Context.-Relatively little is known about the significance and potential impact of glass-digital discordances, and this is likely to be of importance when considering digital pathology adoption.Objective.-To apply evidence-based medicine to collect and analyze reported instances of glass-digital discordance from the whole slide imaging validation literature.Design.-We used our prior systematic review protocol to identify studies assessing the concordance of light microscopy and whole slide imaging between 1999 and 2015. Data were extracted and analyzed by a team of histopathologists to classify the type, significance, and potential root cause of discordances.Results.-Twenty-three studies were included, yielding 8069 instances of a glass diagnosis being compared with a digital diagnosis. From these 8069 comparisons, 335 instances of discordance (4%) were reported, in which glass was the preferred diagnostic medium in 286 (85%), and digital in 44 (13%), with no consensus in 5 (2%). Twenty-eight discordances had the potential to cause moderate/severe patient harm. Of these, glass was the preferred diagnostic medium for 26 (93%). Of the 335 discordances, 109 (32%) involved the diagnosis or grading of dysplasia. For these cases, glass was the preferred diagnostic medium in 101 cases (93%), suggesting that diagnosis and grading of dysplasia may be a potential pitfall of digital diagnosis. In 32 of 335 cases (10%), discordance on digital was attributed to the inability to find a small diagnostic/prognostic object.Conclusions.-Systematic analysis of concordance studies reveals specific areas that may be problematic on whole slide imaging. It is important that pathologists are aware of these areas to ensure patient safety.
Primary pulmonary botryomycosis is a rare cause of haemoptysis and can enter the diVerential diagnosis of a mass on the plain chest radiograph. The case history is presented of a 63 year old man with botryomycosis which was initially thought to be a bronchial carcinoma. When the diagnosis was made several years later it was found to be secondary to persisting vegetable material in the bronchial tree following previous aspiration.
We describe a patient with extensive ischaemic necrosis of the ileum as a result of elastic vascular sclerosis (EVS). A 2 cm carcinoid tumour was located nearby with microscopic evidence of spread to regional lymph nodes. Severe intestinal ischaemia caused by carcinoid associated EVS may be the presenting feature of small carcinoid tumours resulting in their early diagnosis. Carcinoid tumours which have metastasised from GI tract to liver may present with the well known carcinoid syndrome, by which time definitive treatment is usually impossible. Surveys suggest that this syndrome is found in approximately 5% of carcinoid tumours,'2 the remainder being found incidentally or presenting with symptoms referable to their site of origin. Such symptoms may be the result of small bowel obstruction (partial or complete), intussusception or bleeding. The present report describes an alternative manifestation: intestinal gangrene caused by elastic vascular sclerosis (EVS). In contrast with previous reports the present case indicates that severe intestinal ischaemia may be the result of EVS in association with a small carcinoid tumour without macroscopic spread. Case report An 85 year old woman was admitted with a one month history of intermittent nausea and vomiting after meals. These symptoms had worsened two days immediately before admission and she had developed abdominal pain, initially in the lower abdomen but subsequently generalised. Her appetite had been poor with weight loss of an indeterminate amount, probably slight. Her bowel habit had been
Benign tumours of the oesophagus are rare, representing less than 1 % of all oesophageal neoplasms.' Most of them are intramural leiomyomas and other benign tumours encountered only infrequently; among these pedunculated intraluminal hamartomas form a particularly rare group. Special difficulties are associated with their diagnosis, but early detection is important because despite their benign histological nature life threatening sequelae may ensue. We present the case history of a patient with a protracted illness due to a large oesophageal hamartoma, which had remained undiagnosed despite multiple endoscopies and biopsy.Case report A 52 year old non-smoker presented in late 1979 with a dry cough and mild but progressive dysphagia. Barium studies showed a megaoesophagus with large, lobulated filling defects. At oesophagoscopy grossly dilated mucosal folds were visualised within the dilated oesophagus, biopsy of which showed only chronic inflammatory changes. The differential diagnosis included achalasia, oesophagitis with polyp formation, and giant mucosal folds of the oesophagus. The patient was treated symptomatically until November 1982, when he presented again with rapidly progressive dysphagia. The results of the investigations were as before; the condition was thought to be inflammatory and the patient was treated with a brief course of prednisolone, which produced a transient but substantial symptomatic improvement.The patient was readmitted five months later with an episode of complete dysphagia. On admission he was malnourished, hypoalbuminaemic, and anaemic with an iron deficiency picture. Nasoenteric feeding was started and he transferred to the Brompton Hospital. A plain posteroanterior chest radiograph showed a grossly dilated oesophagus with a shelf like filling defect in the upper third. Barium studies (fig 1) showed a megaoesophagus with large, lobulated filling defects. The findings at oesophagoscopy were unchanged. The patient, requiring urgent relief of his complete dysphagia, proceeded to thoracotomy. The approach was made initially through the left chest and a long oesophagotomy was made at the level of the inferior pulmonary vein before the true nature of the lesion was appreciated. This allowed delivery of the apex of a single large polypoid lesion. We decided at this stage to proceed to formal oesophagectomy as primary closure of the compressed and dilated oesophagus was likely to be hazardous. The stomach was mobilised and the thoracotomy closed, the patient was turned, and a right thoracotomy was performed. A mobile mass could be felt
Diaphragm disease of small intestine usually presents with nonspecific clinical features. Radiological investigations often fail to differentiate it from small intestinal tumors and inflammatory bowel disease. It is therefore diagnosed on final histology after surgical resection. We hereby report an interesting case of a suspected small bowel tumor later diagnosed as diaphragm disease on histology.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.