Leiomyosarcoma of the prostate: a novel approach to treatment-case report and review of the literature

Leiomyosarcoma of the prostate is a rare and aggressive tumor, with a quarter of the patients harboring metastatic disease, commonly in the lung. It usually presents with urinary obstruction in a relatively younger patient group. A 29-year-old male presented with lower urinary tract symptoms to the urologist. Computed tomography scan revealed a large pelvic mass involving the prostate. Biopsy on two occasions yielded leiomyoma. Instead of conventional radical surgery, en-bloc resection of the mass was done while preserving the remaining portion of the prostate, seminal vesicles, and ejaculatory duct. Histopathology revealed a high-grade leiomyosarcoma with negative margins. The patient had excellent recovery of defecation, erectile, and ejaculatory functions within 2 months after adjuvant radiotherapy. At the 24-month follow-up there was no evidence of disease. En-bloc resection of the tumor can be considered in select cases to improve functional outcomes and sustain a higher quality of life in patients.

Mechanisms underpinning community stability along a latitudinal gradient: Insights from a niche-based approach

At large scales, the mechanisms underpinning stability in natural communities may vary in importance due to changes in species composition, mean abundance, and species richness. Here we link species characteristics (niche positions) and community characteristics (richness and abundance) to evaluate the importance of stability mechanisms in 156 butterfly communities monitored across three European countries and spanning five bioclimatic regions. We construct niche-based hierarchical structural Bayesian models to explain first differences in abundance, population stability, and species richness between the countries, and then explore how these factors impact community stability both directly and indirectly (via synchrony and population stability). Species richness was partially explained by the position of a site relative to the niches of the species pool, and species near the centre of their niche had higher average population stability. The differences in mean abundance, population stability, and species richness then influenced how much variation in community stability they explained across the countries. We found, using variance partitioning, that community stability in Finnish communities was most influenced by community abundance, whereas this aspect was unimportant in Spain with species synchrony explaining most variation; the UK was somewhat intermediate with both factors explaining variation. Across all countries, the diversity-stability relationship was indirect with species richness reducing synchrony which increased community stability, with no direct effects of species richness. Our results suggest that in natural communities, biogeographical variation observed in key drivers of stability, such as population abundance and species richness, leads to community stability being limited by different factors and that this can partially be explained due to the niche characteristics of the European butterfly assemblage.

Temporal avoidance as a means of reducing competition between sympatric species

Human activity has modified the availability of natural resources and the abundance of species that rely on them, potentially changing interspecific competition dynamics. Here, we use large-scale automated data collection to quantify spatio-temporal competition among species with contrasting population trends. We focus on the spatial and temporal foraging behaviour of subordinate marsh tits Poecile palustris among groups of socially and numerically dominant blue tits Cyanistes caeruleus and great tits Parus major. The three species exploit similar food resources in mixed groups during autumn-winter. Using 421 077 winter recordings of individually marked birds at 65 automated feeding stations in Wytham Woods (Oxfordshire, UK), we found that marsh tits were less likely to join larger groups of heterospecifics, and they accessed food less frequently in larger groups than in smaller ones. Marsh tit numbers within groups declined throughout the diurnal and winter periods, while the number of blue and great tits increased. However, sites that attracted larger groups of these heterospecifics also attracted more marsh tits. The results suggest that subordinate species exhibit temporal avoidance of socially and numerically dominant heterospecifics, but have limited ability for spatial avoidance, indicating that behavioural plasticity enables only a partial reduction of interspecific competition.

Collation of a century of soil invertebrate abundance data suggests long-term declines in earthworms but not tipulids

Large-scale declines in terrestrial insects have been reported over much of Europe and across the world, however, population change assessments of other key invertebrate groups, such as soil invertebrates, have been largely neglected through a lack of available monitoring data. This study collates historic data from previously published studies to assess whether it is possible to infer previously undocumented long-term changes in soil invertebrate abundance. Earthworm and tipulid data were collated from over 100 studies across the UK, spanning almost 100 years. Analyses suggested long-term declines in earthworm abundance of between 1.6 to 2.1% per annum, equivalent to a 33% to 41% decline over 25 years. These appeared greatest in broadleaved woodlands and farmland habitats, and were greater in pasture than arable farmland. Significant differences in earthworm abundance between habitats varied between models but appeared to be highest in urban greenspaces and agricultural pasture. More limited data were available on tipulid abundance, which showed no significant change over time or variation between enclosed farmland and unenclosed habitats. Declines in earthworm populations could be contributing to overall declines in ecosystem function and biodiversity as they are vital for a range of ecosystem services and are keystone prey for many vertebrate species. If robust, our results identify a previously undetected biodiversity decline that would be a significant conservation and economic issue in the UK, and if replicated elsewhere, internationally. We highlight the need for long-term and large-scale soil invertebrate monitoring, which potentially could be carried out by citizen/community scientists.

Standardised empirical dispersal kernels emphasise the pervasiveness of long-distance dispersal in European birds

Dispersal is a key life-history trait for most species and is essential to ensure connectivity and gene flow between populations and facilitate population viability in variable environments. Despite the increasing importance of range shifts due to global change, dispersal has proved difficult to quantify, limiting empirical understanding of this phenotypic trait and wider synthesis. Here, we introduce a statistical framework to estimate standardised dispersal kernels from biased data. Based on this, we compare empirical dispersal kernels for European breeding birds considering age (average dispersal; natal, before first breeding; and breeding dispersal, between subsequent breeding attempts) and sex (females and males) and test whether different dispersal properties are phylogenetically conserved. We standardised and analysed data from an extensive volunteer-based bird ring-recoveries database in Europe (EURING) by accounting for biases related to different censoring thresholds in reporting between countries and to migratory movements. Then, we fitted four widely used probability density functions in a Bayesian framework to compare and provide the best statistical descriptions of the different age and sex-specific dispersal kernels for each bird species. The dispersal movements of the 234 European bird species analysed were statistically best explained by heavy-tailed kernels, meaning that while most individuals disperse over short distances, long-distance dispersal is a prevalent phenomenon in almost all bird species. The phylogenetic signal in both median and long dispersal distances estimated from the best-fitted kernel was low (Pagel's λ < 0.25), while it reached high values (Pagel's λ >0.7) when comparing dispersal distance estimates for fat-tailed dispersal kernels. As expected in birds, natal dispersal was on average 5 km greater than breeding dispersal, but sex-biased dispersal was not detected. Our robust analytical framework allows sound use of widely available mark-recapture data in standardised dispersal estimates. We found strong evidence that long-distance dispersal is common among European breeding bird species and across life stages. The dispersal estimates offer a first guide to selecting appropriate dispersal kernels in range expansion studies and provide new avenues to improve our understanding of the mechanisms and rules underlying dispersal events.

