Clinical Vignettes

Gastrointestinal Clinical Vignettes

At Inform Diagnostics, our subspecialty anatomic pathology services have made a difference for GI patients. The following clinical vignettes for gastrointestinal pathology show how our approach—including high standards for quality assurance and intradepartmental GI consensus case conferencing—has helped clinicians promptly and confidently initiate treatments for their patients, and has helped patients avoid unnecessary surgeries.

Accurate diagnosis of Active Ileitis with Fissuring Ulcers and Transmural Inflammation, not infection or ischemia

42-year-old woman with persistent GI bleeding and negative upper endoscopy. Colonoscopy showed several centimeters of edematous terminal ileum with no areas of ulceration identified. Resection of the terminal ileum and right colon.

Ileal resection with fissuring ulcers, mural thickening and subserosal lymphoid aggregates. No granulomas present.

The outside diagnosis indicated active Ileitis with Ulceration, Hemorrhage and Granulation Tissue, with comments referring to the possibilities of ischemia, infection, drug-induced ileitis and Crohn’s disease. The gastroenterologist asked Inform Diagnostics for consultation due to confusion on how to treat and further evaluate.

Our Diagnosis

Active Ileitis with Fissuring Ulcers and Transmural Inflammation, most consistent with Crohn’s Disease.

Clinician notified that the patient has Crohn’s disease, not infection or ischemia.

The Inform Diagnostics Difference
  • Specific diagnosis rendered.
  • No additional diagnostic work-up for ischemia is necessary.
  • Allows for immediate and effective therapy.
  • No concern about giving immunosuppressive therapy to a patient with an infectious process.

Inform Diagnostics GI Pathology Team recommends against adenoma surgery due to current medical literature

60-year-old man with a history of ulcerative colitis in the far end of his colon (rectosigmoid) underwent a biopsy taken from the near end of his colon (cecum). Our expert GI pathologist found that the tissue contained a tiny dysplastic polyp (a tubular adenoma). In discussing the case, the clinician indicated that he wanted to perform a colectomy surgery, because the diagnosis represented pre-cancerous change in a colitis patient.

After hearing the physician’s surgery plan, the Inform Diagnostics GI pathologist cautioned about the plan and indicated that he wished to first review the case at our daily consensus conference. Our GI pathologist was able to alert the physician that surgery was not indicated, because the polyp was confirmed to occur in an area without prior/current colitis.

Our Diagnosis

Tubular adenoma

The Inform Diagnostics Difference
  • Patient avoided a surgery.
  • Inform Diagnostics GI pathology team recommended a different course of treatment based on current recommendations from the relevant medical literature and review by subspecialist pathologists at the daily consensus conferences.

Atypical cells from past chemo pose as high-grade dysplasia

65-year-old woman underwent a stomach biopsy and a general pathologist diagnosed high-grade dysplasia (a high-risk, pre-cancerous change). Surgery was scheduled, but the biopsy was sent to Inform Diagnostics for a second opinion.

Our Diagnosis

Atypical cells, consistent with chemotherapy effect.

The physician checked with his patient and confirmed that she had, in fact, undergone chemotherapy for colon cancer. No treatment was necessary.

The Inform Diagnostics Difference
  • Patient avoided the expense, pain, and complications of surgery.
  • The Inform Diagnostics expert GI pathologist discerned the difference between cancer and a dangerous mimic.

Inform Diagnostics Pathologist recognized breast cancer metastasized to stomach

44-year-old woman was found to have possible stomach cancer. A biopsy did show cancer (adenocarcinoma), but microscopically, the Inform Diagnostics GI pathologist recognized that while a cancer of the stomach itself was possible, the microscopic appearance suggested spread of breast cancer to the stomach instead. Further tissue analysis supported this diagnosis, and a later examination proved that there was an undetected breast cancer.

Our Diagnosis

Metastatic breast cancer to stomach

The Inform Diagnostics Difference
  • Inform Diagnostics expert GI pathologist recognized the histologic characteristics of breast cancer that had metastasized to the stomach rather than the expected primary stomach cancer.
  • Patient’s treatment was chemotherapy, not gastric surgery.

Epstein-Barr diagnosis too late for unnecessary surgery

71-year-old woman had previous surgery for severe gastritis wherein a section of her stomach was removed. At the time, pathologists diagnosed an obstruction with no known cause. One year later, the patient returned with ongoing severe pain and inflammation (gastritis/duodenitis) in the remaining tissue in that region of her GI tract. This was biopsied and sent to Inform Diagnostics.

