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September 2013

Letters, 9/13

September 2013—Urine cultures: We read with interest your article in the June issue, “To reduce UTIs, one lab takes a long, wide look.” We strongly agree that there is inappropriate prescribing of antibiotics for patients whose urine cultures are reported with organism identification and antibiotic susceptibilities but who do not have urinary tract infection. This is because many physicians send urine for culture inappropriately and then equate a positive result with infection; they believe that these laboratory tests are diagnostic for UTI.

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Q & A, 9/13

September 2013—Our clinicians are asking about testing for IgG4-related disease. What role does IgG4 immunohistochemical staining play? IgG4-related disease is a recently recognized fibroinflammatory condition that may affect a wide variety of organ systems, producing mass lesions and generally responding to immunosuppressive therapy. The pancreas, salivary/lacrimal glands, and kidney are frequently affected, but almost any tissue may be involved, including aorta, pleura, retroperitoneum, and lymph nodes.

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Anatomic Pathology Selected Abstracts, 9/13

September 2013—Quantification of the Ki67 proliferative index in neuroendocrine tumors of the gastroenteropancreatic system; Clinicopathologic and immunohistochemical study of intrapulmonary SFTs; Papillary mucinous metaplasia of the endometrium as a precursor of endometrial mucinous adenocarcinoma; Expression of miRNAs and PTEN in endometrial specimens; Molecular investigation of lymph nodes in colon cancer patients using OSNA; Thymidylate synthase expression and molecular alterations in adenosquamous carcinoma of the lung; Microdensitometry of osteopontin as a prognostic biomarker in colorectal carcinoma tissue microarrays; Evaluation of pathological and molecular features in clinically aggressive dermatofibromas; Interobserver agreement in the reporting of colorectal polyp pathology by bowel cancer screening pathologists

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MOC:PQRS incentive: what it is, how to earn it

September 2013—The Centers for Medicare and Medicaid Services has approved the American Board of Pathology for participation in the MOC:PQRS Additional Incentive Program. This approval allows ABP diplomates who are participating successfully in the PQRS incentive program to earn an additional 0.5 percent incentive payment on the total Medicare part B allowed charges for participating in MOC:PQRS in 2013.

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From the President’s Desk: It’s our teammates who matter most, 9/13


September 2013—Cross-country runners train for terrain and endurance. Downhill routes require biomechanical adaptations because the runners must anticipate and adjust for sudden rocks in the road or lack of traction. While there is time to plan around threats on an uphill route, threats to safety or stability in a downhill race may manifest too late for avoidance strategies. Agility matters.

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aCGH as a diagnostic aid in a childhood Spitzoid melanoma

September 2013—An 18-month-old Hispanic female presented with an enlarging pigmented lesion on her leg. On excisional biopsy, histology showed an atypical melanocytic tumor with Spitzoid features. The differential diagnosis included Spitz nevus (SN), atypical Spitz tumor (AST), and Spitzoid malignant melanoma (SMM). Array comparative genomic hybridization (aCGH) studies were performed as a diagnostic aid and showed multiple chromosomal copy number aberrations, indicative of genomic instability and incompatible with a diagnosis of nevus. A diagnosis of SMM was made.

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A pathologist’s observations about in-office AP labs

September 2013—In this era of declining reimbursement, physicians are searching for creative ways to maintain revenue in a volume-based fee-for-service world. This is not unique to anatomic pathology; it reflects a wider practice of providing a greater level of in-office services that are justified as being convenient for the patient or leading to care that is more integrated. At their root, however, they serve as alternative revenue streams.

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