Spatial consistency in drivers of population dynamics of a declining migratory bird

Many migratory species are in decline across their geographical ranges. Single-population studies can provide important insights into drivers at a local scale, but effective conservation requires multi-population perspectives. This is challenging because relevant data are often hard to consolidate, and state-of-the-art analytical tools are typically tailored to specific datasets. We capitalized on a recent data harmonization initiative (SPI-Birds) and linked it to a generalized modelling framework to identify the demographic and environmental drivers of large-scale population decline in migratory pied flycatchers (Ficedula hypoleuca) breeding across Britain. We implemented a generalized integrated population model (IPM) to estimate age-specific vital rates, including their dependency on environmental conditions, and total and breeding population size of pied flycatchers using long-term (34-64 years) monitoring data from seven locations representative of the British breeding range. We then quantified the relative contributions of different vital rates and population structure to changes in short- and long-term population growth rate using transient life table response experiments (LTREs). Substantial covariation in population sizes across breeding locations suggested that change was the result of large-scale drivers. This was supported by LTRE analyses, which attributed past changes in short-term population growth rates and long-term population trends primarily to variation in annual survival and dispersal dynamics, which largely act during migration and/or nonbreeding season. Contributions of variation in local reproductive parameters were small in comparison, despite sensitivity to local temperature and rainfall within the breeding period. We show that both short- and long-term population changes of British breeding pied flycatchers are likely linked to factors acting during migration and in nonbreeding areas, where future research should be prioritized. We illustrate the potential of multi-population analyses for informing management at (inter)national scales and highlight the importance of data standardization, generalized and accessible analytical tools, and reproducible workflows to achieve them.

Hinfluences severe disease-mediated population declines in two of the most common garden bird species in Great Britain

The influence of supplementary feeding of wildlife on disease transmission and its consequent impacts on population dynamics are underappreciated. In Great Britain, supplementary feeding is hypothesised to have enabled the spread of the protozoan parasite, Trichomonas gallinae, from columbids to finches, leading to epidemic finch trichomonosis and a rapid population decline of greenfinch (Chloris chloris). More recently, chaffinch (Fringilla coelebs), has also declined markedly from the second to fifth commonest bird in Britain. Using citizen science data, we show that both declines were driven primarily by reduced adult survival, with the greatest reductions occurring in peri-domestic habitats, where supplementary food provision is common. Post-mortem examinations showed a proportional increase in chaffinch trichomonosis cases, near-contemporaneous with its population decline. Like greenfinches, chaffinches often use supplementary food, but are less associated with human habitation. Our results support the hypothesis that supplementary feeding can increase parasite transmission frequency within and between common species. However, the dynamics behind resultant population change can vary markedly, highlighting the need for integrating disease surveillance with demographic monitoring. Other species susceptible to T. gallinae infection may also be at risk. Supplementary feeding guidelines for wildlife should include disease mitigation strategies to ensure that benefits to target species outweigh risks.

Differential changes in life cycle-event phenology provide a window into regional population declines

Climate change affects the phenology of annual life cycle events of organisms, such as reproduction and migration. Shifts in the timing of these events could have important population implications directly, or provide information about the mechanisms driving population trajectories, especially if they differ between life cycle event. We examine if such shifts occur in a declining migratory passerine bird (willow warbler, Phylloscopus trochilus), which exhibits latitudinally diverging population trajectories. We find evidence of phenological shifts in breeding initiation, breeding progression and moult that differ across geographic and spring temperature gradients. Moult initiation following warmer springs advances faster in the south than in the north, resulting in proportionally shorter breeding seasons, reflecting higher nest failure rates in the south and in warmer years. Tracking shifts in multiple life cycle events allowed us to identify points of failure in the breeding cycle in regions where the species has negative population trends, thereby demonstrating the utility of phenology analyses for illuminating mechanistic pathways underlying observed population trajectories.

Demographic variation in space and time: implications for conservation targeting

The dynamics of wild populations are governed by demographic rates which vary spatially and/or temporally in response to environmental conditions. Conservation actions for widespread but declining populations could potentially exploit this variation to target locations (or years) in which rates are low, but only if consistent spatial or temporal variation in demographic rates occurs. Using long-term demographic data for wild birds across Europe, we show that productivity tends to vary between sites (consistently across years), while survival rates tend to vary between years (consistently across sites), and that spatial synchrony is more common in survival than productivity. Identifying the conditions associated with low demographic rates could therefore facilitate spatially targeted actions to improve productivity or (less feasibly) forecasting and temporally targeting actions to boost survival. Decomposing spatio-temporal variation in demography can thus be a powerful tool for informing conservation policy and for revealing appropriate scales for actions to influence demographic rates.

Frozen Section Quality Assurance

OBJECTIVES

Composite frozen section turnaround time has limited value, precluding assessment of certain processes: slide preparation (technical) and diagnosis (interpretation). We examined whether measuring these elements could identify delays, hypothesizing that longer times were related to (1) inefficient technical processes and (2) case-specific diagnostic challenges.

METHODS

Technical and interpretive times were determined for 1,992 specimens submitted for frozen section in 2017; the data were sorted by surgical specialty. Mean and quartile times were determined for each category with all specimens assessed equally, including those with multiple frozen section blocks.

RESULTS

Technical times were significantly longer than interpretive times. Specialty grouping facilitated trend identification and enabled assessment of technical and interpretation challenges. We identified technical issues with certain gross specimens involving overdissection and interpretation delays for specific neoplasms and margins.

CONCLUSIONS

Measuring technical and interpretative times and subcategorizing by specialty has aided the assessment of frozen section processing in our laboratory, enabling case isolation for process improvement.

Rapid Validation of Whole-Slide Imaging for Primary Histopathology Diagnosis

OBJECTIVES

The ongoing global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic necessitates adaptations in the practice of surgical pathology at scale. Primary diagnosis by whole-slide imaging (WSI) is a key component that would aid departments in providing uninterrupted histopathology diagnosis and maintaining revenue streams from disruption. We sought to perform rapid validation of the use of WSI in primary diagnosis meeting recommendations of the College of American Pathologists guidelines.