Our GI pathologist suspected that a rare and unusual cause of inflammation and obstruction, Epstein-Barr virus infection, was the problem all along. Further tissue analysis called in situ hybridization confirmed the EBV infection, a treatable condition.

Our Diagnosis

Epstein-Barr virus infection

The Inform Diagnostics Difference
  • Patient was treated for the infection and cured, but unfortunately had already undergone unnecessary surgery.
  • Inform Diagnostics subspecialist pathologists know about the rare conditions that can mimic other illnesses.
  • Definitive diagnosis by Inform Diagnostics GI pathologist led to effective treatment and resolution.

Inform Diagnostics diagnosis recognizes previous lab’s contamination error

A patient underwent a biopsy of the colon by a physician who was a former client of Inform Diagnostics. The new in-office pathologist had diagnosed “non-specific colitis with dysplasia,” a vague diagnosis combined with suggested pre-cancerous change (dysplasia), that left the physician without clear direction. He forwarded the slides to Inform Diagnostics for consultation.

One of Inform Diagnostics’ expert subspecialist GI pathologists provided the specific and correct diagnosis: ulcerative colitis. Notably, though, our expert determined that the “dysplasia” reported by the original pathologist actually represented a contamination by a piece of tissue from a different patient with a polyp (adenoma).

Our Diagnosis

Ulcerative colitis

The Inform Diagnostics Difference
  • While no lab is free of errors, the mistakes by both the original lab and pathologist affected the patient’s diagnosis.
  • Inform Diagnostics GI pathologist recognized that the slides contained contamination from a different patient’s biopsy.
  • Due to Inform Diagnostics’ definitive diagnosis, the patient avoided surgery and is able to be treated appropriately for ulcerative colitis.

Accurate diagnosis of sessile serrated adenoma ensures proper treatment

51-year-old woman with a family history of colon polyps underwent a colonoscopy, performed by a former Inform Diagnostics client, during which a large polyp was removed from the cecum. The client’s new in-office pathologist diagnosed a benign “hyperplastic” polyp, which requires no follow-up for 10 years.

Our former client asked us for a consultation, and Inform Diagnostics’ GI pathologist correctly diagnosed the polyp as a sessile serrated adenoma (SSA) with low-grade dysplasia, a pre-cancerous polyp which must be removed completely. The original pathologist responded that the diagnosis of SSA was “controversial.”

Our Diagnosis

Sessile serrated adenoma (SSA) with low-grade dysplasia

The Inform Diagnostics Difference
  • Patient received proper care and treatment.
  • Definitive diagnosis by Inform Diagnostics follows up-to-date guidelines in current medical literature.

Staying on the leading edge of diagnostics

50-year-old woman with a 1.2 cm polyp in the right colon. Bland serrated lesion resembling a typical hyperplastic polyp; however, recent literature describes architectural and cytologic findings that allow for the correct diagnosis of sessile serrated adenoma.

Our Diagnosis

Sessile serrated adenoma

The Inform Diagnostics Difference
  • Recognizing that many bland polyps previously thought to be hyperplastic polyps are actually pre-malignant lesions.
  • Understanding the difference between:
    • Large hyperplastic polyps
    • Traumatized hyperplastic polyps
    • Mixed hyperplastic-adenomatous polyps
    • “Traditional” serrated adenomas
    • Sessile serrated adenomas
    • Sessile serrated adenomas with dysplasia or carcinoma
  • Seeing more than 2,000 biopsies per day, with 26 expert GI pathologists convening daily to discern subtle cases maximizes the specificity of diagnoses.
    • Including newly identified lesions, such as sessile serrated adenomas, that may explain so-called interval cancers.

Identifying subtle histologic findings

73-year-old woman presented with diarrhea and weight loss. An endoscopic examination revealed an unremarkable colonic mucosa. Biopsies were taken to exclude microscopic colitis. Mucosa appeared unremarkable except for a subtle darkening of the surface that corresponds to microorganisms.

