Comparison of lymph node number and prognosis in gastric cancer patients with perigastric lymph nodes retrieved by surgeons and pathologists

Objective： To compare the numbers of positive and total lymph nodes and prognosis in gastric cancer patients whose perigastric lymph node retrieval was performed by surgeons and pathologists. Methods： We conducted a retrospective analysis of clinical and follow-up data from 1,056 patients who underwent gastric cancer D2 radical lymph node resection between January 2008 and December 2010 in the Gastrointestinal Surgery Department of Yantai Yuhuangding Hospital. The follow-up ended in December 2015. Patients were divided into two groups according to the specialty of physicians who performed the postoperative perigastric lymph node retrieval： the surgeon group （475 cases） and the pathologist group （581 cases）. The numbers of positive and total perigastric lymph nodes and the 3- and 5-year survival were compared between gastric cancer patients in the two groups overall and stratified by TNM stage （AJCC 7th Edition）. Results： Overall, the numbers of positive and total lymph nodes were significantly higher in the surgeon group than in the pathologist group （6.53±4.07 vs. 4.09±3.70, P=0.021; 29.64±11.50 vs. 20.71±8.56, P〈0.001）. Further analysis showed that the total number of lymph nodes in stage Ⅰ patients （19.40±9.62 vs. 15.45±8.59, P=0.011） and the numbers of positive and total lymph nodes in stage Ⅱ（1.38±1.08 vs. 0.87±1.55, P=0.031; 25.35±10.80 vs. 16.75±8.56, P〈0.001） and stage Ⅲ patients （8.11±6.91 vs. 6.66±5.12, P=0.026; 32.34±12.55 vs. 25.45±8.31, P〈0.001） were significantly higher in the surgeon group than in the pathologist group. The survival analysis showed that the 3- and 5-year survival of stage Ⅱ and Ⅲ patients was significantly higher in the surgeon group than in the pathologist group （82.0% vs. 73.1%, 69.5% vs. 61.2%, P=0.038; 49.2% vs. 38.9%, 36.3% vs. 28.0%; P=0.045）. Conclusions： Compared with retrieval performed by pathologists, postoperative perigastrie lymph node retrieval performed by surgeons was associated with significant increase in the total lymph node number of stage Ⅰ patients, the numbers of positive and total lymph nodes of stageⅡ and Ⅲ patients, and the survival of stageⅡ and stage Ⅱ gastric cancer patients.

Huashan Hospital Clinical Laboratory receives accredi- tation from College of American Pathologists

Huashan Hospital Clinical Laboratory, Shanghai, China, has been awarded an accreditation by the Commission on Laboratory Accreditation of the College of American Pathologists （CAP）, based on the results of a recent on-site inspection.

Voluminous Phyllode Tumour of the Breast: A Case Report and Literature Review from Loandjili General Hospital in Pointe-Noire, Congo

Introduction: Breast phyllodes are rare. Histologically, it is a fibro-epithelial tumour that differs from the fibro-adenoma by a more abundant and more cellular stroma. Observation: We report a case of a large breast phyllode tumour in a 42-year-old woman in the Obstetric and Gynaecology Department of Loandjili General Hospital. This tumor has evolved for 3 years. It is by discomfort due to chest pain. The clinical examination showed a voluminous right breast in the form of a calabash that hung down the body with a large collateral circulation, associated with an appearance of “orange peel”, and an axillary lymph node. In addition, there were necrotic areas and retraction of the nipple. In addition to the clinical characteristics, the ultrasound images and the histological analyses following the biopsy made it possible to evoke the diagnosis of phyllode tumour of the breast. The treatment consisted of a full right simple mastectomy with a 50 cm breast with a major axis that weighed 9465 grams, supplemented by homolateral axillary lymph node dissection. At the section of the tumour measuring 40 cm long, the sectional sections alternately showed solid and cystic areas. The histological examination confirmed the phyllode nature of the tumour with intermediate grade 2 malignancy. The lymph nodes showed an inflammatory appearance, with no signs of malignancy. Early post operation period was uneventful. The patient’s follow-up was annual, and the last check dated 09/01/2017 proved to be normal. Conclusion: The phyllode tumor is a rare pathology. In our environment, it can be greatly increased by the lack of diagnosis and early management. In all cases, any tumour of the breast operated, must benefit from an anatomo-pathological analysis, to determine the benign or malignant character of it, allowing proposing a plan of management better adapted.

Autopsy Procedure and Standards for Deaths of Unknown Cause during the COVID-19 Pandemic

At any time during the current coronavirus disease(COVID-19)pandemic period,forensic pathologists of public security departments in China may come in contact with corpses of unknown or unclear disease history.When these forensic pathologists perform autopsies on corpses with unknown cause of death,they inevitably face a high risk of severe acute respiratory syndrome coronavirus 2019(SARS-CoV-2)infection throughout the autopsy process.In the present paper,the various aspects of the autopsy procedure for corpses with unknown cause of death,including preautopsy preparations,personnel protection,autopsy operations,postautopsy disinfection,and equipment requirements,were explored on the basis of relevant laws and regulations such as the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases,characteristics of the novel coronavirus and COVID-19,guidelines for epidemic prevention and control,the guiding opinions on the regulation of on-site inspection and handling processes during the COVID-19 pandemic period issued by the ministry of public security,and the current practices of public security forensic pathologists.Recommendations for the autopsy procedure and protection measures for public security forensic pathologists during the COVID-19 pandemic period have been proposed to provide a reference for frontline forensic pathologists and judicial authenticators.

Medicolegal Investigation of Medical Negligence in India:A Report of Forensic Autopsy Case

In general negligence means failure to take proper care over something and according to law negligence means breach of a duty of care which results in damage.Medical negligence is not very uncommon;every now and then cases of medical negligence are reported in the electronic media.Medical Negligence is doing something that one is not supposed to do,or failing to do something that one is supposed to do.Role of Forensic Pathologist in cases of Medical Negligence is always unquestionable.Forensic Pathologists need to explore and maintain a high degree of transparency between the doctors,patients and the law enforcing agencies.In the present case,a person was attacked by a wild animal and he fell down on a rough surface.Immediately he was rushed to a local hospital.The treating doctor stitched the external injury and allowed him to go home;he neither advised any investigation nor kept him under observation to rule out any internal injury.After 12 hours the victim succumbed to death.At autopsy a fractured skull with underlying subdural haemorrhage was noticed.Was not the treating doctor negligent in this case?Were the protocols followed?What should be the role of a Forensic Pathologist in such kind of cases?