PJP
https://philippinejournalofpathology.org/index.php/PJP
<p style="text-align: justify;"><strong>The Philippine Journal of Pathology (PJP)</strong> is an open-access, peer-reviewed, English language, medical science journal published by the Philippine Society of Pathologists, Inc. Committee on Publications. It shall serve as the official platform for publication of high quality original articles, case reports or series, feature articles, and editorials covering topics on clinical and anatomic pathology, laboratory medicine and medical technology, diagnostics, laboratory biosafety and biosecurity, as well as laboratory quality assurance, that are relevant to the Philippines.</p> <p style="text-align: justify;">The journal's primary target audience are laboratorians, diagnosticians, laboratory managers, pathologists, medical technologists, and all other medical and scientific disciplines interfacing with the laboratory.</p> <p><strong>IMPORTANT: PJP does NOT charge any Article Processing or Submission Fees from authors. It likewise does not charge any Subscription Fees or Download Fees to access scholarly content.</strong></p> <p> </p>Committee on Publications, The Philippine Society of Pathologists, Inc.en-USPJP0118-3265<a href="http://creativecommons.org/licenses/by-nc-sa/4.0/" rel="license"><img style="border-width: 0;" src="https://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png" alt="Creative Commons License" width="157" height="55" /></a><br /><span>The Philippine Journal of Pathology</span> is licensed under a <a href="http://creativecommons.org/licenses/by-nc-sa/4.0/" rel="license">Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License</a>. Based on works made open access at <a rel="dct:source">http://philippinejournalofpathology.org</a>Ileo-Ileal Intussusception with Meckel Diverticulum in a Filipino Adolescent
https://philippinejournalofpathology.org/index.php/PJP/article/view/421
<p>Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. Intussusception occurs primarily in infants and toddlers.<sup>1</sup> 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.<sup> 2</sup> 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.<sup>3</sup> 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.<sup>3,4</sup> 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.</p> <p>Intussusception refers to the invagination (telescoping) of a part of the intestine into itself. Intussusception occurs primarily in infants and toddlers.<sup>1</sup> 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.<sup> 2</sup> 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.<sup>3</sup> 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.<sup>3,4</sup> 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.</p>John Nicholas PantojaManuelito Madrid
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2023-12-132023-12-1382656810.21141/PJP.2023.10Impact of the COVID-19 Pandemic on Blood Supply
https://philippinejournalofpathology.org/index.php/PJP/article/view/415
<p><strong>Objective. </strong>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.</p> <p><strong>Methodology. </strong>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.</p> <p><strong>Results. </strong>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.</p> <p><strong>Conclusion. </strong>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.</p>Johnmerson YapMa. Theresa Fedoc-Minguito
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2023-12-152023-12-1582121710.21141/PJP.2023.11Needs Assessment for Establishment of Telepathology in the Philippines
https://philippinejournalofpathology.org/index.php/PJP/article/view/431
<p><strong>Objective. </strong>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.</p> <p><strong>Methodology.</strong> 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.</p> <p><strong>Results. </strong>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.</p> <p><strong>Conclusion. </strong>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.</p>Christine Mae OlivarGodofredo II InciongPaul Fontelo
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2023-12-282023-12-2882182410.21141/PJP.2023.16Attitudes and Perceptions of Filipino Clinicians and Pathologists towards the Autopsy as a Medical Tool
https://philippinejournalofpathology.org/index.php/PJP/article/view/409
<p><strong>Background. </strong>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.</p> <p><strong>Methodology. </strong>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.</p> <p><strong>Results. </strong>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.</p> <p><strong>Conclusion. </strong>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.</p>Kathrina Aseanne Acapulco-GomezIrene Uson
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2023-12-182023-12-1882253410.21141/PJP.2023.13Correlation of Clinicopathologic Features of Filipino Primary Breast Cancer Patients with HER2 Subgroups Classified according to the ASCO/CAP 2018 Breast Cancer HER2 Testing Guidelines
https://philippinejournalofpathology.org/index.php/PJP/article/view/419
<p><strong>Background</strong>. 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.</p> <p><strong>Objective. </strong>In this study, we examined clinicopathologic features among Filipino breast cancer patients whose HER2 status was reclassified based on the 2018 ASCO/CAP guidelines.</p> <p><strong>Methodology. </strong>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.</p> <p><strong>Results. </strong>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.</p> <p><strong>Conclusion.</strong> 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.</p>Lara Mae GonzalesSarah Jane Datay-LimElizabeth Ann Alcazaren
