Pathology Poster - 2019

Pathology Poster - 2019https://scholarlycommons.libraryinfo.bhs.org/research_education/1010/thumbnail.jp

Perspectives and perceptions of urgent and alert values in surgical pathology and cytopathology: A survey of clinical practitioners and pathologists

In previous editorials, Chapman and Otis in 2011 and Layfield in 2014 have summarized much of the work responsible for establishing the concept of critical diagnoses in surgical pathology and cytopathology. Both editorials end with a list of 8 key policy points needed for an effective strategy of handling and communicating critical diagnoses. We have developed and distributed a Web-based survey to elicit clinicians\u27 attitudes regarding many of those key policy points, such as how, when, and to whom critical diagnoses should be reported; we have allowed some level of collaboration with the clinical staff when developing our communication policies as the Association of Directors of Anatomic and Surgical Pathology (ADASP) consensus statement recommends. We have identified important areas of disagreement between pathologists and clinicians regarding what entities should be considered critical and who should be responsible for correlating histologic findings with the larger clinical context. Identifying these discordant points of view and fostering interdepartmental agreement on the best practices in the communication of critical diagnoses is an important patient care and safety issue. Chapman and Otis have also suggested the importance of increased access to accurate patient information and the clinical history, including the level of clinical suspicion of malignancy, and of forming a periodic review and quality assurance process. Here we explore methods of increasing the ability of pathologists and cytopathologists to identify unexpected diagnoses, including optimization of their workstations for better access to the electronic medical record, and we examine the progress of quality assurance methods in surgical pathology and cytopathology since the ADASP consensus statement in 2012

Association Between Loss of SATB2 Expression in Inflammatory Bowel Disease Indefinite for Dysplasia and a Diagnosis of Definitive Dysplasia on Follow-up

Special AT-rich sequence-binding protein 2 (SATB2) is a sensitive and specific biomarker for sporadic colonic adenocarcinomas. Previous studies have found that SATB2 is lost in some adenocarcinomas and dysplasias associated with inflammatory bowel disease (IBD). In establishing these findings, the prior studies did not examine cases of IBD interpreted as indefinite for dysplasia. We examined SATB2 expression in this diagnostic category to determine if any potential loss is associated with a diagnosis of definitive dysplasia on follow-up. To investigate this possibility, we collected 87 biopsies of IBD indefinite for dysplasia from 62 patients and stained them with SATB2. Among patients\u27 indefinite for dysplasia, we found SATB2 loss in 6/62 (9.7%). Among those with follow-up (n=51), we observed 5/6 (83%) with a future dysplasia in those with SATB2 loss compared with 10/45 (22%) in those with SATB2 retention, absolute difference 61.1% (95% confidence interval=28.9%-93.3%). We conclude that loss of SATB2 on biopsies otherwise interpreted as IBD indefinite for dysplasia may mark a population at high risk for showing definitive dysplasia on future biopsies

Cytomegalovirus Reactivation after Bendamustine-Based Chemotherapy: A Case Report

Cytomegalovirus (CMV) is a DNA hepadnavirus, commonly implicated in reactivation disease after immunosuppression, especially in solid-organ and stem cell transplant patients. Bendamustine is an alkylating chemotherapeutic agent introduced into the management of hematological malignancies within the last decade. Few reports have raised potential concern for CMV reactivation disease after bendamustine therapy involving, but not limited to, the gastrointestinal tract, lungs, retina, and viremia. Cytomegalovirus reactivation in such instances should be added to the differential diagnoses for febrile nonneutropenic immunocompromised patients. Here, we report a case of an elderly gentleman recently diagnosed with mantle cell lymphoma who was started on chemotherapy with rituximab, bendamustine, and dexamethasone and developed CMV colitis and viremia after just 2 cycles of chemotherapy. © 2021 Wolters Kluwer Health, Inc. All rights reserved. Author keywords bendamustine; cytomegalovirus; cytomegalovirus disease; cytomegalovirus reactivatio

Incidental Hepatic Granulomata as the Initial Presentation of Crohn\u27s Disease in a Pediatric Patient

We describe a 9-year-old girl who presented with abdominal pain, found incidentally to have multiple liver granulomata. Extensive autoimmune and infectious workup was negative. The patient had esophagogastroduodenoscopy and colonoscopy, confirming the diagnosis of Crohn\u27s disease. Hepatic granulomata are a rare complication of Crohn\u27s disease and are often secondary to pharmacotherapy or infection in immunosuppressed patients. This case, to our knowledge, is the first reported case of a pediatric patient diagnosed with Crohn\u27s disease after initially presenting with hepatic granulomata as an extraintestinal manifestation of the disease