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* Context.--Increasing implementation of whole slide imaging together with digital workflow and advances in computing capacity enable the use of artificial intelligence (AI) in pathology, including breast pathology. Breast pathologists often face a significant workload, with diagnosis complexity, tedious repetitive tasks, and semi-quantitative evaluation of biomarkers. Recent advances in developing AI algorithms have provided promising approaches to meet the demand in breast pathology. Objective.--To provide an updated review of AI in breast pathology. We examined the success and challenges of current and potential AI applications in diagnosing and grading breast carcinomas and other pathologic changes, detecting lymph node metastasis, quantifying breast cancer biomarkers, predicting prognosis and therapy response, and predicting potential molecular changes. Data Sources.--We obtained data and information by searching and reviewing literature on AI in breast pathology from PubMed and based our own experience. Conclusions.--With the increasing application in breast pathology, AI not only assists in pathology diagnosis to improve accuracy and reduce pathologists' workload, but also provides new information in predicting prognosis and therapy response., Pathology is the gold standard for disease diagnosis. Pathologists are committed to assisting clinicians in the precise treatment of various diseases, especially malignant tumors. The advance in individualized treatment requires [...]

Context.--The original guideline, 'Validating Whole Slide Imaging for Diagnostic Purposes in Pathology,' was published in 2013 and included 12 guideline statements. The College of American Pathologists convened an expert panel to update the guideline following standards established by the National Academies of Medicine for developing trustworthy clinical practice guidelines. Objective.--To assess evidence published since the release of the original guideline and provide updated recommendations for validating whole slide imaging (WSI) systems used for diagnostic purposes. Design.--An expert panel performed a systematic review of the literature. Frozen sections, anatomic pathology specimens (biopsies, curettings, and resections), and hematopathology cases were included. Cytology cases were excluded. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, the panel reassessed and updated the original guideline recommendations. Results.--Three strong recommendations and 9 good practice statements are offered to assist laboratories with validating WSI digital pathology systems. Conclusions.--Systematic review of literature following release of the 2013 guideline reaffirms the use of a validation set of at least 60 cases, establishing intraobserver diagnostic concordance between WSI and glass slides and the use of a 2-week washout period between modalities. Although all discordances between WSI and glass slide diagnoses discovered during validation need to be reconciled, laboratories should be particularly concerned if their overall WSI-glass slide concordance is less than 95%., In 2013, the Pathology and Laboratory Quality Center for Evidence-based Guidelines (the Center) of the College of American Pathologists (CAP) released a guideline on the validation of whole slide imaging [...]

* Context.--The purpose of this review was to compare 3 coronavirus diseases, including severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 caused by SARS-CoV, MERS-CoV, and SARS-CoV-2 viruses, respectively. Objective.--To cover the following topics: clinical considerations, viral characteristics, pathology, immune response, pathogenesis, and the prognosis associated with each coronavirus disease in humans. Data Sources.--Clinically, flu-like symptoms are usual at the time of presentation for all 3 diseases, but these vary from asymptomatic to severe multisystem involvement. The pathology associated with symptomatic severe acute respiratory syndrome and COVID-19 has been well described, the most prominent of which is diffuse alveolar damage. The immune response to each of these viruses is highly complex and includes both humoral and cellular components that can have a significant impact on prognosis. In severe cases of COVID-19, a dysregulated innate host immune system can initiate a hyperinflammatory syndrome dominated by endothelial dysfunction that can lead to a hypercoagulable state with microthrombi, resulting in a systemic microvascular and macrovascular disease. Conclusions.--The severe acute respiratory syndrome and Middle East respiratory syndrome epidemics have been limited, involving approximately 8000 and 2500 individuals, respectively. In contrast, COVID-19 has resulted in a worldwide pandemic with more than 177 million cases and 3.9 million deaths as of June 15, 2021, and fatality rates ranging from less than 0.1% to approximately 10% depending upon the country. Ending on a positive note, the development of a number of vaccines, at least 6 of which now are in clinical use, should mitigate and eventually control the devastating COVID-19 pandemic. doi: 10.5858/arpa.2020-0820-SA, The purpose of this review was to compare the following 3 coronavirus diseases: severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and Coronavirus Disease 2019 (COVID-19) with an [...]

