Keith J. Kaplan

Use of robotic telepathology for frozen-section diagnosis: a retrospective trial of a telepathology system for intraoperative consultation.

Telepathology is the practice of digitizing histological or macroscopic images for transmission along telecommunication pathways for diagnosis, consultation, or continuing medical education. Previous studies have addressed static versus dynamic imaging in several specimen types with a wide variety of systems and communication pathways. The goal of this paper was to assess the validity of a Web-based telepathology system for frozen section consultation within the Army Medical Department. The system provides real-time, dynamic remote control of a robotic microscope over standard Internet connections. Oftentimes, a solo pathologist is called on to provide diagnostic services without the support of immediate second or expert consultation during an intraoperative consultation. The use of telepathology is attractive because it provides an opportunity for pathologists to obtain immediate consultation. For purposes of the study, 120 consecutive frozen section cases were diagnosed at a distance using the system. Intraobserver agreement between the telepathology diagnosis and glass slide diagnosis was observed. Diagnostic agreement was 100% for a wide variety of specimens. This study suggests that such a system will help support pathologists located at distant sites.

Bilateral lipoma arborescens of the bicipitoradial bursa

Abstract. A 37-year-old military mechanic presented to our institution with a chronic history of a slowly enlarging left elbow antecubital fossa mass. There was no history of other chronic illness or trauma. Magnetic resonance imaging (MRI) and excisional biopsy revealed fatty villi and synovial inflammation within the left bicipitoradial bursa, consistent with lipoma arborescens. Four years later the patient presented with a 6-month history of swelling at the antecubital fossa of the opposite elbow. Diagnostic computed tomography and MRI examinations were performed. The surgical and pathologic findings confirmed the imaging diagnosis of lipoma arborescens at the right bicipitoradial bursa.

Fetiform Teratoma (Homunculus)

Fetiform teratoma (homunculus) is a term that has been given to a rare form of ovarian teratoma that resembles a malformed fetus. There are very few reported cases of this entity in the English language literature. In this report, we document a case of fetiform teratoma in a 23-year-old woman, gravida 0, who initially presented with a chief complaint of dyspareunia. The clinical and pathologic aspects of this rare entity are presented here, with a review of the English literature. Differentiating fetiform teratoma from the more highly developed fetus-in-fetu and ectopic pregnancy is also discussed.

The prevalence of BK polyomavirus infection in outpatient kidney transplant recipients followed in a single center

Abstract: Background:  BK polyomavirus (BKV) infection has emerged as an important cause of renal allograft loss. There is no proven therapy, and much basic clinical information is still lacking.

#InSituPathologists: how the #USCAP2015 meeting went viral on Twitter and founded the social media movement for the United States and Canadian Academy of Pathology

Professional medical conferences over the past five years have seen an enormous increase in the use of Twitter in real-time, also known as “live-tweeting”. At the United States and Canadian Academy of Pathology (USCAP) 2015 annual meeting, 24 attendees (the authors) volunteered to participate in a live-tweet group, the #InSituPathologists. This group, along with other attendees, kept the world updated via Twitter about the happenings at the annual meeting. There were 6,524 #USCAP2015 tweets made by 662 individual Twitter users; these generated 5,869,323 unique impressions (potential tweet-views) over a 13-day time span encompassing the dates of the annual meeting. Herein we document the successful implementation of the first official USCAP annual meeting live-tweet group, including the pros/cons of live-tweeting and other experiences of the original #InSituPathologists group members. No prior peer-reviewed publications to our knowledge have described in depth the use of an organized group to “live-tweet” a pathology meeting. We believe our group to be the first of its kind in the field of pathology.

Well-Differentiated Fetal Adenocarcinoma: Rare Tumor in the Pediatric Population

Well-differentiated fetal adenocarcinoma (WDFA) is a rare tumor of the lung, which has gone by many names over the years. The lesion was first described by Kradin et al., in 1982, who called it “pulmonary blastoma with argyrophil cells and lacking sarcomatous features (pulmonary endodermal tumor resembling fetal lung).” Since then, there have been at least 65 cases reported in the literature. Although there has been no consensus in the literature as to the best pathological term for this entity, the most recent World Health Organization classification of lung and pleural tumors uses the term well-differentiated fetal adenocarcinoma. Characteristically, this lesion consists of an epithelium, which recapitulates fetal lung at 3–5 months of gestation and demonstrates neuroendocrine differentiation. Although the classic age range is 30–40 years, there have been seven reports of WDFA in the pediatric age. We report an additional pediatric case of this tumor and review the pediatric cases in the existing literature.

Kudos to the College of American Pathologists and the Archives

To the Editor.—I read with interest the recent article by Hwang et al entitled ‘‘Pulmonary Large Cell Carcinoma Lacking Squamous Differentiation Is Clinicopathologically Indistinguishable From Solid-Subtype Adenocarcinoma’’ and your accompanying editorial with Dr Glassy in the same issue on the use of whole slide images in journal articles. There is no doubt this is an excellent use of digital pathology technologies illustrating a journal article, beyond the traditional use of static imaging alone, showcasing a simple yet effective way to further educate and inform pathologists. Although many advances have come to publishing in recent years, with multiple formats and applications for both submission and viewing with desktop and mobile viewing, this may represent the single most important upgrade for pathology journals. As readers, we can now appreciate more than a snapshot to support findings or conclusions and be more directly involved in the approach to the lesions described that support or refute contributors’ results and conclusions. Many of us can still recall the necessity of returning glass slides mailed months previously at the time of a meeting in order to obtain a course syllabus and perhaps a set of Kodachrome slides, perhaps even risking not being able to obtain CME (continuing medical education) credit without return of the glass slides. Digital pathology technologies, such as those used in the Hwang et al article, highlight the value of whole slide images and their value to the pathology community. Continued advances in scanning, storage, and viewing, along with advances in how textual information is delivered and viewed, will only continue to enhance the value of whole slide images compared with representative figures. Thank you to the College of American Pathologists and the Archives of Pathology & Laboratory Medicine for your thought, vision, and leadership in this effort.