Journal of Clinical Pathology最新文献

Helicobacter pylori is a well-established cause of gastritis and gastric malignancy, but other Helicobacter species-collectively termed non-Helicobacter pylori Helicobacter (NHPH)-also contribute to gastric disease. This study retrospectively analysed the prevalence of NHPH in 1115 routine gastric biopsies from a large academic medical centre submitted for H. pylori drug susceptibility genotyping using a next-generation sequencing (NGS) assay targeting 16S and 23S rRNA genes. NGS results of identified pathogens were compared against those identified on histology. NHPH species were detected in 15 of 1115 cases (1.3%), including 7 NHPH-only infections and 8 mixed infections with H. pylori Detected NHPH species included Helicobacter heilmannii, Helicobacter felis and Helicobacter bizzozeronii No mutations associated with antimicrobial resistance were identified in NHPH. Broader molecular testing may improve recognition of mixed infections and guide more accurate diagnosis and treatment for gastric disease.

Background: Current guidelines emphasise examining at least 12 lymph nodes (LN) in colorectal cancer resections. This study surveyed surgeon perspectives on suboptimal LN yield (<12) to assess interpretive variability and beliefs regarding its clinical impact.

Methods: A voluntary 19-question electronic survey was distributed to colorectal and general surgeons, exploring clinical, pathological and molecular considerations in cases with low LN yield.

Results: Among 168 respondents (58% colorectal surgeons; 32% general surgeons), most practised in academic or mixed settings, and 73% had over 10 years of experience. While 71% reported suboptimal LN yields as infrequent, 29% encountered them more regularly. A majority (92%) contacted pathology when LN yield was low; however, opinions diverged on next steps-particularly when maximum N-stage was already achieved or when considering total fat submission. Nearly half (49%) believed that low LN yield rarely alters treatment decisions, yet many acknowledged its association with poorer outcomes. Regarding potential contributing factors, 56% cited neoadjuvant therapy, 47% noted specimen length or sidedness, but most did not consider mismatch repair status, age or body mass index to significantly impact LN yield.

Conclusion: Despite the '12-node rule', surgeon perspectives vary regarding the significance, aetiology and clinical consequences of suboptimal LN yield. The overarching message for pathology is that thoughtful communication among surgeons and pathologists is critical to understand the idiosyncrasies around individualised care and nuances around factors that may influence LN yield, with the ultimate hope to best manage resources and optimise patient care.

Aims: Colorectal cancer (CRC) is the third most common malignancy worldwide. Accurate pathological diagnosis and predictive abilities for treatment response and prognosis are crucial for patients with CRC. This study aims to analyse the expressions of p21 and EGFR in CRC and their relationships with clinicopathological characteristics and prognosis to enhance diagnostic and prognostic evaluations.

Methods: This study conducted a retrospective analysis of p21 and EGFR expressions in 12 319 Chinese patients with CRC using immunohistochemistry. The relationships between these expressions and clinicopathological characteristics and survival outcomes were explored through statistical and survival analyses.

Results: Differential expressions of p21 and EGFR in CRC were closely related to clinicopathological characteristics and significantly impacted overall survival (OS). p21 expression was associated with the primary tumour site, mucinous subtype, lymphovascular invasion, perineural invasion, circumferential resection margin, T stage, N stage, tumour, node, metastases (TNM) stage, and mismatch repair status. EGFR expression was related to mucinous subtype, tumour differentiation, lymphovascular invasion, perineural invasion, tumour size, T stage, N stage, TNM stage and BRAF gene mutation. p21 and EGFR expressions were positively correlated (r=0.11). High p21 expression correlated with favourable OS, whereas high EGFR expression predicted poorer OS. A prognostic nomogram incorporating these biomarkers and clinical variables demonstrated robust predictive power for patient survival rates.

Conclusion: p21 and EGFR serve as potential indicators for pathological diagnosis, risk stratification, and predicting treatment efficacy and prognosis in patients with CRC. The study's findings provide valuable references for personalised treatment and prognosis evaluation in clinical practice.