Our Diagnosis

Colonic spirochetosis

The Inform Diagnostics Difference
  • Provides a reasonable explanation for this patient’s diarrhea and weight loss (spirochetosis can also cause rectal bleeding, abdominal pain, purulent discharge, and an appendicitis-like picture).
  • Avoidance of complications related to immunosuppressive therapy.
  • Identifies a condition that may respond to antibiotic therapy.
  • Recognition of a subtle finding that may be easily overlooked.

Knowing what isn’t on the slide is as important as what is

78-year-old woman with chronic diarrhea. An upper endoscopy demonstrated numerous small nodules at the duodenal bulb. Normal villous architecture and surface epithelium. The lamina propria appears normal, but close observation reveals the absence of plasma cells in the lamina propria. After contacting the clinician, the patient was later confirmed to be IgA deficient.

Our Diagnosis

Absent plasma cells, consistent with an immunodeficiency disorder

The Inform Diagnostics Difference
  • Identification of a potentially treatable condition.
    • Likely to have been considered “normal” by general pathologists.
  • Extremely subtle features recognized that may explain diarrhea, malabsorption, sinopulmonary disease or bacterial infections.
  • Information may prevent a reaction to a future blood transfusion.

Recognizing that some innocuous processes mimic IBD

74-year-old woman presented with diarrhea. A colonoscopy revealed rectal erythema and mucosal granularity; proctitis was ruled out. Crypt architectural distortion and chronic inflammation suggest IBD; however, close examination shows vascular and smooth muscle proliferation in the lamina propria.

Our Diagnosis

Benign anorectal mucosa with evidence of trauma/prolapse

The Inform Diagnostics Difference
  • Findings suggestive of IBD; however, case reviewed at daily conference and determined to represent only trauma/prolapse changes; patient was not labeled with chronic colitis/proctitis.
  • Inappropriate treatment with immunosuppressive agents was avoided.

Following up to rectify historically incorrect diagnoses

18-year-old woman with a clinical history of ulcerative colitis. Patient presents with diarrhea. Active cryptitis and a lymphoplasmacytic infiltrate suggest ulcerative colitis; however, intraepithelial lymphocytosis and maintenance of the crypt architecture betray the correct diagnosis.

Our Diagnosis

Lymphocytic Colitis

The Inform Diagnostics Difference
  • Patient’s outside slides were requested and reviewed.
    • Our opinion that these outside biopsies (incorrectly interpreted as “Ulcerative Colitis”) also represented Lymphocytic Colitis.
  • Avoidance of complications related to immunosuppressive therapy.
  • Allows for appropriate therapy for lymphocytic colitis.
  • No need for continuance of lifetime colonic surveillance.

Recognizing the effect of medications

Duodenal epithelium shows marked nuclear pleomophism and mild architectural complexity. 63-year-old man with a history of colorectal carcinoma and heme-positive stool. Biopsy of the duodenum, endoscopically showing mucosal irregularity. Histology worrisome for dysplasia/carcinoma. Inform Diagnostics GI pathologists recognized likely therapy effect. Clinician contacted; subsequent chart review revealed previous 5-FU chemotherapy

Our Diagnosis

Active duodenitis with reactive epithelial atypia, consistent with chemotherapy effect

The Inform Diagnostics Difference
  • No confusion as to whether the patient has a malignant process (primary or metastatic) involving the duodenum.
  • No dysplasia or malignancy is present.

Rectal bleeding caused by bacterial infection

A 45-year-old man with rectal bleeding and discomfort and an anal fissure underwent sigmoidoscopy. During the procedure, the colorectal surgeon biopsied ulcerated rectal mucosa. The specimens were sent to Inform Diagnostics for diagnosis. In addition to ulceration, the histopathology findings by our GI pathologists included a plasma-cell predominant inflammatory infiltrate.

Our Diagnosis

Treponema pallidum (syphilitic proctitis)

The Inform Diagnostics Difference
  • The case was presented for consensus review when an initial panel of special stains failed to confirm some of the more common causes of rectal ulceration.
  • The collective expertise of our team of GI pathologists highlighted the possibility of a rare cause of this lesion and guided a follow-up test that correctly diagnosed the patient’s condition.
  • The clinician can start the appropriate treatment for the patient immediately.

Dermatology Clinical Vignettes

The following dermatopathology clinical vignettes highlight patient cases where the Inform Diagnostics diagnosis made a difference. Our dermatopathologists subspecialize in specific areas of cutaneous pathology (lymphomas, drug reactions, and melanocytic lesions, among others), see a greater number of cases than the average dermatopathologist, and regularly engage in phone calls and one-to-one video discussions with clinicians to optimize patient care through improved clinical communication.