* Context.--Pathology practices have begun integrating digital pathology tools into their routine workflow. During 2020, the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a pandemic, causing a global health crisis that significantly affected the world population in several areas, including medical practice, and pathology was no exception. Objective.--To summarize our experience in implementing digital pathology for remote primary diagnosis, education, and research during this pandemic. Design.--We surveyed our pathologists (all subspecialized) and trainees to gather information about their use of digital pathology tools before and during the pandemic. Quality assurance and slide distribution data were also examined. Results.--During the pandemic, the widespread use of digital tools in our institution allowed a smooth transition of most clinical and academic activities into remote with no major disruptions. The number of pathologists using whole slide imaging (WSI) for primary diagnosis increased from 20 (62.5%) to 29 (90.6%) of a total of 32 pathologists, excluding renal pathology and hematopathology, during the pandemic. Furthermore, the number of pathologists exclusively using whole slide imaging for primary diagnosis also increased from 2 (6.3%) to 5 (15.6%) during the pandemic. In 35 (100%) survey responses from attending pathologists, 21 (60%) reported using whole slide imaging for remote primary diagnosis following the Centers for Medicare and Medicaid Services waiver. Of these 21 pathologists, 18 (86%) responded that if allowed, they will continue using whole slide imaging for remote primary diagnosis after the pandemic. Conclusions.--The pandemic served as a catalyst to pathologists adopting a digital workflow into their daily practice and realizing the logistic and technical advantages of such tools. (Arch Pathol Lab Med. 2021;145:1051-1061; doi: 10.5858/arpa.2020-0715-SA, In the last 20 years, substantial advances have occurred in the field of digital pathology (DP). In particular, whole slide imaging (WSI) can now produce high-resolution digital replicas of glass [...]

* April 12, 2017 marked a significant day in the evolution of digital pathology in the United States, when the US Food and Drug Administration announced its approval of the Philips IntelliSite Pathology Solution for primary diagnosis in surgical pathology. Although this event is expected to facilitate more widespread adoption of whole slide imaging for clinical applications in the United States, it also raises a number of questions as to the means by which pathologists might choose to incorporate this technology into their clinical practice. This article from the College of American Pathologists Digital Pathology Committee reviews frequently asked questions on this topic and provides answers based on currently available information.(Arch Pathol Lab Med. 2018;142:1383-1387; doi: 10.5858/arpa.2017-0496-CP), On April 12, 2017, the US Food and Drug Administration (FDA) announced the approval of the first whole slide imaging (WSI) system for primary diagnosis in surgical pathology. (1) This [...]

To the Editor.--We read with interest the recently published pilot study on digital whole slide imaging (WSI) for cervicovaginal cytology by Wright and colleagues. (1) Their study employed 7 cytologists [...]

