International Journal of Surgical Pathology最新文献

IntroductionIn the era of increasing prostate needle core biopsy (PNCB) burden with extended core and MRI-guided biopsies, recommendations are limited on how many histologic levels are needed to identify prostate cancer parameters. Many institutions, including ours, have utilized up to 6 levels. Our quality improvement study evaluates undetected prostate cancer parameters and cost/time savings when reducing to 3 levels.MethodsFifty-eight PNCB series (204 individual PNCB) with prostate cancer were identified from 74 consecutive series (614 individual PNCB). Six levels placed on 2 slides were reviewed. Detection of prostate cancer, secondary Gleason patterns, extraprostatic extension, perineural invasion, and atypical small acinar proliferation (ASAP) were compared between the original 6 levels and a simulated reduction to 3 levels using 3 methods: 1) 3-level spanning most of the tissue block, 2) 3-level spanning the superficial block, and 3) 3-level spanning the deep block. Laboratory costs and microtomy/embedding time data were analyzed to determine savings following change to a 3-level protocol.ResultsThe simulated 3-level method spanning most of the block identified all cancer foci and parameters originally detected with 6 levels, except one focus of ASAP (N = 13). Small cancer foci (< 1 mm) and associated parameters were occasionally undetected when only 3 superficial or deep levels were reviewed. Switching to a 3-level cutting protocol saved $9134 over 6 months and reduced microtomy/embedding time by 9.7 min per 12-part PNCB series.ConclusionAt our institution, evaluating 3 levels spanning most of the block conserves resources while adequately detecting prostate cancer parameters.

Epithelioid angiosarcoma of the bladder is an exceptionally rare and aggressive vascular malignancy, characterized by a poor prognosis due to its high propensity for invasion and metastasis. Due to its rarity, the diagnosis is often challenging and may be misinterpreted as other high-grade malignancies. Patients commonly present with advanced-stage disease, including muscle invasion at the time of diagnosis, leading to unfavorable clinical outcomes. We report a 73-year-old male patient with a history of metastatic colon cancer (to the cervical lymph node) who presented with gross hematuria. Imaging and cystoscopy evaluation revealed a mobile bladder mass with possible right anterior bladder wall thickening and necrotic tissue. Transurethral resection of the bladder tumor performed outside was initially interpreted as muscle-invasive poorly differentiated carcinoma with sarcomatoid differentiation. Upon reviewing the slides at our institution, the diagnosis was revised to epithelioid angiosarcoma of the bladder. Despite an aggressive multimodal therapeutic approach, including chemotherapy and radical prostatectomy, the patient's clinical condition progressively worsened, ultimately leading to mortality 11 months post-diagnosis. This case report highlights the diagnostic challenges and aggressive nature of epithelioid angiosarcoma of the bladder, emphasizing the need for early detection and exploration of novel therapeutic strategies to improve patient outcomes.

Phyllodes tumors are fibroepithelial neoplasms most commonly found in the breast, and their occurrence in the anogenital region-especially in male patients-is exceedingly rare. We describe a man who presented with a localized mass in the anal region. The lesion was excised, and gross examination revealed the characteristic leaf-like clefts typical of phyllodes tumors. Histopathological analysis demonstrated a biphasic morphology, composed of epithelial and stromal components. Immunohistochemical staining showed positivity for estrogen receptor, GATA3, and mammaglobin in the epithelial component, while the stromal component was positive for CD34. This rare tumor highlights that phyllodes tumors can occur in the anogenital region of men and emphasizes the importance of distinguishing them from other anal tumors. Long-term follow-up is recommended after resection.

Bizarre, reactive fibroblastic proliferations associated with localized lymphedema may arise with chronic condom catheter use. We report a unique presentation of innumerable, cutaneous nodules occurring in chronic lymphedema of the right lower extremity due to remote pelvic lymph node dissection and radiation therapy for squamous carcinoma of the uterine cervix. Histologically, the cutaneous nodules consisted of several bizarre, enlarged polygonal to stellate, multinucleated fibroblasts having variably vacuolated cytoplasm in a background of markedly edematous dermis with prominent vascular ectasia. Nuclear hyperchromasia, scattered mitotic figures and pleomorphism in the context of chronic lymphedema led to an original diagnosis of malignancy. However, on histologic re-review, close correlation with imaging studies revealed complete continuity of massive subcutaneous lymphedema with the overlying skin nodules. The presence of diffuse reactive changes of edema and ectasia associated with multinucleated fibroblasts enables recognition of this pseudosarcomatous lesion. To our knowledge, this is the first report of extreme, multiple, cutaneous polypoid lesions comprising bizarre fibroblasts that simulate sarcoma and occur in the setting of chronic lymphedema. Awareness of this entity is critical, as it is easily misdiagnosed as sarcoma complicating lymphedema. We propose the descriptive term florid pseudosarcomatous polypoid fibroplasia for such extreme lesions.

