![](media/image1.emf){width="2.14375in" height="2.201388888888889in"}

![](media/image2.emf){width="1.6465277777777778in"
height="0.7986111111111112in"} **EM News**

Volume 4 Issue 3 May, 2000

Annual EM Program Review letters mailed

The FY 1999 EM Program review letters have been mailed to the VISN and
Medical Center Director of each Program. A separate courtesy copy was
mailed to each EM Program Director as well, since sometimes the copy
routed through the VISN and/or Medical Center Director is lost or
mis-routed. If any Program Director did not receive at least one copy of
their FY 1999 review letter, please contact Alex Tuszynki at
919-286-0411x5218 for a duplicate.

**Particular comments from the Ad Hoc review group**

The review group members noted that the quality of the submitted
diagnostic cases and particularly the summary of each case had improved
in this review cycle. This reflects the fact that the work of these
laboratories continues to improve. Also noted by the reviewers was the
excellent track record of publications and presentations at many
different laboratories. Clearly this is one of the finest success
stories of this program.

**CPT Coding in Diagnostic Electron Microscopy**

This topic was again discussed at the review meeting. One of the review
group members noted that the 88346 code for immunostaining could be used
multiple times for each different stain. Also noted was that the 88313
code for special stain could be used for essentially every TEM study as
long as review of the toluidine blue stained sections is mentioned in
the body of the report. For review purposes and general background
information here is a brief white paper presented previously regarding
this topic.

Before discussing CPT coding for Electron Microscopy, it is useful to
review the major different types of studies done in a hospital Electron
Microscopy Laboratory [for diagnosis]{.underline}. The majority of
studies are done using a Conventional Transmission Electron Microscope
(CTEM) and involve studying the ultrastructure of thin sections of
tissue such as kidney biopsies and certain tumors. In order to select an
appropriate area for thin section study, so called "thick" sections of
plastic embedded tissue must first be examined by light microscopy.
These "thick" sections are actually only 1/4 to 1/2 micron thick, but
they are much thicker than the thin sections used in the electron
microscope. Sometimes the CTEM is used to study thin sections using the
science of morphometry. Morphometric techniques can be applied at any
magnification to any image or flat surface, and thus these techniques
are not unique to electron microscopy. Sometimes negatively stained
samples such as viral suspensions are examined in a CTEM. While the
specimen preparation for these samples is completely different from the
usual plastic embedding technique, the microscopy operations on the
electron microscope are quite similar, and the amount of professional
time and professional expertise needed to interpret these is just as
great.

In recent years an increasing number of samples have been examined in a
scanning electron microscope (SEM). Most of these samples are examined
in an SEM equipped with an energy dispersive x-ray spectrometer (EDX),
which permits the observer to obtain morphologic information and
chemical data on the sample. The major application area is in the
diagnosis of asbestosis and other pneumoconioses. On rare occasions the
SEM can be used without the x-ray detector for diagnostic morphologic
studies such as for genetic abnormalities concerning the shape of
individual hairs.

Currently the CPT coding book available from the AMA refers to two
different types of CPT codes for charges in electron microscopy. The
first of these is "electron microscopy, diagnostic" (88348). The second
of these is indented below the first, and has the confusing name of
"scanning" (88349). Staff at Duke University Medical Center consulted
the AMA and the CAP to ask what the term "scanning" means. Both
organizations state that by this term they refer to the review by light
microscopy of thick sections. Thus they are apparently using the
modifier "scanning" to refer to the practice of looking through numerous
thick sections by light microscopy in order to find one or two
appropriate areas for thin section study by CTEM. It is unfortunate that
these organizations use this term "scanning", since to most electron
microscopists this immediately indicates secondary electron imaging (or
"scanning EM"), not a quick review of light microscopic slides.
Nevertheless, this appears to be the current terminology used by the
AMA, and they have the authority to define these codes.

If one then attempts to apply these two codes to the various studies
indicated at the beginning of this discussion, the code for diagnostic
electron microscopy (88348) should apply to all of the above studies
except for those light microscopic studies in which thick sections are
examined by light microscopy, but CTEM is not done (88349). In all of
the other examples, the electron microscope is being used to reach a
diagnosis, and thus the term "electron microscopy, diagnostic" is
appropriate and accurate, and thus the correct code is 88348.

Both the AMA CPT Consulting Service and CAP say that 88349 should be
used in a clinical setting when thick sections are cut from the plastic
block, are reviewed by the pathologist and the decision is made
[not]{.underline} to continue with thin sections, micrographs and
interpretation. For this service, the 88349 alone should be billed.

Both organizations said that CPT code 88348 should be used when the EM
case has thin sections, micrographs and interpretation. No EM case
should have both an 88348 and an 88349 billed. A case should have either
one code posted or the other.

The above comments are based solely on the AMA coding book. If, however,
one considers [reimbursement]{.underline} [by]{.underline}
[Medicare]{.underline}, then another complication may arise. In the
past, in some states, Medicare has not recognized (has not paid for)
88349. Medicare [does]{.underline} recognize, and [does]{.underline} pay
for 88313, which codes for "all other" special stains, such as iron and
trichrome (but not immunohistochemistry). Since toluidine blue fits this
definition of a special stain, some laboratories bill 88313 for cases
examined by thick sections alone, not 88349. Furthermore, if a CTEM
report mentions the review of the toluidine blue stained sections in the
body of the CTEM report, then some laboratories bill [both]{.underline}
88348 and 88313 for all routine CTEM cases. If review of the toluidine
blue sections is done, but not documented in the report, then only 88348
can be billed.