Context.--There is increasing interest in using whole slide imaging (WSI) for diagnostic purposes (primary and/ or consultation). An important consideration is whether WSI can safely replace conventional light microscopy as the method by which pathologists review histologic sections, cytology slides, and/or hematology slides to render diagnoses. Validation of WSI is crucial to ensure that diagnostic performance based on digitized slides is at least equivalent to that of glass slides and light microscopy. Currently, there are no standard guidelines regarding validation of WSI for diagnostic use. Objective.--To recommend validation requirements for WSI systems to be used for diagnostic purposes. Design.--The College of American Pathologists Pathology and Laboratory Quality Center convened a nonvendor panel from North America with expertise in digital pathology to develop these validation recommendations. A literature review was performed in which 767 international publications that met search term requirements were identified. Studies outside the scope of this effort and those related solely to technical elements, education, and image analysis were excluded. A total of 27 publications were graded and underwent data extraction for evidence evaluation. Recommendations were derived from the strength of evidence determined from 23 of these published studies, open comment feedback, and expert panel consensus. Results.--Twelve guideline statements were established to help pathology laboratories validate their own WSI systems intended for clinical use. Validation of the entire WSI system, involving pathologists trained to use the system, should be performed in a manner that emulates the laboratory's actual clinical environment. It is recommended that such a validation study include at least 60 routine cases per application, comparing intraobserver diagnostic concordance between digitized and glass slides viewed at least 2 weeks apart. It is important that the validation process confirm that all material present on a glass slide to be scanned is included in the digital image. Conclusions.--Validation should demonstrate that the WSI system under review produces acceptable digital slides for diagnostic interpretation. The intention of validating WSI systems is to permit the clinical use of this technology in a manner that does not compromise patient care. (Arch Pathol Lab Med. 2013; 137:1710-1722; doi: 10.5858/arpa.2013-0093-CP), In the last decade, digital imaging in pathology has been significantly impacted by the development and application of whole slide imaging (WSI) technology. (1-7) The automated WSI scanner is a [...]

Context.--Central pathology review (CPR) was initially designed as a quality control measure. The potential of CPR in clinical trials was recognized as early as in the 1960s and quickly became embedded as an integral part of many clinical trials since. Objective.--To review the current experience with CPR in clinical trials, to summarize current developments in virtual microscopy, and to discuss the potential advantages and disadvantages of this technology in the context of CPR. Data Sources.--A PubMed (US National Library of Medicine) search for published studies was conducted, and the relevant articles were reviewed, accompanied by the authors' experience at their practicing institution. Conclusions.--The review of the available literature strongly suggests the growing importance of CPR both in the clinical trial setting as well as in second opinion cases. However, the currently applied approach significantly impedes efficient transfer of slides and patient data. Recent advances in imaging, digital microscopy, and Internet technologies suggest that the CPR process may be dramatically streamlined in the foreseeable future to allow for better diagnosis and quality assurance than ever before. In particular, whole slide imaging may play an important role in this process and result in a substantial reduction of the overall turnaround time required for slide review at the central location. Above all, this new approach may benefit the large clinical trials organized by oncology cooperative groups, since most of those trials involve complicated logistics owing to enrollment of large number of patients at several remotely located participating institutions. (Arch Pathol Lab Med. 2013;137:492-495; doi: 10.5858/arpa.2012-0093-RA), There is a growing awareness that the second opinion may lead to significant changes in diagnoses. Some diseases, especially some types of malignant tumors, are notoriously difficult to classify and [...]

* Primary adenocarcinoma of urinary bladder is an uncommon neoplasm and is a source of diagnostic confusion with adenocarcinomas arising in adjacent organs, especially colon. These tumors show varied histologic picture and degree of differentiation. Clinical association with bladder exstrophy and schistosomiasis has been well documented. Primary bladder adenocarcinomas have overlapping histologic and immunohistochemical features with adenocarcinomas arising from other primary sites and the suggested immunohistochemical panel includes cytokeratins 7 and 20, 34βE12, thrombomodulin, CDX2, and β-catenin. Clinical, imaging, histologic, and immunohistochemical correlation should be done while rendering this diagnosis, as prognosis and therapeutic options for primary versus metastatic adenocarcinoma vary widely. (Arch Pathol Lab Med. 2011; 135:1601-1605; doi: 10.5858/arpa.2009-0713-RS), Adenocarcinoma of the urinary bladder arising from the urothelial lining is an uncommon malignant neoplasm, accounting for 0.5% to 2.0% of all malignant vesical tumors. (1) The histologic variants show [...]

