Pathology International最新文献

This study evaluated ChatGPT's ability to generate clinically integrated multiple-choice questions (MCQs) directly from digestive pathology lecture slides and assessed the educational quality of the output using expert review, psychometric analysis, and student feedback. Lecture slides covering 30 digestive diseases were uploaded to ChatGPT-4o using a structured prompt to produce 30 MCQs, each with a clinical vignette, five answer choices, and explanations. Three pathologists and a gastrointestinal and hepatobiliary pathologist evaluated question quality. Psychometric analysis was conducted using difficulty index, discrimination index, and distractor quality based on responses from 31 s-year medical students. Reviewer and student feedback were also analyzed. Of the 30 MCQs, 28 (93.3%) were rated as excellent by all pathologists. Minor issues such as factual inaccuracies or overly leading clues were found in 11 questions (36.7%) and corrected. Most questions showed acceptable psychometric properties: 23 items (76.7%) met difficulty index thresholds, and 28 (93.3%) met discrimination index thresholds. Of 120 distractors, 54 (45%) were functional. Students reported improved clarity, relevance, and clinical integration. ChatGPT can generate accurate, clinically relevant MCQs aligned with lecture material. With expert review, this approach provides a practical and scalable tool for pathology education in resource- and time-limited settings.

Recent genomic studies have delineated genetic subtypes of diffuse large B-cell lymphoma (DLBCL), and CDKN2A deletion has been reported as an adverse prognostic factor across several of these subtypes. Because MTAP, located adjacent to CDKN2A on 9p21, is frequently co-deleted, loss of MTAP protein expression may serve as a surrogate marker for CDKN2A homozygous deletion (HD) in a subset of malignancies. However, large cohort studies linking MTAP immunohistochemistry (IHC) with CDKN2A genomic status by fluorescence in situ hybridization (FISH) and/or next-generation sequencing (NGS) have been lacking. We therefore investigated the diagnostic significance of MTAP and p16 expression by IHC in relation to the genomic status of CDKN2A and MTAP (by FISH and NGS) in 238 DLBCL cases. Loss of MTAP expression was observed in 40 cases, of which 37 (92.5%) also showed concomitant loss of p16 expression. Among these 37 cases, 32 were identified as having CDKN2A HD by combined FISH/NGS analysis, whereas only 22 were detected by FISH alone. These findings indicate that loss of MTAP expression serves as a surrogate marker for CDKN2A HD, and that MTAP IHC is preferable to FISH for screening CDKN2A HD in DLBCL.

SET domain containing 5 (SETD5), a chromatin regulator involved in adipocytic differentiation, has been identified in various cancers, but its immunohistochemical expression and prognostic significance in liposarcoma remain unclear. This study examined the immunohistochemical expression and prognostic significance of SETD5 in liposarcomas. SETD5 expression was analyzed in 100 adipocytic tumors using immunohistochemistry; these 100 tumors consisted of 24 dedifferentiated liposarcomas (DDLPS), 24 atypical lipomatous tumors/well differentiated liposarcomas (WDLPS), 12 myxoid liposarcomas, 5 pleomorphic liposarcomas, and 35 benign adipocytic tumors. SETD5 expression was assessed using the immunoreactivity score and its prognostic significance was investigated. SETD5 expression was absent in normal adipose tissue and minimal in lipomas. SETD5 expression was significantly higher in WDLPS than in lipomas (p = 0.01). Moreover, SETD5 expression was markedly elevated in the dedifferentiated component of DDLPS compared to the well-differentiated component (p < 0.001). Pleomorphic liposarcoma showed the highest SETD5 expression levels. In DDLPS, high SETD5 expression in the dedifferentiated component correlated with worse overall survival (p < 0.001) but was not correlated with disease-free survival (p = 0.086). Immunohistochemical expression of SETD5 significantly correlates with prognosis in DDLPS and may serve as a candidate pathological factor for dedifferentiation and prognosis.

