Anatomic pathology is a field that relies on visual examination to provide diagnosis. Photos of specimens and microscopic slides play an important role in pathology education. With the internet, sharing and seeing images from different patient cases has become efficient and accessible. However, ethical concerns may be raised since patient images are used for academic purposes in a public setting. Proper de-identification, informed consent and setting professional guidelines for sharing pathology images are suggested.
Pathology ; Social Media ; Ethics ; Policy

Objective: The study aimed to determine the impact of the COVID-19 pandemic on local blood supply management in the Davao Region, Philippines from 2019 to 2021 through the analysis of trends in blood supply in Davao Region, Philippines. Methodology: Secondary data from two blood centers in the Davao Region for the years 2019 to 2021 were used to determine the trends on blood donation supply. To evaluate trends, the overall number of blood donors and the quantities of various types of blood components in whole blood, packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelet concentrate have been compared between pre-pandemic, pandemic periods and as restrictions eased. Results: A substantial decrease of 51.6% in the number of blood donors was seen during 2021 in comparison with 2019. The trend in collection by blood components also showed a significant trend from 2019 to 2021, whole blood (200.8%), packed RBCs (37.1%), fresh frozen plasma (113.6%). While the platelet concentrate supply declined by 34.9% from 2019 to 2020, an increase of 10.7% was noted onwards to 2021. Conclusion The results demonstrate that during the COVID-19 pandemic, there was a major reduction in donation and supply of blood. The challenges faced by blood banks in ensuring a stable and sufficient blood supply are highlighted by the decrease in the number of donors and by the different trends in the supply of blood components. The targeted efforts to promote blood donation and enhance the resilience of the blood supply during and after the pandemic is important.
Blood Donors ; Philippines ; Plasma

Objective: The Philippines has more than a hundred ten million population with a very limited number of general pathologists and subspecialist pathologists. Consultation of pathologists with other pathologists is important to ensure accurate results for difficult cases. However, pathologists are not always accessible to review slides. Telepathology can provide access to other pathologists by sending microscopic images through the internet. This study explores the needs of pathologists for consultation in their practice that may be aided by telepathology. The status of current pathology practice and subspecialty consultations across the different regions in the Philippines were determined and the readiness of pathologists for telepathology was identified. Methodology: This is a cross-sectional descriptive study using an 18-item online survey questionnaire based on the World Health Organization guidelines on needs assessment for medical devices. The survey was distributed among anatomic pathologists practicing in the Philippines. Results: One hundred forty (140) pathologists responded and were included in this study. 5-10% of cases of respondents required subspecialty referral. Diagnostically challenging cases and confirmation of malignancy are the most common reasons for consultation. Respondents practicing outside the National Capital Region (NCR) have fewer subspecialist pathologists available for referrals within their region. Turnaround times for signing out challenging cases are longer outside NCR (>7 days) compared to NCR (4-7 days). Most respondents have access to the basic equipment to perform telepathology, which includes, an internet link, a smartphone with high-resolution camera and a computer. Almost all respondents will use telepathology if it is available. Conclusion A hub-and-spoke telepathology network can provide access to subspecialty consultation to reduce the diagnostic turnaround time and to increase the accuracy of results for challenging cases. The availability of the minimum telepathology infrastructure and the positive attitude of the pathologists towards telepathology may be indicators of readiness for a local telepathology system in the Philippines.
Telepathology ; Philippines ; Pathology ; Needs Assessment ; Telemedicine

Background: Globally, autopsy rates have been continually declining over the course of several years. Previous studies have shown that the perception of pathologists and clinicians may serve as significant factors which may affect the performance of autopsy and contribute to its decreased rate. This study was conducted to determine the attitudes and perceptions of Filipino clinicians and pathologists toward the autopsy as a medical tool. Methodology: This is a cross-sectional descriptive survey of two groups of physicians. Forty-four (n = 44) pathologists nationwide and thirty-three (n = 33) clinicians from Central Visayas participated in the study. A total of seventy-seven (n = 77) physicians completed a survey using a standardized online questionnaire. Results: Of the 77 respondents, 94% of clinicians and 75% of pathologists believed that autopsies could provide relevant findings that could change future clinical practice. Despite this, only 6% of clinicians and 20% of pathologists indicated that the number of autopsy cases in their institutions was sufficient. With regards to their practice, pathologists most strongly agreed (mean = 4.30) that material for medico-legal autopsies should be readily available for teaching and research. However, they most strongly disagreed (mean = 2.00) that residents receive adequate training in performing medico-legal autopsies. The two groups of physicians surveyed determined that there is a deficiency in the number of autopsy cases. This is further influenced by clinicians’ concerns about litigation, religious/superstitious beliefs, and the delay in releasing autopsy results. Furthermore, pathologists specified that performing autopsies was excessively time-consuming with an unjustifiable cost. Sixty-two percent of the pathologists signified more strongly than the clinicians that modern diagnostic techniques have diminished the need to perform hospital autopsies. Nonetheless, 86% of Filipino physicians acknowledged that the autopsy is an important medical tool that should be performed for patients with unknown diagnoses and unexpected death. The number of observed and/or performed autopsy cases was a major factor that affected the pathologists’ attitudes and perceptions toward autopsy. Conclusion In general, there is recognition of the autopsy’s usefulness as a medical tool among the pathologists and clinicians surveyed. However, the lack of cases referred for autopsy remains a challenge undermining the benefits that are derived from its performance.
Autopsy ; Pathologists ; Attitude