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2023-12-282023-12-2882354210.21141/PJP.2023.18The Use of Hedge Phrases in Histopathology Reports by Filipino Pathologists and Clinicians’ Interpretation of Them
https://philippinejournalofpathology.org/index.php/PJP/article/view/435
<p><strong>Introduction.</strong> When communicating uncertainty in histopathology reports, pathologists often use hedge phrases (HPs) to qualify their diagnoses, assuming that clinicians understand their meaning. However, Western studies have shown that these phrases have remarkable variations in intended and perceived certainty, which may impact the next steps of patient care.</p> <p><strong>Objectives. </strong>For seven commonly used HPs, we aimed to determine: how frequently these are used and encountered in histopathology reports in the Philippine setting; if there are differences in certainty among the phrases as well as between the intended and perceived certainty by pathologists and clinicians, respectively; the frequency of seeking clarification for each phrase, the preferred mode of communication, and the frequency that the next steps of patient management are taken for each phrase.</p> <p><strong>Methodology. </strong>Through snowball sampling, 57 pathologists and 111 clinicians from different geographic regions in the Philippines were recruited for an online survey. For each HP, participants reported the frequency of use of or encounter, rated percentage certainty, and answered questions regarding frequency of clarification, next step of management, and preferred mode of communication. Differences between intended and perceived certainty were determined by the Mann-Whitney U test. Differences in certainty among HPs were determined by the Kruskal-Wallis H test with the post-hoc Dunn test.</p> <p><strong>Results. </strong>The phrases “consistent with” and “diagnostic of” were the most and least frequent HPs, respectively. Certainty was perceived to be lower than intended for the phrase “cannot rule out” and for when no HP is used. Differences in certainty were found among most of the HPs. “Diagnostic of” and “consistent with” showed high certainty, “compatible with” and “favor” showed moderate certainty, “suggestive of” and “suspicious for” showed fair certainty, and “cannot rule out” had low certainty.</p> <p><strong>Conclusion. </strong>The variability of intended and perceived certainty for different HPs may warrant standardization of usage in reporting to prevent potential miscommunication and misinterpretation.</p>Paolo MacasaetEmilio Villanueva III
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2024-01-052024-01-0582434810.21141/PJP.2023.19Ethical Concerns and Recommendations for Sharing Anatomic Pathology Images in Online Social Media Networks
https://philippinejournalofpathology.org/index.php/PJP/article/view/429
<p>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.</p>Christine Mae Olivar
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2023-12-182023-12-188261110.21141/PJP.2023.12Mucosal Melanoma of the Male Urethra
https://philippinejournalofpathology.org/index.php/PJP/article/view/425
<p>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.</p>Kathleen Adryon TanMaria Sarah Lenon
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2023-12-282023-12-2882495310.21141/PJP.2023.14An Incidental Finding of Leydig Cell Tumor in a 36-year-old Southeast Asian Male who presents with Infertility
https://philippinejournalofpathology.org/index.php/PJP/article/view/413
<p>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.</p>Josh Matthew ChenBenedict Jose CanoraJeffrey So
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2023-12-282023-12-2882545810.21141/PJP.2023.15A Case Report of Extensive Facial Primitive Myxoid Mesenchymal Tumor of Infancy
https://philippinejournalofpathology.org/index.php/PJP/article/view/427
<p>We report a case of a 14-month-old female presenting with a one-year history of rapidly enlarging left hemifacial mass with recurrence despite excision. The tumor consists of bland round to short spindle cells in a myxoid stroma with positive expression to vimentin, CD99, SATB2, cyclin D1 and BCOR, compatible with a sarcoma with BCOR genetic alteration. Next-generation sequencing was performed that detected a BCOR internal tandem duplication, confirming the diagnosis of a primitive myxoid mesenchymal tumor of infancy (PMMTI). This report highlights the importance of attention to histopathologic characteristics, prudent application of immunohistochemical stains and molecular studies in differentiating PMMTI from other soft tissue sarcomas.</p>Ma. Cristina BrionesJeffrey Domingo
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2024-01-092024-01-0982596410.21141/PJP.2023.20Defining the Terms of Reference of the PSP’s Committee on Academic and Research Pathology
https://philippinejournalofpathology.org/index.php/PJP/article/view/441
<p>In the landscape of medical science, the role of pathology cannot be overstated. Pathologists play a pivotal role in diagnosing diseases, understanding their mechanisms, and advancing medical knowledge. The Philippines, home to a wealth of talented healthcare professionals, possesses a cadre of skilled and accomplished pathologists. However, the research and publication output within the field of pathology in the country has not reached its full potential.</p>Amado Tandoc III
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2023-12-282023-12-28824510.21141/PJP.2023.17