhanced chest CT examination for non small cell lung cancer, stage I-IIIA, was conducted. Lobectomy, lymph nodes dissection and postoperative histo-pathological examination were done. CT findings were as follows: a sensitivity of 100%, a specificity of 25% and an accuracy of 60% in the detection of the nodule stage were found. In 17 patients with adenocarcinoma, the sensitivity, the specificity and the accuracy were 86.6%, 100% and 88.2% respectively. The diagnosis of all patients was confirmed histo-pathologically. Six patients with T2 and 26 patients with T3 were detected by chest CT; the accuracy of the tumor status was 93.7%, confirmed by surgical and histo-pathological examinations. It was concluded that the CT played an important role in determining the clinical stage of non small cell lung cancer. The specificity and accuracy were higher in adeno-carcinoma as compared with squamous cell carcinoma in detecting the nodal status