A benign reactive process mimicking a more aggressive tumor

23-year-old man presented to his clinician with a forehead lesion.

Upon biopsy, another laboratory diagnosed the forehead lesion as a dermatofibromasarcoma protuberans (DFSP), a locally aggressive malignant soft tissue tumor. The clinician was planning Mohs surgery and requested a second opinion from Inform Diagnostics.

Our Diagnosis

Nodular fasciitis, a benign reactive process

The Inform Diagnostics Difference
  • In our daily consensus conference, Inform Diagnostics dermatopathologists differentiated between two microscopically similar conditions.
  • Patient avoided surgery on his face. (DFSP requires wide excision, while nodular fasciitis, a benign condition, resolves on its own.)
  • The Inform Diagnostics dermatopathologist spoke to the clinician, who stated that the patient’s lesion had arisen very quickly, which further supported the diagnosis of nodular fasciitis.

Wide margin surgery cancelled after Inform Diagnostics diagnosis

A woman in her fifties presented with a pigmented lesion, which was biopsied and reviewed by a general pathologist without a subspecialization in dermatopathology. A diagnosis of invasive melanoma was issued.

The surgeon who was planning to perform a wide surgical removal of the tumor sent the original biopsy slides to Inform Diagnostics for a second opinion. Our dermatopathologist determined that the lesion was actually a type of benign mole (dysplastic nevus).

Our Diagnosis

Dysplastic nevus with moderate atypia

The Inform Diagnostics Difference
  • A dysplastic nevus requires a conservative removal.
  • Inform Diagnostics’ expert dermatopathologist rendered a definitive diagnosis and a wide surgical excision was avoided.

Inform Diagnostics dermatopathologists see far more cases, recognize basal cell carcinoma

A woman in her fifties presented with a pigmented lesion that was biopsied. This lesion was diagnosed as nodular melanoma at an outside institution. When the entire tumor was later removed, the large re-excision was sent to Inform Diagnostics.

Our dermatopathologists did not find residual melanoma in the patient’s tumor; rather, they diagnosed residual basal cell carcinoma, a much less dangerous tumor type. Subsequently, the Inform Diagnostics dermatopathologist reviewed the patient’s original biopsy, which in fact showed a pigmented nodular basal cell carcinoma, without evidence of a melanoma. Pigmented nodular basal cell carcinomas and nodular melanomas may show similar architectural features, at low power. However, a closer view of the tumor helps to make the distinction.

Our Diagnosis

Pigmented basal cell carcinoma, nodular type

The Inform Diagnostics Difference
  • Patient is diagnosed with and treated for a less aggressive tumor.
  • Definitive diagnosis is rendered by an Inform Diagnostics subspecialist dermatopathologist.

Definitive diagnosis rendered by Inform Diagnostics dermatopathologist who subspecializes in alopecia

A 23-year-old woman with Crohn’s disease and a prior clinical history (not biopsy-proven) of psoriasis and alopecia areata presented with new “scalp pustules.”

The patient’s dermatologist performed a scalp biopsy, which was sent to Inform Diagnostics. Our laboratory proceeded with the established Headington grossing protocol. The biopsy showed histologic features of psoriatic alopecia. Our dermatopathologist reviewed the patient’s medication list, which was provided through Inform Diagnostics’ interface with the clinician’s EMA software. The patient’s medication included an anti-TNF (tumor necrosis factor) for her Crohn’s disease. Altogether the histopathological features and clinical information helped to make a definitive diagnosis.

Our Diagnosis

TNF-alpha inhibitor-associated psoriatic alopecia

The Inform Diagnostics Difference
  • A definitive diagnosis was rendered by the Inform Diagnostics dermatopathologist who subspecializes in alopecia, and was the senior author of a report on anti-TNF related psoriatic alopecia (see reference).
  • Our dermatopathologist sees a greater number of alopecia cases compared to the average dermatopathologist.
  • The clinician, now with a definitive diagnosis, can give the appropriate treatment with the consideration of withholding, discontinuing, or changing anti-TNF therapy based upon the degree of scalp pustular eruptions (and alopecia) and clinical control of the Crohn’s disease.