This is a complex subject, and there are regional differences. It is not
clear why in some areas it is acceptable to bill both 88348 and 88313,
whereas in other areas it is not acceptable to bill both 88348 and
88349, but these appear to be current practices.

**Below are given some examples of typical specimens studied in our
laboratory, with examples of possible CPT coding for the case
indicated:**

1\. A kidney biopsy studied by light microscopy (paraffin sections),
electron microscopy and direct immunofluorescence - 88305, 88348 and
88346.

2\. A heart biopsy studied by light microscopy and electron microscopy -
88307 and 88348, or 88307, 88313 and 88348.

3\. A nerve biopsy studied by light microscopy (paraffin sections) and
by light microscopic review of "thick" sections, but not using electron
microscopy - 88305 and 88349, or 88305 and 88313.

4\. A lung wedge biopsy studied by light microscopy (paraffin sections),
electron microscopy and immunoperoxidase staining - 88307, 88348 and
88342.

5\. A muscle biopsy studied by light microscopy (paraffin sections) and
electron microscopy - 88305 and 88348, or 88305, 88313, and 88348.

6\. A lung wedge biopsy studied by light microscopy (paraffin sections)
and scanning electron microscopy with EDX - 88307 and 88348.

7\. Fluid from a blister negatively stained with urany1 acetate and
examined by CTEM - 88348.

8\. A sample of several individual hairs from a child with a genetic
abnormality studied by scanning electron microscopy only - 88348.

This short essay on CPT coding is included with this EM Newsletter in
order to encourage discussion on this topic.

Your comments, criticisms, and suggestions are welcome and needed. One
goal is to see if within VHA we can agree on a common strategy before
CPT coding is required. Please send your comments to the FORUM network
mail group (G.ELECTRON [MICROSCOPY@FORUM.VA.GOV)]{.underline} or
[Shelburne,John@forum.va.gov]{.underline} or
[Shelbune,John@durham.va.gov]{.underline} or
[John.Shelburne@med.va.gov]{.underline}

Minutes of the Electron Microscopy Ad Hoc Review Group Meeting

####### March 25, 2000

**1. Welcome/Introductions (Dr. Shelburne)**

Dr. Shelburne welcomed and thanked the members for their timely reviews
of all of the cases and for attending the meeting. He particularly
thanked Dr. Beals for serving as a reviewer as well as a member of the
committee. Dr. Shelburne announced that Dr. David Howell has recently
been named Acting Chief of Pathology and Laboratory Medicine Service at
the Durham, North Carolina VA Medical Center. Dr. Shelburne, himself,
has recently been named as Chief of Staff of that Medical Center.
However, Dr. Shelburne plans to continue to serve as the Electron
Microscopy Program Coordinator, and Alex Tuszynski will continue his
critical role in managing this program.

**2. General Comments**

**(Dr. Beals)**

Dr. Beals reviewed the current status in VA National Headquarters
concerning the departure of Dr. Kizer, and Dr. Garthwaite's current
role. He noted Dr. Garthwaite's support for improving relations between
VA Medical Centers and their academic affiliates, and predicted that
would be beneficial for the EM Program. Dr. Beals reviewed the status of
Pathology and Laboratory Medicine Service in National Headquarters and
in the VISNs. With regard to the EM Ad Hoc Review Group, Dr. Beals noted
that the funding for this group is reviewed every year in VA National
Headquarters. No problems have been encountered during these reviews,
and indeed this program has won praise as one of the most intense and
successful peer review programs in VHA. Thus the value of this program
has been recognized and rewarded with continued funding.

**3. Update on VHA/National Headquarters**

**(Mary Stitak)**

Mary Stitak said that there is an opening in VA National Headquarters
for the position vacated by Agatha Francis. There are numerous
applicants for this position. Mary Stitak hopes that a new enforcement
officer will be named soon. Other staffing changes in the National
office were discussed. Funding for the 2001 meeting of the EM Ad Hoc
Review Group is expected.

**4. Update on Review Group Members**

Members of the Ad Hoc Review Group updated the committee on the status
of electron microscopy in their institution. Briefly, these EM
laboratories are doing well. Renal biopsies comprise an increasing
fraction of the clinical workload.

**5. Review of Interobserver Variability**

At the 1999 meeting of the EM Ad Hoc Review Group, Dr. David Howell
suggested that we look at interobserver variability. That is, how often
do panel members agree as they review individual cases. Accordingly,
Alex Tuszynski produced tabular data documenting the agreement rate.
Briefly, if one assumes that a decision plus or minus one category is
"agreement", then the agreement between reviewers is good. At the next
meeting the committee will review these data from 1996 to the present.
It was also requested that a clear definition of "contributed" versus
"confirmed" be provided to the reviewers to be used as a guide in
decisions for the 2001 review. Dr. Shelburne noted that on each review
there is another category whether or not the reviewer agrees with the
submitted diagnosis. This is decided first by the reviewer and then
ultimately by the committee during the Ad Hoc Review Group meeting. Data
on those agreements will also be assembled and will be provided to the
Ad Hoc Review Group at the 2001 meeting.

