Implementing Synoptic Reporting System in Bangladesh

Journal of Histopathology and Cytopathology
Volume 2 N 1
January 2018

Editorial

Implementing Synoptic Reporting System in Bangladesh

*Talukder SI

Histopathology report is a medical document written by histopathologist. In all types of biopsy sample of tumours such as excisional, incisional, punch, curettage and needle biopsies, traditional histopathology reports of formalin fixed paraffin embedded tissue sections is followed by microscopic examination of haematoxylin and eosin stained slides is a gold standard for tumour diagnosis. Histopathologists have to write name of the organ from which the biopsy has been taken, gross description of the specimen, microscopic description of the lesion mentioning invasion, margin involvement, lymph node metastasis, grades, and diagnosis.  It may also also contain an optional comment section that is used when diagnosis is inclusive or development of cancer is unclear. Histopathologist can mention inadequacy of sample and can recommend for other tests. With the exception of a few most of the practicing histopathologists in Bangladesh usually give histopathology reports in descriptive format. Most of the oncologists in this country manage cancer patients with these traditional descriptive histopathology reports.

Many developed countries are using synoptic (structured) histopathology reports along with traditional reports in the management of cancer patients.1 Synoptic report is applicable when entire or a part of an organ with malignant tumour is removed. This report lists the most important results in a structured format. It is a clinical documentation method that uses structured checklist to help clinicians to produce more complete, consistent and valuable medical reports.2 Synoptic reports are faster to produce and easier to interpret. It includes items or fields considered most important in determining patients’ treatment options and chance of recurrence. It is a clinical template that ensures that pathologists are always prompt to report on data that is critical for clinical decision making.

Some developed countries developed electronic synoptic report writing software to digitize their process, reducing reporting time and simplifying report distribution. Histopathologists can produce consistently complete reports, using configurable template under pinhead by interoperable code such as ICD-10. Because of their consistency and the ease of their distribution, electronic synoptic reports can be compiled and searched for quality assurance and clinical research.

In Bangladesh, those who use synaptic report is usually based on customized version of the college of American Pathologists (CAP) protocol. These reports therefore vary among themselves. Bangladesh Academy of Pathology (BAP) has already taken initiative to implement synoptic reporting in histopathology reporting of cancer patient when entire tissue is removed. BAP has recently arranged a workshop on synaptic report writing among the member of this organization. They decided that these types of workshops will be continued with participants including histopathologists and clinicians.

Adoption of standardized histopathology reporting formats that suits the best in the context of Bangladesh is the first step forward. We hope, synoptic reporting will be implemented soon in Bangladesh.

 *Dr. Sadequel Islam Talukder, Assistant Professor, Department of Pathology, Shaheed Syed Nazrul Islam Medical College, Kishoreganj. Associate Editor, Journal of Histopathology and Cytopathology. sadequel@yahoo.com

References

  1. College of American Pathologists. Resources & Publications: Cancer Protocols www.cap.org/cancerprotocols.
  2. Simplifying cancer reporting with eForm. http://www.cap.org/web/home/lab/proficiency-testing/cap-eFRM?_afrLoop=987349351061638#!%40%40%3F_afrLoop%3D987349351061638%26_adf.ctrl-state%3Djimk1r9yv_30

 

 

Information for Contributors

Journal of Histopathology and Cytopathology

Information for Contributors

 General Information
The Journal of Histopathology and Cytopathology (JHC) aims in our understanding of the pathophysiological and pathogenetic mechanisms of human disease by publishing  original papers, review articles, case reports and short communications related to basic and translational fields in pathology. It serves as  bridges between basic biomedical science and clinical medicine with particular emphasis on, but is not restricted to, tissue based studies only. It is published twice a year as the Journal Committee of the Bangladesh Academy of Pathology.

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Manuscripts should be prepared in MS Word format in accordance with The Uniform Requirements for Manuscripts Submitted to Biomedical Journals

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References to literature should be numbered in Arabic numerical in superscripts consecutively in the order in which they are mentioned in the text. At the end of article the full list of references should give the name of all authors followed by the title of the article, the title of the journal abbreviated according to Index Medicus, the year of publication, volume number and first and last pages of the article. Title of the books should be followed by the edition, place of publication, the publisher, the year and the relevant pages. Examples of correct form of reference are given below: References should begin on a new page, be double-spaced and numbered in order of citation in the text, including citations in tables and figure legends. Citations that first appear in tables, figures, or supplemental data should be numbered according to the item’s first call out in the text; a separate reference list should not be prepared for supplemental data. Complete author citation is required (use of “et al” is only acceptable for sources with more than 35 authors).