Reference: Doyle, Leona A, MD; Sperling, Leonard C, MD; Baksh, Shashi, MD; Lackey, Jeffrey, MD; Thomas, Brian, MD; Vleugels, Ruth Ann, MD; Qureshi, Abrar A, MD, MPH; Velazquez, Elsa F, MD Psoriatic Alopecia/Alopecia Areata–Like Reactions Secondary to Anti–Tumor Necrosis Factor-α Therapy: A Novel Cause of Noncicatricial Alopecia, The American Journal of Dermatopathology: April 2011 – Volume 33 – Issue 2 – p 161-166

Clinician-pathologist interaction uncovers diagnosis of metastatic carcinoma

A 77-year-old female presented with multiple erythematous papules on her neck and trunk. The rash was itchy and had a rapid growth over the last two months. The clinical differential diagnosis was folliculitis versus dermatitis unspecified. No prior pertinent medical history was provided.

The biopsy showed a diffuse and interstitial growth of malignant cells in the dermis. After reviewing the biopsy and based on the histopathological findings, our dermatopathologist called the clinician to discuss the case. The provider confirmed the patient’s prior history of upper gastrointestinal carcinoma and the doctors discussed the unusual clinical presentation mimicking an inflammatory condition.

Given the clinical and histological findings, a minimal panel of immunohistochemical stains were performed to confirm the diagnosis.

Our Diagnosis

Metastatic carcinoma from the upper gastrointestinal tract

The Inform Diagnostics Difference
  • One-on-one interactions between clinicians and our pathologists resulted in a definitive diagnosis.

Urology Clinical Vignettes

Our team of GU pathologists, all subspecialists, help patients get definitive diagnoses that put them on the path to treatment and avoid unnecessary surgeries. At the same time, we help clinicians act efficiently and with confidence so they can deliver value and sustainability for their practices. Read the following urologic pathology clinical vignettes to see how.

Mystery solved of “a small focus of 3+3=6 prostate cancer” with a very high aggressiveness score by a popular genetic prognostic test

An outside pathology lab sent a prostate biopsy to Inform Diagnostics for consultation and ERG status testing. The materials comprised a two-part prostate core biopsy—the original H&E slides and one PIN3 cocktail immunostain slide for part A. The Inform Diagnostics uropathologist diagnosed both parts as benign prostate tissue. Due to the request for ERG, which is expressed in some prostate cancer glands, the uropathologist contacted the urologist and was informed that Part A had been diagnosed by the outside pathology lab as a small focus of 3+3=6 prostate cancer, which was sent for genetic testing and showed a very high aggressiveness score, suggesting a poor prognosis. The clinician and the patient were puzzled by these results.

The Inform Diagnostics uropathologist performed an additional PIN4-ERG immunostain, and confirmed the benign diagnosis based on morphological and immunohistochemical features. The few glands marked by an outside pathologist had apparently been interpreted as cancer based on lack of basal cell by immunostain; however, these glands showed no cytological atypia and adjacent glands with similar morphology had patchy basal cells. Based on the overall morphological and immunohistochemical features, these glands were benign prostate glands.

Why did benign prostate tissue show such high aggressiveness score? Our uropathologist worked closely with the genetic testing company to solve the puzzle. By comparing pictures of the different foci in the core, it was finally determined that a focus with prominent acute inflammation and basal cell hyperplasia was circled as cancer and was tested for cancer aggressiveness. Basal cell hyperplasia is a type of cancer mimicker. Diagnosis of a small focus of prostate cancer can be very challenging, and our urologic specialists are well trained to handle these difficult situations.

Our Diagnosis

Benign prostate tissue

The Inform Diagnostics Difference
  • Definitive diagnosis of a benign condition was rendered by the Inform Diagnostics expert uropathologist.
  • The Inform Diagnostics expert uropathologist thoroughly investigated the case, and solved the mystery that confused the urologist, pathologist and patient.
  • The patient avoided potential unnecessary surgery due to the incorrect diagnosis and misleading information from genetic prognostic testing.

Rare benign condition that mimics cancer recognized

A 64-year-old man presented with difficulty in voiding urine and elevated serum PSA. The patient underwent transurethral resection of the prostate (TURP) to relieve urinary obstruction. The pathologist at an outside laboratory had rendered the diagnosis of prostate cancer, Gleason score 4+4=8. The treating urologist requested a second opinion by Inform Diagnostics. After examining the biopsy materials and clinical information, our expert uropathologist diagnosed the patient with sclerosing adenosis, a recognized rare but important benign mimic of high-grade prostate adenocarcinoma due to its complex architecture.

