Gupta AS
The editors are back with the next issue. This issue brings
together a few cases wherein pathological correlation with clinical features
sprung up some interesting surprises. Such surprises makes clinical practice
challenging and encourages a dialogue between the clinician and the
pathologist. Clinical medicine when correlated with histopathological results
improves the overall diagnostic and management outcomes. It gives direction to
the clinician and helps in making the final diagnosis.
Clinicopathological correlation is a term that defines the
relationship between the clinical and the pathological findings of a patient.
It is not an etiological cause of the disease. A consultation between the
clinician and the pathologist allows the objective review of symptoms, signs,
laboratory investigations, imaging techniques and histopathology, results of
the disease condition and its course. Clinicians reach a provisional diagnosis
when they evaluate the patient’s history, and examination findings. This
diagnosis is then confirmed or refuted, by the laboratory results, imaging
techniques, the histopathologic examination and finally the autopsy results in
the event of the death of the patient. This correlation is a positive
correlation wherein the clinical and the pathological findings sync with each
other. However, when they don't correlate then it is negative
clinicopathological correlation. This is all the more important as the clinical
dilemmas can be resolved.
It is gratifying to the clinician when the pathologist
collaborates his clinical diagnosis.
There is a case of a pregnant patient with a dysgerminoma.
The preoperative clinical and MRI diagnosis was that of a subserosal fibroid
uterus. Surgery revealed it to be an ovarian neoplasm and the gross and typical
round or polygonal tumor cells arranged in nests, sheets and cords with
pleomorphic hyperchromatic
nuclei, thick nuclear membrane, prominent eosinophilic nucleoli and moderate
vacuolated cytoplasm within these cells clinched the diagnosis of a
dysgerminoma.
The pathologist needs to review the clinician’s notes and
then correlate the histopathology or the autopsy findings prior to writing his
report. This clinicopathological summary report should be presented in a
concise, simple, and easy to understand language detailing the positive and the
relevant negative relationship between the clinical and the pathological
findings. These reports aid in constructing the sequence of the disease process
in an individual, especially when this is the summary report of an autopsy.
Unrelated findings should also be highlighted. This will update the knowledge
of the clinician and aid in improving the quality of healthcare.
When the clinician and the
pathologist join hands then the patient, the medical world and academia all
stand to benefit. I have great pleasure in presenting the May issue of our
journal to our readers who are ever willing to learn from others’ experiences.