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Examples follow:

Journals: van Riel D, Leijten LM, Kochs G, Osterhaus AD, Kuiken T: Decrease of Virus Receptors during Highly Pathogenic H5N1 Virus Infection in Humans and Other Mammals. Am J Pathol 2013, 183:1382-1389

Electronic Journals: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group: Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009, 6:e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097

Books: Frosch MP: Central Nervous System. Robbins Basic Pathology, 9th Edition. Edited by Kumar V, Abbas AK, Aster JC. Philadelphia, PA, Saunders, 2012, pp. 811-850

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Tables

Tables should be typed written on separate numbered pages submitted after the main text on separate pages, as part of the manuscript. The preferred file format for Tables is MS Word. and should follow the reference list. All tables should be numbered consecutively using Roman numerical. Each must carry a brief descriptive heading. Tables should be planned to fit within print area. Table footnotes should use the sequential symbols: *, †, ‡, §, ¶, ∥; and abbreviations.

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Figure file formats (including those embedded in the text) are unacceptable.

Photographs and photomicrographs should be of high resolution (minimum 5 mega pixels), in original unedited form and jpg format. These should contain a legend with magnification and stain used. Figure number and name of the first author should be mentioned in each file. Legend should be given in separate page.  Patients’ identification should be hidden.

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Standard abbreviation should be used whenever possible. The full term for which the abbreviation stands followed by abbreviation in parenthesis should be proceed the first use of the abbreviation in the text except for standard units of measurements like 27OC and 25 mmol/L etc.

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Communications with reference to an article published in the journal and current health problems in the community will be accepted as letter to the editor.

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Manuscript Submission

Electronic version of the manuscripts should be submitted through email to the Executive Editor.  Alternatively send DVD/CD to: The Executive Editor of the Journal of Histopathology and Cytopathology.  A cover letter to the editor must accompany the manuscript stating any,  (a) conflicts of interest (both financial and personal), (b) that the manuscript has not been published previously and is not being considered concurrently by another publication, and (c) all authors and acknowledged contributors have read and approved the manuscript. Submissions are not considered for review if previously published in any form (print or online) other than as an abstract. The editor reserves the customary right to style and if necessary shorten the material accepted for publication and to determine the priority and time of publication. Editor assumes that work based on honest observations. It is not the task of the editor to investigate scientific fraud paper.

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On receipt, manuscripts are assessed by the Editor-in-Chief, to one Associate Editor. The Reviewers’ and Associate Editor’s views are used by the Editor-in-Chief (or a Senior Editor) in reaching a decision, usually within three weeks of submission.

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Authors must disclose all financial and personal relationships that might bias their work; to prevent ambiguity, a conflict of interest statement must appear on the manuscript title page, detailing any conflicts (or the absence thereof) for each author.

 

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Concise articles make a greater impact than long ones and are less likely to be delayed by editing to a suitable length. Full articles should be no more than 4000 words from the beginning of the Introduction to the end of the Discussion. Review articles and special features may occasionally exceed this limit by arrangement with the Editor-in-Chief.

 

Abstract (not structured and no more than 300 words)

Following the title page(s), the next page should carry an unstructured prose abstract of 300 words or less. It should clearly convey the purposes of the study, and the main procedures, findings and conclusions. It should be understandable without reference to the rest of the paper, and contain no citation to references in the reference list. Only standard abbreviations as listed below are permitted.

 

Keywords (3 to 10)

Below the abstract, authors should provide and identify as such 3 to 10 keywords or short phrases to assist indexing the article and that may be published with the abstract. MESH headings are a useful guide for authors in considering keywords.

 

Manuscript structure

Research articles are divided into sections with the headings: Abstract, Introduction, Methods, Results and Discussion. Long articles may need subheadings (especially within the Results and Discussion) to clarify their content. The sections should not be numbered. Other types of articles, such as reviews and commentaries, still need a title and abstract and should adhere as closely as possible to these guidelines.

 

 

 

A Rare Case: Non-Syndromic 46,XX Testicular DSD with Derivative Autosome

A Rare Case: Non-Syndromic  46,XX Testicular DSD with  Derivative Autosome

*Banu SG,1 Habib S,2 Islam SS,3 Bhuiyan AZ4

Abstract

46,XX testicular disorder of sex development (DSD) is a known cause of male infertility. Derivative chromosomes formed by complex rearrangements and translocations between two or more autosomes are also found to play role in male and female infertility in different studies. Combinations of sex chromosomal DSD and derivative autosomes are rare and unique. We report a case of 46,XX testicular DSD with a derivative autosome formed by rearrangement between chromosomes 2 and 3. The person was phenotypically normal (non-syndromic) with only complaint of infertility.

