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August 2014

Study hints at new directions on LAMNs

August 2014—A slow leak in a tire may not be all that interesting— until one is cruising down the highway at 75 m.p.h. Suddenly, that same leak becomes much more compelling. Joseph Misdraji, MD, recalls a conversation he had at a meeting about pseudomyxoma peritonei that skirted a similar curve in the road. Approached by a pathologist who expressed a desire to collaborate with him, Dr. Misdraji suggested a study he was working on, looking at the significance of proximal margin involvement in low-grade appendiceal mucinous neoplasms, or LAMN.

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Where smart labs go when the money’s gone

August 2014—Payment rates declining. Bad debt rising. Test orders falling. Diagnostic equipment manufacturers checking in on test-volume commitments. A wrenching transition from fee-for-service care to population-based medicine. These are a few of the trends that laboratories across the country are seeing and that keep lab directors up at night, heavy lidded, checking their email, illuminated by the glow of their smartphones.

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Seamless automation: within reach for AP?

August 2014—A familiar optical illusion uses a drawing of a vase that makes your eyes play tricks. First you see the vase, then two faces gazing at each other, then again, the vase…two faces…ad infinitum. It’s a concept that comes to mind when thinking about “tracking” in the anatomic pathology laboratory. Does it refer to a physical track—a conveyor belt to automatically transport and sort specimens—or to a system for “tracking”—that is, electronically keeping tabs on specimens?

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Q & A Column, 8/14

August 2014—Is there a trough and crest occurrence with blood testosterone levels, or is it like thyroid testing, where one’s result is the total of the previous several days? What is the relationship between the presence of moderate to many spherocytes and the MCHC parameter? We always thought cases that show spherocytes on the blood smear are usually associated with high MCHC. We had a case of autoimmune hemolytic anemia with moderate spherocytes, but the MCHC was normal.

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Newsbytes, 8/14

August 2014—Smartphone use in AP ‘immature’ but advancing: It may never be as famous as Snapchat or Instagram, but another method of photo sharing is gaining favor with some anatomic pathologists by allowing them to use their smartphones to send images from glass slides quickly and inexpensively. “The use of smartphones is still at an immature stage for pathology, but I think the emerging area is utilizing the camera functions in the phones to manage decisionmaking,” says Douglas J. Hartman, MD, assistant professor, Department of Anatomic Pathology, University of Pittsburgh Medical Center.

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Anatomic Pathology Selected Abstracts, 8/14

August 2014—GATA3: a multispecific but potentially useful marker in surgical pathology: The transcription factor GATA3 is important for differentiating breast epithelia, urothelia, and subsets of T lymphocytes. It has been suggested that it may be useful in evaluating carcinomas of mammary or urothelial origin or metastatic carcinomas, but its distribution in normal and neoplastic tissues is incompletely mapped. The authors conducted a study in which they examined normal developing and adult tissues and 2,040 epithelial and 460 mesenchymal or neuroectodermal neoplasms for GATA3 expression to explore its diagnostic value in surgical pathology.

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Clinical Pathology Selected Abstracts, 8/14

August 2014—Anti-D alloimmunization after D-incompatible platelet transfusions: Because a small but immunogenic dose of red blood cells may be contained in apheresis platelets, transfusion services establish protocols to provide D– recipients with D– platelets to prevent anti-D alloimmunization. This is of particular concern for young females as there is potential for hemolytic disease of the newborn. In cases where D+ platelets are given to D– recipients, Rh immune globulin (RhIG) may be used to help prevent sensitization. The authors retrospectively analyzed during a 14-year period the anti-D formation in D– recipients who received D+ platelets without the use of RhIG.

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Cytopathology and More | Of confusion, cost, and communication

August 2014—In the days after my “Perspective” piece on the thousand-dollar Pap smear was published,1 I was profoundly moved by the number of physicians from diverse specialties and practice settings who reached out to tell me how important they believe issues of cost and cost transparency are to our ability to practice in the best interest of our patients. Barbara Crothers, DO, of the CAP Cytopathology Committee, was among those who reached out. I learned from Dr. Crothers and her colleagues that pathologists share the sense of frustration and loss of control that I often have as a primary care provider confronted by opaque ordering systems and skyrocketing costs for a simple, potentially life-saving test.

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