Annals of diagnostic pathology
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Kappa statistics have been widely used in the pathology literature to compare interobserver diagnostic variability (IOV) among different pathologists but there has been limited discussion about the clinical significance of kappa scores. Five representative and recent pathology papers were queried using clinically relevant specific questions to learn how IOV was evaluated and how the clinical applicability of results was interpreted. The papers supported our anecdotal impression that pathologists usually assess IOV using Cohen's or Fleiss' kappa statistics and interpret the results using some variation of the scale proposed by Landis and Koch. ⋯ Kappa scores and diagnostic sensitivity, specificity, positive and negative predictive values were calculated using the majority consensus diagnosis for each case as the gold reference diagnosis for that case. Diagnostic specificity estimates among multiple pathologists were > 90%, although kappa scores were considerably more variable. We explain why kappa scores are of limited clinical applicability in pathology and propose the use of positive and negative percent agreement and diagnostic specificity against a gold reference diagnosis to evaluate IOV among two and multiple raters, respectively.
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The recent 2017 update of the World Health Organization classification of lymphomas has significant changes from the previous edition. Subtypes of large B cell lymphoma and related aggressive B cell lymphomas are addressed. ⋯ Specific subtypes addressed include: T cell/histiocyte-rich large B cell lymphoma, primary diffuse large B cell lymphoma (DLBCL) of the CNS, primary cutaneous DLBCL leg-type, EBV-positive DLBCL, NOS, DLBCL associated with chronic inflammation, primary mediastinal large B cell lymphoma, intravascular large B cell lymphoma, ALK-positive large B cell lymphoma, plasmablastic lymphoma, primary effusion lymphoma, HHV8-positive diffuse large B-cell lymphoma, NOS, Burkitt lymphoma, Burkitt-like lymphoma with 11q aberration, high-grade B cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, high grade B cell lymphoma, NOS, B cell lymphoma, unclassifiable, with features intermediate between DLBCL and classic Hodgkin lymphoma and large B cell lymphoma with IRF4 translocation. In addition, EBV positive mucocutaneous ulcer is addressed.
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Myeloid sarcoma involving soft tissue is rare and may present a pathologic diagnostic challenge, particularly when it precedes or coincides with hematological malignancies. Furthermore, it may mimic non-Hodgkin lymphoma, poorly differentiated carcinoma, melanoma, or round blue cell tumors, which is a potential diagnostic pitfall. In addition to a retrospective review of myeloid sarcoma (MS) cases seen at our institution, we describe differential diagnoses, diagnostic pitfalls, and practical approaches to diagnosing soft tissue MS preceding or coinciding with acute myeloid leukemia. ⋯ These tumors were consistently positive for CD117 (9/9), CD43 (7/7), myeloperoxidase (8/10), CD68 (4/5), and CD34 (5/9) by flow cytometry and/or immunohistochemistry. We also described a referral case, which had classic MS morphology and a myelomonocytic immunophenotype including positivity for CD45, lysozyme, and CD117 with supporting molecular information. Based on our institution's experience and review of the literature, we recommend that when the index of suspicion for MS is high, an immunohistochemical stain and/or flow cytometry panel should include CD43, lysozyme, CD117, CD68, CD33, Human Leukocyte Antigen DR (HLA-DR), and myeloperoxidase, in addition to thorough review of the patient's history, cytogenetic studies, and proper discussion with the clinician.
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The radiographic features of sarcoidosis of bone are such as to suggest a possible infection as a cause of the lesions. This article explains how such lesions can be explained without resorting to a hypothesized infection as the etiology. Accepting that sarcoidosis definitely is not an infection is important for clinicians because not doing so can result in treatment errors.
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Review Case Reports
Acute respiratory distress syndrome and blastomycosis: presentation of nine cases and review of the literature.
Mississippi has the highest prevalence of blastomycosis in the country. In 20 years and 5 months there were 123 patients treated for blastomycosis at the University of Mississippi Medical Center. Among these, 107 patients had lung involvement and nine patients (8.4%) developed acute respiratory distress syndrome. ⋯ Underlying diseases that lead to immunodepression were present in only one patient and probable partial immunodepression was present in two other patients. Data from 19 other cases reported in the literature are discussed. Ann Diagn Pathol 5:1-9, 2001.