Diagnostic Pathology最新文献

Presently, pathologists need to stain biopsy samples with standard and antibody-based immunocytochemistry (ICC) reagents for final diagnosis. Antibody reagents take hours to days to perform staining, along with requiring specialized equipment and technical skills. We have developed an AI-based virtual ICC platform that measures individual cell morphological features in whole slide images and labels the cells as immuno-positive or negative. The platform runs on the cloud in minutes, saving pathologists significant time and cost. For this purpose, cytopathology slides were obtained from N = 100 suspected cases of canine T-cell and B-cell lymph node lymphomas through Fine Needle Aspiration (FNA). Cytopathology slides were initially stained with the standard Wright-Giemsa (WG) and then re-stained with ICC reagents, anti-CD3 or anti-PAX5 antibodies, resulting in a pair of stained slides (WG-CD3 or WG-PAX5). Prior to AI training, cytopathology slides were digitally scanned, and the resulting images underwent a comprehensive pre-processing protocol to separate stains of interest for nuclei segmentation in WG and CD3 or PAX5. Following nuclei segmentation, the cell features from processed image pairs were translated into a structured tabular features format with immuno-positive and negative labeled classes. In total, the geometrical features of 8.48 million segmented cells (4.24 million pairs) were translated into a tabular format and paired based on the Euclidean cell matching algorithm. This approach facilitated the prediction of cell labels, achieving sensitivity and specificity of 0.98 and 0.97 (0.94 and 0.99), respectively for CD3 (PAX5). Additionally, the AI-based virtual ICC has demonstrated capabilities in cell counting, cell spatial distribution, cell segmentation, and classification. It offers a rapid, accurate, and precise evaluation of FNA samples and has the potential to help advance diagnostic cellular and molecular pathology capabilities.

This manuscript presents a manifesto developed by a multifaceted board of stakeholders aimed at guiding the implementation of Digital Twin (DT) technology in pathology laboratories. DTs, already transformative in other sectors, hold substantial promise for enhancing operational efficiency, diagnostic accuracy, and quality of care in pathology. We provide a comparative analysis of traditional versus DT-enhanced workflows across critical steps including accessioning, grossing, processing, embedding, cutting, staining, scanning, diagnosis, and archiving. The framework highlights measurable gains such as up to 90% reduction in labeling errors, 20-30% improvements in slide quality, and 30-50% reductions in diagnostic turnaround time. Alongside these benefits, we address key implementation challenges including upfront infrastructure costs, workforce adaptation, and data security concerns. A practical, phased deployment strategy is proposed-centered on LIS integration, IoT sensors, AI modules, and robust data governance. Estimated setup costs for a medium-sized laboratory range between USD 100,000 and USD 200,000, with a phased rollout timeline of 12-24 months. Supporting technologies like robotic process automation (RPA), collaborative robotics, and edge computing are also discussed as enablers of successful DT adoption. The manifesto closes by identifying critical research gaps, including the need for longitudinal studies evaluating DTs' clinical and economic impacts, integration within existing hospital IT systems, and ethical implications of AI-assisted diagnostics. Through this collective vision, we provide a realistic and actionable roadmap to drive the transition toward predictive, efficient, and digitally optimized pathology laboratories.

Objective: This study aimed to evaluate the value of cancer-associated fibroblasts (CAFs) that positively express α-smooth muscle actin (α-SMA) and fibroblast activation protein (FAP) as survival indicators for patients with extrahepatic cholangiocarcinoma (eCCA).

Methods: The clinicopathological data of eCCA patients who underwent surgical treatment in Tianjin Nankai Hospital from January 1, 2019, to December 31, 2022, were retrospectively analysed. A total of 79 patients were included, 49 were male and 30 were female, with an age of (64.3 ± 8.3) years. Clinicopathological data such as age, gender, tumour location, lymph node metastasis, tumour differentiation degree, and TNM stage of the patients were recorded. The expressions of α-SMA and FAP, the markers of CAFs, in eCCA were detected by immunohistochemistry. The relationships between the expressions of the two proteins and the clinicopathological data and prognosis of the patients were analysed.

Results: The positive expressions of α-SMA and FAP in CAFs were observed in 78.5% (62/79) and 35.4% (28/79) of the patients, respectively. There was a highly positive correlation between the expression of α-SMA and that of FAP (r = 0.992, P < 0.001). Univariate analysis showed that CAFs with positive FAP expression and tumour location were statistically significant in terms of overall survival time and recurrence-free survival time. Multivariate analysis indicated that positive FAP expression and tumour location might be independent factors affecting overall survival time and recurrence-free survival time.

