Andreas Gschwendtner

Pathologists' attitudes to implementing telepathology

If pathologists will benefit so much from using telepathology, why is it taking so long to be introduced? This question has been discussed between experts, but the potential users are rarely asked for their opinions. A questionnaire was sent to the 256 members of the Austrian Society of Pathology; this addressed general aspects of telemedicine, telepathology in frozen-section services and expert consultation, videoconferencing technologies, teleteaching and teletraining. The response rate was 46 . In general, the pathologists thought that telemedicine could become valuable in their daily routine. However, pathologists were most afraid of sampling errors in remote diagnosis and would not readily accept an alternative to the conventional method of looking at a sample. This is only possible using realtime, remotely controlled microscopes. Telepathology systems providing only still images would not be acceptable to most respondents. There was interest in the use of videoconferencing for clinicopathological conferences. Teleteaching and teletraining were seen as welcome additional techniques, but were nevertheless judged unable to replace classical methods of teaching and training.

Longer failure-free survival interval of Epstein-Barr virus-associated classical Hodgkin's lymphoma: a single-institution study.

We analyzed Epstein-Barr virus association in classical Hodgkin’s lymphoma from a single center in Austria with special emphasis on the latent membrane protein1 gene configuration and clinical outcome. All 119 (65 male, 54 female) patients were treated from 1974 to 1999 in the Division of Hematology and Oncology at the Department of Internal Medicine, University of Innsbruck, Austria. The mean follow-up time was 122 months (range, 3–333 mo). Epstein-Barr virus was examined by latent membrane protein1 immunohistochemistry and by in situ hybridization for Epstein-Barr virus–encoded early ribonuclein acid transcripts. For assessment of the Epstein-Barr virus subtype (A/B) and latent membrane protein1 gene configuration, the polymerase chain reaction was employed. Fifty-four reactive tonsils were used as the control population. These results as well as clinical parameters such as age, gender, tumor stage, risk factors, and B symptoms were correlated with failure-free and overall survival. Latent membrane protein1 was detected in 31/119 (26%) classical Hodgkin’s lymphoma, and Epstein-Barr virus subtyping was successful in 19 of the 31 virus-infected classical Hodgkin’s lymphoma cases, as well as in 28 of 54 reactive tonsils. Subtype A was observed in all classical Hodgkin’s lymphoma patients and in 26/28 (93%) tonsils. The 30–base pair latent membrane protein1 gene deletion was found in only 4/31 (13%) Epstein-Barr virus-associated classical Hodgkin’s lymphoma as well as in 20/54 (37%) reactive tonsils. Patients with Epstein-Barr virus–associated classical Hodgkin’s lymphoma showed a significantly longer mean time to first relapse of 99 months, as compared with 49 months for the Epstein-Barr virus–negative cases (P < .02), and were more frequent in those aged >45 years (P < .04). Epstein-Barr virus–associated classical Hodgkin’s lymphoma were predominantly of the mixed-cellularity subtype and occurred more frequently in male patients, in patients with Stage III and IV, and in patients with B symptoms as well as risk factors. However, overall survival did not correlate with Epstein-Barr virus association. The 30–base pair latent membrane protein1 gene deletion had no influence on overall survival and failure-free survival time. Although the number of patients with this specific mutation was low, it further shows that an increased oncogenic potential of the latent membrane protein1 deletion variant is unlikely. This large single-center study demonstrates a low prevalence of Epstein-Barr virus positivity in classical Hodgkin’s lymphoma in western Europe. In accordance with results of similar studies, the presence of Epstein-Barr virus has a beneficial effect on the length of failure-free survival despite the higher frequency of risk factors such as higher tumor stage or advanced age.

Diffuse large B-cell lymphoma with overexpression of cyclin e substantiates poor standard treatment response and inferior outcome.

