John R. Goldblum

A Multi-Institutional Survey of Critical Diagnoses (Critical Values) in Surgical Pathology and Cytology

Critical values (CVs) are well established in clinical pathology, and an analogous concept has recently been suggested in anatomic pathology, with the terminology of critical values, or, alternatively, critical diagnoses (CDs). To better identify anatomic pathology CVs, a survey was sent to 225 members of the Association of Directors of Anatomic and Surgical Pathology (ADASP) for grading 17 possible surgical pathology and 18 possible cytology CVs. There were 73 responses for surgical pathology and 57 for cytology. The majority of the respondents believed in the concept of CVs in anatomic pathology. There was good agreement concerning most of the possible CVs, although there were differences of opinion for some diagnoses. Several additional CVs were suggested, and there was discussion of the best terminology for CVs, degree of urgency, and appropriate notification documentation. A few respondents expressed concern about medicolegal implications. Based on the results of this survey, an ADASP committee has developed national guidelines for CDs (CVs) in surgical pathology and cytology.

Factitial soft tissue pseudotumor due to injection of anabolic steroids: a report of 3 cases in 2 patients

Traumatically induced inflammation or reactive processes are a relatively well-known phenomenon in both skin and soft tissue. These include panniculitides, fat necrosis, nodular fasciitis, and nonspecific fibrosis. Occasionally, traumatic reactions can be associated with factitial injury due to self-induced blunt trauma or injection of chemical agents. Factitial pseudotumors of soft tissue mimicking neoplasms and occurring in deep-seated locations are rare and not well recognized. We have had the opportunity to review a handful of cases over the years of soft tissue pseudotumors caused by self injection of steroids for the purposes of bodybuilding. Three of these cases in 2 patients are presented here. One patient developed a deep lateral thigh mass that was radiologically suspicious for sarcoma but upon core biopsy was found to be a lipogranulomatous reaction. The second patient had 2 masses occurring in the upper and lower extremity with an interval of 1 year between the two. This patient had both masses resected. The first had the appearance of a giant cell tumor with no immediately discernible foreign material. The second mass was initially presumed to be a metastasis from the upper extremity tumor and showed similar areas to the first specimen; however, it also had areas of obvious reactive features with foreign material. These features were found in the first tumor as well upon retrospective review. Both patients admitted to self injection of anabolic steroids after further history was sought by the clinicians. Deep soft tissue pseudosarcomas caused by injection of steroids are not well documented, and patients reluctance to provide this information leads to difficulty in arriving at a correct diagnosis. Recognition of this possibility is important in avoiding incorrect diagnoses and unnecessary treatments.

Additional file 1: Figure S1. of Increasing diagnostic accuracy to grade dysplasia in Barrett’s esophagus using an immunohistochemical panel for CDX2, p120ctn, c-Myc and Jagged1

Expression levels of four-marker protein panel in Barrett’s esophagus disease progression. (A) CDX2 expression with the quartile scoring method and (B) IRS scoring, decreased from ND-BE to EAC