Background: Guidelines for testing human epidermal growth factor receptor 2 (HER2) in breast cancer using fluorescence in situ hybridization (FISH) were released in 2018. These guidelines were jointly developed by the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) to achieve a clearer designation of breast cancer HER2 status. Clinical correlation with other factors was also considered appropriate, especially for those cases classified under ISH groups 2, 3, and 4. Objective: In this study, we examined clinicopathologic features among Filipino breast cancer patients whose HER2 status was reclassified based on the 2018 ASCO/CAP guidelines. Methodology: One hundred and thirty-two (132) breast cancer cases with immunohistochemistry (IHC) equivocal results in the Medical City were enrolled from January 2017 up to December 2020. HER2 FISH results classified under groups 2, 3, and 4 were then re-evaluated for HER2-IHC status in accordance with the 2018 ASCO/CAP guidelines. The relationship between clinicopathologic features and HER2 status was analyzed using the Fisher exact test. Results: Significant differences were found in histologic type, nuclear pleomorphism, mitotic rate, progesterone receptor (PR) status, and regional lymph node involvement among the reclassified ISH groups. In the conv+ group, the tumor cells did not involve the regional lymph nodes as compared to group 5, where the tumor cells were involved. The conv- group had a higher grade for nuclear pleomorphism, mitotic count, and overall Nottingham Histologic Grade than group 5. There was a significant association between progesterone receptors among the conv- group and group 1. Conclusion Filipino breast cancer cases whose HER2 status was reclassified to negative following the 2018 ASCO/CAP guidelines had statistically different clinicopathologic features from those classified as group 5.
Breast Neoplasms ; Immunohistochemistry

This is a rare case of a mucosal melanoma, located in the urethra of a 59-year-old male. Malignant melanomas of the genitourinary tract are rare, representing <1% of malignancies in the genitourinary tract, and <0.1% of all melanomas. In the male genitourinary tract, the most affected sites are the glans penis and the distal urethra in the fossa navicularis. Urethral melanomas comprise 4% of all urethral cancers.
Urethra

Leydig cell tumor is a rare testicular neoplasm that can present as a non-palpable small testicular nodule. Here we present a case of a 36-year-old Filipino male who initially came in for fertility work-up. Semen analysis showed azoospermia. However, an incidental finding on ultrasound showed a well-circumscribed round tumor. The patient underwent radical orchiectomy. On histopathologic examination, a Leydig cell tumor was identified and supported by immunohistochemical staining. We discuss the clinical features pathogenesis, treatment, diagnosis and prognosis of this uncommon entity.
Leydig Cells ; Testis ; Orchiectomy ; Infertility

Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. Intussusception occurs primarily in infants and toddlers.1 The peak incidence is between 4 and 36 months of age, and it is the most common cause of intestinal obstruction in this age group. 2 Approximately 1 percent of cases are in infants younger than three months, 30 percent between 3 and 12 months, 20 percent between one and two years, 25 percent between two and three years, and 10 percent between three and four years.3 Although intussusception is most common in infants and young children, it is important to consider this diagnosis in children outside this age range. Approximately 10 percent of cases are in children over five years, and 3 to 4 percent in those over 10 years.3,4 We share here images from an actual case of a 15-year-old Filipino male with an ileo-ileal intussusception that is beyond the typical age range, with an incidental finding of an intraluminal mass that was histomorphologically diagnosed as Meckel’s diverticulum (MD). The diagnosis of intussusception is relatively rare in the patient’s age and the diagnosis of MD in the presence of intussusception is sparsely reported in the Philippines. Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. Intussusception occurs primarily in infants and toddlers.1 The peak incidence is between 4 and 36 months of age, and it is the most common cause of intestinal obstruction in this age group. 2 Approximately 1 percent of cases are in infants younger than three months, 30 percent between 3 and 12 months, 20 percent between one and two years, 25 percent between two and three years, and 10 percent between three and four years.3 Although intussusception is most common in infants and young children, it is important to consider this diagnosis in children outside this age range. Approximately 10 percent of cases are in children over five years, and 3 to 4 percent in those over 10 years.3,4 We share here images from an actual case of a 15-year-old Filipino male with an ileo-ileal intussusception that is beyond the typical age range, with an incidental finding of an intraluminal mass that was histomorphologically diagnosed as Meckel’s diverticulum (MD). The diagnosis of intussusception is relatively rare in the patient’s age and the diagnosis of MD in the presence of intussusception is sparsely reported in the Philippines.
Meckel Diverticulum ; Strabismus ; Adolescent