[Journal of Histopathology and Cytopathology, 2018 Jul; 2 (2):162-167]

Key words: 46, XX testicular DSD, derivative chromosome, infertility

 

  1. *Dr. Sultana Gulshana Banu, Associate Professor, Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. sgbanu.bsmmu@gmail.com
  2. Saequa Habib, Associate Professor, Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka.
  3. SM Shahedul Islam, Scientific Officer, Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka.
  4. ARM Zakaria Bhuiyan, Resident, MD Pathology, Department of pathology,Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka.

*For correspondence

Introduction

Disorder of sex development (DSD) is a congenital condition where there is a disagreement between chromosomal, gonadal and phenotypic  sex.1 The discrepancies  among  these three determinants are highly variable and depend on patients’ cytogenetic and molecular abnormalities.2 The Chicago Consensus Nomenclature (2005) divides DSD into three broad categories: sex chromosomal DSD, 46,XY DSD and 46,XX DSD. Each of these has subclassifications with defined characteristics. Non-syndromic 46XX testicular DSD is a subclass of 46,XX DSD in which the person is phenotypically male and possesses testes.3 These individuals, though are deficient of a Y chromosome, have SRY (sex-determining region on Y) gene in one of the X chromosomes. This SRY gene induces development of testes that are, however, often smaller in size with impairment of spermatogenesis of varying degrees. As a result the persons are infertile though otherwise normal.4 The mechanisms underlying SRY-positive 46,XX testicular DSD are understood by multiple studies.5,6

A derivative chromosome (der) is a structurally rearranged chromosome generated either by a rearrangement involving two or more chromosomes, or by multiple aberrations within a single chromosome. The term always refers to the chromosome that has an intact centromere.7 The structural  changes involving autosomes, in different studies, are also seen to be associated with male and female infertility.8-11

We report a case of male infertility  with a combination of 46,XX testicular DSD and a derivative autosome formed by rearrangement between chromosomes 2 and 3. To our knowledge, no report has been published so far with this unique combination.

Case Report

A 30 year old male person and his 26 year old wife attended the Gynaecology Outdoor, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka with the complaint of infertility. On query, they revealed that they had been married for four years and had not been using any contraceptive. Their past and present medical history, family history and drug history were non-contributory. The wife was examined physically in the Gynaecology Outdoor and no abnormality was detected. She was advised an ultrasonography of pelvic organs, thyroid function tests, and assay of sex hormones (oestrogen, progesterone) and their trophic hormones (follicle stimulating hormone and luteinizing hormone). The husband was advised semen analysis, ultrasonography of the testes, serum levels of testosterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH).

The reports of investigations of the wife were normal. Those of the husband revealed azoospermia, small-sized testes with heterogenous echotexture on ultrasonography, low serum level of testosterone and high LH. His thyroid function tests, however, were normal. The couple was next advised karyotyping to find out chromosomal abnormality if any. They were referred to the department of Pathology, BSMMU.

The wife’s karyotype was found normal with normal autosomes and sex chromosomes (46,XX). The husband was found having abnormalities in both autosomes and sex chromosomes. His karyotype showed two X chromosomes and a large derivative chromosome which appeared a long chromosome 2 with attached extra portion to its long arm. The extra portion was recognized as the long arm of chromosome 3. The karyogram also showed single normal second and single normal third chromosome. The other chromosome 3 was clearly deficient of its long arm and consisted only of the short arm. We reported the karyotype as 46, XX + der(2)t(2;3) (qter;q). The man was advised a FISH (fluorescence in situ hybridization) to study the breakpoints of the involved chromosomes; however, he did not come for a follow-up and we could not get further information.

Figure 1. Photomicrograph of a chromosome spread showing a derivative autosome formed of chromosomes 2 and 3 (black arrow), one normal chromosome 2 and one normal chromosome 3 (white arrows). The spread also shows two X chromosomes (in ellipses) and short arm of the other chromosome 3 (star).

Figure 2. Karyogram of the study case: 46, XX, der(2)t(2;3) (qter;q).

Discussion

Male infertily can result from a variety of genetic, chromosomal, developmental, hormonal and other causes like infections. There are a number of genetic and chromosomal aberrations related to male infertility. Disorders of sex development (DSD) are a group of sex chromosomal aberrations commonly associated with male and female infertility. Though the DSD categories usually show varying degrees of genital and other phenotypic  abnormalities, the 46,XX testicular DSD subgroup males are sometimes phenotypically normal with mere complaints of infertility.4,5 On examination, however, these persons often show small testes and different levels of cryptorchidism. Impairment of spermatogenesis ranges from oligo-, through astheno- and teratozoospermia to complete azoospermia.5 The testicular development in these Y-deficient individuals is instructed by the SRY (sex-determining region on Y) gene present in the paternally derived X chromosome. The SRY gene which is normally located in Y chromosome, is generally misplaced on to the X chromosome in the affected person’s father during  formation of sperm cells. This occurs in a random fashion by an abnormal exchange of genetic material between the chromosomes (translocation).4,6