METHODS

Glass slides from clinically reported cases from 5 participating pathologists with a preset washout period were digitally scanned and reviewed in settings identical to typical reporting. Cases were classified as concordant or with minor or major disagreement with the original diagnosis. Randomized subsampling was performed, and mean concordance rates were calculated.

RESULTS

In total, 171 cases were included and distributed equally among participants. For the group as a whole, the mean concordance rate in sampled cases (n = 90) was 83.6% counting all discrepancies and 94.6% counting only major disagreements. The mean pathologist concordance rate in sampled cases (n = 18) ranged from 90.49% to 97%.

CONCLUSIONS

We describe a novel double-blinded method for rapid validation of WSI for primary diagnosis. Our findings highlight the occurrence of a range of diagnostic reproducibility when deploying digital methods.

Covariation in population trends and demography reveals targets for conservation action

Wildlife conservation policies directed at common and widespread, but declining, species are difficult to design and implement effectively, as multiple environmental changes are likely to contribute to population declines. Conservation actions ultimately aim to influence demographic rates, but targeting actions towards feasible improvements in these is challenging in widespread species with ranges that encompass a wide range of environmental conditions. Across Europe, sharp declines in the abundance of migratory landbirds have driven international calls for action, but actions that could feasibly contribute to population recovery have yet to be identified. Targeted actions to improve conditions on poor-quality sites could be an effective approach, but only if local conditions consistently influence local demography and hence population trends. Using long-term measures of abundance and demography of breeding birds at survey sites across Europe, we show that co-occurring species with differing migration behaviours have similar directions of local population trends and magnitudes of productivity, but not survival rates. Targeted actions to boost local productivity within Europe, alongside large-scale (non-targeted) environmental protection across non-breeding ranges, could therefore help address the urgent need to halt migrant landbird declines. Such demographic routes to recovery are likely to be increasingly needed to address global wildlife declines.

Basal Cell Adenoma and Basal Cell Adenocarcinoma

Basal cell adenoma (BCA) and basal cell adenocarcinoma (BCAC) are uncommon biphasic salivary gland tumors having morphologic similarities to other biphasic salivary gland neoplasms having differentiation toward the intercalated ducts of the salivary gland. Both tumors show mixtures of trabecular, tubular, solid, and membranous solid patterns. BCAC is separated from BCA primarily by the presence of invasion in the former. The diagnosis of BCA and BCAC is best carried out with hematoxylin and eosin-stained sections and careful attention to detail of tumors in the differential diagnosis, including adenoid cystic carcinoma, pleomorphic adenoma, and epithelial myoepithelial carcinoma.

Aflatoxin and ochratoxin A residues in supplementary foods used for wild birds

Provision of supplementary food for garden birds is practiced on a large scale in multiple countries. While this resource has benefits for wild bird populations, concern has been expressed regarding the potential for contamination of foodstuffs by mycotoxins, and the implications this might have for wildlife health. We investigated whether aflatoxin (AF) and ochratoxin A (OA) residues are present in foodstuffs sold for wild bird consumption at point of sale in Great Britain using high pressure liquid chromatography analyses. The hypothesis that production of these mycotoxins occurs in British climatic conditions, or under storage conditions after the point of sale, was tested under experimental conditions but was not proved by our study. While the majority of peanut samples were negative for AF residues, 10% (10/98) of samples at point of sale and 11% (13/119) of those across the storage and climate exposure treatment replicates contained AFB₁ that exceeded the maximum permitted limit of 20 μg/kg. No significant difference was found in the detection of either mycotoxin between branded and non-branded products. The clinical significance, if any, of exposure of wild birds to mycotoxins requires further investigation. Nevertheless, the precautionary principle should be adopted and best practice steps to reduce the likelihood of wild bird exposure to mycotoxins are recommended.

Survival varies seasonally in a migratory bird: Linkages between breeding and non-breeding periods

Migratory species form an important component of biodiversity; they link ecosystems across the globe, but are increasingly threatened by global environmental change. Understanding and mitigating threats requires knowledge of how demographic processes operate throughout the annual cycle, but this can be difficult to achieve when breeding and non-breeding grounds are widely separated. Our goal is to quantify the importance of variability in survival during the breeding and non-breeding seasons in determining variation in annual survival using a single population and, more broadly, the extent to which annual survival across species reflects variation in probability of surviving the migratory period. We use a 25-year dataset in which individuals of a long-distance migratory bird, the alpine swift Tachymarptis melba, were captured towards the beginning and end of each breeding season to estimate age- and season-specific survival probabilities and incorporate explicit estimation of the correlations in survival between age-classes and seasons. Monthly survival was higher during the breeding period than during the rest of the year and strongly affected by conditions in the breeding season; effects that remained apparent in the following non-breeding season, but not subsequently. Recruitment of juveniles was dependent on the timing of breeding, being higher if egg-laying commenced before the median date, and substantially lower if not. Across migratory bird species, variation in annual survival largely reflects variation in the probability of surviving the migratory period. Using a double-capture approach, even within a single season, provides valuable insights into the demography of migratory species, which will help understand the extent and impacts of the threats they face in a changing world.

Integrating dynamic environmental predictors and species occurrences: Toward true dynamic species distribution models

While biological distributions are not static and change/evolve through space and time, nonstationarity of climatic and land-use conditions is frequently neglected in species distribution models. Even recent techniques accounting for spatiotemporal variation of species occurrence basically consider the environmental predictors as static; specifically, in most studies using species distribution models, predictor values are averaged over a 50- or 30-year time period. This could lead to a strong bias due to monthly/annual variation between the climatic conditions in which species' locations were recorded and those used to develop species distribution models or even a complete mismatch if locations have been recorded more recently. Moreover, the impact of land-use change has only recently begun to be fully explored in species distribution models, but again without considering year-specific values. Excluding dynamic climate and land-use predictors could provide misleading estimation of species distribution. In recent years, however, open-access spatially explicit databases that provide high-resolution monthly and annual variation in climate (for the period 1901-2016) and land-use (for the period 1992-2015) conditions at a global scale have become available. Combining species locations collected in a given month of a given year with the relative climatic and land-use predictors derived from these datasets would thus lead to the development of true dynamic species distribution models (D-SDMs), improving predictive accuracy and avoiding mismatch between species locations and predictor variables. Thus, we strongly encourage modelers to develop D-SDMs using month- and year-specific climatic data as well as year-specific land-use data that match the period in which species data were collected.

