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ARCHIVESof Pathology & Laboratory Medicine
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Figure 1. International Federation of Gynecology and Obstetrics (FIGO) grade 3 endometrioid carcinoma has .50% solid architecture with focalgland formation and moderate nuclear atypia (hematoxylin-eosin, original magnification320).
Figure 2. Undifferentiated carcinoma has monotonous proliferation of medium-sized cells in solid and diffuse pattern (hematoxylin-eosin, originalmagnification320).
Figure 3. Serous carcinoma features a papillary component with slitlike spaces (A and B) and/or a solid component (C and D) with high nucleargrade. Pleomorphic nuclei with prominent nucleoli, hyperchromatic nuclei with smudged chromatin, and increased mitotic activity are readilyobserved (hematoxylin-eosin, original magnification320 [A through D]).
838 Arch Pathol Lab Med—Vol 140, August 2016 Diagnostic Variability in Endometrioid Carcinomas—Thomas et al
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which was statistically significant (P¼ .01). Both institutionshad a high proportion of mixed SC and endometrioidcarcinoma as a reclassified diagnosis (48% [12 of 25] and36% [4 of 11]). In addition, MSK had a significantly greaterproportion of undifferentiated carcinoma than WSU did(45% [5 of 11] versus 8% [2 of 25]; P¼ .02); WSU had a highproportion of G2EC with focal marked nuclear atypia (28%,7 of 25) while MSK did not have any (P ¼ .03). Overall,mixed endometrioid and SC was the most common subtype(44%; 16 of 36) (Table 1).
Clinicopathologic Parameters of Reviewed Histology:G3EC and Reclassified Subtypes
Patients with G3EC had a median age of 61 years (range,27–90 years) and a follow-up period of 1 to 209 months(mean, 66 months). Most patients presented at stage I (63%;60 of 95), followed by stage III (24%; 23 of 95). Ninety-onepercent (86 of 95) had myometrial invasion, 67% (64 of 95)had lymphovascular invasion, and 20% (19 of 95) hadcervical stromal invasion (Table 2). Disease recurrence was
seen in 22 of 95 patients (23%); of those, 15 (68%) died. Atotal of 60 patients (63%; 60 of 95) died; death by stage ofdisease was stage I, 39 (41%); stage II, 3 (3%); stage III, 14(15%); and stage IV, 4 (4%) (Table 3).For the 7 patients with undifferentiated carcinomas, the
median age was 61 years (range, 42–69 years) and thefollow-up period ranged from 1 to 111 months (mean, 50months). Three of 7 patients (43%) presented with stage Idisease, 2 of 7 with stage III (29%), and 2 of 7 (29%) withstage IV disease. Eighty-six percent (6 of 7) had myometrialinvasion. None of the patients had recurrent disease (Table2). Of the 3 who died, 1 had stage III and 2 had stage IVdisease (Table 3). Patients with mixed epithelial carcinomashad a median age of 62 years (range, 49–80 years) and thefollow-up period was 3 to 135 months (mean, 50 months).Most presented with stage I disease (76%, 13 of 17) and hadmyometrial invasion (94%, 16 of 17). Only 2 of 17 patients(12%) had cervical stromal invasion, and 1 of 16 (6%) hadadnexal involvement (Table 2). A total of 7 of 17 patients(41%) patients died (stage I ¼ 5; stage III ¼ 2). One patienthad recurrent disease (stage I) and was among those who
Figure 4. Mixed epithelial carcinoma. A, Areas of high-grade endometrioid carcinoma showing predominantly solid growth, focal evidence of glandformation, and moderate nuclear atypia. B, Other areas in the same case have serous carcinoma with papillary/glandular architecture, high nucleargrade, increased mitosis, and necrotic luminal debris (hematoxylin-eosin, original magnification320 [A and B]).
Figure 5. International Federation of Gynecology and Obstetrics (FIGO) grade 2 endometrioid carcinoma with focal nuclear atypia. Area ofendometrioid carcinoma showing low nuclear grade with oval nuclei and inconspicuous nucleoli (A), and foci in the same case showing highernuclear grade with rounded nuclei, open chromatin, and distinct nucleoli (B) (hematoxylin-eosin, original magnification320 [A and B]).
Arch Pathol Lab Med—Vol 140, August 2016 Diagnostic Variability in Endometrioid Carcinomas—Thomas et al 839
August 2016
Special Sections—Contributions From the Canadian Anatomic and
Molecular Pathology Conference, Part I; Second Princeton Integrated
Pathology Symposium: Breast Pathology-2015, Part II
Solid Papillary Carcinoma Showing Multiple Circumscribed
Solid Nodules With Fibrovascular Cores
2017 Bonus Distribution at important pathology shows: USCAP (March–San Antonio); ASCO (June–Chicago); CAP17 (October–Washington D.C.); AMP (November–Salt Lake City); ASH (December–Atlanta)
You should advertise in the Archives of Pathology & Laboratory Medicine if:
Pathologists are important targets for your services and products
Your therapeutic drugs are tied to tests establishing personalized diagnostics
You value smart media buying* The Archives is received by 81% of pathologists The Archives is read by 70% of pathologists The Archives provides ad exposure to 38% of pathologists *Kantar Media Readership Survey of Pathologist Publications 2015
All advertising earns a combined rate based on the total number of ad units in the Archives of Pathology and CAP TODAY.