**6. Overview of FY 99 EM Program (Dr. Shelburne)**

Dr. Shelburne next reviewed the minutes of the EM Ad Hoc Review Group at
its meeting in San Francisco on Saturday, March 20, 1999. There were no
corrections or additions to those minutes, which were approved
unanimously. Dr. Shelburne then reviewed requests by the Ad Hoc Review
Group made at both the 1998 and 1999 committee meetings. Requests from
the 1998 meeting were met during the next year and are discussed in the
March 20, 1999 minutes. Briefly, all requests by the Ad Hoc panel were
accomplished. At the 1999 meeting, the Ad Hoc panel asked Dr. Shelburne
to send to all EM Labs selected examples of some excellent clinical
cases to ensure that all labs understand the types of cases being sought
by the committee, and to understand the ideal format for EM reporting.
Dr. Shelburne and Alex Tuszynski did that during the prior year. The Ad
Hoc panel felt that this activity had been worthwhile. They noted that
the quality of the cases and particularly the summary of each case had
improved in this review cycle. The one thing not done was to stress the
importance of commenting in the Surgical Pathology Report that EM tissue
has been saved. Dr. Shelburne and Alex Tuszynski will stress this point
in the cases sent out during this next year. It was agreed that the best
cases from each cycle should always be sent out in future years for the
benefit of the labs. Dr. Shelburne and Alex also distributed reprints of
articles on diagnostic electron microscopy by Dr. Herrera and Dr.
Dardick. Other activities requested and done included rotating the
programs for review to different reviewers, discussions of CPT coding, a
summary of the total number of renal biopsies in VHA, lists of the top
five non-renal clinical diagnoses in which EM plays a significant role,
and activity attendant to Ultrapath IX and X.

**7. New Business**

**(Dr. Shelburne)**

Dr. Shelburne then reviewed the rest of the material distributed to the
committee.

[Topic: EM Program Notes]{.underline}: Dr. Shelburne congratulated the
laboratories at Cleveland, Gainesville and Minneapolis for obtaining new
electron microscopes by transfer from closed programs. The three oldest
electron microscopes in VHA are the Zeiss 9A at Miami (1967), the
Phillips 300 at Shreveport (1972) and the Phillips 301 at Dallas (1974).
The panel agreed that all three microscopes should be replaced. Dr.
Shelburne then commented briefly on each EM Lab in the system including
numbers of specimens accessioned and the summary of publications, grants
and presentations. Dr. Beals noted the excellent track record of
publications and presentations at many different laboratories. Clearly
this is one of the finest success stories of this program. Dr. Fred
Clayton at the Salt Lake City VAMC received special praise, as he is the
principle investigator on a VA Merit Review.

[Topic: Review of Individual Cases]{.underline}: During the review of
all 120 cases submitted this year, only 19 cases were questioned by
panel members as potentially of concern. This represents only 15.8% of
the total and reflects the fact that the work of these laboratories
continues to improve. These 19 cases were reviewed at this meeting by
the Ad Hoc panel as well as all cases from each lab, as well as a
summary review of each lab.

[Topic: Number of Renal Biopsy Specimens during FY 99]{.underline}: Dr.
Shelburne and Alex Tuszynski collected data on the number of renal
biopsy specimens received during FY 99. Data was received in two ways
from most laboratories. In some cases, a SNOMED search for the topology
code for the kidney was done. This produced a large number since renal
tumors and resected kidneys were counted. Fortunately several
laboratories also provided specific data on the number of medical renal
biopsies done on VA patients. Based on input from several different
VISNs where EM activity is centralized, it would appear that
approximately 25 medical renal biopsies are done per year in each VISN.
Thus the approximate total number of medical renal biopsies done on VA
patients would be less than 1000. An approximate VHA total would be
500-600 per year. The panel agreed that this should be restudied in next
year's report with a more specific definition of renal biopsy being
provided. The major interest for the Ad Hoc panel is the number of
medical renal biopsies done on VA patients.

[Topic: Non-Renal Clinical Diagnoses]{.underline}: Attached with these
minutes is a list of the top 5 non-renal clinical diagnoses for each
laboratory in which EM plays a significant role. The panel discussed
these lists. Clearly there is variation depending on the expertise of
the program director.

[Topic: Statistical Data]{.underline}: The committee reviewed
statistical data for each laboratory showing numbers of specimens
studied and (when available) the charge for EM on non-VA cases and for
research studies. Dr. Shelburne noted that the sum of income from
Sharing Agreements for Clinical and Research Studies is approaching one
million dollars. He and Dr. Beals felt that this number would be an
underestimate since some laboratories did not report and since in some
research studies the funding is obtained by mechanisms such as having
the investigator buy film. In that case it is difficult to quantitate
the charge but the income is real and significant.

[Topic: CPT Coding in Diagnostic Electron Microscopy]{.underline}:
Attached with these minutes is a brief White Paper on CPT Coding in
Diagnostic Electron Microscopy. Dr. Herrera noted that the 88346 code
for immunostaining should be used multiple times for each different
stain. He also felt that the 88313 code should be used every time for
essentially every TEM study. As noted, the EM report must specifically
comment on the review of toluidine blue-stained one micron sections.

[Topic: Ultrapath X]{.underline}: Ultrapath X will be held July 2 -- 7,
2000 in Florence, Italy. Drs. Beals, Tucker, Howell, Herrera and
Shelburne are involved as organizers. Program Directors are encouraged
to attend. For detailed information about this meeting, contact Dr. J.
Allan Tucker at Department of Pathology, University of South Alabama,
2451 Fillingham Street, Mobile, Alabama, 36617 Tel: (334) 471-7790/7799
Fax: (334) 471-7884, e-mail: [jtucker@usamail.usouthal.edu]{.underline}
Also, the Society for Ultrastructural Pathology website
[http://sup.ultrakohl.com]{.underline} has registration forms and
information.

[Topic: Ultrapath XI]{.underline}: Ultrapath XI will be held August 5 --
9, 2002 in Aspen, Colorado at the Given Biomedical Institute. Dr.
Shelburne and Alex Tuszynski will seek funding for all Program Directors
to attend.