Targeted deep sequencing of urothelial bladder cancers and associated urinary DNA: a 23-gene panel with utility for non-invasive diagnosis and risk stratification

OBJECTIVES

To develop a focused panel of somatic mutations (SMs) present in the majority of urothelial bladder cancers (UBCs), to investigate the diagnostic and prognostic utility of this panel, and to compare the identification of SMs in urinary cell-pellet (cp)DNA and cell-free (cf)DNA as part of the development of a non-invasive clinical assay.

PATIENTS AND METHODS

A panel of SMs was validated by targeted deep-sequencing of tumour DNA from 956 patients with UBC. In addition, amplicon and capture-based targeted sequencing measured mutant allele frequencies (MAFs) of SMs in 314 urine cpDNAs and 153 urine cfDNAs. The association of SMs with grade, stage, and clinical outcomes was investigated by univariate and multivariate Cox models. Concordance between SMs detected in tumour tissue and cpDNA and cfDNA was assessed.

RESULTS

The panel comprised SMs in 23 genes: TERT (promoter), FGFR3, PIK3CA, TP53, ERCC2, RHOB, ERBB2, HRAS, RXRA, ELF3, CDKN1A, KRAS, KDM6A, AKT1, FBXW7, ERBB3, SF3B1, CTNNB1, BRAF, C3orf70, CREBBP, CDKN2A, and NRAS; 93.5-98.3% of UBCs of all grades and stages harboured ≥1 SM (mean: 2.5 SMs/tumour). RAS mutations were associated with better overall survival (P = 0.04). Mutations in RXRA, RHOB and TERT (promoter) were associated with shorter time to recurrence (P < 0.05). MAFs in urinary cfDNA and cpDNA were highly correlated; using a capture-based approach, >94% of tumour SMs were detected in both cpDNA and cfDNA.

CONCLUSIONS

SMs are reliably detected in urinary cpDNA and cfDNA. The technical capability to identify very low MAFs is essential to reliably detect UBC, regardless of the use of cpDNA or cfDNA. This 23-gene panel shows promise for the non-invasive diagnosis and risk stratification of UBC.

Microstructure and water distribution in catalysts for polymer electrolyte fuel cells, elucidated by contrast variation small-angle neutron scattering

By using small-angle neutron scattering (SANS) reinforced by scanning electron microscopy, the fine structure of catalysts for polymer electrolyte fuel cells has been investigated. The experimental data resulting from contrast variation with mixed light and heavy water (H2O/D2O) are well described by a core–shell model with fluctuations in concentration between water and Nafion. In particular, SANS obtained with the mixed water ratio 30/70, which corresponds to a matching point between mixed water and Nafion, shows a broad scattering maximum, which is attributed to a 5 nm-thick Nafion shell on the surface of the larger carbon particles. After swelling by water, the ionomer layer absorbs water at the 17 wt% level. By changing the H2O/D2O ratio, it was further confirmed that the catalyst with the ionomer exhibits water repellence, whereas the bare catalyst without the ionomer is wetted by water. Because it is very difficult to extract more information, for instance regarding the Pt–Nafion interactions, by means of small-angle scattering, reflectometry and grazing-incidence scattering experiments with neutrons should be attempted on a model catalyst prepared on a flat substrate.

Avian malaria-mediated population decline of a widespread iconic bird species

Parasites have the capacity to affect animal populations by modifying host survival, and it is increasingly recognized that infectious disease can negatively impact biodiversity. Populations of the house sparrow (Passer domesticus) have declined in many European towns and cities, but the causes of these declines remain unclear. We investigated associations between parasite infection and house sparrow demography across suburban London where sparrow abundance has declined by 71% since 1995. Plasmodium relictum infection was found at higher prevalences (averaging 74%) in suburban London house sparrows than previously recorded in any wild bird population in Northern Europe. Survival rates of juvenile and adult sparrows and population growth rate were negatively related to Plasmodium relictum infection intensity. Other parasites were much less prevalent and exhibited no relationship with sparrow survival and no negative relationship with population growth. Low rates of co-infection suggested sparrows were not immunocompromised. Our findings indicate that P. relictum infection may be influencing house sparrow population dynamics in suburban areas. The demographic sensitivity of the house sparrow to P. relictum infection in London might reflect a recent increase in exposure to this parasite.

Creating Pathologists From a Post-Sophomore Pathology Fellowship: 21 Years and 126 Fellows at an Academic Pathology Department

Medical student exposure to pathology is a continued concern for departments across the country as traditional pathology content is trimmed from medical school curricula. In a longstanding effort to recruit and expose more medical students to the practice of pathology, our institution has supported a year-long post-sophomore fellowship in pathology since the 1930s. The program employs 6 full-time medical students per year to function as junior residents, taking an active role in delivering surgical pathology and autopsy services, with additional opportunities for teaching, research, and electives. We evaluated residency specialty choices and current practice locations for our department’s former post-sophomore fellows (PSFs) who participated in the program from 1995 to 2016. We surveyed them about their reasons for pursuing the post-sophomore fellowship and the program’s effect on their clinical practice. From 1995 to 2016, our department employed 126 PSFs, 54 (43%) of whom pursued careers in pathology after completion of the post-sophomore fellowship. This represented 63% of our medical school’s graduates who matched into pathology during this time frame (1997-2018; 86 total). Thirteen former PSFs (32.5%) have held academic faculty positions in pathology. PSFs who chose another specialty affirmed the positive influence of the fellowship on their current practice. Our post-sophomore fellowship program is exceptional in the number of students participating each year, and our institution shows a higher percentage of former PSFs pursuing careers in pathology compared to similar studies. The post-sophomore fellowship is an effective tool for recruiting medical students to a career in pathology.

Histologic effect of the potassium-titanyl phosphorous laser on laryngeal papilloma

Objectives

Tissue effects occurring with potassium‐titanyl phosphorous (KTP) laser treatment are difficult to quantify due to the multiple variables that affect not only the fluence (energy delivered) but also the laser–tissue interaction. This histopathologic analysis of recurrent respiratory papilloma (RRP) removed after treatment with KTP laser therapy permits correlation of histologic effect with method of laser treatment.

Methods

The histopathology of RRP resected specimens in a single patient was compared following treatment with KTP laser in contact and non‐contact modes as documented with intraoperative photography and video imaging.

Results

Epithelial‐sparing injury selective to the microvasculature was identified on histopathologic assessment of a specimen treated with noncontact angiolysis. Highly cauterized papillomatous epithelium without identifiable vascular structures was identified on tissue removed after treatment with the KTP laser in contact mode.

