Human pathology
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The specialty of Pathology and Laboratory Medicine has entered into a phase when the 4-year sequence of Anatomic Pathology and/or Clinical Pathology Residency Training is almost universally followed by 1 or more years of Subspecialty Fellowship Training. Such training may occur in one of the American Board of Pathology-recognized subspecialties or any number of "subspecialty fellowships" that, although not leading to subspecialty board certification, may nevertheless fall under the oversight of the local institutional Graduate Medical Education Committee and the Accreditation Council for Graduate Medical Education Review Committee for Pathology. Unlike the application process for first-year Pathology Residency, which is run through the National Resident Matching Program, applications for Subspecialty Pathology Fellowships are not coordinated by any consistent schedule. ⋯ Responding to widespread dissatisfaction voiced by national pathology resident organizations, in 2007, the Association of Pathology Chairs began evaluation and potential intervention in the fellowship application process. Three years of intermittently intense discussion, surveys, and market analysis, have led the Council of the Association of Pathology Chairs to recommend implementation of a Pathology Subspecialty Fellowship Matching program starting in the 2011 to 2012 recruiting year, for those Applicants matriculating in fellowship programs July 2013. We report on the data that informed this decision and discuss the pros and cons that are so keenly felt by the stakeholders in this as-yet-incomplete reform process.
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Comparative Study
A comparative study of intraductal papillary neoplasia of the biliary tract and pancreas.
Intraductal papillary mucinous neoplasm of the pancreas is a rare but well-established entity in contrast to intraductal papillary mucinous neoplasm of the biliary tract. The aim of this study was to compare the clinicopathologic features of intraductal papillary mucinous neoplasms of the biliary tract and of the pancreas. Twenty patients who underwent resection for intraductal papillary mucinous neoplasm of the biliary tract were compared with 29 cases resected for intraductal papillary mucinous neoplasm of the pancreas. ⋯ Finally, p53 and Ki67 proliferation index were both associated with the carcinogenesis of intraductal papillary mucinous neoplasm, whereas DPC4 and CDX2 were not. Clinicopathologic features of intraductal papillary mucinous neoplasm of the biliary tract largely resemble those of intraductal papillary mucinous neoplasm of the pancreas, although intraductal papillary mucinous neoplasm of the biliary tract was associated with a higher malignancy rate at the time of surgical treatment. The level of membranous mucin expression and positive lymph nodes are significant prognosticators in patients with malignant intraductal papillary mucinous neoplasm.