13 June 2022: Textbook Updates

We have posted updates of the following topics:

Colon > Inflammatory bowel disease > Ulcerative proctitis
by John D. Paulsen, M.D., Alexandros D. Polydorides, M.D., Ph.D.
Topic summary: Subgroup of idiopathic ulcerative colitis wherein the extent of disease is anatomically limited to the rectum (i.e., distal to the rectosigmoid junction). Diagnosis is based on constellation of symptoms, endoscopic findings, histopathology and exclusion of alternative diagnoses. Factors associated with poor outcomes in adults include young age of onset (< 40 years), nonsmokers and ex smokers, deep ulcerations. Treatment same as ulcerative colitis. Because disease in ulcerative proctitis is limited to within 15 – 20 cm of the anal verge, medical therapies (such as mesalamine) may be administered topically (i.e., by suppository or enema).

Ear > Middle ear and inner ear tumors – benign / nonneoplastic > Cholesteatoma
by Kelly Magliocca, D.D.S., M.P.H.
Topic summary: Cholesteatoma is a benign, nonneoplastic destructive lesion in the middle ear or mastoid, most commonly unilateral. Cystic strips of nonneoplastic, nondysplastic keratinizing squamous epithelium, with a prominent granular layer, keratin debris and background stromal inflammation. Annual incidence ranges between 3 – 14 per 100,000 children and 9.2 – 13 per 100,000 adults. Prognosis and potential for complications influenced by elements such as ossicular chain status, ossicular chain reconstruction, extension of cholesteatoma, labyrinthine fistula, infection or abscess, cranial nerve dysfunction. Treatment of cholesteatoma is surgical.

Gallbladder & extrahepatic bile ducts > Extrahepatic bile duct tumors > Traumatic neuroma
by Elaina Daniels, M.D., Naziheh Assarzadegan, M.D.
Topic summary: Nonneoplastic, disorganized proliferation of normal nerve components at the site of previously damaged peripheral nerves. Commonly seen after gallbladder surgery (i.e., cholecystectomy). No predilection for gender or age. Most are asymptomatic without any specific physical examination findings; can present with right upper quadrant pain, obstructive jaundice, ascending biliary cholangitis (upper abdominal pain, fever, jaundice) and mass. Favorable prognosis. Surgical resection is curative.

Laboratory Administration & Management of Pathology Practices > Qualifying board topics Safety > Patient safety
by Anoshia Afzal, M.D., Lewis A. Hassell, M.D.
Topic summary: Patient safety involves prevention of errors and adverse effects. Promoting a just culture; preventing / reducing pre-analytic, analytic and postanalytic errors; using tools and technology to evaluate and improve patient safety. Spaghetti diagrams or workflow charts can be created in order to maximize the utility and efficiency of work space. A quality indicator portfolio has been offered by College of American Pathologists (CAP), which is called the Q probes program, including the Q track program. Transparency and a team approach should be encouraged whenever an error occurs.

Stomach > Dysplasia > Dysplasia
by Kyra Berg, M.D., Teri A. Longacre, M.D.
Topic summary: Gastric dysplasia is a precursor lesion to gastric adenocarcinoma; it can be flat, polypoid (adenoma) or arise on the surface of an existing nondysplastic polyp. Classified into low and high grade. Male predominant; higher incidence in Asia, Eastern Europe and South America. High grade dysplasia is associated with a much higher rate of progression to adenocarcinoma. Treated with endoscopic submucosal resection or endoscopic submucosal dissection.

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