Conclusion

The histopathologic assessment of acute KTP laser effect on papilloma permits correlation between technique of application and tissue effect. Similar assessments may be helpful to modify dosimetry for individual patients requiring repeated treatment and may also assist in refining the development of existing KTP laser treatment classification systems.

Level of Evidence

4

Health hazards to wild birds and risk factors associated with anthropogenic food provisioning

Provision of supplementary food for wild birds at garden feeding stations is a common, large-scale and year-round practice in multiple countries including Great Britain (GB). While these additional dietary resources can benefit wildlife, there is a concomitant risk of disease transmission, particularly when birds repeatedly congregate in the same place at high densities and through interactions of species that would not normally associate in close proximity. Citizen science schemes recording garden birds are popular and can integrate disease surveillance with population monitoring, offering a unique opportunity to explore inter-relationships between supplementary feeding, disease epidemiology and population dynamics. Here, we present findings from a national surveillance programme in GB and note the dynamism of endemic and emerging diseases over a 25-year period, focusing on protozoal (finch trichomonosis), viral (Paridae pox) and bacterial (passerine salmonellosis) diseases with contrasting modes of transmission. We also examine the occurrence of mycotoxin contamination of food residues in bird feeders, which present both a direct and indirect (though immunosuppression) risk to wild bird health. Our results inform evidence-based mitigation strategies to minimize anthropogenically mediated health hazards, while maintaining the benefits of providing supplementary food for wild birds.This article is part of the theme issue 'Anthropogenic resource subsidies and host-parasite dynamics in wildlife'.

Long-term declines in winter body mass of tits throughout Britain and Ireland correlate with climate change

The optimum body mass of passerine birds typically represents a trade-off between starvation risk, which promotes fat gain, and predation pressure, which promotes fat loss to maintain maneuvrability. Changes in ecological factors that affect either of these variables will therefore change the optimum body masses of populations of passerine birds. This study sought to identify and quantify the effects of changing temperatures and predation pressures on the body masses and wing lengths of populations of passerine birds throughout Britain and Ireland over the last 50 years. We analyzed over 900,000 individual measurements of body mass and wing length of blue tits Cyanistes caeruleus, coal tits Periparus ater, and great tits Parus major collected by licenced bird ringers throughout Britain and Ireland from 1965 to 2017 and correlated these with publicly available temperature data and published, UK-wide data on the abundance of a key predator, the sparrowhawk Accipiter nisus. We found highly significant, long-term, UK-wide decreases in winter body masses of adults and juveniles of all three species. We also found highly significant negative correlations between winter body mass and winter temperature, and between winter body mass and sparrowhawk abundance. Independent of these effects, body mass further correlated negatively with calendar year, suggesting that less well understood dynamic factors, such as supplementary feeding levels, may play a major role in determining population optimum body masses. Wing lengths of these birds also decreased, suggesting a hitherto unobserved large-scale evolutionary adjustment of wing loading to the lower body mass. These findings provide crucial evidence of the ways in which species are adapting to climate change and other anthropogenic factors throughout Britain and Ireland. Such processes are likely to have widespread implications as the equilibria controlling evolutionary optima in species worldwide are upset by rapid, anthropogenic ecological changes.

Estimating age-dependent survival from age-aggregated ringing data-extending the use of historical records

Bird ring-recovery data have been widely used to estimate demographic parameters such as survival probabilities since the mid-20th century. However, while the total number of birds ringed each year is usually known, historical information on age at ringing is often not available. A standard ring-recovery model, for which information on age at ringing is required, cannot be used when historical data are incomplete. We develop a new model to estimate age-dependent survival probabilities from such historical data when age at ringing is not recorded; we call this the historical data model. This new model provides an extension to the model of Robinson, 2010, Ibis, 152, 651-795 by estimating the proportion of the ringed birds marked as juveniles as an additional parameter. We conduct a simulation study to examine the performance of the historical data model and compare it with other models including the standard and conditional ring-recovery models. Simulation studies show that the approach of Robinson, 2010, Ibis, 152, 651-795 can cause bias in parameter estimates. In contrast, the historical data model yields similar parameter estimates to the standard model. Parameter redundancy results show that the newly developed historical data model is comparable to the standard ring-recovery model, in terms of which parameters can be estimated, and has fewer identifiability issues than the conditional model. We illustrate the new proposed model using Blackbird and Sandwich Tern data. The new historical data model allows us to make full use of historical data and estimate the same parameters as the standard model with incomplete data, and in doing so, detect potential changes in demographic parameters further back in time.

Adult type rhabdomyoma presenting as a parathyroid adenoma

BACKGROUND

Adult-type rhabdomyoma (ATR) is a rare mesenchymal tumor of skeletal muscle differentiation. Extracardiac ATR occurs most commonly in the head and neck, but do so in a heterogeneous fashion, arising at numerous different locations within this region.

METHODS

At our institution, we encountered a patient who was diagnosed clinically with parathyroid adenoma based on signs and symptoms of hyperparathyroidism and suggestive radiologic findings. A parathyroidectomy with intraoperative consultation was performed.

RESULTS

The frozen section diagnosis was ambiguous and a diagnosis of ATR was only made on permanent section.

CONCLUSION

Awareness of this tumor can prevent incorrect diagnosis and overtreatment intraoperatively. Herein, we describe the clinical history, pathologic findings, and review histologic features of rhabdomyomas.

Estimating mortality rates among passerines caught for ringing with mist nets using data from previously ringed birds

Mist netting is the most commonly used method for catching birds for scientific ringing, but despite decades of use, there have been few attempts to quantify the associated potential risks to the individuals caught. Any incidence of mortality through capture and handling, however low, is of potential ethical concern and may also introduce biases into the data. We estimate the mortality rate associated with capture of previously ringed (recaptured) passerines from the British and Irish Ringing Scheme (c. 1.5 million records) caught using mist nets. The importance of species, age, mass, month, time, previous captures, and an index of predator occurrence was tested using generalized linear mixed-effects models. The average mortality rate was 0.0011, most of which was reported to occur before the individuals had been extracted from the nets (c. 70% of incidents). Juveniles appeared to be at higher risk and the incidence of predation from mist nets was seasonal, with increased risk during the winter. Species differed in their reported mortality rates with the apparent risk being greatest for Chiffchaff Phylloscopus collybita (0.0029) and Bullfinch Pyrrhula pyrrhula (0.0027). To improve our understanding (and hence minimize risk in future), we recommend collecting more complete data on incidences of mortality, and also injuries; exercising increased care when the species we have identified as being at greater risk are likely to be captured, and ensuring there are robust procedures for the checking of nets (as most reported incidents of mortality occur before handling). We also recommend that all Ringing Schemes should collate and make available data on capture-related mortality. Overall rates of mortality associated with capture, although, were low and support the use of mist netting as a safe capture technique, without undue bias from mortality, when used by appropriately trained individuals.