Background: Diagnosing paediatric Crohn's disease (CD) based on histology can present challenges. We evaluate the histological spectrum of treatment-naïve biopsies from children with CD and assess these findings' diagnostic and predictive value.

Methods: Three cohorts were identified: (1) 137 patients with CD, (2) 116 patients with ulcerative colitis (UC) and (3) 50 patients without inflammatory bowel disease. Biopsies from the gastrointestinal (GI) tract were re-examined for signs of active and chronic inflammation, including lymphocyte-pattern oesophagitis, focal enhancing gastritis and indicators of chronicity. Additionally, granulomas and microgranulomas (defined as clusters of 4-9 epithelioid histiocytes) were evaluated.

Results: Lymphocyte-pattern oesophagitis was observed in 15% of patients (n=20). Moderate-to-severe diffuse gastritis was noted in 50.4% of patients (n=68), while focal enhancing gastritis was identified in 11.1% (n=15). In terminal ileal biopsies, 46.1% exhibited activity and 5.3% showed features of chronicity. Active colitis was present in 73% of patients (n=100), with chronic colitis seen in 11.7% (n=16). Granulomas and microgranulomas were observed in 31.4% (43/137) and 48.9% (67/137) of patients, respectively. Notably, 30.7% (42/137) of patients with microgranulomas were without granulomas. Previously undetected microgranulomas were found in 20 of 27 cases. 2.5% of patients with UC and none of the control cohort showed microgranulomas. Lymphocyte-pattern oesophagitis was associated with an increased need for anti-tumor necrosis factor (TNF) therapy (p=0.007).

Conclusions: GI microgranulomas, often overlooked, are specific to CD in the proper clinical context. Oesophageal lymphocytosis may predict a need for more aggressive treatment. The study brings to light under-recognised aspects of CD's histological diagnosis, including the oversight of microgranulomas, the high prevalence of diffuse gastritis and low prevalence of focal enhancing gastritis, the frequent absence of terminal ileitis and the infrequent occurrence of chronic colitis.

Aims: In the end-to-end digital pathology workflow, variability can be introduced at each step, resulting in differences in the final image dataset. The effectiveness of quality control processes at each step of the workflow will impact the extent and relevance of this variability.

Methods: To assess the maturity of whole slide imaging (WSI) quality processes for the whole digital pathology workflow, we conducted an online questionnaire across 19 digitally active members of the Bigpicture consortium.

Results: A key finding was that a lower proportion of centres are implementing rigorous quality processes and checks processes at the post-scanning steps of the WSI workflow, such as 'digital reporting and display' (44%) and computational analysis (34%), when compared with pre-scanning steps such as 'pre-staining' (72%) and 'staining' (77%).

Conclusions: This information allows us to identify priorities for quality improvement of the overall WSI workflow.

Aims: The aim of this research is to diagnose polycythaemia vera (PV) disease using different machine learning (ML) algorithms with complete blood count (CBC) parameters before further investigations such as Janus kinase 2 (JAK2), erythropoietin (EPO) and bone marrow biopsy (BMB).

Methods: The study included 1484 patients who presented to the adult haematology clinic with elevated haemoglobin. Participants were retrospectively screened for JAK2, EPO and BMB results, and patients were categorised as PV group (n=82) and non-PV (other) (n=1402). First, the synthetic minority oversampling technique (SMOTE) method was used to avoid data imbalance. Then, classification predictions were made using Random Forest, Support Vector Machine Technique, Extreme Gradient Boosting (XGBoost) and K-Nearest Neighbours algorithms according to the participants' CBC parameters of white cell count (WBC), haematocrit (HCT), haemoglobin (HGB) and platelet (PLT).

Results: The XGBoost algorithm was found to be the most effective ML algorithm in predicting the model (area under the curve=0.99, accuracy=0.94, F1-Score=0.94). In addition, the most effective parameter in the prediction of the model was PLT with 42.4%. As a result of the t-test, there was a highly significant difference between the WBC, PLT, HGB, HCT, EPO, JAK2 and bone marrow density results of PV and other groups (p<0.001).

