Search

Objectives The novel coronavirus, severe acute respiratory syndrome coronavirus 2, causing coronavirus disease 2019 (COVID-19) remains a global health threat and a significant source of human morbidity and mortality. While the virus primarily induces lung injury, it also has been reported to cause hepatic sequelae. Methods We aimed to detect the virus in formalin-fixed tissue blocks and document the liver injury patterns in patients with COVID-19 compared with a control group. Results We were able to detect viral RNA in the bronchioalveolar cell blocks (12/12, 100%) and formalin-fixed, paraffin-embedded tissue of the lung (8/8, 100%) and liver (4/9, 44%) of patients with COVID-19. Although the peak values of the main liver enzymes and bilirubin were higher in the patients with COVID-19 compared with the control group, the differences were not significant. The main histologic findings were minimal to focal mild portal tract chronic inflammation (7/8, 88%, P < .05) and mild focal lobular activity (6/8, 75%, P = .06). Conclusions We found that most patients who died of COVID-19 had evidence of mild focal hepatitis clinically and histologically; however, the virus was detected in less than half of the cases.

We thank the speakers and participants for their contributions to the workshop. The activities of the National Cancer Policy Forum are supported by its sponsoring members, which currently include the Centers for Disease Control and Prevention, the National Institutes of Health/National Cancer Institute, the American Association for Cancer Research, the American Cancer Society, the American College of Radiology, the American Society of Clinical Oncology, the Association of American Cancer Institutes, the Association of Community Cancer Centers, Bristol-Myers Squibb, the Cancer Support Community, the CEO Roundtable on Cancer, Flatiron Health, Helsinn Therapeutics (U.S.) Inc., the LIVESTRONG Foundation, Merck, the National Comprehensive Cancer Network, Novartis Oncology, the Oncology Nursing Society, and Pfizer Inc. The responsibility for the content of this article rests with the authors and does not necessarily represent the views of the National Academies of Sciences, Engineering, and Medicine, its committees, its sponsors, or its convening activities.

The cytologic similarity to hepatocellular carcinoma (HCC) of 2 cases of granular renal cell carcinoma (RCC) with hyaline globules (HGs) prompted us to evaluate the frequency of HGs in RCC and HCC and the association between cell type, differentiation, and malignant potential of these 2 neoplasms and the presence of HGs. We studied fine-needle aspirates from 23 cases of RCC (primary, 7; metastatic, 16) and 23 cases of primary HCC and noted anatomic site, tumor cell type, and presence, quality, and quantity of HGs. Fuhrman nuclear grade was assigned to RCC and overall differentiation to HCC cases. RCC cell type was granular (7), mixed (4), and clear (12). HCC cases were granular (22) and clear (1). Morphologically similar, predominantly intracytoplasmic HGs were identified in 4 RCCs and 10 HCCs. All 4 RCCs with HGs were at metastatic sites, granular cell type, and high Fuhrman grade. HGs showed no association with differentiation of HCC. While HGs are seen more commonly in HCC than in RCC, their presence in an adenocarcinoma should bring renal origin into consideration. The presence of HGs in metastatic granular RCC, particularly in the liver, can lead to misinterpretation as primary HCC.

Graduated responsibility for residents in anatomic pathology has been the subject of discussion among supervising staff and residents during the past few years. Presently a wide variation exists within pathology residency programs in the United States both in the degree of autonomy given to residents and in the areas of anatomic pathology (ie, surgical pathology, cytopathology, and autopsy pathology) within which the autonomy is granted. Recent surveys of supervising staff and residents have indicated a willingness to increase the level of independence for residents, especially at senior levels. Impediments include reimbursement, credentialing, and medicolegal issues. The results of the ASCP-Resident Physician Section (RPS) surveys pertaining to graduated responsibility for residents in anatomic pathology are discussed.

Forty-one specimens from patients infected with the human immunodeficiency virus were stained with an anti–Pneumocystis carinii monoclonal antibody. Twenty-eight of the specimens were transbronchial biopsies (TBBx) negative for P carinii by silver stain (SS), and 13 cases were positive for P carinii by SS; 3 of the 13 cases had disseminated disease. Immunohistochemical staining (IHS) revealed P carinii in 3 of the 28 SS-negative TBBx; the finding was limited to a few small clusters of poorly preserved cysts in two cases and was extensive in one case. In the 13 SS-positive cases, IHS staining was strong and delineated the cysts. The number of organisms detected in cases with disseminated disease was strikingly higher than on SS. IHS for P carinii is easier to interpret than SS and visualizes a larger number of organisms. Cost may restrict use to cases in which SS was unable to confirm a physician’s strong suspicion of P carinii infection.

The recent debate on autopsy and the role of this unique doctor-patient relationship in the modern medical profession prompted the Resident Physician Section of the American Society of Clinical Pathologists to conduct a survey on postmortem practice as it relates to pathology residents. A total of 102 of 176 (58%) Resident Physician Section (RPS) liaisons from pathology residency programs in the United States, Canada, and Puerto Rico responded to a survey that consisted of 30 questions. The findings of the survey confirm the decrease in autopsy numbers, highlighting the problem of providing sufficient autopsy training to pathology residents. Interestingly, the majority of programs showed a striking similarity with regard to basic autopsy protocol procedures. Liaisons identified incorporation of clinical pathology, basic science, and clinicopathologic interaction as areas of weakness. In the final analysis, the majority of liaisons had a favorable opinion of their autopsy experience.