Our Diagnosis

Benign sclerosing adenosis

The Inform Diagnostics Difference
  • Definitive diagnosis of a benign condition mimicking cancer was rendered by the Inform Diagnostics expert uropathologist.
  • The patient avoided the psychological, physical, and financial cost of a cancer diagnosis.

Different diagnosis rendered for follow-up biopsy

A 60-year-old male, with a history of high-grade bladder cancer diagnosed at an outside lab, underwent a follow-up bladder biopsy which was sent to Inform Diagnostics. The Inform Diagnostics expert uropathologist confirmed that there was residual malignancy but suspected a diagnosis of high-grade lymphoma. Due to major disagreement with previously rendered diagnoses of high-grade urothelial carcinoma at the outside institution, the Inform Diagnostics pathologist requested and obtained additional medical history and the previous pathology report. Further work-up at Inform Diagnostics confirmed the diagnosis of high-grade B-cell lymphoma. Due to this difference in diagnosis, the treating urologist requested a second opinion. Our diagnosis of lymphoma was confirmed by an outside academic consultant.

Our Diagnosis

High-grade B-cell non-Hodgkin lymphoma

The Inform Diagnostics Difference
  • The Inform Diagnostics expert uropathologist reviewed previous materials and performed additional studies to make a definitive diagnosis.
  • Inform Diagnostics’ diagnosis was confirmed by an outside academic consultant.
  • The patient received chemotherapy appropriate for lymphoma and avoided unnecessary surgery.

Inform Diagnostics’ test correctly predicts prostate cancer at repeat biopsy

A 60-year-old man was found to have a high blood PSA level and then underwent a set of 12 prostate biopsies. The Inform Diagnostics uropathologist diagnosed a pre-cancerous condition, HGPIN (high-grade prostatic intraepithelial neoplasia) in two separate sites (one on each side of the prostate). Using our PINgenius™ Test, the patient was classified as being High Risk, and Inform Diagnostics recommended a repeat biopsy within a short time frame. The client requested a second opinion from a highly prestigious academic and research hospital, which interpreted just one site with HGPIN and the other with low-grade PIN. The pathologist at the academic hospital recommended follow-up with a repeat biopsy after three years. Despite the difference of opinion, and after a discussion of the results with the Inform Diagnostics uropathologist, the urologist decided to follow Inform Diagnostics’ recommendations and performed a repeat biopsy shortly after the initial biopsy. The repeat biopsy showed significant volume of adenocarcinoma of prostate with a Gleason score 3+4=7.

Our Diagnosis

Bilateral HGPIN with PINgenius test result: High Risk. Cancer confirmed on follow-up biopsy.

The Inform Diagnostics Difference
  • The patient’s malignant diagnosis was not delayed, and he benefitted from immediate treatment.
  • Our uropathologist utilized Inform Diagnostics’ PINgenius™ Test, a unique test developed at Inform Diagnostics which is now widely available to the medical community.
  • Although a prestigious hospital recommended follow-up at three years, our client trusted the Inform Diagnostics diagnosis.
  • The urologist may have saved the life of his patient by not delaying the follow-up biopsy.

Signet-ring adenocarcinoma is a subtle histologic finding

36-year-old man was sent to a urologist with pain in the abdomen and radiologic evidence of hydronephrosis. During a cystoscopy, the urologist saw that the bladder appeared nodular and scarred.

A biopsy was performed, and an outside pathologist diagnosed “ruptured cystitis glandularis/cyst.” The urologist requested a second opinion from Inform Diagnostics. Our expert uropathologist identified a subtle, yet malignant signet-ring cell adenocarcinoma of the colon that had metastasized to the patient’s bladder.

Our Diagnosis

Metastatic signet-ring cell adenocarcinoma

The Inform Diagnostics Difference
  • Appropriate treatment for the patient.
  • Subspecialist expert uropathologist at Inform Diagnostics recognized a subtle histologic difference.
  • Definitive diagnosis by Inform Diagnostics.

Benign tissue fragment poses as cancer

58-year-old man underwent a prostate biopsy due to an elevated PSA. The specimens were sent to an outside laboratory where the patient was diagnosed with cancer, Gleason score 3+3=6.