[Topic: EM Reviews]{.underline}: The panel then divided into three
groups to review each of the laboratories. Particular attention was paid
to flagged cases in which a reviewer had expressed some concern.
However, each group reviewed all cases for each lab. A group consensus
for each flagged case as well as for each lab was obtained. The panel
members also were asked to identify particularly good cases that could
be sent to labs as examples of general interest. Finally the panel
summarized the accomplishments of each laboratory.

**The next meeting of the Electron Microscopy Ad Hoc Review Group will
be on Saturday, March 3, 2001 at the beginning of the U.S. and Canadian
Academy of Pathology Meeting in Atlanta, Georgia.**

Top five non-renal clinical diagnoses listed in which EM plays
significant role

**Detroit**

Small cell carcinomas

Melanomas

Neuroendocrine tumors

All lymphomas

Squamous cell carcinomas

**Cleveland**

Tumors of the lung

Tumors of the hemapoietic system

Tumors of G.I. Tract

Head and neck tumors

Endocrine tumors

**Dallas**

Neuroendocrine tumors

Lung tumors

Gastrointestinal tumors

Undifferentiated tumors

Infectious diseases

**Durham**

Asbestosis

Id & analysis of renal stones

Tumors of unknown primary site

Id of poorly differentiated tumors

Id of tumors of neuroendocrine origin

**Gainesville**

Adenocarcinoma involving variety of sites

Squamous cell carcinoma

Malignant neoplasms

Renal carcinoma

Poorly differentiated carcinoma

**Houston**

Poorly differentiated carcinomas

Mesothelioma

Malignant effusions

Melanoma

Renal tumors

**Indianapolis**

Neoplasms, pulmonary (oat cell CA, bronchiolo-alveolar adenocarcinoma)

Neoplasms, lymph nodes (metastases, lymphoma)

Neoplasms, CNS (primary, secondary)

Neoplasms, genitourinary (renal cell carcinoma)

Neoplasms, soft tissue (sarcoma)

**Kansas City**

Lung cancer

Metastatic cancer

Muscle weakness

Soft Tissue Tumor

Brain cancer

**Little Rock**

Soft tissue sarcoma

Amyloid

Brain neoplasms

Periph. Nerve lesion

Carcinoid

**Madison**

Classification of poorly differentiated neoplasms

Lung adenocarcinoma vs. malignant mesothelioma

Viral diagnosis

FNA in which only small amt of tissue is available

Amelanotic melanoma

Mitochondrial genetic diseases

**Minneapolis**

Undifferentiated lung carcinoma

Amelanotic melanoma

Mesothelioma

Soft tissue neoplasms

Neuroendocrine CA, incl. Merkel cell tumors.

**Nashville**

Small cell carcinoma - lung

Soft tissue sarcomas

Poorly diff. Tumor-carcinoma vs. sarcoma vs. lymphoma

Malignant melanoma

Poorly diff. Lung carcinoma

**New Orleans**

Tumors

Liver

Lung

**New York**

FNA specimens

Lung tumors

Blood and bone marrow

Liver biopsies

Brain tumors

**Philadelphia**

To dx mesothelioma and adenocarcinoma

To dx neuorendocrine carcinoma

Tumor dx: Carcinoma/Sarcoma/Melanoma

To dx obligate intracellular parasites in immunosuppressed patients

To dx viral infections in immunosuppressed patients.

**Salt Lake City**

Tumor classification,

Neuropathy,

Ciliary immotility,

Other congenital or storage diseases,

Myopathy

**San Francisco**

Malignancies

Immotile cilia

Infectious diseases

Bullous diseases of skin

Ceroid lipofuscinosis

**Seattle**

Identified cell type differentiation in variety of neoplastic
infiltrates of uncertain histologic types.

Identified neoplastic cell types in mechanically distorted,
histiological uncertain, yet clinically worrisome infiltrates

Identification of presence or absence of CADSIL assoc. changes in skin
biopsies.

Identification of specific organisms (e.g. microsporidia)

Detection of axonal degenerative changes.

**Shreveport**

1\. Better classify neoplasms of lung, liver and GI tract.

2\. To resolve anaplastic carcinoma vs. lymphoma in lymph nodes

3\. To identify nonhemopoetic cells in bone marrows

4\. Support the FNA service

5\. Identification of infectious agents

**Tampa**

Small cell carcinoma

Large cell neuroendocrine tumor

Mesothelioma

Carcinoma vs. sarcoma

Melanoma

**Washington**

Poorly diff. Carcinoma, especially neuroendocrine carcinoma

Plasmacytoma and lymphoplasmacytic lymphoma

Cutaneous T-cell lymphoma

Meylodysplastic syndrome

Infections of obscure nature.

**West Los Angeles**

Leukemias

Lymphomas

Lung cancer

Brain tumors

Soft tissue tumors

**Web sites, e-mail**

###### 

###### Pathology Resources WWW

Electron Microscopy Yellow Pages

A collection of links to electron microscopy laboratories, education in
EM, news and publications on EM, software for EM, and much more.

