Duke Surgery Research Central: an open-source Web application for the improvement of compliance with research regulation

Background  

Although regulatory compliance in academic research is enforced by law to ensure high quality and safety to participants, its implementation is frequently hindered by cost and logistical barriers. In order to decrease these barriers, we have developed a Web-based application, Duke Surgery Research Central (DSRC), to monitor and streamline the regulatory research process.     

Going beyond “Basaloid neoplasm”: Fine needle aspiration cytology of epithelial‐myoepithelial carcinoma of the parotid gland

Epithelial‐myoepithelial carcinoma (EMC) is a rare salivary gland malignancy with variable cytologic findings. Its rarity, variable morphologic findings, and similarities with more common salivary gland entities make it a difficult cytologic diagnosis. As the name signifies, the key feature of this tumor is presence of an epithelial and myoepithelial component. However, when one of these two components is scant on the fine needle aspiration (FNA) smears, it may be overlooked. We present a case from a 62 year‐old female who presented to the clinic with a parotid nodule and episodes of sharp, throbbing pain. A fine needle aspiration was performed which revealed a highly cellular specimen comprised primarily of aggregates of cells with small, round nuclei and scant to absent cytoplasm. Abundant hyaline stromal material was also noted. The case was signed out as basaloid neoplasm with a recommendation for surgical resection. The subsequent resection specimen revealed EMC. By reviewing the FNA specimen following the surgical resection of the tumor, we were able to utilize the benefit of hindsight to more clearly identify the subtle, biphasic components of the tumor. Diagn. Cytopathol. 2016;44:422–425. © 2016 Wiley Periodicals, Inc.     

Cytopathological and immunocytochemical findings of pancreatic anaplastic carcinoma with ZEB1 expression by means of touch imprint cytology

Pancreatic anaplastic carcinoma (PAC) is rare and has an aggressive clinical course. We report an autopsy case of PAC focusing on the cytopathological characteristics of the tumor and immunocytochemical staining for vimentin, E‐cadherin, and zinc finger E‐box binding homeobox 1 (ZEB1), which markers are associated with epithelial markers of epithelial‐mesenchymal transition (EMT). A 50‐year‐old woman presented to our hospital with a chief complaint of jaundice. A pancreatic head tumor and multiple liver nodules were detected on abdominal computed tomography. Biliary cytology under endoscopic retrograde cholangiopancreatography suggested ductal adenocarcinoma. Three months after admission, she died of multiorgan failure. At autopsy, touch imprint cytology using squash preparation of the pancreatic tumor identified two different cell types; numerous isolated malignant cells with large and pleomorphic nuclei and a few clusters showing irregularly overlapped nuclei and irregular contours within the necrotic background. Immunocytochemically, isolated cells were positive for vimentin and ZEB1, and negative for E‐cadherin. Conversely, clusters were negative for vimentin and ZEB1, and positive for E‐cadherin. Histologically, the tumor was composed of sarcomatous cells with small foci of adenocarcinoma, which were consistent with a diagnosis of PAC. Immunohistochemical staining of the adenocarcinoma and sarcomatous cells corresponded to those of the clusters and isolated malignant cells, respectively. Immunostaining of these EMT markers is useful to distinguish sarcomatous cells from adenocarcinoma and can contribute to the accurate diagnosis of pancreatic tumors with EMT.     

Liquid‐based Papanicolaou test (SurePath) interpretations before histologic diagnosis of endometrial hyperplasias and carcinomas

BACKGROUND.

In addition to the reporting of atypical glandular cells (AGC) and adenocarcinoma (ADCA), the 2001 Bethesda System requires the reporting of benign‐appearing endometrial cells in women aged >40 years (BAEMC). In this study, the authors evaluated the contribution of each of these reporting categories to the sensitivity and specificity of a liquid‐based Papanicolaou test for endometrial carcinoma or hyperplasia.

METHODS.

Over the 3‐year study period, in the setting of a large, multihospital health care system, the authors analyzed the results from liquid‐based Papanicolaou tests that were performed within the 6 months that preceded a histologic diagnosis of endometrial carcinoma or hyperplasia and that were reported according to the 2001 Bethesda System.

RESULTS.

Two hundred seventy‐two women had a histologic diagnosis of endometrial hyperplasia (n = 199) or malignancy (n = 73) within 6 months after a Papanicolaou test. In total, 188,594 Papanicolaou tests (91,385 from women aged >40 years) were interpreted during the study period and resulted in 3810 diagnoses of BAEMC, 326 diagnoses of AGC, and 30 diagnoses of ADCA. Only 28 of 73 women (38.4%) with endometrial carcinoma had cytologically AGC or ADCA reported on a previous Papanicolaou test. The reporting of BAEMC increased this sensitivity by only 5.5% (4 additional tests) but decreased the specificity of the Papanicolaou test for endometrial malignancy from 99.8% to 96%. For endometrial hyperplasias, the sensitivity of the Papanicolaou test was even lower (39 of 198 tests; 19.7%), but BAEMC represented the majority of endometrial‐type cells reported (36 of 39 tests).

CONCLUSIONS.

The reporting of BAEMC led to an only marginal increase in sensitivity that had to be weighed against the significant loss in specificity of the Papanicolaou test for endometrial neoplasia. Cancer (Cancer Cytopathol) 2007. © 2007 American Cancer Society.     

缺血性肠病CT检查与诊断

目的着重探讨45例缺血性肠病患者的病因、CT检查技术及其影像表现。资料与方法45例缺血性肠病均经螺旋CT扫描。26例经过手术证实,14例经过治疗痊愈,5例急性死亡。结果其中肠系膜动脉缺血24例,肝固有动脉缺血4例,肠系膜静脉缺血17例。结论严格掌握CT检查技术,根据CT影像表现并密切结合临床,对缺血性肠病患者可以作出确定诊断。     

Effectiveness of the Thin Prep® Imaging System in the detection of adenocarcinoma of the gynecologic system

BACKGROUND.

The ThinPrep Imaging System (TIS) has been approved by the U.S. Food and Drug Administration for use to decrease the number of false‐negative results in ThinPrep (TP) gynecologic specimens and increase cytotechnology productivity. Although the increased detection of squamous abnormalities using the TIS has been well documented, to the authors' knowledge, data regarding the impact of the TIS in the detection of glandular abnormalities is limited. The goal of the current study was to evaluate the effectiveness of the TIS in detecting glandular abnormalities in cervicovaginal specimens.

METHODS.

TIS evaluated TP tests with histologic confirmation of adenocarcinoma involving the gynecologic system were included in the current study. Two cytotechnologists independently reviewed the cases for the presence or absence of atypical glandular cells. Review results were correlated with initial cytologic and histologic diagnoses.

RESULTS.

A total of 124 cases met the criteria for inclusion in the current study. Seventy of these cases (56%) were found to contain atypical glandular cells on the TP slide. TIS was able to identify atypical cells in 97% of these cases (68 of 70 cases). Nine cases initially reported as benign were found to contain atypical glandular cells on secondary review. All but 1 of these cases contained atypical glandular cells detected by the TIS. The majority of these false‐negative cases (6 of 9 cases) derived from endometrial adenocarcinoma. No cytologic evidence of a glandular abnormality was found in the 54 remaining cases.

CONCLUSIONS.

The TIS was found to be effective in identifying atypical glandular cells in specimens containing malignant glandular cells, leading to a full review of the slide. Cancer (Cancer Cytopathol) 2008. © 2007 American Cancer Society.