Wanting a second opinion, the patient’s urologist sent the biopsy slides to Inform Diagnostics. Inform Diagnostics’ expert uropathologist saw that the slides included a tissue fragment that represented benign rectal mucosa with ischemic changes (the prostate is biopsied through the rectum) that the previous lab had misinterpreted as prostate cancer.

Our Diagnosis

Benign rectal tissue

The Inform Diagnostics Difference
  • Inform Diagnostics expert uropathologists recognized the common misinterpretation of normal tissue.
  • Patient avoided unnecessary major surgery.

Prostate surgery was unnecessary

A man in his mid-sixties underwent the removal of his prostate following a diagnosis of cancer, Gleason score 3+3=6, by a solo pathologist at an outside laboratory. After the prostatectomy, the hospital’s pathology department could not find any cancer in the removed prostate, so they decided to cut the entire prostate into 180 slides, and still no cancer was found.

All 180 slides were sent to Inform Diagnostics. Our expert uropathologist did not find cancer either, so therefore asked for the original biopsies. Upon receipt, the Inform Diagnostics uropathologist found that the original biopsies contained atrophied glands that were over-interpreted as cancer. Atrophic glands can be a mimicker of prostate cancer.

Subsequently, a review by an outside academic institution confirmed atrophy in the original biopsies.

Our Diagnosis

Atrophied glands

The Inform Diagnostics Difference
  • Diligent review of 180 slides as well as request for pre-surgery biopsy slides.
  • Definitive diagnosis by Inform Diagnostics confirmed by outside academic institution.
  • Patient could have avoided surgery and its cost, pain, time, and complications.

Hematology/Oncology Clinical Vignettes

Our hematopathologists at Inform Diagnostics provide definitive diagnoses and comprehensive reports for specialized testing. With pathologist-to-physician communication, we help clinicians move patients confidently into life-saving treatments. Read the following Hematology/Oncology clinical vignettes to learn how the Inform Diagnostics diagnosis made a difference.

Successful specialized testing on suboptimal specimen; Clinician: “Inform Diagnostics saves another life”

A man received a bone marrow biopsy at a local hospital to investigate low levels of white and red blood cells as well as platelets.

The local hospital’s pathologist was unable to render a specific diagnosis. The clinician performed a second bone marrow biopsy in the same week and sent it to Inform Diagnostics.

Although the specimen was suboptimal (no marrow fluid material was obtained on aspiration), Inform Diagnostics’ hematopathologists collectively were able to diagnose acute promyelocytic leukemia based on microscopic examination and immunohistochemical stains on the marrow core biopsies, and flow cytometry and FISH testing on a sample of peripheral blood.

Our Diagnosis

Acute promyelocytic leukemia

The Inform Diagnostics Difference
  • Subspecialist experts were able to render a definitive diagnosis.
  • Successful specialized testing on suboptimal biopsy specimen.
  • Patient was immediately started on the life-saving disease-specific therapy.
  • Per the treating physician, “Inform Diagnostics saves another life.”

Monoclonal B-cell lymphocytosis consistent with marginal zone lymphoma in a patient with paraproteinemia

An elderly patient was referred to an oncologist with a recent history of incidental elevated IgM, as well as a significant weight loss over the last six months.

Overall, the abnormalities detected in her blood included increases in total protein, blood urea nitrogen-to-creatinine ratio, red cell distribution width, serum viscosity, gamma globulins, serum IgA, kappa-to-lambda ratio, globulins, and vitamin B12. Blood testing also identified the presence of kappa free light chain, M spikes, and a decreased albumin-to-globulin ratio. Additionally, urine testing detected the presence of M spikes and protein.

To investigate the paraproteinemia, the oncologist performed a bone marrow aspiration and core biopsy procedure, among other tests, and sent the biopsy specimens to Inform Diagnostics’ hematopathology lab.

Our Diagnosis

Low-level marginal zone lymphoma

The Inform Diagnostics Difference
  • Provided clinically actionable information to assist the clinician in counseling the patient and managing her cancer.
  • Performed cascading tests of the patient’s bone marrow. Our pathologists perform only the testing that is medically necessary to reach an accurate diagnosis, which promotes cost-effectiveness.
  • Provided a comprehensive diagnostic correlation report to the clinician that included historical reports and images, facilitating improved disease monitoring, treatment, and patient management.