We recently identified a high prevalence of the MCD-like subtype in primary sinonasal DLBCL, defined by MYD88 L265P and/or CD79B Y196 mutations, which is associated with poor prognosis and preferred relapse sites. In this study, we characterized 56 primary pharyngeal DLBCLs and compared them with 55 sinonasal cases from our prior cohort, assessing mutations by droplet digital PCR and immunophenotype by immunohistochemistry. Pharyngeal and sinonasal DLBCLs exhibited site-specific heterogeneity, with pharyngeal cases showing lower frequencies of MYD88 L265P (15/56 [26.8%] vs. 29/55 [52.7%], p = 0.007) and CD79B Y196 mutations (15/56 [26.8%] vs. 20/55 [36.4%], p = 0.312), and correspondingly fewer MCD-like cases (20/56 [35.7%] vs. 32/55 [58.2%], p = 0.023). Nevertheless, MCD-like pharyngeal cases shared similar features with sinonasal MCD-like cases, including high tendencies for non-GCB phenotype (75% vs. 96.9%), inferior prognosis, and specific site relapse (CNS, testis, and/or skin). Across the entire upper airway cohort (n = 111), MCD-like status consistently correlated with site-specific relapse and adverse clinical outcomes. These findings support expanding the utility of simplified MCD-like classification as a practical tool for prognostic prediction, relapse site estimation, and therapeutic guidance in upper airway DLBCL, with potential for broader application to anatomically diverse DLBCL-NOS cases.

We report the first case of bilateral malignant ciliary body medulloepithelioma (CBME) in an adult, with comprehensive histopathological and genomic analyses. The right eye harbored a malignant teratoid CBME with sarcomatous elements, while the left eye showed a non-teratoid variant. Whole-exome sequencing revealed shared chromosomal losses and additional aberrations in the teratoid tumor. No pathogenic germline mutations were identified. These findings suggest a potential correlation between histological subtype and genomic complexity in CBME.

With the exception of certain specific fields, such as trauma and poisoning, very few neuropathological studies have been reported on forensic autopsy cases. Craniotomy is performed in all forensic autopsy cases, and subjects are often medically healthy. Such studies could provide a vast amount of information to contribute to a wide range of fields, such as anatomy, neuropathology, neurology, and psychiatry. In addition to rare case reports, immunohistochemical staining can be performed on a range of samples; appropriately designed research could produce valuable clinical pathology data. Such an approach could be a useful resource, for example to explore early presymptomatic pathology of neurodegenerative diseases and contributing factors in mood disorders, suicide, and falls, and to establish neuropathological diagnostic criteria for diseases. Furthermore, molecular autopsy-recently developed genetic analysis for autopsy cases-is expected to have a significant impact on postmortem diagnosis and research of neurological diseases. In this paper, we present an overview of neuropathological research conducted using forensic autopsy cases to demonstrate its usefulness.

Medial arterial calcification, ectopic deposition of calcium phosphate crystals in the media, causes aortic stiffness which is associated with the mortality of cardiovascular diseases. Previous studies clarified several factors which are related to disease progression processes, on the contrary, inducing factors of medial arterial calcification remain obscure. In this study, we performed pathological analyses of the aorta in an experimental animal model under the condition of hypoperfusion to understand unexplored events underlying medial arterial calcification. The area of calcium deposition varied with the severity of hypoperfusion, and the extent of calcium deposition was highest under conditions of severe hypoperfusion. Thinning of the media, destruction of elastic fibers, and increased transformation marker of vascular smooth muscle cells into osteoblast-like cells were observed earlier than calcium deposition. Time-dependent observations of the hypoperfusion-induced aorta show the flattening of elastic fibers and death of medial cells prior to calcium phosphate deposition, followed by the formation of microvoids which were used as scaffolds for calcium phosphate crystal formation. These data showed that aortic wall hypoperfusion can be an initiating factor of calcium phosphate deposition in the arterial media.

The aim of this study was to clarify the clinicopathological significance of the glycan profile of clear cell renal cell carcinoma (ccRCC). Comprehensive glycomic analysis and methylome analysis were performed using 50 paired nontumorous renal tissue (N) and tumorous tissue (T) specimens from patients with ccRCC. In comparison to N samples, T samples showed higher signal intensities for lectins recognizing high-mannose glycans and lower intensity for fucose and sialic acid, indicating that N-type glycans remain "immature" in ccRCCs. Hierarchical clustering using the signal intensities of lectins recognizing high-mannose glycans, fucose, and sialic acid divided T samples into Cluster A (n = 32) and Cluster B (n = 18). In Cluster B, the incidence of tumor-related death was higher (p = 0.017) and overall survival was lower (p = 0.019). Moreover, asialo-type glycans and N-acetyllactosamine residues, which are recognized by lectins DSA, ECA, and PHA-E, had an impact on both recurrence-free and overall survival. The expression of glycogenes, such as MGAT1, ST6GAL1, and TUSC3, may be epigenetically regulated. These results suggest that the glycan profile may be at least partly attributable to epigenetic regulation of glycogenes, and that comprehensive glycan profiling could provide clinically useful information for patients with ccRCC.