Xanthogranulomatous pyelonephritis is an uncommon chronic destructive granulomatous process of renal parenchyma in association with long-term urinary tract obstruction and infection. It affects females more often than males, with a wide range of age, from newborn to elderly. Almost all patients are symptomatic and the most common symptoms are flank or abdominal pain, lower urinary tract symptoms, fever, palpable mass, gross hematuria, and weight loss. The common laboratory findings are leukocytosis and anemia. Urine cultures most often reveal Escherichia coii and Proteus mirabilis. Computed tomography is the mainstay of diagnostic imaging for xanthogranulomatous pyelonephritis. Imaging studies may demonstrate diffuse or focal form. Histologically, xanthogranulomatous pyelonephritis presents a granulomatous inflammatory infiltrate composed of neutrophils, lymphocytes, plasma cells, xanthomatous histiocytes, and multinucleated giant cells. The differential diagnosis includes clear cell renal cell carcinoma, papillary renal cell carcinoma, sarcomatoid renal cell carcinoma, leiomyosarcoma, malakoplakia, and megalocytic interstitial nephritis. Both antibiotics and surgery can be treatment options depending on the patient's disease status. (Arch Pathol Lab Med. 2011;135:671-674), Xanthogranulomatous pyelonephritis (XGP) is a chronic destructive granulomatous inflammation of renal parenchyma. (1) This entity was first described by Schlagenhaufer (2) in 1916. Three forms were recognized: diffuse, segmental, and [...]

Context.--Novel anatomic pathology technologies allow pathologists to digitally view and diagnose cases. Although digital pathology advocates champion its strengths and move to integrate it into practice and workflow, the capabilities and limitations of digital slides have not been fully investigated. Objectives.--To estimate intrapathologist diagnostic discrepancy between glass and digital slides and to determine pathologists' diagnostic certainty when diagnosing with the 2 formats. Design.--Intrapathologist diagnostic consistency between glass and digital slides was measured. Three pathologists diagnosed 101 cases digitally and with corresponding glass slides. Discrepancies between formats were evaluated, and diagnostic precision and certainty were compared. Results.--A total of 606 diagnoses were evaluated in pairs (202 per pathologist). Seven cases did not transfer to the database and were eliminated from further study. We report no discrepancies between media in 75%, 87%, and 83% of the cases diagnosed by the 3 pathologists, respectively; significant discrepancies were identified in 3%, 3%, and 7% of cases by each pathologist. In total, we identified significant clinical and therapeutic discrepancies in 13 of 296 cases (4.4%). The certainty values provided by each pathologist were similar between formats. Conclusions.--This study did not detect significant differences between diagnoses based on digital and glass slides. We believe that this study further supports the integration of digital slides into pathology workflow, particularly considering the low rate of discrepancy documented here., Although pathologists have used the microscope since the 17th century, the evolution of information technology during the past decade has facilitated the development, implementation, and use of novel technologies in [...]

Context.--The site-specific cancer checklists developed by the College of American Pathologists have the potential to improve the quality of data derived from pathology reports and incorporated into cancer registry databases and are now mandated report elements by various accrediting bodies. A pilot project, funded by the Centers for Disease Control National Project for Cancer Registries in 2004, brought 4 pathology services in 3 states, with differing baseline implementations of the checklists, the opportunity to partner with their state National Project for Cancer Registry and their laboratory information system vendors to evaluate the feasibility of using electronically encoded College of American Pathologists cancer checklists for melanoma and tumors of the breast and prostate. Objectives.--To identify existing and potential barriers to adoption of electronically encoded checklists and to also identify unique benefits not associated with text-only uses of the checklists. Design.--Participants mapped an implementation process from their current state to an electronic checklist-capable state. For a sample of cases of melanoma, prostate, and breast cancers, the checklist elements were captured and transmitted to the registry using Health Level 7 (version 2.3.1). Process assessments with adoption of electronic checklists were conducted to assess pathologist effect and other potential barriers. An evaluation of the utility and usefulness of electronic checklists was performed after the project. Results.--All 4 laboratories successfully performed the capture of individual data elements from the College of American Pathologists checklist into a discrete format suitable for electronic transmission. The effect on pathologist performance and laboratory workflow was neutral. Points of resistance were identified in the checklists and in individual users. Specific challenges in individual laboratories varied according to the personnel and the baseline system in use. Clinical responses to implemented changes were generally positive. Analysis of the post project experiences of the laboratories showed expansion of use and additional utility in some, but not all, laboratories. Conclusions.--Pathology laboratory adoption of the College of American Pathologists cancer checklists in an electronic format suited to direct transmission to cancer registries poses business case, information technology, and human resource challenges. Laboratory information system vendor readiness to upgrade systems to facilitate this process helps to reduce some of these challenges. Personalities and preferences in practices may yet pose barriers to widespread adoption., Although the pathology report is crafted and primarily designed in the context of the physician-consultant-patient relationship, the 'consumers' of this information are clearly not limited to the primary parties in [...]