INTRODUCTION: Ovarian cancer is one of the leading causes of mortality in women. In 2020, 5,395 (6.2%) of diagnosed malignancies in females were ovarian in origin. It also ranked second among gynecologic malignancies after cervical cancer. The prevalence in Asian /Pacific women is 9.2 per 100,000 population. Increased mortality and poor prognosis in ovarian cancer are caused by asymptomatic growth and delayed or absent symptoms for which about 70% of women have an advanced stage (III/IV) by the time of diagnosis. The most associated gene mutations are Breast Cancer gene 1 (BRCA1) which is identified in chromosome 17q21 and Breast Cancer gene 2 (BRCA2) identified in chromosome 13. Both proteins function in the double-strand DNA break repair pathway especially in the large framework repair molecules. Olaparib is a first-line drug used in the management of ovarian cancer. It targets affected cells by inhibition of poly (ADP-ribose) polymerase (PARP) activity which induces synthetic lethality in mutated BRCA1/2 cancers by selectively targeting tumor cells that fail to repair DNA double-strand breaks (DSBs). OBJECTIVE: The study aims to determine the prevalence of pathogenic somatic mutations in BRCA1 and BRCA2 among patients diagnosed of having ovarian cancer, to characterize the identified variants into benign/ no pathogenic variant identified, variant of uncertain significance (VUS), and pathogenic, and to determine the relationship of specific mutations detected with histomorphologic findings and clinical attributes. METHODOLOGY: Ovarian cancer tissues available at the St. Luke’s Medical Center Human Cancer Biobank and formalin-fixed paraffin-embedded (FFPE) tissue blocks diagnosed as ovarian cancer from the year 2016 to 2020 were included. Determination of the prevalence of somatic BRCA1 and BRCA2 mutations using Next Generation Sequencing (NGS). RESULTS: A total of 60 samples were processed, and three samples were excluded from the analysis due to an inadequate number of cells. In the remaining 57 samples diagnosed ovarian tumors, pathogenic BRCA1/2 variants were identified in 10 (17.5%) samples. Among the BRCA1/2 positive samples, 3 (5.3%) BRCA1 and 7 (12.3%) BRCA2 somatic mutations were identified. CONCLUSION Identification of specific BRCA1/2 mutations in FFPE samples with NGS plays a big role in the management of ovarian cancer, particularly with the use of targeted therapies such as Olaparib. The use of this drug could provide a longer disease-free survival for these patients. Furthermore, we recommend that women diagnosed with ovarian cancer should be subjected to genetic testing regardless of the histologic subtypes or clinical features. Lastly, genetic testing should be done along with proper genetic counseling, especially for patients who are susceptible to these mutations.
ovarian cancer

INTRODUCTION: Complete blood count (CBC) and cell population data (CPD) are hematologic parameters used in several clinical scenarios including infection and neoplastic processes. In the setting of COVID-19 infection, there is relative paucity of data in their use as possible prognostic markers. OBJECTIVE: We aim to evaluate the utility of the baseline CBC and CPD as prognostic markers for in-hospital mortality among COVID-19 patients admitted in Philippine General Hospital from March 2020 to January 2022. METHODOLOGY: This is a case-control study. Expired patients served as cases, and recovered patients served as controls. Data from eligible patients including age, sex, admitting COVID diagnosis with severity, final disposition, baseline CBC and CPD results were collected from the hospital medical records and hematology section of the Department of Laboratories. Statistical analyses were done to determine the prognostic value of these parameters for in-hospital mortality. RESULTS: Among the different CBC and CPD parameters, the study shows total white blood cell (WBC) count, absolute neutrophil count (ANC), absolute eosinophil count (AEC), and neutrophil-lymphocyte ratio (NLR) were statistically significant predictors for in-hospital mortality. For total WBC count, at a cut off 9.9 x 10 9 /L, the sensitivity and specificity is 70.9% and 66.2%, respectively. For ANC, at a cut off of 7.3 x 10 9 /L, the specificity is 76.4% and the specificity is 68.2%. At a cut off of 7.62, the NLR shows a sensitivity of 76.4% and specificity of 70.1%. For AEC, at a cut off of 0.006 x 10 9 /L, the sensitivity is 53.3% and the specificity is 87.3%. AEC predicts towards the direction of survival rather than to the direction of in-hospital mortality. CONCLUSION The total WBC count, ANC, and NLR were statistically significant predictors for in-hospital mortality, while AEC predicts towards the direction of survival. The sensitivities and specificities of the cut off for these parameters were less than ideal. Correlation with clinical and other laboratory parameters is still recommended. For future studies, the authors recommend monitoring CBC and CPD parameters at different time points during the patients’ hospital course.
COVID-19 ; hematology ; blood cell count ; complete blood count ; prognosis