Cytopathology in the Philippines is currently practiced by board-certified anatomic pathologists who receive only a three-month rotation in the discipline during their four-year combined Anatomic and Clinical Pathology residency training. At present, the country lacks a formal fellowship program in cytopathology, and no national core curriculum has been developed for this subspecialty. Local pathologists with advanced training and extensive experience in cytopathology recognized by the Philippine Society of Pathologists, Inc. (PSP) developed the first national core curriculum for cytopathology fellowship training. This initiative marks the first locally developed guideline for cytopathology fellowship training in the Philippines, representing a significant milestone in the advancement of subspecialty pathology education in the country.

Human ; Cytology

BACKGROUND

Serum-sodium reporting tolerates a total allowable error (TEa) of only ±4 mmol/L, yet many laboratories continue to operate at the marginal three-sigma level because the quantitative benefit of additional sigma capability is poorly characterized.

OBJECTIVES

The study aims to translate sigma metrics into clinically intuitive risk estimates by (1) quantifying the proportion of QC results that exceed the TEa at five sigma levels (2 – 6 σ) and (2) determining whether successive sigma gains produce statistically significant reductions in error.

METHODOLOGY

Five (5) hypothetical assays were parameterized with a common mean of 140 mmol/L and CVs corresponding to 2-, 3-, 4-, 5- and 6-sigma performance. For each assay, 1,000 Monte-Carlo iterations were run, each iteration simulating 36,500 QC results (assuming 100 runs/day for 365 days) drawn from N(μ = 140, σ = μ × CV). The error rate (the proportion of results outside ±4 mmol/L) was recorded per iteration. Distributions were summarized (mean, range, SD); differences were evaluated with one-way ANOVA followed by Tukey’s HSD.

RESULTS

Mean (±SD) error rates declined significantly with increasing sigma: Assay A (2 σ): 0.0456 ± 0.0011; Assay B (3 σ): 0.00270 ± 0.00027;Assay C (4 σ): 6.3 × 10-5 ± 4.1 × 10-5; Assay D (5 σ): 5.8 × 10-7 ± 8.0 × 10-7; and Assay E (6 σ): 2.0 × 10-7 ± 3.1 × 10-7. The maximum single-iteration error rate fell from 0.0505 at 2 σ to 1.1 × 10-4 at 4 σ. The 5 σ and 6 σ processes produced zero TEa violations in ≥96 % of iterations. ANOVA confirmed a global difference (p < 0.001); all pairwise contrasts were significant (p < 0.001) except between 5 σ vs 6 σ (p = 0.62).

CONCLUSIONS

Each one-sigma gain yields an order-of-magnitude reduction in TEa violations until a plateau is reached at ≥5 σ, where residual analytical risk is negligible. These simulations support the recommendation that laboratories operating serum-sodium assays below 4 σ should prioritize precision improvements or enhanced QC strategies, whereas ≥5 σ assays may safely adopt less intensive QC without compromising patient safety.

Human ; Quality Control ; Total Quality Management ; Tea

BACKGROUND

Invasive candidiasis is defined by the growth of Candida species in the bloodstream or other internal organs. It is a global concern due to increasing multidrug resistance and high mortality rates. This study aimed to update prevalence data on Candida infections in the Philippines, analyzing demographic factors (age, sex), specimen sources, and associated risk factors. We compared antifungal resistance patterns against CLSI epidemiological cutoff values (ECVs) and clinical breakpoints and examined MIC variations by underlying disease to inform potential standardized empiric therapies.

METHODOLOGY

We conducted a retrospective analytical cross-sectional study (SLMC-IERC approval, minimal risk) reviewing one year of Candida speciation and susceptibility results from January 2024 to December 2024 at a private tertiary hospital. All aseptically collected samples that tested positive for Candida species were included. Respiratory and wound specimens required a Gram stain demonstrating yeasts and hyphae prior to culture, while urine cultures were included only if they yielded ≥100,000 CFU/mL. Identification and susceptibility testing were performed using the VITEK 2 system, with results interpreted using CLSI breakpoints and ECVs.

RESULTS

Among 266 patients with Candida infections, invasive candidiasis predominated in those aged ≥60 years (66.4%). Candida albicans (21.7%) and Candida tropicalis (13.5%) were more frequent in females, while Candida parapsilosis (13.2%) and Candida glabrata (5.3%) were more common in males. Blood and CSF samples strongly correlated with invasive disease and underlying risk factors. C. albicans was linked to infection-related conditions (13.9%), malignancy (9.0%), and cardiovascular disease (6.8%). C. parapsilosis(23.3%) and C. tropicalis (20.7%) were frequently associated with infection, malignancy, and metabolic disorders. C. glabrata (7.5%), noted for antifungal resistance, was isolated in patients with direct infections (3.4%) and malignancies (1.9%). Among azoles, fluconazole demonstrated greater susceptibility against Candida species, requiring lower concentrations for inhibition, despite a higher resistance rate (13.22%) compared to voriconazole (8.95%). Among echinocandins, micafungin showed better susceptibility than caspofungin. Amphotericin B demonstrated the highest overall susceptibilit y (93 –10 0%), though MICs approached ECV limits. Most susceptible MIC values were fluconazole 0.5 μg/mL for C. albicans and C. parapsilosis, 1.0 μg/mL for C. tropicalis; voriconazole and caspofungin 0.12 μg/mL; micafungin 0.06 μg/mL; amphotericin B 0.5 μg/mL; and flucytosine