 

Among the structural chromosomal abnormalities, complex rearrangements involving sex chromosomes and/or autosomes in various combinations are seen. Derivative chromosomes formed by reciprocal translocations between autosomes are found associated with both male and female infertility.7,8 These are, however, rare in humans. Relatively commoner are rearrangements within Y chromosome (deletions, inversions, insertions) in males and within chromosome 9 in both males and females.9

Other reported patterns are very rare and appear unique events. Lauricella SA, et al (2016) found an infertile mosaic woman with a karyotype  45,XX,der(18)t(18;21)(p11;q21)-21/46,XX,t(18;21)(p11;q21). 86% of her cell lines showed 45,XX-21 pattern and only 14% showed 46,XX pattern containing the derivative (18 & 21) chromosome. This is explained by the marked instability of the derivative chromosomes which can be reduced in size or disappear during karyotype evolution. The authors also explained the patient’s infertility despite having two X chromosomes by the possibility of formation of a high risk offspring affected by an unbalanced chromosomal disorder (deletion or duplication of chromosomes 18 and 21) that might had been eliminated every time of attempted conception.

The patient of the present report is already an XX male; however, the unbalanced derivative (2 & 3) chromosome he possesses can be explained similarly in having a role in his infertility. Song SH, et al (2011) found impaired spermatogenesis ranging from oligo-, astheno-, teratozoospermia to complete azoospermia in their male subjects with complex chromosomal rearrangements (CCRs) of various combinations. Among their 10 cases, there were inversions within chromosome 3, complex translocations between chromosomes 2, 7 and 4, and between chromosomes 2, 19 and 22, and also other patterns. All these cases, however, possessed normal male sex chromosomes, that is 46, XY.

Other similar studies on autosomal rearrangements producing derivative autosomes also showed association with male infertility.10,11

Conclusion

Cases of male and female infertility are best investigated through a multidisciplinary approach involving cytogenetic, molecular, hormonal, histopathological and imaging studies. With cytogenetic study, rare sex chromosomal and autosomal rearrangements forming derivative chromosomes should be kept in mind for proper evaluation.

References

  1. Chan AOK, But WM, Lee CY, Lam YY. Aetiological bases of 46, XY disorders of sex development in the Hong Kong Chinese population. Hong Kong Med J. 2015; (21): 499-510.
  2. Tian L, Chen M, Peng JH, Jhang JW, Li L. Clinical characteristics, cytogenetic and molecular findings in patients with disorders of sex development. J Huazhong Univ Sci Technol [Med Sci]. 2014; 34(1): 81-86.
  3. Hughes IA. Disorders of sex development : a new definition and classification. Best Pract Res Clin Endocrinol 2008; 22(1): 119-134.
  4. Délot EC, Vilain EJ. Nonsyndromic 46, XX testicular disorders of sex development. 2003 Oct 30 [Updated 2015 May 7]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews [Internet], Seattle (WA): University of Washington, Seattle; 1993-2018. Available from: http://www.ncbi.nlm.nih.gov/book/NBK1416/
  5. Barseghyan H, Délot EC, Vilain EJ. New genomic technologies: an aid for diagnosis of disorders of sex development. Horm Metab Res. 2015; 47: 312-320.
  6. Grinspon RP, Rey RA. Disorders of sex development with testicular differentiation in SRY-negative 46, XX individuals: Clinical and genetic aspects. Sex Dev. 2016; 10: 1-11.
  7. Simons A, Shaffer LG, Hastings RJ. Cytogenetic nomenclature: Changes in the ISCN 2013 compared to the 2009 edition. Cytogenet Genome Res. 2013; 141: 1-6.
  8. Lauricella SA, Buse M, Cavani S, Cuttaia HC, Malacarne M, Mazara MV, et al. A rare complex structural chromosomal anomaly in mosaic due to the instability of a derivative chromosome 18 in a female infertile patient. J Down Syndr Chr Abnorm. 2016; 2: 110. Doi: 10.4172/2472-1115.1000110.
  9. Kim JW, Chang EM, Song SH, Park SH, Yoon TK, Shim SH. Complex chromosomal rearrangements in infertile males: complexity of rearrangements affects spermatogenesis. Fertil Steril. 2011; 95(1): 349-352.e5.
  10. Ergul E, Liehr T, Mrasek K, Sazci A. A de novo complex chromosome rearrangement involving three chromosomes (2,13 and 18) in an oligospermic male. (e9-e12) Fertil Steril. 2009; 92: 391.
  11. Coco R, Rahn MI, Estanga PG, Antonioli G, Solari AJ. A constitutional complex chromosomal rearrangement involving meiotic arrest in an azoospermic male: case report. Hum Reprod. 2004; 19: 2784-2790.