The use of endoscopic ultrasound-guided fine needle liver biopsy (EUS-FNLB) has been rising. However, limited data are available comparing the quality of biopsy specimens obtained via EUS-FNLB with those from traditional methods, such as percutaneous liver biopsy (PC-LB) and transjugular liver biopsy (TJ-LB). We sought to assess the microscopic quality of liver biopsy specimens obtained through EUS-FNLB compared to PC-LB and TJ-LB.A retrospective, cross-sectional study was conducted on liver biopsy specimens collected via EUS-FNLB, PC-LB, and TJ-LB at our institution between April 2022 and August 2024. Demographic, clinical, and histopathologic data were extracted from medical records and pathology reports. Specimen quality was assessed using the American Association for the Study of Liver Diseases criteria for adequate biopsy length and portal tract count (≥2 cm and ≥11 portal tracts), as well as the presence of fragmentation and the overall tissue yield.A total of 160 patients were included, with 85 EUS-FNLB, 50 PC-LB, and 25 TJ-LB. EUS-FNLB demonstrated the greatest median aggregate length (3.5 cm) and the highest median number of complete portal tracts (CPT) (18 CPT) compared to PC-LB (1.9 cm; 13 CPT) and TJ-LB (2.4 cm; 12 CPT). Although EUS-FNLB showed the highest rate of tissue fragmentation (62%), this approach still led to an adequate diagnosis in 99% of patients.EUS-FNLB may provide superior specimen quality in terms of aggregate length and CPT count compared to PC-LB and TJ-LB, although it results in a higher degree of tissue fragmentation.

Tumors characterized by BCOR abnormalities occur in diverse body sites and rarely in the bone and soft tissues, in the form of BCOR::CCNB3 sarcomas and BCOR-ITD sarcomas, mostly in the pediatric patients. A 35-year-old male patient presented with pain in his right thigh and fullness in his right abdomen. Radiological imaging disclosed a large mass lesion measuring 7 cm × 8.4 cm × 12.3 cm in the right lower abdomen, involving the iliac bone and adjacent muscles. Histopathological examination of the biopsy revealed a tumor comprising oval to spindle cells arranged in interlacing fascicles and focal palisades with interspersed mitotic figures and distinct areas of fibromyxoid stroma exhibiting focal hyalinization in some places. By immunohistochemistry, the tumor cells were diffusely, intensely positive for BCOR, significantly positive for cyclin D1, weakly and patchily for TLE1, and also for SATB2. Furthermore, fluorescence in-situ hybridization for BCOR rearrangement revealed negative results, while comprehensive genetic testing, as well as Sanger sequencing, revealed BCOR-ITD exon 15 mutation (inframe_90). This constitutes an extremely rare BCOR-ITD sarcoma, in an adult male patient. The various differential diagnoses and the value of high-throughput molecular testing to uncover these rare tumors are discussed herewith.

