To demonstrate how the educational presentation and targeted review of cases with discrepant interpretive findings between pathologists can raise awareness for specific diagnostic errors through identification of common overarching patterns of error in interpretive pathology.We performed a review of 147 surgical pathology and cytopathology cases of discordances from 23 PowerPoint presentations presented between 2010 and 2017. Pathologists and pathology residents, blinded from the official interpretations, were presented each case and surveyed for their own diagnostic assessments. Survey results were compared with the final/correct interpretations of the signing pathologists.Of the 134 cases with available survey results, there were 87 (64.9%) for which most survey respondents proposed a diagnostic interpretation concordant with the final/correct diagnosis. There were 37 (27.6%) cases for which most survey responses were either wholly or partially discordant with the final/correct diagnosis. For 10 (7.5%) cases, there were equal numbers of concordant and discordant survey responses.Our analyses of the cases with frequent erroneous diagnoses reveal common patterns of error that are widely applicable and outline specific error-prone interpretive tendencies. Greater awareness for these tendencies, highlighted by presentation of discordant cases, can improve the quality of diagnostic pathology services.
Background: Diets high in fructose may result in abnormalities in glucose and lipid metabolism. Purpose: To investigate the effects of a high‐fructose diet on liver fatty acid composition. Methods: Male Sprague‐Dawley rats were divided into two groups: a control group (n=5) receiving standard chow diet, and treatment group (n=7) receiving a diet containing 10% w/w lard and 60% w/w fructose for 20 weeks. Fatty acid profile of various lipid fractions in the liver of these animals was characterized. Results: Total liver lipids including cholesterol and triacyglycerol (TAG) were significantly higher in the treated group as compared to controls. The livers from treated animals had significantly lower levels of C16:0 and higher levels of C18:1 in the TAG fraction, and lower levels of C18:1c11, C18:2c9, C20:1c11, C20:1c13 along with higher levels of C16:1 and C18:1c9 in the free fatty acid fraction. The levels of C16:0, C18:2c9, C20:1c11, C20:1c13, C20:2c11 and C24:0 were significantly increased in the phosholipid fraction of the treated animals. Conclusions: High intakes of fructose change liver lipid composition and fatty acid profile in rats. TAG and phospholipid fractions seem to be affected more. These changes may lead to alterations in hepatocyte functions including lipid metabolism and may modify cardiovascular risk.
Background: Despite beneficial cholesterol‐lowering and antioxidant properties of probucol, it paradoxically increases coronary atherogenesis in apo E‐KO mice. The aim of this study was to investigate the effects of probucol on cardiac function in apo E‐KO mice. Materials and Methods: Male apo E‐KO and C57BL/6 mice were fed an atherogenic diet with (treated, n=8) or without (control, n=8) 1% probucol for 16 weeks. Plasma cholesterol levels were measured. Murine echocardiography was performed serially at 6 week intervals. Results: Probucol treatment resulted in significant reductions in plasma cholesterol levels in both apo E‐KO (−30%, p<0.05) and C57BL/6 mice (−90%, p<0.01). Apo E‐KO mice treated with probucol showed early regional LV systolic dysfunction as early as 6 weeks with further decrease over time [endocardial velocity −40%; strain −40%, ejection fraction −10% (p<0.01)], with no impact on mortality. Such effects of probucol were not observed in C57BL/6 mice. Conclusions: Probucol impairs cardiac function in apo E‐KO mice. This may be related to previously observed coronary atherogenesis due to probucol in this animal model. Supported in part by URGP, HSF and NSERC.
Abstract Introduction/Objective The 2020 WHO classifies endometrial stromal tumors into endometrial stromal nodule (ESN), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma, and undifferentiated sarcoma. Minimal irregularity of the interface is allowed in ESN (up to 3 foci of <3 mm). In a small number of cases, the irregular interface exceeds the acceptable criteria for ESN but relatively limited compared to most LGESS. These cases are classified as endometrial stromal tumor with limited infiltration. These tumors may recur, and it is best managed as LGESS. Methods/Case Report We report a case of endometrial stromal tumor in a 42-year-old female who presented with abnormal vaginal bleeding. Imaging showed multiple fibroids. She underwent total abdominal hysterectomy and bilateral salpingectomy. On gross examination three endometrial polyps with sharp demarcation from the adjacent myometrium were identified (largest 4 cm). Histology revealed proliferation of uniform small cells with scant cytoplasm and round to oval nuclei with rare mitotic figures in a delicate network of arterioles. Immunostains showed positive staining for CD10 and estrogen receptor while negative for Caldesmon. These polyps were mainly confined to the endometrium with only small foci of irregular border with the myometrium. No vascular invasion, high grade cytologic atypia or necrosis were seen. The tumor showed JAZF1-SUZ12 gene fusion. This case was diagnosed as an endometrial stromal tumor with limited infiltration. Results (if a Case Study enter NA) NA Conclusion In conclusion, endometrial stromal tumors are commonly submucosal or intramural, we report a rare case that presented as multiple endometrial polyps, with very limited myometrium infiltration. To our knowledge, no cases have been reported so far. It is essential to be cognizant of this entity when dealing with polypoid lesions of the endometrium, they may recur and should be managed as LGESS.
