Pathophysiology for Journal of Clinical Pathology-myassignmenthelp

Question: Discuss about thePathophysiology for Journal of Clinical Pathology. Answer: Summary of an interesting pathology case experienced by a pathologist: The experience of pathologist in their field of practice has revealed that increase in demand for pathology services and the need to improve turnaround time in clinical management poses many challenges in pathology practices. The ordeal for pathologist also increases with the increase in number of biopsies and the need to comply with guidelines for cancer case reporting (Kamel, 2011). Similar challenges was also faced a pathologist when he had to conduct the biopsy of the mass of the tongue of a 53 year old man. The old man came to the clinician with a white patch and mass in the base of his tongue which showed up since the past six months. Suspecting the diagnosis of cancer, the clinician ordered a biopsy test for the patients. The pathologist conducted the biopsy test for the mass. He experienced dilemma in reporting and conveying correct information of result as different groups of clinicians were involved in handling the case. Poor communication between pathologist, oncologist an d surgeons resulted in misinterpretation of results and initiation of appropriate treatment for patients. The pathology report of the biomass of the tongue has revealed that normal histology of the squamous mucosa was replaced with proliferation of the cell. The usual maturation process was replaced with haphazard pattern and large vesicular nuclei. The main conclusion that the pathologist made from the examination of the tongue biomass was diagnosis of differentiated squamous carcinoma of the tongue. However, the diagnosis was not right because the patient suffered from leukoplakia and tissue biopsy normally shows keratin build up, however it is not always an indication of abnormal or cancerous cells. The risk of cancer is high in such patients, but the tongues tissue had not become malignant (Van der Waal, 2015). The critical information of result was mistinterpreted and lack of detail in reporting resulted in great disaster for patient. The pathology report should mainly have three key areas including patient identification, reporting style and content and interpretation. The mistake done by pathologist came in erroneous critical information category as patient diagnosis was misinterpreted (Cree et al., 2017). The reporting should have mentioned about moderate detection and risk of squamous epithelial cells and main diagnosis of leukplakia. However, the reporting about malignant cells resulted in the initiation of treatment for cancer and the patient had to endure many sufferings during the process. Secondly, as group of clinicians were involved in handling the case, poor communication between the team resulted in loss of suffering and morbidity for patient. Lack of importance to quality assurance in pathology testing and review of the diagnosis resulted in adverse outcome for patients. Analysis of the case The analysis of the case gave example about the error in misinterpretation in pathology practice particularly in cancer cases. Although leukoplakia increased the risk of cancer, however the keratin build up was wrongly interpreted as cancerous cells. The review of recent research literature has shown that misinterpretation of squamous intraepithelial lesion in a significant challenges in pathology practice and the research mainly pointed out that high misinterpretation rate is mainly due to the differences in reporting responsibilities and proficiency test grading criteria (Zhao et al., 2016). In the context of the case scenario, it can be said that such mistake by pathologist occurred due to lack of test taking confidence and compliance to quality reporting. The ultimate impact of such incidence was that patient had to go through both emotional and physical suffering as the name of cancer itself is associated with great distress in patients. Hence, the main lesson that can be learnt from the review of case is that the proficiency of the pathologist in the practice needs to be enhanced with greater focus on providing test taking environment to pathologist. Often high demand of pathology service and heavy workload is also the cause of misinterpretation. To curb the misinterpretation rate, continual involvement in Pathologist Laboratory Accreditation Program is necessary so that pathologist develop confidence in pathological testing and they become accustomed to issuing a final diagnosis that directs correct treatment option for patients (Ellis Srigley, 2016. The College of American Pathologist programs is involved in educational efforts to establish best practice to promote efficiency in the pathology field. The accreditation program ensures that the laboratory practice is upto date and maintain gold standard in practice and reporting (Wheeler, 2009). Reference Cree, I. A., Deans, Z., Ligtenberg, M. J., Normanno, N., Edsj, A., Rouleau, E., ... Dequeker, E. (2014). Guidance for laboratories performing molecular pathology for cancer patients.Journal of clinical pathology, jclinpath-2014. Ellis, D. W., Srigley, J. (2016). Does standardised structured reporting contribute to quality in diagnostic pathology? The importance of evidence-based datasets.Virchows Archiv,468(1), 51-59. Kamel, H. M. (2011). Trends and challenges in pathology practice: choices and necessities.Sultan Qaboos University medical journal,11(1), 38. Van der Waal, I., 2015. Oral leukoplakia, the ongoing discussion on definition and terminology.Medicina oral, patologia oral y cirugia bucal,20(6), p.e685. Wheeler, T. M. (2009). The role of CAP in standardisation of pathology practice, including our laboratory accreditation program, predictive markers (HER2, ER, PR) and pathology report standardisation.Pathology,41, 1-2. Zhao, C., Crothers, B. A., Ghofrani, M., Li, Z., Souers, R. J., Hussain, M., ... College of American Pathologists Cytopathology Committee. (2016). Misinterpretation rates of high-grade squamous intraepithelial lesion in the College of American Pathologists gynecologic PAP education and PAP proficiency test program.Archives of pathology laboratory medicine,140(11), 1221-1224.