Purpose: Gold standard to predict survival and stratify patients for risk-adapted therapy in diffuse large B-cell lymphoma (DLBCL) is the international prognostic index, although it does not consider the molecular heterogeneity of DLBCL. Deregulation of cyclin E (CCNE) is a strong predictor of poor prognosis in some neoplastic diseases. In tumor cells, it induces chromosomal instability with an increased rate of aneuploidy/polyploidy. Experimental Design: We analyzed in this retrospective study the prognostic value of immunohistochemical CCNE expression on a validated tissue microarray containing 101 de novo DLBCLs and, in 9 cases, the CCNE-induced chromosomal instability as assessed by cytometry. Results: Forty-six of 98 evaluable DLBCLs expressed CCNE in a mean proportion of 20 ± 29% of tumor cells; 38 cases expressed CCNE in ≥20% of tumor cells. CCNE-positive samples were aneuploid compared with near tetraploidy in CCNE-negative cases. Multivariate analysis showed CCNE expression in ≥20% of tumor cells to be an international prognostic index–independent, Adriamycin-based treatment-independent, and BCL2-independent prognostic factor for poor disease-specific survival. CCNE expression in ≥80% of tumor cells was associated with dismal short-term prognosis. CCNE expression in ≥50% of tumor cells emerged as an independent predictive factor for standard CHOP treatment resistance. Conclusions: CCNE expression assessment is easy on paraffin-embedded tissue. The high prognostic value of CCNE expression in DLBCL may be the basis for future prospective trials. In addition, a high CCNE expression hints at the presence of a possible target for individualized cancer therapy.

Optimized preembedding method improves the histologic yield of prostatic core needle biopsies

The aim of this study was to optimize the core shape of prostatic core needle biopsies using a novel preembedding method, and to investigate the influence of the number of cores per tissue block on the histologic yield per section level.

Primary intestinal non-Hodgkin's lymphoma and Epstein-Barr virus: high frequency of EBV-infection in T-cell lymphomas of Mexican origin.

Epstein-Barr virus is universally associated with endemic Burkitts lymphoma (BL) and undifferentiated nasopharyngeal carcinoma and can be detected in a significant proportion of cases of Hodgkins disease (HD) and peripheral T-cell lymphoma, but only rarely in sporadic B-NHL. The frequency of EBV-positivity in certain neoplasms shows important geographic variations. Both HD and sporadic BL from Latin America have shown higher rates of EBV-association than cases from Western countries. In T-NHL, the frequency of EBV-positivity is influenced by the site of the primary tumor and the phenotype of the neoplastic cells. Nasal and nasal-type T-NHL, which show a T/NK-cell phenotype with expression of CD56 are virtually always EBV-associated, whereas only a proportion of nodal, gastrointestinal and pulmonary T-NHL are EBV-infected. A recent investigation of primary intestinal lymphomas of Mexican origin demonstrated EBV-positivity in all examined cases of T-NHL and BL and a proportion of other B-NHLs. The presence of EBV was independent of the presence or absence of enteropathy. Two of 6 cases studied showed CD56 expression. The high rate of EBV-positivity independent of histologic subtype is in contrast to the low to intermediate rates of EBV-positivity found in cases of intestinal T-NHL from Western countries and indicates that geographic differences in the frequency of EBV-association of lymphoid neoplasms might also extend to a fraction of peripheral T-cell lymphomas.

Incidental oral plasmablastic lymphoma with aberrant expression of CD4 in an elderly HIV-negative patient: how a gingival polyp can cause confusion.

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What do students think about telemedicine

A questionnaire was distributed to 300 medical students attending a conference in 1996. The return rate was 32 . The majority of students believed that telemedicine will become very important in future. About a quarter of students had had practical experience of telemedicine in a hospital. More than 75 of the respondents said that they would attend telemedicine lectures if they were offered by their university. There were no major concerns among medical students about telematics and its applications in medicine. There was a clear need for more information, which suggests that universities should offer special lectures and practical courses in telemedicine. The interest of students in tele-learning was very high. This interest would justify more attempts to introduce tele-learning by the universities.