Clampdowns on out-of-network billing climbAnne Paxton
To the average reader, “out-of-network billing”
might seem like a technical concept that should
mainly concern hyperaware insurance wonks. Me-
dia outlets from NBC News to Time to the Huffing-
ton Post have found that phrases like “surprise
medical bill,” “angry patients,” and sometimes
“sticker shock” in recent stories are much more
likely to grab attention.
But out-of-network billing is what those stories are
about—and it’s not being painted in glowing terms.
In fact, a growing number of states have imposed
curbs on out-of-network billing, and the implications
for pathologists could be serious. However, patholo-
gist awareness of the trend is lagging, says Margaret
Havens Neal, MD, president of the Florida Society
of Pathologists. “There are pathologists out there who
don’t recognize this as a major issue for them yet.”
“Anecdotally, we hear about surprise medical
bills more and more,” says Emily E. Volk, MD,
MBA, chair of the CAP Council on Government and
Professional Affairs and chief quality officer, Baptist
Health System, San Antonio. And pathologists,
along with other hospital-based physicians such as
radiologists, anesthesiologists, emergency physi-
cians, hospitalists, and neonatologists, are among
the billers being highlighted. Almost one in every three pri-
vately insured adult patients had re-
ceived a surprise medical bill in the
previous two years, a 2015 Consumer
Reports survey found. When such
patients find out they owe unexpect-
ed amounts because the provider
who took care of them is not part of
the network covered by their insur-
ance—even though the facility may
be covered—it’s the provider who
often gets the blame.Why are such out-of-network bills
on the increase? “It’s because insur-
ance companies are creating narrow
networks, limiting the number of
physicians patients see, so more and
more physicians become ‘out of net-
work,’” says Robert DeCresce, MD,
MBA, director of clinical laboratories
at Rush University Medical Center in
Chicago and chair of the state affairs subcommittee of the CAP Federal and State Affairs Committee.
“Even if you go to an in-network hospi-
tal, the hospital may not give you a
choice between an in- or out-of-net-
work pathologist because their con-
tracts are usually exclusive.” Then the
patient gets billed for the difference
between what the insurance company
allows and what the pathologist
charges. “Is it a deceptive practice by
the hospital or the insurance compa-
ny? That’s a reasonable question to
ask,” Dr. DeCresce says.Some of the rise in such cases may
be linked to the
Finding the fast track with ’14 HIV algorithm
William Check, PhD
Laboratories that use the HIV testing
algorithm the CDC recommended in
2014 report shorter turnaround times
for those with detectable antibodies.
And among state and local public
health laboratories that responded to
a 2015 survey, more than half report
having implemented the algorithm.
This was just some of the information
presented in March at the annual HIV
Diagnostics Conference, where speak-
ers, a handful of whom spoke with
CAP TODAY since, shared data on the
use and efficacy of the algorithm.
“From a recent Association of Pub-
lic Health Laboratories survey [re-
ported at the conference] we know
that the algorithm has been imple-
mented in approximately 55 percent
of state and local public health labs
that responded,” says Michele Owen,
PhD, conference
Reid H
orn
Glucose PT criteria reset stirs standards debateAnne Paxton
It may not be an exact science, but resetting standards is a
long-established means of improving quality of testing,
and it can also be a way of adapting to improvements in
quality that have already been realized. In the case of the
CAP’s recent tightening of proficiency testing criteria for
hospital glucose testing, both purposes are at work. The
new criteria reflect the fact that glucose meter performance
has improved significantly, CAP Chemistry Resource
Committee chair Gary L. Horowitz, MD, explains in the
2016 Program Update on Glucose Meter Performance.
But the change in Survey criteria has brought unex-
pected pushback from one of the leading hospital glucose
meter manufacturers.The CAP’s Chemistry Resource Committee approved
and implemented the new PT grading
JUNE 2016 page 1
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pathology ◆ laboratorymedicine ◆ laboratorymanagement JUNE 2016
Vol. 30 No. 6 Moving? Fax a copy of the above address with corrections to CAP TODAY: 847-832-8153.
“ We don’t particularly want or choose to be out of network, but
as the insurers’ networks have narrowed, we find ourselves
out,” says Dr. A. Joe Saad.
Synovial sarcomaUse of RT-PCR and FISH assays to detect SS18-SSX2 fusion transcript
Page 88
case report
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June 2016
Sarcomatoid Urothelial Carcinoma With Chordoid Differentiation
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Readership: Pathologists: 13,000 Paid Subscriptions: 1,000 Total: 14,000
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