CONCLUSION

These findings support a species-specific, risk-adapted approach to antifungal therapy, incorporating demographic and clinical variables. Continuous surveillance of invasive candidiasis prevalence and antifungal MIC trends, with periodic breakpoint updates, is crucial to preserve therapeutic efficacy. Effective management of multidrug-resistant Candidainfections also requires close collaboration between clinicians and pharmacists, as well as the development of new dosing strategies based on pharmacokinetic/pharmacodynamic (PK/PD) principles.

Human ; Candidiasis ; Antifungal Agents ; Drug Resistance ; Candida ; Azoles

BACKGROUND

Approximately 15% of colorectal cancers exhibit deficient mismatch repair (dMMR) status, and these cases have a better prognosis and are less prone to metastasis. Moreover, dMMR is associated with an improved response to immune checkpoint inhibitors. Currently, local data on the MMR status of colorectal cancer patients remains scant.

OBJECTIVES

The proponents aimed to determine the MMR status among colorectal cancer patients in a Philippine tertiary hospital.

METHODOLOGY

This is a descriptive cross-sectional study that included 42 patients with colorectal cancer seen at the Chinese General Hospital and Medical Center (CGHMC) from January 2021 to June 2024. Data was collected via retrospective review of histopathologic reports.

RESULTS

Forty-two (42) patients were included in the study. The mean age of included patients was 61.8 years, and most were males. Half had well-differentiated tumor grade, and the most common tumor locations were rectum (38%) and sigmoid (36%). Three patients (7.14%; 95% CI:1.50-19.48%) were considered deficient. Tumor locations in dMMR patients were the cecum, descending colon, and rectum. Compared to MMR-proficient, dMMR patients had a lower mean age (63.1 vs. 45.7 years). Also, a higher proportion of males (13%) were dMMR than females (0%).

CONCLUSION

dMMR is uncommon among the colorectal cancer cases in this study, and was only seen at the cecum, descending colon, and rectum. Descriptive analysis revealed that patients with dMMR were younger than MMR-proficient patients. Moreover, a higher proportion of males were dMMR than females. Larger, multicenter studies are warranted to validate these preliminary findings and guide future clinical decision-making.

Human ; Biomarkers ; Colorectal Neoplasms ; Dna Mismatch Repair

Recent advancements in molecular techniques such as real-time PCR, isothermal amplification, next-generation sequencing, metagenomics, microarray, and CRISPR-infectious disease diagnostics have significantly evolved and improved over the past years. This overview will explore the innovations that have shaped the molecular diagnostics workflow, as well as the progress made in these innovative techniques. Additionally, it will address existing gaps, unmet needs, and the potential future directions for further enhancing diagnostic capabilities in the field.

Human ; High-throughput Nucleotide Sequencing ; Metagenomics

Artificial Intelligence (AI) is transforming the landscape of pathology, particularly in resource-constrained settings like the Philippines. This narrative review explores the applications, challenges, and future potential of AI in digital image analysis for pathology practices. By synthesizing peer-reviewed literature from 2019 to 2024, the review highlights the role of machine learning (ML) and deep learning (DL) algorithms in enhancing diagnostic accuracy, workflow efficiency, and clinical decision-making. AI-driven tools such as convolutional neural networks (CNNs) and transfer learning models have demonstrated significant success in tumor detection, biomarker evaluation, and predictive analytics, paving the way for personalized medicine. However, barriers such as limited annotated datasets, privacy concerns, and model interpretability hinder widespread adoption. The review emphasizes the need for ethical frameworks, workforce training, and infrastructure development to ensure equitable and effective integration of AI into pathology practices. By addressing these challenges, AI has the potential to improve diagnostic precision, expand access to healthcare, and modernize pathology services in the Philippines.

Human ; Artificial Intelligence ; Pathology ; Philippines ; Deep Learning ; Machine Learning

SMARCB1 (INI-1)-deficient sinonasal carcinoma is a rare, poorly differentiated, and locally aggressive neoplasm. Frequently, this disease entity mimics benign head and neck conditions, making diagnosis and management challenging. We report the case of a 66-year-old female who presented with a right nasal mass on endoscopy. Microscopy revealed well-defined nests of plasmacytoid tumor cells infiltrating a desmoplastic stroma, with areas of necrosis and focal hemorrhage. Based on the histomorphology and immunohistochemistry studies, the case was signed out as SMARCB1 (INI-1)-deficient sinonasal carcinoma. This is the first reported case in the Philippines based on a search of local journal databases. Recent advancements in therapeutics highlight the importance of providing molecular characterization of these tumors.