* Context.--Sarcoidosis is a granulomatous disease of unclear etiology. It is not commonly fatal, but when sarcoidosis is fatal, it is most often from cardiac involvement and when sarcoidosis involves the heart, it frequently causes death. The disease presents diagnostic challenges both clinically and histologically. Objectives.--To review the histology of cardiac sarcoidosis and the histologic differential diagnosis of cardiac granulomatous disease and to review the epidemiology and gross pathology of cardiac sarcoid as well as discuss current controversies, clinical diagnostic criteria, and proposed mechanisms of pathogenesis. Data Sources.--We reviewed the literature searchable on PubMed as well as selected older studies revealed by our review of the recent literature. Photographs were taken from cases on file at the University of Pittsburgh Medical Center (Pittsburgh, Pennsylvania) and Columbia University Medical Center (New York, New York). Conclusions.--Sarcoidosis is a focal or disseminated granulomatous disease that likely represents the final common pathway of various pathogenic insults in a genetically susceptible host. The type of insult may influence the specific sarcoid phenotype. Controversy still abounds, but many areas of investigation around sarcoidosis are yielding exciting discoveries and bringing us closer to a richer understanding of this puzzling disease., Sarcoidosis is an aggressively studied systemic granulomatous disease that has been a source of considerable controversy due to its unclear etiology and diverse presentation. It has been aptly described as [...]

* Xp11.2 translocation renal cell carcinomas (RCCs), a recently recognized distinct subtype, are rare tumors predominantly reported in young patients. They comprise at least one-third of pediatric RCCs, and only few adult cases have been reported. They are characterized by various translocations involving chromosome Xp11.2, all resulting in gene fusions involving the transcription factor E3 (TFE3) gene. In recent years, at least 6 different Xp11.2 translocation RCCs have been identified and characterized at the molecular level. These include a distinctive RCC that bears a translocation with the identical chromosomal breakpoints (Xp11.2, 17q25) and identical resulting ASPL-TFE3 gene fusion as alveolar soft part sarcoma. They typically have papillary or nested architecture and are composed of cells with voluminous, clear, or eosinophilic cytoplasm. Their most distinctive immunohistochemical feature is nuclear labeling for TFE3 protein. Although only limited data are available so far, they are believed to be rather indolent, but there have been increasing, recent reports of an aggressive clinical course in adult cases. The consistent immunohistochemical staining for TFE3 in all RCC with unusual histology, regardless of patient age, is likely to expand the spectrum of Xp11.2 translocation RCC with respect to age, clinical behavior, and molecular abnormalities. (Arch Pathol Lab Med. 2010;134:124-129), Xp11.2 translocation renal cell carcinomas (RCCs), a recently classified distinct subtype, are rare tumors that usually affect children and adolescents, (1-8) with only a few reported adult cases to date. [...]

Spermatocytic seminoma is a rare germ cell tumor distinct from classical seminoma, both clinically and pathologically. It affects older men, has not been associated with a history of cryptorchidism, and has no known counterpart in ovary or any other site. Pathologically, it is characterized by 3 distinct cell types, lack of cytoplasmic glycogen, and scant to absent lymphocytic infiltrate. Gain of chromosome 9 is the most consistent genetic abnormality. There have been few case reports of sarcomas arising in spermatocytic seminoma and only an occasional report of metastasis. It is important to differentiate this condition from its frequent mimics, such as classic seminoma and embryonal carcinoma, because patients with spermatocytic seminoma may not require further treatment after surgery., Testicular germ cell tumors represent the most frequent solid malignancy in young white men between the ages of 20 and 35 but are relatively uncommon among African Americans. (1-4) Epidemiologically, [...]

