160 e-Letters

  • Never mind religion, how about desecration?

    In their article considering the relationship between Articles 8 and 9 of the European Convention of Human Rights (ECHR) and coronial autopsies, Leadbeatter and James argue that recourse to invasive autopsy ought only to be made after an ‘issues based’ investigation establishes that this is necessary. This stands in stark contrast to current practice.

    Whilst Leadbeatter and James write to report their own research findings and discuss the decision in R (Rotsztein) v HM Senior Coroner for Inner London North, I was prompted to consider whether they were too restrained in their conclusions. My primary concern is that whilst redress to the ECHR may be legally and rhetorically attractive, it means that outcomes are dependent on the still living taking action. This may, or may not, promote the deceased person’s preferred course of action.

    Prior to addressing this point in more detail, however, a brief mention to the necessity of invasive autopsies where a death occurs in suspicious circumstances. Leadbeatter and James discuss this; I found their discussion of ‘injury’ (Box 2, Issue 4) particularly interesting. They give the example of road or train deaths, where their approach was to first review evidence from the scene, take toxicology samples and remove trace evidence. Another example might be where a person is shot in the head at close range, the events being caught on CCTV. These examples highlight that even in extreme circumstances evisceration of the body m...

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  • Corroborating evidence for atypical breast aspirates

    Dear Editor
    RE: Atypical aspirates of the breast: a dilemma in current cytology practice. Shuang-Ni Yu, Joshua Li, Sio-In Wong, Julia Y S Tsang, Yun-Bi Ni, Jie Chen, Gary M Tse. J Clin Pathol 2017;0:1–9. doi:10.1136/jclinpath-2016-204138
    We read with interest the findings of Shuang-Ni Yu et al regarding “Atypical aspirates of the breast: a dilemma in current cytology practice” first published on May 29 2017 in Journal of Clinical Pathology.
    Breast fine needle aspiration (FNA) utilisation has been in decline for some time and there are several reasons for the drop in the uptake of cytology in the investigation of breast diseases. Although the main sited reason is increased demand for ancillary tests, greater subjectivity of cytology when compared to histology which is generally regarded as the gold standard, and the unpreparedness of pathologists to provide unequivocal diagnoses not only in the borderline lesions but also in low grade malignancies. The need to provide a consistently high quality service to engender confidence in our speciality has never been greater.
    The probabilistic approach to reporting FNA based on the 5 tier categories (C1 unsatisfactory; C2 benign; C3 atypical/indeterminate; C4 suspicious; and C5 malignant) does provide reliable accurate diagnoses for all categories except C1 unsatisfactory and C3 atypical/indeterminate categories. The C1 category highlights a failed FNA procedure whilst a C3 result indicates some diagnostic un...

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  • [Error figure 1] Sokal Score Formula

    Good Morning,

    I just want to put out a typo in figure (1) : the sokal score formula should be : exp(0.0116*(age - 43.4 ) + ... and not exp(0.0116*(age - 4.34 ) +... .

    If you use 4.34 all you patients will be in "High Risk Group".

    source : Sokal JE, Cox EB, Baccarani M, Tura S, Gomez GA, Robertson JE, et al. Prognostic discrimination in « good-risk » chronic granulocytic leukemia. Blood. 1 avr 1984;63(4):789‑99.


    Jim Canet

  • Chronic neutrophilic leukaemia: a molecularly defined disease?
    Stephen E. Langabeer

    In their recent review, Uppal and Gong provided a comprehensive overview of the pathological findings in the uncommon myeloproliferative neoplasm of chronic neutrophilic leukaemia (CNL) [1]. Subsequent to the landmark discovery of somatic mutations in the CSF3R gene in CNL patients which provided a rationale for adoption of tyrosine kinase inhibitor therapies, studies on further cohorts now suggest that activating CSF3R...

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  • Rewriting "Little Red Riding Hood" story may be dangerous
    Giulio Rossi

    Rewriting "Little Red Riding Hood" story may be dangerous

    Maria Cecilia Mengoli,1 Giuseppe Bogina,2 Alberto Cavazza, 3 Giulio Rossi 1

    1Section of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy 2Section of Pathologic Anatomy, Hospital "Don Calabria", Negrar, Verona, Italy 3Department of Oncology and Advanced Technologies, Operative Unit of Oncology, Arcispedale S. Maria Nuova /...

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  • Medicolegal quasi-hospital autopsies
    Richard Y. Ball

    The paper by Turnbull and colleagues (1) on the decline of the adult hospital autopsy rate in UK prompted me to review and extend the Norwich data that they kindly quoted (2). I calculated the adult hospital autopsy rate since our publication (including that relating to the first five months of this year) using the method that we both employed. The modest improvement that we reported in the adult hospital autopsy rate i...

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  • Effect of diet and medicines on the serum iron and transferrin saturation
    Thein H. Oo

    I read this article with interest. I totally agree with the authors' statement that many requests for HFE mutation analysis are frequently ordered in the community without measuring serum iron and transferrin saturation (T-sat) first. While this report is intriguing, I am very much interested to know if the samples for serum iron and T-sat in this study were fasting samples or postprandial samples. The diet rich in iron...

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  • Authors Response: Histological grade in needle core biopsies of invasive carcinoma of the breast: the potential role of reduction of mitotic count threshold in improving agreement with grade in the surgical specimen
    Joseph F Loane

    Dear Sir / Madam,

    We are happy to address the points raised by Lee et al in their commentary on our paper [1] and thank them for their interest in it.

    Lee et al correctly note that our re-assessment was of the mitotic count in these specimens. To clarify, these were carried out by either of two observers (CAD, JL) blinded to the original core and excision grading. The other elements of the tumour grade...

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  • Histological grade in needle core biopsies of invasive carcinoma of the breast: the potential role of reduction of mitotic count threshold in improving agreement with grade in the surgical specimen.
    Andrew HS Lee

    Accurate histological grading of invasive carcinoma of the breast in needle core biopsies is important for patient management, for example for selecting patients for neoadjuvant chemotherapy. The grade in the core biopsy tends to underestimate the grade in the excision specimen, particularly due to underestimation of the mitotic count. We recently proposed a reduction in the threshold for the mitotic count which we found...

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  • Comment on: 'The value of autopsies in the era of high-tech medicine: discrepant findings persist." Kuijpers C.C.H.J. et al. J Clin Pathol 2014;67:512-519 doi:10.1136/jclinpath-2013-202122
    Simone L. Van Es

    To the Editor: Without doubt the hospital-based autopsy is an effective quality assurance and learning tool. The study by Kuijpers et al. supports this.[1] However, autopsy is a time-consuming and expensive procedure which may sometimes cause distress to the deceased patient's family and be associated with complex consent issues. It is therefore important to ask how far reaching, beyond the pathologist and the referring cli...

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