**http://cimewww.epfl.ch/emyp/**

**[Electronic Journals]{.underline}** There are well over a thousand
biomedical journals available in some form on the Internet. The Emory
Health Sciences Library maintains a terrific list with addresses at:

http://www.cc.emory.edu/WHSCL/medweb.ejs.html

The great majority of e-journals are limited to tables of contents of
recent issues, abstracts of major articles, and sometimes the text of
selected sections. A couple of examples are the *New England Journal of
Medicine*, available at: http://www.nejm.org (the current issue is
posted on Thursday mornings) and the publications of the American
Medical Association - The Archives titles as well as JAMA, [available
at: http://www.ama-assn.org/]{.underline}

**[Computer]{.underline} terminology** http://whatis.com

[**Super-fast and reliable search engine**]{.underline}
http://google.com

**[Digital scanners]{.underline}** http://scantips.com

Women\'s College Hospital - Toronto, Ontario

A useful resource for EM images from the pathology findings in selected
skin biopsies, plus general information and services provided by the
Electron Microscopy Unit, Department of Pathology at Women\'s College
Hospital, Toronto, Ontario.

**http://www.onramp.ca/wch/pathology/em.htm**

Petr Schauer Electron Microscopy Resources

Looking for announcements of EM meetings, databases for EM images, EM
vendors and suppliers, EM Societies, and journals and books dealing with
EM, this site has it all.

**[http://pecka.isibrno.cz/\~petr/hypertext/elmikro.html]{.underline}**

St Georges Hospital EM Unit, London, England

This facility operates primarily as an EM service for St. Georges
Hospital Medical School and Hospital. The site has a TEM and SEM
micrograph gallery,

current research projects, and technical information.

**http://www.sghms.ac.uk/em/welcome.html**

Dennis Kunkel\'s Image Gallery - Electron Microscopy

A site devoted to SEM, but the quality of these colorized images
warrants a visit. Since viruses, bacteria, and some medical SEM images
are available, it

may have practical value for some electrom nicroscopists.

**http://www.pbrc.hawaii.edu/\~kunkel/gallery/**

The University of Utah\'s WebPath

An exceptional website, which is of considerable interest for residents
and practicing pathologists. An electronic laboratory chocked full of
text and tutorials demonstrating gross and microscopic pathology and
more than 1800 images. Some of these images, as evidenced below, even
illustrate the beauty

of Utah. Multiple choice questions abound for those preparing for
qualifying examinations. There is even a section of forensic pathology
devoted to firearms. This ever expanding educational site is worth a
visit.

**http://medlib.med.utah.edu/WebPath/webpath.html**

New York University Case Studies

Hematopathology, lymph node and aspiration cytology of breast case
studies,provided by New York University. A well organized web site with
instructive, well documented and illustrated cases.

**http://mchip00.med.nyu.edu/path-cases/pathcases.html**

Anatomic Pathology Informatics, Imaging and the Internet (APIII).

The \"electronic poster\" session is a form for presenting works in

informatics, a listing of posters and materials presented at the APIII96

session from a variety of Departments of Pathology and Laboratory
Medicine.

**http://www.pathology.pitt.edu/apiii97/postlst.htm**

Internet Resources for Pathology and Laboratory Medicine

Many links and resources related to pathology in general, plus a number
of specific subspecialty resources and links.

**http://www.pds.med.umich.edu/users/amp/path_resources.html**

Immunohistochemistry Home Page

A comprehensive list of immunohistochemistry resources on the internet,
including forums and user groups related to immunohistochmistry, listing
of

tutorials on this topic, selected laboratories and vendors.

**http://immuno.hypermart.net/**

Cytolink

The virtual cytology, multimedia resource center. Includes conferences,
cases

and other information.

**http://www.cytology.com/home.htm**

Cytopathnet

An online cytopathology resource base with an \"interesting cases\"
section.

**http://www.cytopathnet.org**

University of North Carolina

Nephropathology Biopsy Review Cases Excellent series of renal biopsy
cases with clinicopathological correlation.

Micrographs of high quality and useful discussion of the cases.

**http://www.gamewood.net/pathcase/nephpath.html**

Renal Image Database

Part of an instruction course in renal pathology with a supplemental
database

of images on normal anatomy, cystic disease, glomerulopathies,

glomerulonephritis, and more.

**http://www.kumc.edu/instruction/medicine/pathology/ed/ch_16/ch_16_nf.html**

Review of Pediatric Renal Neoplasms

John Hicks, Texas Children\'s Hospital, Houston, Texas **(email:**

**jhicks@msmail.path.tch.tmc.edu)** Presentation notes on a series of
pediatric renal tumors including nephroblastoma, congenital mesoblastic
nephroma, clear

cell sarcoma, and more. Clinocopathologic information and micrographs
are

available**. hicks98.htm**

RENALNET

Extensive listing of academic nephrology departments. This web site also
has renal biopsy case reviews and other information related to kidney
diseases.

**http://realnet.org/realnet/nephrology/nephrology1.cfm**

Neuroanatomy and Neuropathology on the Internet.

A handy collection of images of brain cutting and sections stained for
myelin. Also access to neuroanatomy structures and an online
neuropathology

atlas. Many handy links.

**http://www.dote.hu/\~hegedus/**

Brain Pathology

A neuropathology journal now in its ninth year, but additionally a
useful resource in this field. Not only is there a listing of back
issues, but the current issue is online. Well structured case reports
from current and previous iussues are available with excellent images
and final diagnoses.

**http://brainpathology.upmc.edu/**

Neuropathology on the Internet

This site offers light micrograph images of \"Basic Pathology of the
Central Nervous System\", as well as representative images of tumors of
the CNS organized as to the WHO International Histological
Classification of Tumours.

**http://ampat.amu.edu.pl/guzyuno/program.htm**

Oral Pathology Image Database

Though mainly clinically based, this site illustrates the potential of
such an image database for lectures, post-graduate education, and for
review by students.

**http://www.uiowa.edu/\~oprm/AtlasHome.html**

Medical Information Center

A broad based medical information center with a page dealing with
medical school education including pathology courses, post-graduate
pathology education and the Department of Laboratory Medicine at the
University of

Texas - Houston Medical School. There are also links to other

pathology-related WWW sites.