Mixed epithelial and stromal tumor of the kidney is a recently recognized distinct neoplasm that should be distinguished from other renal neoplasms. These tumors are relatively rare with a female preponderance. Imaging studies are not diagnostic but reveal a solid or solid and cystic mass in most cases. Histopathologically, these tumors reveal biphasic growth pattern comprising mesenchymal and epithelial elements with characteristic estrogen and progesterone receptor immunoreactive mesenchyme reminiscent of ovarian stroma. Malignant transformation, recurrence, and metastasis are rare; however, recently a few cases of malignant mixed epithelial and stromal tumors have been reported in the literature. Recently a case with translocation t(1;19) has been described. This article provides a brief overview of the current knowledge of mixed epithelial and stromal tumor of the kidney., Adult renal neoplasm with a variable admixture of epithelial and mesenchymal components is a distinctive benign neoplasm that has recently been recognized and termed as benign mixed epithelial and stromal [...]

Epithelioid sarcomas are rare, mesenchymal tumors of unknown histogenesis and display multidirectional differentiation, which is predominantly epithelial. They have no normal cellular counterpart and differ from both synovial sarcoma and carcinoma. They account for less than 1% of all soft tissue sarcomas and are usually slow growing, with peak incidence in young adult men and occur predominantly in extremities. Histologically, they form nodules, with central necrosis surrounded by bland, polygonal cells with eosinophilic cytoplasm and peripheral spindling. They regularly express vimentin, cytokeratins, epithelial membrane antigen, and CD34, whereas staining is usually negative with S100, desmin, and FLI-1. Ultrastructurally, they display epithelial and mesenchymal features, including myofibroblasts differentiation. They manifest no specific cytogenetic findings, but several cases have displayed chromosomal abnormalities in 22q region. Clinically, they have a high recurrence rate, and up to 50% of epithelioid sarcomas metastasize. Proximal, fibroma-like, and angiomatoid variants have been described. The proximal variant (with larger cells, prominent nucleoli, and rhabdoid changes) is clinically more aggressive., Epithelioid sarcoma (ES) is a soft-tissue tumor, composed of large, polygonal cells resembling carcinomas. Epithelioid sarcoma was first characterized as a distinct clinicopathologic entity by Enzinger in 1970 (1) after [...]

Perivascular epithelioid cell tumors are mesenchymal neoplasms defined by the presence of histologically and immunohistochemically distinctive perivascular epithelioid cells. The perivascular epithelioid cell has no known normal tissue counterpart and coexpresses myoid and melanocytic markers. This tumor family shows marked female predominance and includes angiomyolipoma, clear cell sugar tumor, lymphangioleiomyomatosis, and a group of rare, morphologically and immunophenotypically similar tumors arising at a variety of visceral and soft tissue sites. This latter subset has been collectively termed perivascular epithelioid cell tumors-not otherwise specified. They are usually composed of epithelioid, but occasionally spindled, cells with clear to granular eosinophilic cytoplasm and focal perivascular accentuation. The mainstay of treatment is wide excision. Although most cases are benign, a subset behaves in a malignant fashion. Since few malignant cases have been reported, firm criteria for malignancy have yet to be established. This review focuses on the perivascular epithelioid cell tumors-not otherwise specified subset., The World Health Organization defines perivascular epithelioid cell tumors (PEComas) as mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells (PECs). (1) In 1991, Pea and colleagues (2) [...]

