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Medical technologists who perform serum protein electrophoresis can provide valuable input and assistance in the interpretation of the electrophoretic pattern. Recognition of common alterations in conjunction with the utilization of standardized interpretation comments expedites the final interpretation performed by the clinical pathologist. Improved understanding of the clinical utility of the electrophoretic interpretation enhances the role and satisfaction of the medical technologists.

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A postmenopausal woman with lobular breast carcinoma metastatic to a large ovarian fibrothecoma is presented. The two metastatic tumor nodules were grossly subtle and could have been overlooked in the background of the large ovarian stromal tumor. Thorough sampling of the tumor for histologic examination and supporting immunohistochemical stains were important in establishing the diagnosis. Differential diagnostic considerations are discussed.

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The potential utilization of Demodex mites as delivery vectors for cytotoxic medications directed to early skin cancer is proposed. Potential benefits, proof of concept, and limitations are discussed.

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An educational program is described that was developed with the specific purpose of enhancing resident performance on the pathology portion of the Urologic National Board Examination. A pathologist and a urologist serve as moderators to ensure appropriate clinico-pathologic correlation. The program consists of a series of interactive lectures/discussions offered in a repeating annual cycle that addresses the neoplastic and non-neoplastic pathologic features of urologic diseases. Special attention is focused on topics that have been stressed in prior examinations.

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PURPOSE: We evaluated the efficacy of intravesical aminolevulinic acid (delta-aminolevulinic acid hydrochloride) (Frontier Scientific, Logan, Utah) and photodynamic therapy for the removal of small intestinal mucosa in augmented bladders in a rat model. MATERIALS AND METHODS: Enterocystoplasty was performed in 70 female rats using a patch of terminal ileum. A total of 28 were used to determine the pharmacokinetics (0.3, 0.6 and 0.9 M) and dwell time (30, 60 and 90 minutes) of intravesically administered aminolevulinic acid to optimize intestinal mucosal absorption and minimize bladder mucosal absorption. The remaining augmented rats were treated with intravesical photodynamic therapy at light doses of 75, 100 and 125 J. Ileal and bladder tissues were evaluated by light microscopy. Cystometric studies to evaluate bladder volume were measured before and after photodynamic therapy. RESULTS: The concentration of 0.3 M aminolevulinic acid with a dwell time of 30 minutes resulted in an average +/- SE bowel-to-bladder concentration of 2,156 +/- 269/749 +/- 62 ng/gm (ratio 2.9:1). After photodynamic therapy histology revealed uniform ablation and replacement of the intestinal mucosa with urothelium and minimal damage to the bladder wall at all light doses. Bladder cystometry revealed no significant change in bladder capacity after photodynamic therapy. CONCLUSIONS: In the rat model intravesical aminolevulinic acid and photodynamic therapy resulted in the replacement of intestinal mucosa with urothelium, leaving the underlying muscular layer intact. This could potentially be a viable option for patients with a preexisting bladder augment.

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Recommendations are proposed to enhance the role of the pathologist in the hospital-based tumor conference (tumor board). The modifications focus on two components integral to the conference: the presentation of salient pathologic features of each tumor selected for discussion within the time constraints allotted, and the pathologist's role as a principal institutional educator with respect to neoplastic processes. Opportunities to utilize conference presentations as a resource in other educational settings are also considered.

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Serum transient paraproteins are small monoclonal immunoglobulins that are induced by a self-limiting regulatory defect in the control of certain terminally differentiated B-cell clones. Relatively uncommon and ill-defined in the medical literature, such proteins may be regarded as immunologic anomalies. Their clinical significance and potential impact on patient management are poorly understood. To elucidate this phenomenon, we reviewed the serum transient paraproteins that were encountered in a large community hospital during a 12 mo period. Twelve transient paraproteins were identified in a total of 895 serum protein electrophoreses reviewed (1.3% incidence). The relationships of the transient paraproteins to specific diseases were studied.

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An educational program for cancer patients is reported that focuses specifically on the interpretation of their surgical pathology reports. In this program, features of the surgical pathology report that are important to an understanding of the biology, prognosis, and therapy of the different forms of cancer are explained to the patients. Individual interaction of each patient with an experienced surgical pathologist, who serves as the program moderator, permits frank discussion about aspects of cancer diagnosis that are of particular interest to these patients, but that are not routinely addressed during their disease management. Opportunities are provided for periodic follow-up with the moderator in order to address any additional questions or concerns that arise regarding subsequent surgical pathology reports.

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