**http://medic.med.uth.tmc.edu/edprog/tocedpr.htm**

Canadian Association of Pathologists

**http://cap.medical.org/**

Royal College of Pathology

**http://www.rcpath.org/contents.html**

Italian Society of Anatomical Pathology and Cytopathology

**http://www.siapec.it/**

Adriatic Society of Pathology

**http://www.siapec.it/adriatic/index.htm**

American Society of Cytopathology

**http://www.cytopathology.org/**

American Society for Investigative Pathology The American Society for
Investigative Pathology fosters investigations directed towards
understanding the pathogenesis of disease. Towards this end,

they organize an annual meeting (usually in conjunction with
Experimental Biology and other FASEB Societies) as well as publish The
American Journal of

Pathology. A link is also available to the web pages for the American
Journal of Pathology, which highlights key articles in recent issues.

**http://asip.uthscsa.edu/**

Renal Pathology Society

World Wide Web site at the University of Alberta with an excellent
resource listing of links to many additional sites devoted to renal
pathology.

**http://www.med.ualberta.ca/rps/000r000q.htm**

Ultrastructural Pathology

General information and instructions for authors for the journal
Ultrastructural Pathology. By subscribing to their listserver it is
possible to get a table of contents for current issues of this and other
journals they publish. Taylor and Francis, Publishers

**http://www.tandf.co.uk**

Microscopy and Analysis

This site contains many links to Microscopy-related WWW sites, e.g.,
laboratories, societies, news groups and resources. This site is
prepared by the journal \"Microscopy and Analysis\"
**(www.microrgc.demon.co.uk/index.htm).**

If you are involved in purchasing EM supplies and equipment, you might
qualify for a subscription.

**http://www.microrgc.demon.co.uk/linkssci.htm**

**[MicroWorld News]{.underline}** is an e-mail newsletter for
microscopists and microanalysts. The issue lists a large number of web
sites, resources, meetings and conferences in the area of EM, imaging,
etc. To subscribe to the e-mail newsletter send an e-mail message to
MWN@mwrn.com

To subscribe to the e-mail Microscopy newsgroup or discussion group send
an e-mail message containing the message "Subscribe Microscopy
YourUserID@YourDomain" to Listserver@MSA.Microscopy.com

An example message from John Doe in FORUM might be:

Subscribe Microscopy doe.john@forum.va.gov

A few sample entries from the e-mail discussions and the MicroWorld
newsletter are provided in the meetings calendar section and in the
following web site listings.

**[From MicroWorld Resources, your guide to microscopy on the Internet
at]{.underline}**

http://www.mwrn.com/

http://www.mwrn.com/guide.htm

(the above location contains articles on electron microscopy, laser and
confocal microscopy, light microscopy, job postings, etc,)

**[University of Washington]{.underline}**

http://www.pathology.washington.edu./

**[University of Pittsburgh]{.underline}**

http://path.upmc.edu/

**[Uniformed Services University]{.underline}**

http://wwwpath.usuf2.usuhs/mil/

**[Virgil's Web]{.underline}**

http://virgil.mc.vanderbilt.edu/

**[GI and Liver Pathology]{.underline}**

http://www.pds.med.umich.edu/users/ greenson/

**[Osaka Medical College]{.underline}**

http://www.osaka-med.ac.jp/

**[Microscopy Society of America]{.underline}**

http://www.msa.microscopy.com/

***[MSA - FTP site address]{.underline}***

ftp.msa.microscopy.com

**[Emory University School of Medicine]{.underline} has a Web page for
the residency program**

http://www.emory.edu/PATHOLOGY/ RESIDENT/

**Government sites of possible interest**:

***[Armed Forces Institute of Pathology]{.underline}***

http://www.afip.mil

**[CancerNet]{.underline}**

gopher.nih.gov:70/11/clin/cancernet

**[National Cancer Institute]{.underline}**

http://www.nci.nih.gov

**[National Library of Medicine]{.underline}**

http://www.nlm.nih.gov

**[Institute of Medicine]{.underline}**

http://www2.nas.edu/iom

**[Morbidity and Mortality Weekly Review]{.underline}**

http://www.cdc.gov/epo/mmwr/mmwr.html

**[National Institutes of Health]{.underline}**

http://www.nih.gov

**[Visible Human Project]{.underline}**

http://www.nlm.gov/research/visible/visible_human.html

**[Cumulative Survey of Histopathological and Cytological Findings
1989-1996]{.underline}** (more than 55,000 aspiration biopsy findings
and more than 90,000 histopathological findings) is available on the
Internet on:

[http://www.mpt.com.mk/stavric/survey96.zip]{.underline}

**Future**![](media/image2.emf){width="0.2791666666666667in"
height="0.16944444444444445in"} **EM Newsletters:**

If you have any comments, suggestions, article submissions for use in a
future Newsletter, please send to: Alex Tuszynski (EM-QA/QM) Coordinator
via FAX 919-286-6818 or call 700-671-6925x5218 or e-mail
[tuszynski.a@forum.va.gov]{.underline}

**Microscopy Calendar**

**FOR INFORMATION** on specialty and regional meeting and links to
additional meeting information, **visit** the MicroWorld Resource\'s
Meetings and Conference at
**[www.mwrn.com/feature/meeting.htm]{.underline}**