QUOKKA, the pinhole small-angle neutron scattering instrument at the OPAL Research Reactor, Australia: design, performance, operation and scientific highlights

QUOKKA is a 40 m pinhole small-angle neutron scattering instrument in routine user operation at the OPAL research reactor at the Australian Nuclear Science and Technology Organisation. Operating with a neutron velocity selector enabling variable wavelength, QUOKKA has an adjustable collimation system providing source–sample distances of up to 20 m. Following the large-area sample position, a two-dimensional 1 m2position-sensitive detector measures neutrons scattered from the sample over a secondary flight path of up to 20 m. Also offering incident beam polarization and analysis capability as well as lens focusing optics, QUOKKA has been designed as a general purpose SANS instrument to conduct research across a broad range of scientific disciplines, from structural biology to magnetism. As it has recently generated its first 100 publications through serving the needs of the domestic and international user communities, it is timely to detail a description of its as-built design, performance and operation as well as its scientific highlights. Scientific examples presented here reflect the Australian context, as do the industrial applications, many combined with innovative and unique sample environments.

Implementation of Epic Beaker Anatomic Pathology at an Academic Medical Center

Background:

Beaker is a relatively new laboratory information system (LIS) offered by Epic Systems Corporation as part of its suite of health-care software and bundled with its electronic medical record, EpicCare. It is divided into two modules, Beaker anatomic pathology (Beaker AP) and Beaker Clinical Pathology. In this report, we describe our experience implementing Beaker AP version 2014 at an academic medical center with a go-live date of October 2015.

Methods:

This report covers preimplementation preparations and challenges beginning in September 2014, issues discovered soon after go-live in October 2015, and some post go-live optimizations using data from meetings, debriefings, and the project closure document.

Results:

We share specific issues that we encountered during implementation, including difficulties with the proposed frozen section workflow, developing a shared specimen source dictionary, and implementation of the standard Beaker workflow in large institution with trainees. We share specific strategies that we used to overcome these issues for a successful Beaker AP implementation. Several areas of the laboratory-required adaptation of the default Beaker build parameters to meet the needs of the workflow in a busy academic medical center. In a few areas, our laboratory was unable to use the Beaker functionality to support our workflow, and we have continued to use paper or have altered our workflow. In spite of several difficulties that required creative solutions before go-live, the implementation has been successful based on satisfaction surveys completed by pathologists and others who use the software. However, optimization of Beaker workflows has continued to be an ongoing process after go-live to the present time.

Conclusions:

The Beaker AP LIS can be successfully implemented at an academic medical center but requires significant forethought, creative adaptation, and continued shared management of the ongoing product by institutional and departmental information technology staff as well as laboratory managers to meet the needs of the laboratory.

Targeting the SUMO pathway as a novel treatment for anaplastic thyroid cancer

Cancer stem cells (CSCs) are expanded in anaplastic thyroid cancer (ATC) and standard treatment approaches have failed to improve survival, suggesting a need to specifically target the CSC population. Recent studies in breast and colorectal cancer demonstrated that inhibition of the SUMO pathway repressed CD44 and cleared the CSC population, mediated through SUMO-unconjugated TFAP2A. We sought to evaluate effects of inhibiting the SUMO pathway in ATC. ATC cell lines and primary ATC tumor samples were evaluated. The SUMO pathway was inhibited by knockdown of PIAS1 and use of SUMO inhibitors anacardic acid and PYR-41. The expression of TFAP2A in primary ATC was examined by immunohistochemistry. All ATC cell lines expressed TFAP2A but only 8505C expressed SUMO-conjugated TFAP2A. In 8505C only, inhibition of the SUMO pathway by knockdown of PIAS1 or treatment with SUMO inhibitors repressed expression of CD44 with a concomitant loss of SUMO-conjugated TFAP2A. The effect of SUMO inhibition on CD44 expression was dependent upon TFAP2A. Treatment with SUMO inhibitors resulted in a statistically improved tumor-free survival in mice harboring 8505C xenografts. An examination of primary ATC tissue determined that TFAP2A was expressed in 4 of 11 tumors surveyed. We conclude that inhibition of the SUMO pathway repressed the CSC population, delaying the outgrowth of tumor xenografts in ATC. The effect of SUMO inhibition was dependent upon expression of SUMO-conjugated TFAP2A, which may serve as a molecular marker for therapeutic effects of SUMO inhibitors. The findings provide pre-clinical evidence for development of SUMO inhibitors for the treatment of ATC.

Implicit assumptions underlying simple harvest models of marine bird populations can mislead environmental management decisions

Assessing the potential impact of additional mortality from anthropogenic causes on animal populations requires detailed demographic information. However, these data are frequently lacking, making simple algorithms, which require little data, appealing. Because of their simplicity, these algorithms often rely on implicit assumptions, some of which may be quite restrictive. Potential Biological Removal (PBR) is a simple harvest model that estimates the number of additional mortalities that a population can theoretically sustain without causing population extinction. However, PBR relies on a number of implicit assumptions, particularly around density dependence and population trajectory that limit its applicability in many situations. Among several uses, it has been widely employed in Europe in Environmental Impact Assessments (EIA), to examine the acceptability of potential effects of offshore wind farms on marine bird populations. As a case study, we use PBR to estimate the number of additional mortalities that a population with characteristics typical of a seabird population can theoretically sustain. We incorporated this level of additional mortality within Leslie matrix models to test assumptions within the PBR algorithm about density dependence and current population trajectory. Our analyses suggest that the PBR algorithm identifies levels of mortality which cause population declines for most population trajectories and forms of population regulation. Consequently, we recommend that practitioners do not use PBR in an EIA context for offshore wind energy developments. Rather than using simple algorithms that rely on potentially invalid implicit assumptions, we recommend use of Leslie matrix models for assessing the impact of additional mortality on a population, enabling the user to explicitly define assumptions and test their importance.

Association of Main Specimen and Tumor Bed Margin Status With Local Recurrence and Survival in Oral Cancer Surgery

Importance

There is controversy surrounding surgical margins in oral cavity squamous cell carcinoma (OCSCC), with debate regarding the assessment and prognostic value of margins.

