Nephropathology is an integral component of nephrology education. Online teaching sites provide valuable educational materials to learners, but learner satisfaction has not been measured. We developed a nephropathology website and measured learners' satisfaction. The Nephrology On-Demand Histopathology website (http://blog.ecu.edu/sites/ nephrologyondemand/?page_id=4502) provided nephropathologic specimens with explanations. Users were asked to complete a Likert-based survey (1-strongly agree . . . 5-strongly disagree) regarding four key areas of content quality: accuracy, currency, objectivity, and usefulness. Learners of all training levels perceived the content quality favorably. The mean (±SD) for accuracy was 1.70 (0.89), currency 1.62 (0.90), objectivity 1.80 (1.01), and usefulness 1.72 (0.95). Nephrology On-Demand Histopathology is a well-received teaching tool to learners of all training levels. Educators may consider using it, as well as other online nephropathology sites, as adjunctive teaching tools.
Despite progress in the classification of renal cell carcinomas (RCC), a subset of these carcinomas remains unclassified (RCC-U). Patients with RCC-U usually present at a late stage and have a poor prognosis. Several studies have attempted to extract new classifications of newly recognized renal carcinomas from the group of RCC-U. However, to date, no studies in the literature have attempted to characterize the RCC-U with unrecognizable cell types beyond the morphologic evaluation on H&E-stained sections. The purpose of this study was to evaluate this group of RCC-U using electron microscopy and novel renal markers. Ten cases of such RCC-U were identified for this study. At the ultrastructural level, they did not show typical morphology that resembled any of the well-studied, recognizable subtypes of RCC. However, they did reveal features of renal tubular epithelial differentiation. The histologic, ultrastructural, and immunophenotypic features indicated that these tumors are poorly differentiated renal epithelial tumors, possibly derived from the proximal nephron, with an immunohistochemical profile similar to high-grade clear cell RCC. It is, therefore, proposed that this group of renal carcinomas be renamed "poorly differentiated renal cell carcinoma, not otherwise specified." The current study showed that PAX-8 and carbonic anhydrase IX are reliable markers for this novel group of renal carcinoma, and that electron microscopy is an important adjunct in the evaluation of new and unusual renal entities.
Routine hormone receptor protein and human epidermal growth factor receptor 2 (HER2) oncoprotein analysis on invasive breast carcinomas provide therapeutic, predictive, and prognostic values and have revealed clinically significant subgroups. The best characterized of these have been designated luminal A, luminal B, HER2, and the so-called triple-negative tumors. The aim of this study was to determine the expression of basal cytokeratins and epidermal growth factor receptor (EGFR) in triple-negative invasive breast carcinomas in Puerto Rico. All invasive breast carcinoma cases consulted to our laboratory from 2008 to 2010, were included in this study. Assessment of the level of intratumoral expression of estrogen receptor, progesterone receptor, and HER2 was done. The cases were divided into cohorts based on their molecular categories and analyzed according to the histologic tumor grade and age. Triple-negative tumors were further analyzed according to their expression of EGFR and cytokeratins 5/6 and 14. From 717 breast consultation cases reviewed during the study period, 487 cases of invasive breast carcinoma were included in the study. The prevalence of molecular categories was 65%, 10%, 9%, and 15% for the luminal A, luminal B, HER2, and triple-negative groups, respectively. Assessment of basal cytokeratins and EGFR expression was performed on 41 triple-negative tumors, of which 71% expressed at least 1 basal cytokeratin or EGFR and 29% were negative to all markers. A statisticallly significant difference (P < .001) was found between the molecular categories and tumor histological grade. Triple-negative tumors were related to a higher grade. No statistical difference was found between the molecular categories and patient age. Prevalence and relation between tumor grade and molecular categories and the expression of basal cytokeratins in triple-negative tumors in our population is comparable to that published in the literature for other ethnic groups.
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