**Biennial UltraPath Meeting**

**Preliminary Announcement for UltraPath X**

**Plan to attend what is shaping up to be a superb scientific and social
Program in an unique location**

**Course Description:**

**Ultrapath X will be held in the historic city of Florence, Italy, July
2-7, 2000.**

**As in years past, a variety of topics will be covered and
participation will be solicited from those attending. Those wishing to
contribute to the scientific program are urged to contact Professor
Marco Santucci (Local Arrangements Director) or J. Allan Tucker (Program
Director) at the addresses below. The scientific program will emphasize
the applications of immmunocytochemistry, electron microscopy, in situ
hybridization and related techniques in diagnostic pathology.**

**Conference location:**

**The course will be held at the Grand Hotel Baglioni, Florence,Italy.
The Grand Hotel Baglioni is a four star hotel located in the historic
center of Firenze (Florence). The hotel was established in 1902 and is
only a few minutes away from major galleries containing the art work of
the renaissance. The spacious public rooms have ornate carved wood
ceilings.**

**Hotel Information:**

**Contact for information concerning hotel accomodations and pre- or
post-congress tours:**

**CSS Agency**

**Ms. Susanna Casprini,**

**Tel: +39 55 2480202 Fax: +39 55 2480246**

**E-mail: CSS@MEGA.IT**

**NOTE: To obtain the special hotel rate, all hotel reservations must be
made through the above agency and not directly with the hotel.**

**In Italian lire, the daily rate will be 280,000 for single occupancy
and 320,00 for double occupancy. As of March 29, 1999, this would
convert to approximately US\$150.00 and US\$175.00, respectively.**

**These rates include American-style buffet breakfast and taxes (VAT 10
percent).**

**For further information, please contact: Local Arrangements Committee
Chair:**

**Professor Marco Santucci**

**Istituto di Anatomia e Istologia Patologica Università degli Studi di
Firenze V. le G. B. Morgagni 85-50134 Firenze, Italy**

**Telephone: + 39 055 432144**

**Fax +39 055 4379868**

**Email: Santucci@CESIT1.UNIFI.IT**

**Program Director:**

**J. Allan Tucker, M.D.**

**Department of Pathology University of South Alabama 2451 Fillingim
Street Mobile, Alabama 36617 USA**

**Tel: 334-471-7799 Fax: 334-471-7884**

**Email: jtucker@usamail.usouthal.edu**

***[Remember, you do not need to be a member of the Society for
Ultrastructural Pathology to attend Ultrapath X.]{.underline}***

**7th Asia-Pacific Conference in Electron Microscopy** 26 to 30 June
2000.

**12th European Congress on Electron Microscopy** Brno, Czech Republic,
July 9 - 14, 2000. EUREM2000, Královopolská 147, CZ - 612 64 Brno, Czech
Republic eurem2000@isibrno.cz, Phone: ++420 5 41514 336, Fax: ++420 5
41514 337

**Meeting of the International Union of Microbeam Analysis Societies**,
Kailua-Kona, Hawaii, July 9th-13th 2000

**The Microscopy & Microanalysis Meeting 2000**, Philiadelphia, PA.
August 13th-17th 2000

**11th International Congress for Histochemistry and Cytochemistry,**
3-8th September 2000 in York, United Kingdom

**Meeting: 7th Asia-Pacific Conference on Electron Microscopy**

Dates: 26 to 30 June 2000

Topic: We would like to extend a warm invitation to all friends and
colleagues in microsopy to welcome the 21st Century together at the 7th
APEM. The science will be food for many thought intercalated with
exciting social events and delicious cuisine on a tropical island, 2§
north of the equator. Delegates will benefit from interesting topics
such as cryo-techniques, failure analysis, image analysis and
processing, environmental materials, new microscopy, x-ray analysis,
molecular microscopy and neurosciences. The Who\'s who in microscopy
arena will also be participating to exhibit their products and services.
Other highlights include pre-conference workshops, 5th NUS-PHILIPS
Electron Optics Symposium, 2nd ASEAN Microscopy Conference and
Micrograph Competition.

Sponsor: Under the auspices of Microscopy Society (Singapore), National
University of Singapore, The International Federation of Societies for
Electron Microscopy (IFSEM), and The Committee of Asia-Pacific Societies
for Electron Microscopy (CAPSEM)

Location: Singapore Internationl Convention & Exhibition Centre, SUNTEC
CITY, Singapore, Singapore

Interests: Both Physical & Biological Sciences

Fields: Light/Optical, Confocal, X-Ray Microscopy, SEM, TEM, STEM, EELS,
EDS, FIM/AtomProbe, XRF/XRD

Contact: Mary M L Ng, Electron Microscopy Unit (MD5), Faculty of
Medicine, National University of Singapore, 10 Kent Ridge Crescent,
Singapore 119260

Tel: 65 874 3216 Fax: 65 776 4971

E-mail: micngml@nus.edu.sg

http://www.med.nus.edu.sg/micsoc/7apem

**Meeting: 12th European Congress on Electron Microscopy**

Dates: July 9 - 14, 2000

Topic: The Congress is intended to provide an overview of present
achievements and expected future trends in electron microscopy and
related fields. This is to include the instrumentation and methodology
and all main application areas, particularly in life and material
sciences. The Congress will also cover scanning probe microscopies and
near-field optical microscopy.

Sponsor: Organized by the Czechoslovak Society for Electron Microscopy
under the auspices of the Committee of European Societies for Microscopy
and the International Federation of Societies for Electron Microscopy
and in co-operation with the Institute of scientific Instruments AS CR
under the Patronage of Professor Rudolf Zahradnk, President of AS CR.

