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Humanos , Femenino , Lactante , Anomalías del Sistema Respiratorio/diagnóstico , Bronquios/anomalías , Infecciones del Sistema Respiratorio/etiología , Mucocele/etiologíaRESUMEN
OBJECTIVE: The aim of this study was to investigate the interobserver agreement in determination of the dominant histological pattern and the final diagnosis in lung adenocarcinomas. MATERIAL AND METHOD: A total of 12 patients with a diagnosis of primary lung adenocarcinoma were included in the study. Twelve pathologists from eight study centers were asked first to determine the dominant histological pattern in these cases and then to decide whether the final diagnosis was in situ, minimally invasive or invasive adenocarcinoma. RESULTS: The kappa value for the agreement in determining the dominant pattern among the pathologists was 0.36 (p < 0.001), with the values for the lepidic, acinar, papillary, solid, micropapillary patterns and mucinous character of adenocarcinoma being 0.34, 0.28, 0.30, 0.80, 0.16 and 0.38 respectively (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001). None of the cases was diagnosed as in situ adenocarcinoma. On the other hand, the kappa value for the agreement in differentiating minimally invasive from invasive adenocarcinoma among reviewers was 0.17 (p < 0.001). CONCLUSION: The agreement among pathologists in determining the subtype of lung adenocarcinomas that depends on the identification of the dominant pattern was at intermediate level. In addition, the agreement in deciding whether the case is minimally invasive or invasive, was at low level. The criteria defining the histological patterns should be clarified and described in more detail. Educational activities and larger multicenter studies might be helpful in improving the agreement and standardization.
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Adenocarcinoma/patología , Carcinoma in Situ/patología , Neoplasias Pulmonares/patología , Patología Clínica/normas , Adenocarcinoma del Pulmón , Humanos , Variaciones Dependientes del ObservadorRESUMEN
INTRODUCTION: Diffuse alveolar damage (DAD) is a morphological prototype of acute interstitial pneumonia. Hospital autopsies or open-lung biopsies are used to monitor common alveolar damage and hyaline membrane (HM) development histopathologically. The aim of this study was to detect histopathological profiles and frequency of DAD and HM in adult forensic autopsies. MATERIALS AND METHODS: In total, 6813 reports with histopathological samples in 12,504 cases on which an autopsy was performed between 2006 and 2008 were investigated. Sixty-six individuals >18 years of age who were diagnosed with DAD were included. Hematoxylin- and eosin-stained lung preparations were reexamined in line with the 2002 American Thoracic Society/European Respiratory Society idiopathic interstitial pneumonia consensus criteria. RESULTS: Histopathological examination revealed that 50 cases (75.7%) were in the exudative phase and 16 (24.2%) were in the proliferative phase. Only the rate of alveolar exudate/oedema in exudative phase cases (P = 0.003); those of alveolar histiocytic desquamation (P = 0.037), alveolar fibrosis (P = 0.017), chronic inflammation (P = 0.02), and alveolar fibrin (P = 0.001) in proliferative cases were significantly higher. The presence of alveolar fibrin was the only independent variable in favour of proliferative cases (P = 0.016). CONCLUSION: The detection of all DAD morphological criteria with the same intensity is not always possible in each case. Forensic autopsies may provide a favourable means for expanding our knowledge about acute lung damage, DAD, and interstitial lung disease.
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Patologia Forense/métodos , Neumonías Intersticiales Idiopáticas/patología , Pulmón/patología , Alveolos Pulmonares/patología , Adulto , Anciano , Anciano de 80 o más Años , Autopsia , Causas de Muerte , Progresión de la Enfermedad , Eosina Amarillenta-(YS)/metabolismo , Femenino , Hematoxilina/metabolismo , Humanos , Neumonías Intersticiales Idiopáticas/metabolismo , Neumonías Intersticiales Idiopáticas/mortalidad , Masculino , Persona de Mediana Edad , Neumonía/patología , Alveolos Pulmonares/metabolismo , Edema Pulmonar/metabolismo , Edema Pulmonar/patología , Eosinofilia Pulmonar/patología , Índice de Severidad de la Enfermedad , Coloración y Etiquetado , Adulto JovenRESUMEN
We present a rare case of schwannoma of the supraglottic larynx in a 30-year-old woman with a 5-year history of dysphonia. Excision of the mass was performed by transoral robotic surgery (TORS) without complication using the robotic da Vinci Surgical System, 0-degree three-dimensional endoscope, 5-mm microinstruments compatible with the da Vinci robot, and an FK retractor. Transoral robotic surgery rendered good exposure that allowed complete tumor resection. An external approach and tracheotomy were not necessary in this case. We found that TORS was practicable, efficient, and nonhazardous for the resection of a supraglottic schwannoma. We propose TORS for the treatment of large benign and selected malignant laryngeal tumors.