Conclusion: ML algorithms can diagnose PV with CBC parameters with high accuracy, thus emphasising the potential to reduce the dependence on costly diagnostic methods such as JAK2, EPO and BMB.

Aims: Although some cases of intussusception in older children are associated with pathological changes such as lymphoma or polyps, the cause of most cases in infants is unknown. Several reports have identified an association between adenovirus infection and intussusception in children. However, much of the evidence is indirect, such as stool samples or throat swab data. Our study analysed intestinal tissue, which may be more direct evidence of the relationship between adenovirus infection and intussusception.

Methods: We retrospectively reviewed children<6 years of age with intussusception who underwent surgery for failed reduction. The pathological tissue was processed into formalin-fixed paraffin-embedded (FFPE) sections. Adenovirus immunohistochemistry (IHC) and PCR testing were performed to obtain direct evidence of the relationship between adenovirus infection and intussusception.

Results: Our study included 29 patients, 27 appendiceal and 8 intestinal tissues. Only eight appendix specimens were successfully processed into FFPE tissue. IHC testing was positive in three cases (37.5%), and PCR testing was positive for adenovirus type C in four cases (50%). The control group consisted of eight children <6 years who underwent incidental appendectomies, and all control subjects had negative IHC and PCR analyses. PCR is as useful and reliable as IHC in diagnosing adenovirus in intussusception and has greater sensitivity than IHC.

Conclusion: We directly confirmed the relationship between adenovirus infection and intussusception through IHC analysis and PCR detection of pathological evidence. PCR is more sensitive than IHC for diagnosing adenovirus in intussusception.

Aims: Concerns over population-level immunity have been heightened with each successive wave of COVID-19, prompting questions about whether it is primarily derived from vaccination efforts or from previous natural infections with the virus. We wished to determine the seroprevalence of SARS-CoV-2 antibodies among healthcare workers (HCWs) in Pretoria (Tshwane), South Africa, and to establish whether they were derived from vaccination or natural infection.

Methods: Serum samples were collected from HCWs during the fourth wave of COVID-19 between 1 December 2021 and 13 March 2022. The samples were tested using the Abbott SARS-CoV-2 Spike IgG (S-IgG), IgM (S-IgM) and the SARS-CoV-2 Nucleocapsid IgG (NC-IgG) kits.

Results: Of the 221 participants, 76% (n=168) were women and 24% (n=53) were men. A total of 96.4% (n=213) of the participants were vaccinated. Natural infection-derived antibodies were detected in 23% (n=51) of participants, and vaccine-derived antibodies in 74% (n=164) of the HCWs.

Conclusions: Even after three waves of COVID-19, HCWs derived most of their detectable antibodies from vaccination. Vaccination remains an essential tool to protect HCWs and patients from SARS-CoV-2 infection.

Despite advances in cancer immunotherapies across various cancers, survival outcomes in colorectal cancer (CRC) with these agents remain largely unsatisfactory despite the high tumour burden. Colorectal stem cells (CSCs), especially LGR5+ CSCs, are the significant drivers in CRC initiation, progression and resistance to conventional therapies. Although native immune surveillance is sufficient to combat early tumour formation, CRC evades early immune detection with its well-documented adenoma-to-carcinoma sequence. The exact mechanism underlying this phenomenon still needs to be better understood. SRY-related HMG box gene 17 (SOX17), a transcription factor that specifies embryonic gut formation, is increasingly recognised as a significant factor in CRC tumourigenesis. However, its role as a tumour suppressor or oncogene is still debated. Evidence from a recent study highlighted the critical role of SOX17 in reshaping the tumour immune ecosystem through the simultaneous inhibition of CD8+ T cells and selective suppression of LGR5 expression in CSCs through transcriptional repression, thereby facilitating disease progression. Given its role in immune evasion, SOX17 could be a promising marker in personalised therapy. Additionally, SOX17 could play a role in the diagnostic arena, potentially identifying dysplasia in the gastrointestinal tract. Future clinical, basic and genetic studies focusing on SOX17 are needed to ascertain its mechanistic role in tumour immunomodulation in CRC and diagnosing preneoplastic lesions in the gastrointestinal tract.