Objective

To analyze a large cohort of OCSCC cases for correlation between tumor specimen margins and intraoperative tumor bed frozen margins and evaluate how margin status associates with local recurrence and survival.

Design, Setting, and Participants

Retrospective cohort study of 406 patients treated with OCSCC resection between 2005 and 2014 at the University of Iowa Hospitals and Clinics. Included cases underwent margin evaluation on the tumor specimen and intraoperative frozen margin assessment from the tumor bed.

Main Outcomes and Measures

Findings of intraoperative frozen margin analysis as a test of tumor specimen margins; local recurrence and survival based on margin findings; prognosis based on clearance of positive frozen margins. To evaluate whether additional resection to "clear" positive frozen margins affected prognosis, we compared local recurrence rates for patients in 3 groups: group A included those patients with negative margins on both intraoperative and permanent specimens; group B included those with positive intraoperative margins subsequently cleared by additional resection to negative margins; and group C included those with negative intraoperative but positive permanent specimen margins.

Results

The median age of the 406 patients (234 men and 172 women) was 61 years (interquartile range, 53-72 years). When frozen margins were correlated with tumor specimen margins, frozen margin accuracy was 65%, with a 46% false-negative rate. We observed a local recurrence rate of 36% (95% CI, 24%-49%) when invasive carcinoma was present at an intraoperative frozen margin and 45% (95% CI, 34%-57%) when invasive carcinoma was found on the permanent specimen margin compared with 19% (95% CI, 14%-26%) and 13% (95% CI, 7%-22%) for completely negative frozen and permanent margin findings, respectively. There was a significant difference in local recurrence between group A (13%) and group B (27%) (absolute difference, 14%; 95% CI, 3%-26%) and between group A and group C (34%) (absolute difference, 21%; 95% CI, 8%-34%), but there was no difference between groups B and C (absolute difference, 7%; 95% CI, -8% to 22%), suggesting that additional resection to clear positive frozen margins does not improve prognosis.

Conclusions and Relevance

Intraoperative frozen margins from the tumor bed are not ideal predictors of positive margins on the main specimen. Both frozen and specimen margins are associated with local recurrence, but the specimen margin has the stronger association. Importantly, we demonstrate that clearing positive frozen margins from the tumor bed is not associated with improved outcomes.

Aggressive Salivary Malignancies at Early Stage: Outcomes and Implications for Treatment

BACKGROUND

Few studies have examined whether the use of adjuvant treatment impacts survival for early stage high-grade salivary tumors.

METHODS

A retrospective review of the SEER database between 1973 and 2012 was performed. Patients with high-grade major salivary gland tumors including salivary duct carcinoma, carcinoma ex-pleomorphic adenoma, high-grade mucoepidermoid carcinoma, or adenocarcinoma, NOS were identified. Only stage I-II tumors were included. The impact of radiation status on observed and relative survival was examined.

RESULTS

Five hundred seventy-four patients with high-grade, early stage salivary tumors met inclusion criteria. Sixty-seven percent of patients received radiation therapy. There was no difference in observed or relative survival based on having received radiation.

CONCLUSIONS

Adjuvant radiation is indicated for advanced stage tumors or early stage tumors with adverse features. For early stage tumors without adverse features, there was no survival benefit from radiation therapy. Adjuvant radiation should be decided on a case-by-case basis for these patients.

Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship

Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.

Demographic drivers of decline and recovery in an Afro-Palaearctic migratory bird population

Across Europe, rapid population declines are ongoing in many Afro-Palaearctic migratory bird species, but the development of appropriate conservation actions across such large migratory ranges is severely constrained by lack of understanding of the demographic drivers of these declines. By constructing regional integrated population models (IPMs) for one of the suite of migratory species that is declining in the southeast of Britain but increasing in the northwest, we show that, while annual population growth rates in both regions vary with adult survival, the divergent regional trajectories are primarily a consequence of differences in productivity. Between 1994 and 2012, annual survival and productivity rates ranged over similar levels in both regions, but high productivity rates were rarer in the declining southeast population and never coincided with high survival rates. By contrast, population growth in the northwest was fuelled by several years in which higher productivity coincided with high survival rates. Simulated population trajectories suggest that realistic improvements in productivity could have reversed the decline (i.e. recovery of the population index to more than or equal to 1) in the southeast. Consequently, actions to improve productivity on European breeding grounds are likely to be a more fruitful and achievable means of reversing migrant declines than actions to improve survival on breeding, passage or sub-Saharan wintering grounds.

Causes and consequences of spatial variation in sex ratios in a declining bird species

Male‐biased sex ratios occur in many bird species, particularly in those with small or declining populations, but the causes of these skews and their consequences for local population demography are rarely known. Within‐species variation in sex ratios can help to identify the demographic and behavioural processes associated with such biases.

Small populations may be more likely to have skewed sex ratios if sex differences in survival, recruitment or dispersal vary with local abundance. Analyses of species with highly variable local abundances can help to identify these mechanisms and the implications for spatial variation in demography. Many migratory bird species are currently undergoing rapid and severe declines in abundance in parts of their breeding ranges and thus have sufficient spatial variation in abundance to explore the extent of sex ratio biases, their causes and implications.

Using national‐scale bird ringing data for one such species (willow warbler, Phylloscopus trochilus), we show that sex ratios vary greatly across Britain and that male‐biased sites are more frequent in areas of low abundance, which are now widespread across much of south and east England. These sex ratio biases are sufficient to impact local productivity, as the relative number of juveniles caught at survey sites declines significantly with increasing sex ratio skew.

Sex differences in survival could influence this sex ratio variation, but we find little evidence for sex differences in survival increasing with sex ratio skew. In addition, sex ratios have become male‐biased over the last two decades, but there are no such trends in adult survival rates for males or females. This suggests that lower female recruitment into low abundance sites is contributing to these skews.

These findings suggest that male‐biased sex ratios in small and declining populations can arise through local‐scale sex differences in survival and dispersal, with females recruiting disproportionately into larger populations. Given the high level of spatial variation in population declines and abundance of many migratory bird species across Europe at present, male‐biased small populations may be increasingly common. As singing males are the primary records used in surveys of these species, and as unpaired males often sing throughout the breeding season, local sex ratio biases could also be masking the true extent of these population declines.

Single thyroid tumour showing multiple differentiated morphological patterns and intramorphological molecular genetic heterogeneity

AIMS

A 49-year-old man presented with a single thyroid tumour that showed a combination of conventional papillary carcinoma, follicular variant of papillary carcinoma, clear cell papillary carcinoma, columnar cell carcinoma and poorly differentiated carcinoma. As all of the morphologies have been associated with papillary carcinoma in the literature, we wished to determine if they contained identical or different molecular abnormalities.

