7 April 2022: Textbook Updates

We have posted updates of the following topics:

Autopsy & forensics > General > Forensic toxicology
by Fabiola Righi, D.O., Lorenzo Gitto, M.D.
Topic summary: Forensic toxicology is the science that deals with the harmful effect of chemicals on the human body and the use of toxicology for the purpose of law. Toxicology results should be interpreted in the context of a thorough medicolegal investigation. Postmortem redistribution: redistribution of drugs into the blood from adjacent solid organs with high drug concentrations, such as lungs, liver and myocardium, affecting the interpretation of substance concentration in the blood after death. Quality and quantity of the sample determine the reliability of the toxicological analysis.

Breast > Breast stains > Ki67 breast
by Anas Mohamed, M.D., Joseph Geradts, M.D.
Topic summary: Nuclear protein that is expressed during all active phases of the cell cycle (G1, S, G2 and M) but is absent in resting cells (G0). Encoded by MKI67 gene on chromosome 10q25. Cellular proliferation marker that is reported as percentage of tumor cells with nuclear staining. Anti-Ki67 antibody binds Ki67 protein in formalin fixed paraffin embedded tissue block and highlights nuclei of all cells in nonresting cell cycle phases. Used as an independent prognostic marker to predict disease free survival, overall survival and complete pathologic response to neoadjuvant chemotherapy.

Chemistry, toxicology & urinalysis > Organ specific > Adrenal > Adrenal insufficiency-diagnosis
by Sarrah Lahorewala, B.D.S., Ph.D., Roger L. Bertholf, Ph.D.
Topic summary: Deficiency in the production of glucocorticoids (e.g., cortisol) due to a disorder of the adrenal gland (primary adrenal insufficiency), inadequate pituitary adrenocorticotrophin hormone (ACTH; secondary adrenal insufficiency) or suppression of ACTH due to decreased corticotrophin releasing hormone (CRH; tertiary adrenal insufficiency). Clinical presentation of adrenal insufficiency is nonspecific; therefore, diagnosis is confirmed via laboratory testing. Low basal cortisol levels are indicative of insufficiency; abnormal response on the ACTH stimulation test is confirmatory.

Lymphoma & related disorders > Mature B cell neoplasms > DLBCL and large B cell lymphomas with high grade features > Burkitt-like lymphoma with 11q aberration
by Anna Shestakova, M.D., Ph.D., Anamarija M. Perry, M.D.
Topic summary: Rare B cell lymphoma that resembles Burkitt lymphoma morphologically, phenotypically and by gene expression profiling. Features overlapping with Burkitt lymphoma but lacks MYC rearrangement. Most common in children and young adults, median in third decade; male predominance. Overall good prognosis, comparable to Burkitt lymphoma; 5 year overall survival of 80%. Treatment: intense chemoimmunotherapy with central nervous system prophylaxis.

Skin nontumor > Infectious disorders > Leishmaniasis
by Gerardo Cazzato, M.D., Giuseppe Ingravallo, M.D., Ph.D.
Topic summary: Protozoal disease caused by over more than 20 Leishmania species, in both tropical and subtropical regions. In H&E, presence of small hematoxylinophilic formations that are round, uniform in appearance, intracytoplasmic and sometimes distributed around the outer rim of the vacuoles (the marquee sign). Cutaneous form is predominantly in the Middle East, whereas the mucocutaneous form occurs in South America (Brazil, Bolivia, Peru). Treatment: organic salts of pentavalent antimony, antimoniate of N methylglucamine and sodium stibogluconate.

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