Primary Gastrointestinal B-Cell Lymphoma - A Clinicopathological and Immunohistochemical Study of 61 Cases with an Evaluation of Prognostic Parameters

We hereby present a retrospective clinicopathological and immunohistochemical study of surgically resected primary gastrointestinal (GI) lymphoma with an analysis of parameters of potential prognostic relevance. From a larger series of 144 cases of primary GI lymphomas, we chose 61 cases with sufficient clinical follow-up (mean 60, range 1-219 months), classified either as extranodal marginal zone B-cell lymphoma of MALT type (MALT lymphoma) or diffuse large B-cell lymphoma (DLBCL), after having excluded other subtypes. In addition to conventional clinical and morphological parameters, the expression levels of Ki-67 (MIB-1), bcl-2 and p53 were evaluated for prognostic significance. Twenty-one (34.4%) cases were classified as pure low grade marginal zone B-cell lymphoma of MALT type, 12 (19.7%) cases as low grade MALT lymphoma with a high grade component (mixed type), and 28 (45.9%) cases as primary extranodal DLBCL. Most of the lymphomas (53/61; 86.9%) were localized in the stomach, 3 (4.9%) in the small bowel, 3 (4.9%) multifocal in both stomach and small intestine and 2 (3.3%) in the large bowel. MIB-1 expression in more than 30% of tumor cells was detected in 42 (68.6%), bcl-2 expression in 20 (32.8%) and p53 accumulation in more than 10% of neoplastic cells in 16 (26.2%) lymphomas. Both high Ki-67 expression and p53 accumulation were more prevalent in the DLBCL. 30 (49%) patients showed lymph node involvement at surgery, 14 (23%) patients suffered tumor recurrence, and 24 (38.5%) died during the follow-up period. Tumor recurrence occurred primarily in patients who had presented lymph node involvement (9/14, 64.3%). The 5-year survival rate was 66.1% for all patients. Important prognostic factors for overall survival were tumor stage (p < .004) and p53 accumulation (p < .05) in univariate analysis, and tumor stage in multivariate analysis (p < .001). Although p53 accumulation did not reach statistical significance in our small study group, it may be both important in the transformation of low grade MALT lymphoma and an indicator for aggressive behavior in high grade tumors.

Consideration of Low PSA Cut-Off Levels to Optimize the Detection of Curable Prostate Cancer

Routine use of prostate-specific antigen (PSA) testing has affected prostate cancer incidence rates, contributed to a favorable shift in tumor stage at diagnosis and is responsible for the recent decrease in prostate cancer mortality rates [1, 2]. In most screening projects a total PSA of 4 ng/ml or greater leads to further urological evaluation, including digital rectal examination, transrectal ultrasound and prostate biopsies [3–5]. However, prostate cancer has extended beyond the prostate in one third of men with PSA levels between 4 and 10 ng/ml and in more than half with PSA levels greater than 10 ng/ml [6–9]. Therefore, the use of lower PSA cut-off levels should more frequently lead to the detection of prostate cancers in its curable stages. However, there is concern that screening with a low cut-off level may detect possibly harmless cancer. In 1993, a mass screening program, the Tyrol PSA Screening Project, using PSA as the only screening test was launched in the Federal State of Tyrol, Austria [10]. Since October 1995, to enhace the sensitivity of the screening program, we used low PSA cut-off levels in combination with free PSA of less than 18% (table 1). Several projects dealing with low PSA cut off levels and low tumor volume were conducted within this screening program. The experience Table 1. Age-specific reference ranges for PSA levels

Occupational backache: surface electromyography demonstrates the advantage of an ergonomic versus a standard microscope workstation

Abstract. Musculoskeletal symptoms such as low back pain, neck pain, and tension headache are reported by up to 80% of professional personnel involved in daily microscope work. Yet, in striking contrast to the high prevalence of complaints, there is a general unawareness of this issue both in those suffering, and those ordering and designing microscopes. We intend to call attention to this underestimated work-related health hazard and to demonstrate a potential means of prevention. We obtained repeated surface electromyographic (EMG) recordings from the most strained neck, upper limb, and back muscles in 12 healthy volunteers while they were operating a near-to-ergonomic prototype workstation and a conventional microscope, respectively. Mean EMG activity was reduced in all recorded muscles when operating the ergonomic workstation compared to the standard microscope. This improvement became more distinct with sustained work, and was most pronounced in those muscles displaying the highest degree of activity while using the standard microscope. We demonstrate the usefulness of surface EMG recordings to show the advantage of an ergonomically tailored and individually adjustable microscope workstation over a standard microscope. The former allows the operator to maintain a more physiological posture, and may thus prevent the development of cumulative musculoskeletal disorders during prolonged microscope-related work.