EXAMPLES OF CRITICAL DIAGNOSES IN ANATOMIC PATHOLOGY

CASES THAT HAVE IMMEDIATE CLINICAL CONSEQUENCES

• crescents in greater than 50% of glomeruli in a kidney biopsy

• leukocytoclastic vasculitis

• uterine contents without villi or trophoblast

• fat in an endometrial curettage

• mesothelial cells in a heart biopsy

• fat in colonic endoscopic polypectomies

• transplant rejection

• malignancy in superior vena cava syndrome

• neoplasms causing paralysis

UNEXPECTED OR DISCREPANT FINDINGS

• significant disagreement between frozen section and final diagnosis

• significant disagreement between immediate interpretation and final FNA

diagnosis

• unexpected malignancy

• significant disagreement and/or change between primary pathologist and

outside pathologist consultation (at either the original or consulting

institution)

INFECTIONS

• bacteria or fungi in CSF cytology in immunocompromised or

immunocompetent patients

• pneumocystis, fungi or viral cytopathic changes in bronchoalveolar lavage

(BAL), bronchial washing or brushing cytology specimens in

immunocompromised or immunocompetent patients

• acid-fast bacilli in immunocompromised or immunocompetent patients

• fungi in FNA of immunocompromised patients

• bacteria in heart valve or bone marrow

• herpes in Pap smears of near term pregnant patients

• any invasive organism in surgical pathology specimens of immunocompromised

Patients

Reference:

This report was prepared by an Ad-hoc Committee composed of Jan F.

Silverman, MD, Allegheny General Hospital, Pittsburgh, PA; Virginia LiVolsi, MD,

University of Pennsylvania Hospital, Philadelphia, PA (Co-Chairs); Christopher D.

M. Fletcher, MD, Brigham and Women’s Hospital, Boston, MA; William J. Frable,

MD, Virginia Commonwealth University, Richmond, VA; John R. Goldblum, MD,

Cleveland Clinic, Cleveland, OH; Telma C. Pereira, MD, Allegheny General

Hospital, Pittsburgh, PA and Paul E. Swanson, MD, University of Washington,

Seattle, WA.