A Review Of Experience And Update On The Pathology Of Wilson\u27s Disease: Correlations Between Histopathological And Clinico-Pathological Features

Wilson\u27s disease is a rare autosomal recessive disorder of copper metabolism that often proves a difficult diagnosis for the both the clinician and pathologist largely because of its low incidence and variable presentations. There have been few studies detailing the histopathological features of hepatic specimens in patients with Wilson\u27s disease and fewer correlating these features with clinical presentation. When left untreated, the disease is ultimately fatal, thus good diagnostic criteria that take into account the histopathological features of the disease is important. The aim of this study was to evaluate the histopathological features of hepatectomy and biopsy specimens in patients with Wilson\u27s disease and correlate these features with the clinical parameters of these patients. Twelve biopsy and hepatectomy specimens from patients with Wilson\u27s disease were reviewed and placed into three categories: (A) Near normal/mild, (B) Chronic hepatitis and (C) Acute injury on chronic hepatitis/decompensated cirrhosis. The clinical presentations were reviewed and any correlation between clinical parameters and anatomic features reported. Histopathological features consistent with previous findings in the early stages of Wilson\u27s disease were found in group A with clinical findings in this category of mild elevation of transaminases. In group B, while typical markers of chronic hepatitis were found, glycogenated nuclei, a feature often reported as prominent in specimens with Wilson\u27s disease hepatitis was absent. There was one patient with relevant laboratory data in this group, which was notable for mild elevations of transaminases. In group C, features of acute on chronic injury were found. Regarding clinical parameters, transaminases and bilirubin levels were increased, and alkaline phosphatase:total bilirubin ratio was consistent with previously reported findings of fulminant hepatic failure in Wilson\u27s disease. Urinary copper levels increased with increasing levels of histopathological injury. Staining for copper proved to be an unreliable method of diagnosis. This characterization of the histopathological and clinical features of Wilson\u27s disease further elucidates the challenge of Wilson\u27s disease but also serves to provide some guidance to both clinician and pathologist as to how recognizing the variable presentations of the disease may help in establishing a diagnosis

Liver injury is most commonly due to hepatic metastases rather than drug hepatotoxicity during pembrolizumab immunotherapy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151912/1/apt15413-sup-0001-FigS1.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151912/2/apt15413.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151912/3/apt15413_am.pd

Gluten Induces Subtle Histological Changes in Duodenal Mu-cosa of Patients with Non-Coeliac Gluten Sensitivity: A Multi-center Study

Histological changes induced by gluten in the duodenal mucosa of patients with non-coeliac gluten sensitivity (NCGS) are poorly defined. Objectives: To evaluate the structural and inflammatory features of NCGS compared to controls and coeliac disease (CeD) with milder enteropathy (Marsh I-II). Methods: Well-oriented biopsies of 262 control cases with normal gastroscopy and histologic findings, 261 CeD, and 175 NCGS biopsies from 9 contributing countries were examined. Villus height (VH, in μm), crypt depth (CrD, in μm), villus-to-crypt ratios (VCR), IELs (intraepithelial lymphocytes/100 enterocytes), and other relevant histological, serologic, and demographic parameters were quantified. Results: The median VH in NCGS was significantly shorter (600, IQR: 400−705) than controls (900, IQR: 667−1112) (p < 0.001). NCGS patients with Marsh I-II had similar VH and VCR to CeD [465 µm (IQR: 390−620) vs. 427 µm (IQR: 348−569, p = 0·176)]. The VCR in NCGS with Marsh 0 was lower than controls (p < 0.001). The median IEL in NCGS with Marsh 0 was higher than controls (23.0 vs. 13.7, p < 0.001). To distinguish Marsh 0 NCGS from controls, an IEL cut-off of 14 showed 79% sensitivity and 55% specificity. IEL densities in Marsh I-II NCGS and CeD groups were similar. Conclusion: NCGS duodenal mucosa exhibits distinctive changes consistent with an intestinal response to luminal antigens, even at the Marsh 0 stage of villus architecture

