Daniel Schultz

Amended reports: development and validation of a taxonomy of defects.

Amended pathology reports produce rework, confusion, and distrust. To develop a reproducible amendment taxonomy we derived a classification from 141 amended reports, then validated it with 130 new cases before 4 observers independently reviewed 430 cases measuring agreement (k). Next, agreement in classifying 30 other amended reports in 7 institutions was measured. We further tracked amendment rates, defect categories, defect discoverers, and discovery mechanisms. In the 430-case validation set agreement was excellent (k = 0.8780 [range, 0.8416-0.9144]). Among the 7 institutions, agreement was good (k = 0.6235 [range, 0.3105-0.8975]). Amendment rates ranged from 2.6 to 4.8 per 1,000 reports. Misinterpretation fractions varied least (23%-29%). Misidentification fractions ranged more widely (20%-38%). Specimen defects were least frequent (4%-10%) and report defects most frequent (29%-48%). Misidentifications and report defects inversely correlated. Pathologists discovered most misinterpretations, and clinicians found most misidentifications. Conference review revealed 40% to 80% of misinterpretations. This taxonomy produced excellent reproducibility and good agreement across institutions.

The histologic spectrum of apocrine breast proliferations: a comparative study of morphology and DNA content by image analysis.

Apocrine features occurring in sclerosing adenosis (apocrine adenosis), atypical ductal hyperplasia (ADH), and non-comedo ductal carcinoma in situ (DCIS) often add to diagnostic difficulty. We have evaluated the usefulness of DNA content determined by image analysis in apocrine metaplasia and hyperplasia, apocrine adenosis, ADH, DCIS, lobular carcinoma in situ, invasive ductal carcinoma, and infiltrating lobular carcinoma as a potential diagnostic aid in some of these problematic breast lesions with apocrine features. Infiltrating ductal carcinoma and DCIS were further subdivided into high- or low-grade category based on nuclear features. Microscopic fields containing 63 lesions were identified in slides from breast excisions. From each selected area 100 cells in corresponding fields in paired Feulgen-stained sections were digitized for computerized ploidy analysis with lymphocyte nuclei in the same slides serving as internal diploid controls. Aneuploidy was assessed using combined DNA index and modified Auer histogram criteria for DNA content abnormalities. There was strong association between the assessment of nuclear grade and ploidy (Fishers exact test, P < .00001). All but one of the benign and low-grade malignant lesions (97%) were in the diploid range (six of seven apocrine metaplasia cases, three of three apocrine adenosis cases, 14 of 14 ADH cases, 10 of 10 low-grade DCIS cases, two of two lobular carcinoma in situ cases, and two of two infiltrating lobular carcinoma cases). In contrast, 24 of 25 (96%) of the high-grade malignant lesions were aneuploid (10 of 10 DCIS cases and 14 of 15 infiltrating ductal carcinoma cases). We conclude that DNA ploidy status does not offer additional diagnostic information to light microscopy in distinguishing among benign apocrine proliferations, ADH, and low-grade DCIS since these proliferations share a diploid range DNA content.

Photodynamic therapy in prostate cancer: optical dosimetry and response of normal tissue

The present study explores the possibility of utilizing photodynamic therapy (PDT) in treating localized prostate carcinoma. Optical properties of ex vivo human prostatectomy specimens, and in vivo and ex vivo dog prostate glands were studied. The size of the PDT induced lesion in dog prostate was pathologically evaluated as a biological endpoint. The data indicate that the human normal and carcinoma prostate tissues have similar optical properties. The average effective attenuation depth is less in vivo than that of ex vivo. The PDT treatment generated a lesion size of up to 16 mm in diameter. The data suggest that PDT is a promising modality in prostate cancer treatment. Multiple fiber system may be required for clinical treatment.

Evaluation of prostatic optical properties and tissue response to photodynamic therapy in a canine model

A new modality of interstitial therapy to treat prostate cancer using photodynamic principles has been studied in a canine model. The effect of interstitial application of monochromatic light from an argon pumped dye laser at 630 nm was studied in a canine model. No significant hyperthermia was seen during the treatment. A concentric zone around the treatment fiber was seen during the treatment. A concentric zone around the treatment fiber was seen in PDT treated dogs and the maximum size was 18 mm. The data suggests that PDT may be clinically applicable in achieving tissue necrosis using interstitial light application in a solid organ like prostate.

Solitary ovarian plasmacytoma. A case report and review of literature.

Highlights • A patient with rare solitary ovarian plasmacytoma is reported• Diagnostic work-up is mandatory to rule out ovarian involvement as part of multiple myeloma.• After complete surgical resection, the prognosis appears to be very favorable.

Clinical outcome of pathologic Stage IIA endometrial adenocarcinoma after intravaginal brachytherapy alone

PURPOSEnWe studied the impact of different prognostic factors on the clinical outcome for the patients with pathologic Stage IIA endometrial adenocarcinoma who had surgical staging (SS) and received adjuvant high-dose-rate intravaginal brachytherapy (IVB) alone.nnnMETHODS AND MATERIALSnSixty-one patients with Stage IIA endometrial adenocarcinoma were retrospectively studied. Cox proportional hazards regression was used to study prognostic factors.nnnRESULTSnAll the patients underwent SS between July 1994 and December 2005. The median age was 64 years (range, 46-71 years). The median number of lymph nodes sampled was 8 (range, 7-12). All the patients received adjuvant IVB to doses of 35-36Gy in four to five fractions prescribed to the surface. The myometrial invasion was <50% in 33 patients and > or =50% for 28 patients. The lymphovascular invasion (LVI) and the lower uterine segment involvement were identified in 18% and 61%, respectively. At a median followup of 64 months (range, 8-153 months), there were 7 patients who developed recurrences. On univariate analysis, the only factor significantly predictive for locoregional recurrence was LVI (p=0.01). In regard to overall survival (OS), factors that were significantly predictive on univariate analysis were LVI (p=0.03), tumor grade (p=0.04), and depth of myometrial invasion (p=0.04). The 5-year rates of vaginal and pelvic recurrences were 1.7% and 8.2%, respectively. The 5-year local control and OS rates were both 87%.nnnCONCLUSIONSnOur results suggest excellent local control with adjuvant IVB alone for selected patients with Stage IIA endometrial adenocarcinoma. The patients with positive LVI and deep myometrial invasion have a worse locoregional control and OS despite SS and adjuvant IVB.

Photodynamic therapy of normal canine prostate

To provide basic scientific information for utilizing photodynamic therapy to treat prostatic carcinoma, PDT dosimetry and effective treatment volume were investigated using canine prostate as an in vivo animal model. The prostate glands were surgically exposed. Isotropic tip fibers were inserted into the gland for either light irradiation or detection. PDT doses of 400 J and 1, 3 or 5 mg/kg Photofrin were used for single fiber irradiation treatments. All animals were terminated at 1 week and the prostates evaluated histopathologically. The results show that the lesion size was dependent on the treatment dose. The maximum lesion dimension was approximately 1.6 cm. The data acquired from the single fiber irradiation study were then used to plan for multi-fiber interstitial PDT treatments with a goal of achieving a larger treatment volume for practical purpose. The data indicate that the lesion size from the multiple fiber treatment could be predicted based on the single fiber treatment with the light pattern summed from all sources.