Conclusions: CAFs with positive FAP expression may be a prognostic indicator of poor postoperative survival in eCCA patients and may serve as an independent predictor of poor postoperative survival rate in these patients.

Background: Skin cutaneous melanoma (SKCM) is one of the highly malignant tumor. This study aimed to investigate the expression levels of MTHFD1L in cutaneous melanoma and to uncover its potential biological significance.

Methods: This investigation employed the TCGA-SKCM dataset along with combined GSE15605 and GSE19234 datasets to analyze MTHFD1L expression patterns. Comprehensive bioinformatics analyses were conducted, including GO and KEGG pathway enrichment analyses, protein-protein interaction network construction, and evaluation of the relationship between MTHFD1L expression and immune infiltration. Prognostic significance was assessed using the GEPIA2 database. Experimental validation involved: (1) RT-qPCR, Western blot, and IHC staining to compare MTHFD1L expression between SKCM and normal tissues; (2) establishment of MTHFD1L knockdown models in A375 and 2058 cell lines for functional characterization.

Results: The MTHFD1L level was increasing in SKCM tissues from GSE15605/GSE19234 and TCGA-SKCM, and high MTHFD1L expression correlated with poor overall survival. The RT-qPCR, Western blot and IHC confirmed the accuracy of bioinformatics. Knockdown of MTHFD1L significantly inhibited proliferation, migration, invasion, and clonogenic ability in A375 and A2058 melanoma cells, potentially through regulation of the TGF-β/SMAD signaling pathway.

Conclusion: MTHFD1L is a potential biomarker in cutaneous melanoma, and could potentially serve as a therapeutic target for SKCM.

Introduction: Pyodermatitis-pyostomatitis vegetans (PPV) is a rare inflammatory mucocutaneous dermatosis of unknown etiology. It is characterized by the appearance of vesicles, pustules, vegetating plaques, and erythematous lesions, often associated with underlying inflammatory bowel diseases such as Crohn's disease.

Objective: To report a case of vegetative pyostomatitis in a patient with Crohn's disease, focusing on the diagnostic process and therapeutic approach.

Case report: A 47-year-old female patient, identified as AMSP, with a known diagnosis of Crohn's disease and a history of colostomy, presented with complaints of lesions affecting both the skin and oral mucosa. Dermatological examination revealed a well-defined, flat, round lesion with darkened borders in the right axillary region. Intraoral examination showed erythematous, net-like plaques along the lateral border of the tongue, accompanied by ulcerations and vesicles. An incisional biopsy of the tongue was performed. Histopathological analysis revealed a predominantly eosinophilic inflammatory infiltrate in the connective tissue and epithelial acantholysis. The clinical presentation, patient history, and histopathological findings led to the diagnosis of pyodermatitis-pyostomatitis vegetans. The patient was treated with topical 0.1% tacrolimus ointment applied twice daily for 15 days. Following this intervention, there was complete resolution of the lesions.

Conclusion: Pyodermatitis-pyostomatitis vegetans is an uncommon condition that may serve as an oral and cutaneous manifestation of Crohn's disease. The presence of vegetating plaques on the skin and vesiculopustular lesions in the oral cavity should raise clinical suspicion. Histopathological examination via biopsy remains the gold standard for definitive diagnosis. Treatment is typically straightforward, with an excellent prognosis when managed appropriately.

Background: Oral squamous cell carcinoma (OSCC) is associated with poor prognosis due to extensive local invasiveness and lymph node metastasis, often leading to a significant decrease in aesthetics and function after surgery. Therefore, elucidation of the molecular mechanisms underlying OSCC is necessary for its early detection and treatment. N6-methyladenosine (m6A) modification of mRNA is the most common form of post-transcriptional RNA methylation and is often involved in the progression of cancer by regulating the expression of various genes. Recent studies reported the tumor-promoting effects of vir-like m6A methyltransferase associated (VIRMA, also termed KIAA1429), a novel molecule involved in m6A modification; however, its role in OSCC remains poorly understood.

Methods: In the present study, we determined the total m6A levels and VIRMA expression in OSCC using immunohistochemistry of tissue specimens and evaluated their association with clinicopathologic characteristics. We also performed gene expression analysis of VIRMA/KIAA1429 using public datasets.

Results: We found that the m6A levels were significantly higher in the OSCC specimens of patients with a more advanced clinical stage (P = 0.0063), lymph node metastasis (P = 0.0323), and venous invasion (P = 0.0380) compared to those without. The analysis of the public datasets revealed that VIRMA/KIAA1429 expression levels were higher in head and neck SCC than in normal mucosa, whereas immunohistochemistry revealed that VIRMA-expressing OSCC was associated with a significantly shorter disease-free survival (P = 0.0043) and was an independent poor prognostic factor (P = 0.0179).