In pathology (surgical pathology/cytopathology) specimens, Aspergillus species can be challenging to differentiate from other fungi that produce hyaline septate hyphae by morphology alone. It has been suggested that fruiting bodies-if present-indicate Aspergillus. The aim of this study was to determine whether the presence of fruiting bodies in pathology specimens is specific for Aspergillus. Specimens containing fungal hyphae with fruiting bodies were identified and fungal culture and PCR results were reviewed to determine the identity of the fungi. To determine whether fruiting bodies can be formed in tissue by other fungi, non-Aspergillus fungi were included for analysis if cultures or PCR confirmed a non-Aspergillus fungus. Fruiting bodies were present in specimens from 13 patients (12 surgical pathology, 1 cytology). In 11/13, the identity of the fungus was confirmed (10 Aspergillus fumigatus, 1 Rhizopus species). In 6/13, A. fumigatus was confirmed by microbiologic cultures. In 4/13, A. fumigatus was confirmed by PCR on formalin-fixed paraffin-embedded tissue. In 2/13 specimens, cultures/PCR were not performed. The one Rhizopus sp. was confirmed by culture. In most (10/13) specimens, fruiting bodies of Aspergillus consisted of yellow vesicles containing a row of radiating phialides, occasional stalks/conidiophores and detached yellow conidia (spores) in the background. In contrast, fruiting bodies of the Rhizopus sp. were sporangia (large spore-containing sacs) lacking phialides. To evaluate fruiting bodies in non-Aspergillus fungi, 18 specimens were identified with hyphal structures in tissue with available microbiologic culture or PCR results. No fruiting bodies were identified in the 18 non-Aspergillus fungal infections (11 Fusarium, 6 Mucorales order genera, 1 Acrophialophora). In pathology specimens, fruiting bodies with the morphologic features described in this study (conidiophores with yellow-brown vesicles, attached phialides, detached yellow conidia) are specific for Aspergillus and can be differentiated from Rhizopus, whose fruiting bodies feature sporangia (large spore-containing sacs lacking phialides).

Nonsebaceous lymphadenoma-like mucoepidermoid carcinoma (NSLA-like MEC) is an exceedingly rare subtype of MEC. We present such a tumor in a 65-year-old woman with a 2-year history of a left parotid mass. Histologically, the tumor was characterized by a proliferation of neoplastic epithelial cells within a prominent lymphoid stroma containing germinal centers. The epithelial component displayed a bilayered or multitiered growth pattern composed of inner cuboidal cells and outer basaloid cells, forming tubules, microcysts, and complex glandular and cribriform structures. Immunohistochemically, the outer basaloid cells were positive for P63 but were negative for S100 and SMA, while the inner cuboidal cells were positive for keratin 7. Mucicarmine stain demonstrated intracytoplasmic mucin in a small percentage (<1%) of epithelial cells. Fluorescence in situ hybridization analysis revealed CRTC1::MAML2 fusion in 78% of tumor cells, confirming the diagnosis of MEC. The morphological distinction between NSLA-like MEC and NSLA poses a significant diagnostic challenge. Features suggestive of MEC include complex branched glandular structures and subtle cytologic atypia. We emphasize the importance of incorporating MAML2 molecular testing into diagnostic algorithms for accurate classification, particularly in challenging lesions with lymphoid-rich stroma.

BackgroundThoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a rare neoplastic entity classified in the 2021 World Health Organization Classification of Thoracic Tumors. Due to its rarity, challenges remain in achieving accurate diagnosis, determining optimal therapeutic strategies, and assessing prognosis.Patient PresentationAn elderly heavy smoker was admitted due to the rapid growth of a solid tumor in the right lower lobe. Histopathological examination revealed undifferentiated, epithelioid morphology. Immunohistochemistry demonstrated diffuse positivity for SOX2, alongside loss of expression of brahma-related gene 1 (BRG1) and brahma (BRM). Next-generation sequencing identified a nonsense mutation in SMARCA4 (c.2196T > G, p.Y732Ter), with wild-type status for SMARCA2. The tumor was staged as T1N2M0 (stage IIIA), exhibiting a programmed death-ligand 1 tumor proportion score of 2%, a tumor mutational burden of 16.3 mutations per megabase (Mb), and microsatellite stability. The patient received neoadjuvant chemo-immunotherapy followed by right lower lobectomy, resulting in a complete pathological response with ypT0N0Mx status. Subsequently, 5 cycles of adjuvant chemo-immunotherapy were administered. Throughout a 38-month follow-up period, neither computed tomography imaging nor minimal residual disease assessments indicated evidence of recurrence or metastasis.ConclusionThe diagnosis of SMARCA4-UT requires the co-loss of BRG1 and BRM expression, characteristic histological features, and the exclusion of other SMARCA4-deficient thoracic malignancies. This tumor exhibits aggressive clinical behavior, limited availability of targeted therapeutic options, and only modest responses to conventional chemotherapy. The present report underscores the potential efficacy of immune checkpoint inhibitors as a viable treatment modality for SMARCA4-UT.