Location: Brno, Czech Republic

Interests: Both Physical & Biological Sciences

Fields: Light/Optical, Confocal, 2 Photon, Near Field, Scanning Probe,
X-Ray Microscopy, SEM, TEM, STEM, IVEM/HVEM, LEEM, AEM, EELS, EDS, WDS,
EMPA, AES, ESCA, Other

Contact: Dr. Ludek Frank, EUREM2000, Kralovopolska 147, Brno, CZ-61264,
Czech Republic

Tel: ++420 5 41514 336

Fax: ++420 5 41514 337

E-mail: eurem2000@isibrno.cz

http://www.eurem2000.isibrno.cz/

**Meeting: IUMAS 2000**

Dates: July 8-15,2000

Topic: 2nd meeting of the International Union of Microbeam Analysis
Societies

Sponsor: IUMAC

Location: Kona, Hawaii

Interests: Both Physical & Biological Sciences

Fields: Light/Optical, Scanning Probe, Scanning Ion, SEM, TEM, STEM,
EELS,

EDS, WDS, EMPA

Contact: David B. Williams, Lehigh University., Lehigh,USA

Tel: +215-758-4224

E-mail: DBW1@lehigh.edu

http://www.microanalysis.org/iumas2000/iumas2000.html

**Meeting: Microscopy & Microanalysis-2000**

**\*\*\*\*\* [NOTICE THE CHANGED DATE for this year]{.underline}!!!
\*\*\*\*\*\***

Dates: Aug. **13-17, 2000**

Location: Philadelphia, Pa., USA

Sponsors: Microscopy Society of America , MicroBeam Analysis Society

Contact: MSA Business Office

Tel:312-644-1527, Toll-free: 1-800-538-3672

Fax: 312-644-8557

Email: BusinessOffice@MSA.Microscopy.Com

**Meeting: 11th International Congress of Histochemistry and
Cytochemistry (ICHC 2000)**

Dates: 3-8 September, 2000

Topic: ICHC 2000 presents the very latest developments in histochemical
and cytochemical techniques for and their application to alll areas of
the Life Sciences including Medicine. ICHC 200 consist of plenary
lectures, parallel symposia, poster sessions and a commercial
exhibition.

Sponsor: International Federation of Societies for Histochemistry and
Cytochemistry

Location: York, United Kingdom

Interests: Biological Sciences

Fields: Light/Optical, Confocal, 2 Photon, SEM, TEM

Contact: Dr. Gary R Coulton , Royal Microscopical Society, 37/38 St.
Clements, Oxford, OX41AJ, United Kingdom

Tel: +44 (0)1865 248768

Fax: +44 (0)1865 791237

E-mail: info@rms.org.uk

[http://www.med.ic.ac.uk/external/ichc_2000]{.underline}

**[EM Training Schools & Short Courses]{.underline}**

**LOM/AFM/SEM/TEM Specimen Preparation Workshops -** contact AMC Group,
7620 E. McKellips Rd. No 4109, Scottsdale, AZ 85257-4600 for schedule &
locations.

**Image Analysis Workshop** College Park, Maryland, Contact: Dr. John
Russ, Fax: (301) 495-5964 or http://www.mediacy.com

**Scanning Electron Microscopy and X-ray Microanalysis** New Paltz, NY
Contact: Dr. A.V. Patsis, The Inst. of Mats. Sci., SUNY, New Paltz, NY
12561, (9194) 255-0757 or FAX: (914) 255-0978, e-mail:
inquiries@ims-np.org

**[Electron Microscopy Courses]{.underline}**

**[Department of Material Sciences, Lehigh University - Microscopy
School]{.underline}**

**Scanning EM and X-Ray Microanalysis June 12-16, 2000**

**Advanced Scanning EM with Digital Imaging June 19-22, 2000**

**Quantitative X-ray Microanalysis June 19-23, 2000**

**Other Microscopy courses listed in current catalog for June 11-23,
2000 -- contact Lehigh University Microscopy School for details**

**San Joaquin Delta College EM Courses**

**Australian Key Centre for Microscopy and Microanalysis at the
University of Sydney\
Many courses at various dates**

EDS and WDS Microanalysis

**Department of Material Sciences, Lehigh University - Microscopy
School**

**Small World introduces a new one day EDS course. Check out our web
site for more information:**

**[Australian Key Centre for Microscopy and Microanalysis]{.underline}
at the University of Sydney\
Many courses at various dates**

**[Moran Scientific]{.underline}, kmoran@goulburn.net.au, P.O. Box 651
Goulburn N.S.W. 2580 Australia, phone: 61 24844 4234**

**[LOM/AFM/SEM/TEM Specimen Preparation Workshops]{.underline} - contact
AMC Group, 7620 E. McKellips Rd. No 4109, Scottsdale, AZ 85257-4600 for
schedule & locations.**

[**Optical Microscopy & Imaging in the Biomedical**
**Sciences**]{.underline} (October 11 -- 19, 2000) application deadline
August 1, 2000\
Contact: Carol Hamel, Admissions Coordinator\
Marine Biological Laboratory\
7 MBL Street, Woods Hole, MA 02543-1015\
(508) 289-7401 e-mail: admissions@mbl.edu

**[Microscopy Technology Center]{.underline}**, San Joaquin Delta
College, 5151 Pacific Avenue, Stockton, CA 95207 (209) 474-5284 FAX:
(209) 474-5600 e-mail: murphy@ms.sjdccd.cc.ca.us

**[Madison Area Technical College]{.underline} - Electron Microscopy
Program**, 3550 Anderson Street, Madison Wisconsin 53704, Glenn Boda
(608) 246-6254 Michael Kostrna (608) 246-6762