Conclusions: These results highlight the potential utility of RNA methylation and VIRMA expression for the diagnosis and treatment of OSCC.

Introduction: Squamous cell carcinoma (SCC) is the most common type of penile cancer, and infection with human papillomavirus (HPV) is one of the most highly associated risk factors. The WHO classification for penile SCC (2022) strongly recommends and advocates penile SCC to be reported as HPV-associated or HPV-independent type in pathology reports. Further, p16 immunohistochemistry (IHC) is recommended to classify SCC into the above major types, although it is not completely reliable for HPV infection. Although there are no established differences in the prognosis or treatment between HPV-associated and HPV-independent penile tumours, there is recent evidence to suggest that HPV-associated SCC may respond better to radiation therapy, immunotherapy, etc. AIM AND OBJECTIVES: This study aims to = analyse the clinicopathological features of penile squamous cell carcinoma and reclassify penile SCC into HPV-associated and HPV-independent types to align with the WHO classification of penile carcinoma (2022) and study the expression of p16 by immunohistochemistry. Additionally, we studied the prognostic significance of HPV-associated and independent SCC based on histology and p16 immunostaining.

Materials and methods: This is a five-year retrospective single-institution study that included all diagnosed cases of penile SCC. Clinicopathological features and p16 expressions were studied and analysed.

Results: A total of 72 cases of penile SCC were included during the study period. The mean age of occurrence of penile SCC was 58 years. The most common site of the tumor was the glans penis (50.74%). We encountered only 6 cases (8.3%) of HPV-associated type of penile SCC, while the majority belonged to the HPV-independent type (91.7%) based on histology. p16 immunohistochemistry showed positivity in 15 cases (21%) and negativity in 57 cases (79%). Most of the tumors showed favorable features- histological grade I, pathological T1 stage with a low incidence of nodal metastasis. There was a strong association between histological subtyping into HPV-associated and independent SCC with p16 IHC expression (p = 0.015). Classification of penile SCC by histology and p16 expression into HPV associated and independent type showed no prognostic significance with pathological stage but was significant with histological grade and lymph node metastasis.

Background: Glaucoma is a major eye disease that causes blindness. The loss of retinal ganglion cells (RGCs) due to mitophagy impairment is a key driver of glaucoma. SHMT2 depletion leads to an increase in reactive oxygen species (ROS), but its role in regulating mitophagy remains unclear. This study aims to investigate the mechanism by which SHMT2 contributes to glaucoma through the regulation of RGC mitophagy.

Methods: The role of SHMT2 in glaucoma was evaluated through hematoxylin and eosin (H&E) staining and immunofluorescence (IF) staining of acute ocular hypertension (AOH) mouse eyeballs. Mitophagy was assessed by measuring LDH release, apoptosis, mitochondrial membrane potential, lipid ROS, and the protein levels of mitophagy-related proteins in RGCs. The underlying mechanism was investigated using co-immunoprecipitation, IF staining, and Western blot analysis.

Results: Results showed that SHMT2 expression was decreased in the AOH mouse model. NMDA inhibited mitophagy in RGCs, which was restored by SHMT2 overexpression. Moreover, SHMT2 overexpression stabilized PINK1 expression by enhancing the phosphorylation of PINK1. In vivo experiments suggested that SHMT2 overexpression increased the thickness of the retinal ganglion cell-inner plexiform layer.

Conclusion: This study confirmed that SHMT2 overexpression alleviated glaucoma by enhancing mitophagy in RGCs through the upregulation of PINK1 phosphorylation, suggesting that SHMT2 may serve as a potential therapeutic target for glaucoma.

Background: Primary intra-articular synovial sarcoma is a rare condition that is frequently misdiagnosed due to its indolent growth pattern and similarity to other common joint disorders.

Case presentation: A 48-year-old Chinese woman presented with a 3-year history of recurrent pain and limited mobility in her left ankle. She had previously been misdiagnosed with conditions such as ankle sprain, synovitis, or tarsal sinus syndrome. After undergoing arthroscopic synovectomy, pathological examination confirmed the diagnosis of synovial sarcoma.

Conclusion: Primary intra-articular synovial sarcoma is an exceedingly rare and often misdiagnosed condition. It's slow growth and clinical overlap with other joint pathologies contribute to diagnostic challenges. Accurate diagnosis relies on comprehensive evaluation, particularly when clinical manifestations deviate from typical presentations. A high index of suspicion and thorough pathological assessment are essential for timely and accurate diagnosis.