Human pathology最新文献

Endometrial gastric (gastrointestinal)-type mucinous adenocarcinoma (EGMA) is a rare histologic subtype of endometrial carcinoma that is challenging to recognize as a distinct entity. Mucinous differentiation has been observed in endometrial carcinomas since the 1980s. However, the definitive characterization of endometrial carcinomas with mucinous differentiation has been unclear in the past. Since its formal inclusion in the latest 5th edition of the World Health Organization (WHO) Classification of Female Genital Tumors, and with increasing awareness of this rare entity, more case reports and studies on EGMAs have emerged in the recent years. Some studies sought to understand the expression of gastrointestinal immunohistochemical markers in neoplastic and/or normal endometrium, while others performed comprehensive clinicopathologic characterization of EGMAs, including their molecular characteristics. However, there still exist challenges in the diagnosis of EGMA, with considerable overlaps in morphologic features and immunohistochemical phenotype existing between EGMAs and the other differential diagnoses. This review sought to summarize the known clinical presentation, radiological findings and pathologic features of EGMA to date. We also discuss in detail the salient differential diagnoses to consider, and evaluate the utility of immunohistochemistry in the workup of this entity.

Resections from the mobile tongue, the oropharynx and neck dissections constitute a large proportion of routine head and neck pathology workload. Histologically detected proximity to margins and prognostic factors like depth of invasion, perineural or lymphovascular invasion, or extranodal extension guide adjuvant radiotherapy and/or chemotherapy. This review discusses practical approaches to macroscopic examination of the various types of tongue and oropharyngeal resections and neck dissections. Differential inking and radial sections demonstrate proximity of tumour to margins. The macroscopic examination and sampling should then be directed towards identifying remaining adverse prognostic features including the maximum extent of invasion at the primary site and extranodal extension, nodal matting or soft tissue deposits in the neck dissections. The diagnostic challenges differ in the tongue and oropharynx. The diagnosis of tongue SCC is relatively easy, however, precursor oral epithelial dysplasia can be challenging. Architectural and cytologic clues assisting in identifying dysplasia and practical clues distinguishing it from reactive changes are discussed. In contrast, dysplasia is not diagnosed in the oropharynx. p16 immunostaining and detection of human papillomavirus (HPV) play a critical role in the diagnosis and prognosis of oropharyngeal SCC. Nuances in the implementation and interpretation of p16 immunostaining and HPV assays are discussed.

Diagnostic pathology of the upper gastrointestinal tract continues to evolve as molecular insights, clinical practices, and updated international standards improve our understanding of disease. The World Health Organization (WHO) classification of digestive system tumors, now in its 6th edition, includes several important changes, including incorporating esophageal epidermoid metaplasia as a separate section, and modifying the approach to metaplastic and dysplastic gastric lesions. These updates reflect a broader trend toward simplified terminology, clearer definitions of precursor lesions, and more consistent grading systems across the digestive tract. At the same time, increased use of immunotherapy has introduced new patterns of injury. Beyond immune checkpoint inhibitors, several agents, including rituximab and chimeric antigen receptor T-cell therapy have been associated with distinctive upper-GI mucosal alterations that can resemble infectious or immunologic diseases. Failure to recognize these patterns of injury can carry significant clinical implications, including treatment delay or discontinuation, and require careful histologic evaluation to avoid misclassification. This review summarizes select upper-GI updates from the 6th edition of the WHO classification and outlines emerging therapy-related injuries with a focus on rituximab- and CAR-T-associated changes. The aim is to provide a practical and contemporary guide for pathologists navigating these evolving diagnostic challenges.

The field of central nervous system (CNS) tumor diagnostics continues to evolve and expand with the emergence and integration of diagnostic, prognostic, and predictive genomic markers. Despite such ever-increasing complexity, it remains within the ability of practicing surgical pathologists to perform an informed assessment of a majority of CNS tumors. In this review, we provide practical guidelines to evaluate the most common primary malignant and benign CNS tumor entities - high-grade diffuse glioma and meningioma.

In last few decades our understanding of bone and soft tissue tumors has evolved significantly, expanding and clarifying our current classification system. Due largely to increased utilization of ancillary testing, particularly molecular tools, new entities are continually emerging and/or being further refined. In addition to morphological and molecular differences, in many instances, the recognition of a new entity carries significant prognostic and potentially therapeutic relevance. In this review on practice updates, we endeavor to discuss five recently described tumors including pseudoendocrine sarcoma, NUT-rearranged sarcoma, VGLL3-rearranged spindle cell rhabdomyosarcoma of head and neck, superficial neurocristic FET::ETS fusion tumors, and NFATC1/2-rearranged epithelioid vascular tumors.