Objectives Since neuropathologic diagnosis in the developing world is hampered by limitations in technical infrastructure, trained laboratory personnel, and subspecialty-trained pathologists, the use of telepathology for diagnostic support, second-opinion consultations, and ongoing training holds promise as a means of addressing these challenges. This study aims to assess the utility of static teleneuropathology in improving neuropathologic diagnoses in low- and middle-income countries. Methods Consecutive neurosurgical biopsy and resection specimens obtained at Muhimbili National Hospital in Tanzania between July 1, 2018, and June 30, 2019, were selected for retrospective, blinded static-image neuropathologic review followed by on-site review by an expert neuropathologist. Results A total of 75 neuropathologic cases were reviewed. The agreement of static images and on-site glass diagnosis was 71% with strict criteria and 88% with less stringent criteria. This represents an overall improvement in diagnostic accuracy from 36% by general pathologists to 71% by a neuropathologist using static telepathology (or from 76% to 88% with less stringent criteria). Conclusions Telepathology offers a promising means of providing diagnostic support, second-opinion consultations, and ongoing training to pathologists practicing in resource-limited countries. Moreover, static digital teleneuropathology is an uncomplicated, cost-effective, and reliable way to achieve these goals.
Introduction: Ameloblastoma is a benign odontogenic tumor that may exhibit aggressive biological behavior with local recurrence. It more commonly occurs in the mandible than the maxilla. Rarely, ameloblastoma may metastasize to local regional lymph nodes and/or distant organs, notably lungs, brain, and skin, hence the term metastasizing (malignant) ameloblastoma (MA), in keeping with the WHO definition of MA in its recent classification of odontogenic tumors (2017). Here, we report a rare case of maxillary ameloblastoma that metastasized to the lungs in a 22-year-old African male. Radiological evaluation revealed a massive maxillary tumor that had a local extension to the brain. Chest x-ray and CT scan pointed out metastatic mass to the lungs. Histology of the tumor mass revealed it to be follicular ameloblastoma with aggressive behavior shown by abnormal mitoses and further characterization by immunohistochemical reactivity to Ki-67. CT-guided fine-needle aspiration cytology of the lung mass showed microscopic features of ameloblastoma bearing resemblance to the primary jaw tumor. Socioeconomic constraints on the patient’s side and limited medical resources necessitated planning that served the purpose of proper diagnosis and treatment options. In this paper, we discuss the clinical behavior, differential diagnosis, and challenges faced by clinicians in managing metastatic ameloblastoma in a resource-limited setting. Conclusively, reporting this rare case and first of its kind in our locality raises awareness, hence reducing misdiagnosis of primary tumor in sites other than the jaw, while also sharing our experience of managing metastasizing ameloblastoma in a resource-limited setting to the larger medical community.
Introduction/Objective Stillbirth is defined as fetal death that occurs at gestational age of ≥28 weeks. In our setting clinical assessment is the only method used to determine cause of stillbirths, with no reported proportion of unknown clinical diagnosis. Studies showed that unknown cause of stillbirths can be reduced by examination of placenta. Causal identification aids in the mourning process and identifying recurrence risks. The study aimed to describe pathological changes in the placentas of stillbirths which have risk to cause fetal death Methods A descriptive cross-sectional study done for the period of 6 months, it involved examination of 80 placentas of stillbirths born at gestational age of ≥ 28 weeks, placentas were fixed in 10% neutral buffered formalin for 8–12 hours. Grossing and interpretation of placenta pathology was according to Amsterdam Placental Workshop Group Consensus Statement. Results Out of 80 stillbirths, 32(40%) had unknown clinical diagnosis. Majority of stillbirth placentas 71(91%) found with either one or combined pathologies with the risk to cause stillbirth. Maternal vascular malperfusion was the commonest pathology and was significantly associated with preterm stillbirths. Maternal floor infarction, a placenta pathology with risk to cause fetal death and high risk of recurrence was among the pathologies found, was seen in 4(5%) of stillbirth placentas. Conclusion Findings in this study clearly indicated the importance of pathological examination of placenta in determining cause of stillbirth. Placenta examination in stillbirths can identify more pathology related to stillbirths than clinical assessment alone.
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