Centrilobular emphysema: CT-pathologic correlation

Over a 5-year period, 25 patients who had undergone chest computed tomography (CT) died and were autopsied. Their lungs were fixed in the inflated state and were assessed for the presence and severity of centrilobular emphysema (CLE). Three radiologists independently evaluated the CT scans for nonperipheral low-attenuation areas, peripheral low-attenuation areas, pulmonary vascular pruning, pulmonary vascular distortion, and pulmonary density gradient. The CT criterion that best correlated with the presence and severity of CLE was the nonperipheral low-attenuation area. With this CT criterion, lung destruction was correctly identified in 13 of 15 cases. The absence of this criterion resulted in correct identification of eight of ten normal lungs. These preliminary data suggest that CLE can be reliably identified and quantified with current CT scanners.     

BD focalpoint slide profiler performance with atypical glandular cells on SurePath Papanicolaou smears

BACKGROUND:

The FocalPoint Slide Profiler is an automated cervical cytology screening system that is approved for primary screening. It identifies up to 25% of slides as requiring No Further Review. However, few studies have evaluated FocalPoint performance with glandular abnormalities.

METHODS:

Sixty‐six SurePath Papanicolaou (Pap) tests with a diagnosis of atypical glandular cells were identified. A total of 172 Pap tests with a diagnosis of “endometrial cells present” were included as controls. Follow‐up histology was abnormal if diagnosed as high‐grade squamous intraepithelial lesions, adenocarcinoma in situ, carcinoma, or complex endometrial hyperplasia. The FocalPoint software ranked each case into 1 of 7 categories: quintiles 1 (high risk) through 5 (low risk), No Further Review, and Process Review.

RESULTS:

A total of 215 slides were qualified for review; 38 (57.6%) atypical glandular cells cases were abnormal on follow‐up biopsy, and 27 (71.1%) atypical glandular cells with abnormal follow‐up qualified for review; no cases were classified No Further Review, and 9 (33%) were ranked in quintile 1. Twenty‐three (82.1%) atypical glandular cells with benign follow‐up were qualified for review; 3 (11%) cases were classified No Further Review, and 4 (17%) were ranked in quintile 1. There was a statistically significant difference between the ranking of benign atypical glandular cells cases, abnormal atypical glandular cells cases, and control cases (P = .03). However, when collapsed into No Further Review versus all other quintiles, the differences were not significant (P = .20).

CONCLUSIONS:

The FocalPoint Slide Profiler did not classify glandular lesions with abnormal follow‐up in the No Further Review category. However, these cases were not preferentially ranked in quintile 1. FocalPoint‐screened slides need to be carefully reviewed for glandular abnormalities, regardless of the quintile ranking. Cancer (Cancer Cytopathol) 2010. © 2010 American Cancer Society.     

Current concepts in teaching and learning in surgery

Modern surgical teaching is evolving at speed. The environment in which we learn and teach is subject to a number of extrinsic pressures. These are influencing ways in which medical students and trainees learn and are taught the discipline of surgery. As a surgical educator it is useful to understand the reasons for these changes and to acquire the skills necessary to provide effective teaching. This short article looks at reasons why one would wish to develop surgical teaching skills, covers basic principles associated with delivery of effective teaching sessions and briefly reviews other avenues that may enhance teaching practice.     

Porokeratosis Causing Change in Melanocytic Nevi

Large cell transformation of mycosis fungoides (MF) is an uncommon phenomenon. We present a case of CD30‐positive large cell transformation and discuss its possible pathophysiology. A 74 year‐old male with a 36‐year history of patch stage MF presented with a 3‐month history of right chest cellulitis that was refractory to IV antibiotic treatment. Skin biopsies from his thigh demonstrated a patchy dermal infiltrate of irregular and hyperchromatic lymphocytes and epidermotropism. The majority of the infiltrate was positive for CD4, CD3, CD2, and negative for CD7. Only 10% were positive for CD25 and CD8. Biopsies obtained from the ulcerated chest nodules showed a dermal infiltrate of large and pleomorphic lymphoid cells with prominent nucleoli. These large lymphoid cells were strongly positive for CD3, CD30, CD25, CD2 and UCHL‐1. Occasional cells were positive for CD4 and CD20. They were negative for ALK‐1, TIA‐1, CD7, CD8, and CD15. T‐gamma receptor gene rearrangement analyses by polymerase chain reaction demonstrated a clonal process with similar rearrangement patterns identified in the patch stage MF as well as in large cell transformation areas. Examinations of his peripheral blood and bone marrow were negative. The patient had tolerated one cycle of CHOP chemotherapy.     

Endoscopic management of choledocholithiasis during pregnancy

Extrahepatic biliary obstruction by gallstones during pregnancy is a difficult management problem. We present five patients--four with acute cholangitis and one with gallstone pancreatitis--in whom a surgical procedure was avoided by endoscopic sphincterotomy. All five women delivered healthy babies at term. Endoscopic retrograde cholangiopancreatography and sphincterotomy can be performed safely in pregnancy with minimal exposure to radiation. Endoscopic management should be considered in women presenting with acute cholangitis or gallstone pancreatitis during pregnancy.