Black women's leadership: indigenous knowledges for empowerment

The result of the study shows that transnational Black women's leadership use African indigenous knowledge retained from Africa and the African Diaspora, inclusive of the Caribbean where many of my participants were born. African women in leadership in Canada are simply Africans in the wider African Diaspora using African indigenous knowledge different embodied forms of knowing. Most importantly, the participants showed that Black women's leadership represent junctures of cultural resistance, transformation and empowerment through their agency where they set the stage to empower themselves and others as admired Black women and role models. A new dominant paradigm of leadership has become more inclusive through making room for women's ways of leading while implying that all women are included within this approach. This study attempts to challenge the dominant paradigm, which only expresses the thoughts and experiences of White European leadership while negating Black women's leadership. The critical element of my research is to examine the retention and continuity of indigenous knowledge in transnational Black women's leadership through investigating ways in which indigenous knowledge informs transnational African Canadian women's leadership practices in the Black grassroots community, organization and continuity of indigenous knowledge in transnational Black women's leadership through investigating ways in which indigenous knowledge informs transnational African Canadian women's leadership practices in the Black grassroots community, organization and workplace. The study uses data collected from 15 participants from the African Canadian Diaspora while utilizing a qualitative approach of employing oral narratives through semi-structured interviews. This research on leadership takes a race, gender, class, historical and cultural approach where it begs the question, what happens when the indigenous woman from the South is represented in the geopolitical space of leadership in Canada, through transnationalism? Does the Black woman bring the epistemology of transnational African indigenous knowledge into her position of leadership? How has Black women's leadership empowered the self and others for political action and what are the theoretical and pedagogical implications?Furthermore, the study highlighted ways in which transnational, transformational, womanist and indigenous knowledge perspectives of leadership should be taught and learned while making use of the oral tradition of success stories. Generally, the research project shows the difference and importance of Black women's leadership. The study showed that there were a number of indigenous knowledge practices influencing Black women's leadership. They include the problematics of indigenous knowledge; culture of spirituality; intuition and memory; and sharing and collectivism. Several tenets of Black women's leadership supported the continuity and retention of indigenous knowledge. They include community support and a gift to be shared; culture, value and belief; re-memory and activism; and admired Black women and role models.Ph.D

Highlights and Perspectives From a Collaborative Global Health Pathology Experience in Trinidad and Tobago

Abstract Objectives Global health education is important during residency training in exposing doctors to conditions that are not common in the United States and developing their awareness of global health care disparities. Most medical decisions are based on results from anatomic or clinical pathology laboratories, which are essential services for appropriate medical care in international settings. Nevertheless, US pathology residency trainees have limited global health exposure and thus are rarely exposed to diagnostic services in these settings. Moreover, literature documenting what is needed to create a global health elective in pathology is limited. Methods We designed an international pathology elective in Trinidad and Tobago involving one main public hospital site and several off-site laboratories. Objectives and goals were established before the rotation. Apart from daily mentor-led education sessions, the trainee participated in teaching, quality improvement projects, and cultural experiences. Engagement with medical officers, personnel staff, and people in the community was encouraged.Results: Challenges encountered included funding, transportation, limited laboratory resources, medical registration, and malpractice insurance. These were mitigated through carefully planned steps, including communicating with registration bodies and liaising with pathology organizations for funding. Conclusions Overall, the global health rotation was successful. We provide a detailed roadmap for other pathology training programs interested in establishing similar global health electives. </jats:sec

Malformations, choristomas, and hamartomas of the gastrointestinal tract and pancreas

Congenital and hamartomatous lesions of the gastrointestinal tract cause diagnostic challenges for surgical pathologists. Many of these are merely histologic curiosities, whereas others have substantial clinical implications because they herald cancer syndromes or associated anomalies. Although a comprehensive discussion of all developmental abnormalities that can occur in the gastrointestinal tract is beyond the scope of a single manuscript, some entities are more likely to be encountered by surgical pathologists, have important clinical consequences, or pose diagnostic difficulties. The purpose of this review is to discuss the more common malformations and choristomas, as well as hamartomatous lesions that may be clinically important due to their risk for cancer development, frequent associations with heritable cancer syndromes and other anomalies, or potential to simulate other entities