Context.--Increasing implementation of whole slide imaging together with digital workflow and advances in computing capacity enable the use of artificial intelligence (AI) in pathology, including breast pathology. Breast pathologists often face a significant workload, with diagnosis complexity, tedious repetitive tasks, and semiquantitative evaluation of biomarkers. Recent advances in developing AI algorithms have provided promising approaches to meet the demand in breast pathology. Objective.--To provide an updated review of AI in breast pathology. We examined the success and challenges of current and potential AI applications in diagnosing and grading breast carcinomas and other pathologic changes, detecting lymph node metastasis, quantifying breast cancer biomarkers, predicting prognosis and therapy response, and predicting potential molecular changes. Data Sources.--We obtained data and information by searching and reviewing literature on AI in breast pathology from PubMed and based our own experience. Conclusions.--With the increasing application in breast pathology, AI not only assists in pathology diagnosis to improve accuracy and reduce pathologists' workload, but also provides new information in predicting prognosis and therapy response. [ABSTRACT FROM AUTHOR]

This article presents a case study of a 35-year-old man with gross hematuria and flank pain. Prior to this episode, he had been otherwise healthy. A cystoscopic evaluation showed high-grade obstruction of his right ureter at the right ureteral vesicle junction. A right ureteral stent was placed. A subsequent computed tomographic scan showed significant right hydronephrosis in spite of the ureteral stent. A series of 8 prostate biopsies were performed, including one of a hypoechoic area at the right apex. Histologic examination showed a neoplasm composed of anastomosing cell cords or trabecular arrangement of tumor cells.

Provides information on the medical case of an adolescent girl with a history of sickle cell trait presented with supraclavicular lymphadenopathy and pleural and pericardial effusions. Results of the histopathologic and immunoperoxidase examination of the supraclavicular tissue biopsy; Common symptoms of patients with metastatic renal medullary carcinoma (RMC); Prognosis for patients with RMC.

This article focuses on the treatment of a 30-year-old man with lower abdominal and back pain. The man presented with lower abdominal and back pain, nausea, vomiting, and a significant weight loss. He also complained of persistent fever and night sweats. On physical examination he was noted to be jaundiced. Imaging studies performed subsequently demonstrated ascites and a heterogeneous, hypovascular mass in the proximal pancreatic body and neck. An ultrasound-guided fine-needle aspiration of the pancreatic mass was performed. Smears were air-dried and stained with Diff-Quik for immediate on-site evaluation and wet-fixed in ethanol for subsequent Papanicolaou staining. Smears were hypercellular and comprised predominantly relatively large and pleomorphic, discohesive single cells.

This article focuses on a case study related to a male infant with a large hydrocele. A 2-month-old male infant presented with a large hydrocele and an associated hernia. The diagnosis was first established at birth, when an ultrasound indicated abundant fluid in the scrotum consistent with a hydrocele. Examination of his external genitalia revealed an enormous hydrocele. The testes were nonpalpable. During surgery, it was noted that the hydrocele extended up into the left groin. Examination of the scrotum itself revealed a large cystic structure.

Describes the case of a 3-year-old girl with dysuria and urinary incontinence. Highlights of the pathologic diagnosis of primary embryonal rhabdomyosarcoma (RMS) of the urinary bladder; Information on RMS a common soft tissue sarcoma in children; Characteristics of embryonal and alveolar RMSs.

Presents the case of a 50-year-old man with a lung mass, respiratory distress and pericardial effusion. Highlights of the pathologic diagnosis of metastatic clear cell sarcoma (CCS); Description of CCS also referred to as malignant melanoma of soft parts.

Presents a pathologic case study of primary high-grade leiomyosarcoma of the inferior vena cava seen in a middle-aged man with hypertension. Clinical history of the patient; Results of physical and laboratory examinations performed on the patient; Background on the disease.

Presents a case study of an 85-year-old woman suffering from osteoclast-like giant cell tumor of the pancreas. Laboratory findings; Ultrasonography findings; Cytologic differential diagnosis.

Discusses a case study of an 81-year-old woman with chondroid syringoma of the breast. Clinical characteristics of the patient; Clinical and pathological characteristics of the disease; Physical examination results; Cytologic differential diagnosis.