METHODS

Targeted next generation sequencing (NGS) of each morphological component and metastases was performed.

RESULTS

NGS revealed a BRAF p.K601E mutation in both the clear cell papillary carcinoma and poorly differentiated carcinoma and a KRAS p.G12R mutation in the papillary carcinoma, follicular variant. Two different areas of columnar cell variant were tested, with one showing a KRAS p.G12D mutation but no mutation in the other area. A KRAS p.G12R mutation was seen in the metastatic clear cell variant. Two different lymph nodes had metastatic columnar cell carcinoma, one negative for mutations but the other with a compound KRAS p.G12R and KRAS p.G12V mutation on different alleles. No mutations including BRAF and KRAS were seen in the conventional papillary carcinoma.

CONCLUSIONS

Although all of the morphological patterns in this tumour have been reported as having aetiological or other association with one another, there was only partial concordance with their molecular signatures. There was significant molecular discordance, however, even with identical morphologies.

Case of Progressive Dysplasia Concomitant with Intralesional Cidofovir Administration for Recurrent Respiratory Papillomatosis

Recurrent respiratory papillomatosis (RRP) is characterized by benign wartlike growths in the larynx with occasional spread to the lungs. A broad range of therapeutic measures have been used to treat RRP; the primary treatment is laser vaporization of the lesions. Recurrences of the disease are common, and alternate methods of treatment are being used to prevent recurrence, including cidofovir. Cidofovir is a cytosine nucleotide analog with antiviral properties that is approved by the US Food and Drug Administration for treatment of cytomegalovirus retinitis and is currently being used off-label for RRP. Cidofovir has gained initial success in slowing the rate of disease recurrence when used at the time of surgery. However, the use of cidofovir lends concern to several adverse side effects, including the potential for carcinogenesis. We report here a 28-year-old woman who was treated with intralesional cidofovir at the time of surgery over the span of 27 months. The initial pathology results demonstrated benign disease with progression to severe dysplasia during the treatment time. Cidofovir's potential for carcinogenicity remains largely undefined, and thus, we are currently undertaking a project involving the evaluation of sequential paraffin-embedded samples of resections from a large cohort of patients with RRP treated at the University of Iowa Hospitals and Clinics.

Winter wren populations show adaptation to local climate

Most studies of evolutionary responses to climate change have focused on phenological responses to warming, and provide only weak evidence for evolutionary adaptation. This could be because phenological changes are more weakly linked to fitness than more direct mechanisms of climate change impacts, such as selective mortality during extreme weather events which have immediate fitness consequences for the individuals involved. Studies examining these other mechanisms may be more likely to show evidence for evolutionary adaptation. To test this, we quantify regional population responses of a small resident passerine (winter wren Troglodytes troglodytes) to a measure of winter severity (number of frost days). Annual population growth rate was consistently negatively correlated with this measure, but the point at which different populations achieved stability (λ = 1) varied across regions and was closely correlated with the historic average number of frost days, providing strong evidence for local adaptation. Despite this, regional variation in abundance remained negatively related to the regional mean number of winter frost days, potentially as a result of a time-lag in the rate of evolutionary response to climate change. As expected from Bergmann's rule, individual wrens were heavier in colder regions, suggesting that local adaptation may be mediated through body size. However, there was no evidence for selective mortality of small individuals in cold years, with annual variation in mean body size uncorrelated with the number of winter frost days, so the extent to which local adaptation occurs through changes in body size, or another mechanism remains uncertain.

Decreased E-Cadherin but not β-Catenin Expression is Associated with Vascular Invasion and Decreased Survival in Head and Neck Squamous Carcinomas

OBJECTIVES: We wished to correlate the expression of E-cadherin and β-catenin in squamous carcinomas of the head and neck to outcome and other clinicopathologic variables.

STUDY DESIGN AND SETTING: This retrospective study was carried out in a tertiary care setting. The tumors of 45 patients who had their head and neck squamous carcinoma primarily treated by resection were evaluated immunohistochemically with antibodies to E-cadherin and β-catenin. Thirty-two tumors arose in the oral cavity, 9 tumors originated in the larynx, and 4 tumors began in the hypopharynx. Patient outcome and the clinicopathologic variables of tumor site, tumor stage, cervical lymph node status, tumor differentiation, perineural invasion, and vascular invasion were correlated to immunohistochemical expression of E-cadherin and β-catenin.

RESULTS: Low expression of E-cadherin in the tumors was significantly associated with decreased overall survival ( P = 0.004), disease-free survival ( P = 0.007), and vascular invasion ( P = 0.02) but not with other clinicopathologic variables. β-catenin expression was not significantly associated with any of the studied clinicopathologic variables.

CONCLUSION: Decreased E-cadherin but not β-catenin expression is associated with decreased survival in patients with head and neck squamous carcinomas.

SIGNIFICANCE: Detection of loss of E-cadherin expression may help predict which patients with head and neck squamous cell carcinoma will experience a worse outcome compared to patients whose tumors have not lost this tumor suppressor.

EBM rating: C-4

Thyroid Frozen Sections in Patients With Preoperative FNAs: Review of Surgeons' Preoperative Rationale, Intraoperative Decisions, and Final Outcome

OBJECTIVES

We wished to discover (1) in what circumstances surgeons wished to request frozen sections (FSs) on thyroid nodules having a prior fine needle aspiration (FNA) and the preoperative plan in these cases; (2) what the surgeons did with the information provided by FS and (3) in what types of cases was value added with the FS.

METHODS

A retrospective chart review was performed of 121 consecutive patients receiving an intraoperative FS diagnosis on a thyroid nodule, all of which had been evaluated with a preoperative FNA.

RESULTS

The medical record documented rationale for the request in 83% of cases. The most common reason for a FS request of a nodule was whether a planned hemithyroidectomy should proceed to a total thyroidectomy (TT). This scenario led to a TT in 9% of patients with a FNA diagnosed as benign thyroid nodule, 16% diagnosed as follicular neoplasm/suspicious for follicular neoplasm and 69% diagnosed as suspicious for malignancy.

CONCLUSIONS

The stated rationale for FSs in patients with preoperative FNA was not supported by patient outcome in most cases. There may be some utility for FSs in lesions with a suspicious for malignancy preoperative FNA diagnosis.