Human ; Carcinoma ; Hemorrhage ; Immunohistochemistry ; Endoscopy

This is a case of a 55-year-old female, surgical menopause for nine years, not on hormone therapy with one year history of a progressively enlarging left vulvar mass, who sought consult and subsequently underwent excision of mass. Microscopic findings showed alternating hypo- and hypercellular areas composed of plump spindle to epithelioid cells distributed in an edematous stroma with varying amount of collagen. Tumor cells have bland chromatin, inconspicuous nucleoli, and absent mitoses. The cells surround small to medium-sized thin-walled, hyalinized vessels found in hypercellular areas. An adipocytic differentiation of more than fifty percent of tumor is observed further classifying this neoplasm as lipomatous angiomyofibroblastoma, making this an even rarer type of benign mesenchymal tumor of the vulva. Immunohistochemistry stains performed showed positive staining for vimentin, smooth muscle actin, BCL-2, ER, PR, and negative staining for desmin which supports the diagnosis. The clinical presentation, operative findings, histopathologic features and the various considerations are discussed. Literature review of vulvar angiomyofibroblastoma is also presented.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Vulva

Objective: Management of thyroid nodules relies on the Thyroid Imaging Recording and Data System (TIRADS) for sonographic findings and the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The proponents aimed to determine the concordance between sonographic TIRADS findings and cytological diagnosis by TBSRTC in the evaluation of malignancy of patients with thyroid nodules. Methodology: Sonographic and cytology results collected from 2018 to 2022 were obtained to determine whether there is an agreement between TIRADS and TBSRTC findings. Results: Two hundred sixty-two (262) samples were obtained. Overall accuracy of predicting TIRADS category was highest for echogenic foci. Thyroid nodule distribution was highest for TIRADS 3 and 4 sonographically and TBSRTC II cytologically. There is low agreement between TBSRTC and TIRADS in the categorization of nodules as benign, implying that nodules may show sonographic features suspicious of malignancy despite being categorized as TBSRTC I or II by cytology. However, nodules categorized as TBSRTC III to VI show sonographic features suspicious for malignancy at the very least. Conclusion The correctness of TIRADS prediction is highest for echogenic foci although not significantly higher than other parameters. The overall predicting power of TIRADS for the absence of malignancy is high for TIRADS 1 and 2, whereas TIRADS 5 predicts a 31.11% risk of malignancy making it a strong indication for FNAC. However, prediction of malignancy in TIRADS 3 and 4 nodules must be in association with other factors since a significant percentage may turn out to be TBSRTC II.
Thyroid Nodule

Objectives: The aim of this study is to evaluate the breast panel biomarker changes and tumor intrinsic subtype after neoadjuvant chemotherapy among patients with residual invasive breast carcinoma whose breast specimens were processed at St. Luke’s Medical Center - Quezon City SLMC-QC) from 1 January 2017 to 30 June 2023. Methodology: Cases of residual invasive breast carcinoma status post neoadjuvant systemic therapy were identified by retrospective review of cases. The baseline characteristics, type of biopsy and resection procedures, pre – and post–neoadjuvant ER, PR and HER2 status and pre – and post–neoadjuvant tumor intrinsic subtype were analyzed using frequency and percentage. The comparison of the changes in pre- and post-neoadjuvant breast panel biomarkers were analyzed by using McNemar test while the changes in the intrinsic tumor subtype was done using Wilcoxon signed-rank test. Results: This study encompassed a total of 43 cases of residual invasive breast carcinoma following neoadjuvant systemic therapy. The data disclosed shifts in the breast molecular profile and intrinsic subtype post-administration of neoadjuvant systemic therapy. The alterations in hormone receptor status, ER and PR, were observed in 11.6% of cases, while HER-2 status exhibited changes in 2.3%. A 14% change in the tumor intrinsic subtype is observed. Among the initial 18 Luminal A cases, 1 transitioned to Luminal B, and among the 6 Luminal B cases, 2 become HER2 enriched subtypes. Furthermore, among the initial 12 HER2 enriched cases, three shifted to Luminal B, while all triple-negative cases remained unchanged after chemotherapy. Conclusion Based on our findings, alterations in the molecular profile of breast tumors, including shifts in intrinsic subtype after neoadjuvant chemotherapy (NAC), could impact patient prognosis. While the data generated from this study may not exhibit statistical significance, its clinical relevance is noteworthy. In summary, retesting of breast biomarkers in the resection specimen is recommended to accurately ascertain the appropriate use of targeted therapy.
Neoadjuvant Therapy