Diagnostic Histopathology最新文献

英文中文

Diagnostic Histopathology

Pub Date : 2025-12-09 DOI: 10.1016/j.mpdhp.2025.11.002

Mary N. Sheppard

Infective endocarditis is an infection of the cardiovascular endothelium and occurs on heart valves, in the cardiac chambers or on the intimal surface of blood vessels. It is a rare but deadly disease and is often difficult to diagnose and as a result has a high mortality. It is increasing in incidence due to an increase in vascular and cardiac interventions and devices. It is also becoming a disease in an elderly population with comorbidities like diabetes. Left sided valves are the predominant structures affected with growth of infective vegetations and valve destruction. Right sided valves are affected in intravenous drug use. The organisms have changed over the decades from Streptococcus species to Staphylococcus. The clinical presentation is very diverse ranging from cardiac sudden death to heart failure, pyrexia, weight loss and stroke, so clinical suspicion is important in a patient with risk factors. Complication include myocardial, cerebral, splenic, renal and peripheral infarction due to emboli. Echocardiography, serology, PCR and blood cultures are the cornerstone of diagnosis. Diagnosis and thus treatment relies on clinical, laboratory and imaging techniques. The treatment relies on the combination of prolonged antimicrobial therapy and surgical eradication of the infected tissues. Antibiotics are the first line of treatment with surgery for extensive disease and complications. Resistance to many antibiotics is rising so microbiological sensitivities are important. There is a lack of scientific evidence for the efficacy of antibiotic prophylaxis.

感染性心内膜炎是一种心血管内皮的感染，发生在心脏瓣膜、心腔或血管内膜表面。这是一种罕见但致命的疾病，通常难以诊断，因此死亡率很高。由于血管和心脏干预和设备的增加，发病率正在增加。它也正在成为一种老年人群的合并症，如糖尿病。左侧瓣膜是受感染植物生长和瓣膜破坏影响的主要结构。静脉用药对右侧瓣膜的影响。在过去的几十年里，这些生物从链球菌变成了葡萄球菌。临床表现非常多样，从心源性猝死到心力衰竭、发热、体重减轻和中风，因此对有危险因素的患者进行临床怀疑是很重要的。并发症包括心肌梗死、脑梗死、脾梗死、肾梗死和外周梗死。超声心动图、血清学、PCR和血培养是诊断的基础。诊断和治疗依赖于临床、实验室和影像技术。治疗依赖于长期抗菌治疗和手术根除感染组织的结合。抗生素是手术治疗广泛疾病和并发症的第一道防线。对许多抗生素的耐药性正在上升，因此微生物敏感性很重要。缺乏关于抗生素预防效果的科学证据。

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引用次数: 0

Fibromuscular dysplasia: an update 纤维肌肉发育不良：最新进展

Diagnostic Histopathology

Pub Date : 2025-12-09 DOI: 10.1016/j.mpdhp.2025.11.003

Fazarina Mohammed, Michael A. Seidman

Fibromuscular dysplasia (FMD) is a family of non-atherosclerotic noninflammatory vascular conditions that has a predilection for women in their middle age. FMD is classically diagnosed in renal arteries, but it can affect all vascular beds, hence producing a variety of symptoms. The diagnosis is often driven by clinical and radiologic criteria, only rarely with tissue biopsy confirmation. However, there are multiple diseases within the FMD spectrum, and still others that may mimic FMD, making biopsies vital for diagnosis in some cases. Surgical pathologists must be aware of these diagnoses in view of possible implications in the patient’s management. This article discusses the pathology and diagnosis of FMD in view of the current literature.

纤维肌肉发育不良（FMD）是一类非动脉粥样硬化性非炎症性血管疾病，多发于中年女性。口蹄疫通常在肾动脉诊断，但它可以影响所有血管床，因此产生各种症状。诊断通常由临床和放射学标准驱动，很少有组织活检证实。然而，口蹄疫谱系中有多种疾病，还有一些可能与口蹄疫相似，因此在某些情况下，活检对于诊断至关重要。外科病理学家必须意识到这些诊断在病人的管理中可能产生的影响。本文结合文献对口蹄疫的病理及诊断作一探讨。

引用次数: 0

Pathology of lung tumours: WHO 2021 updates and resection status 肺肿瘤病理学：WHO 2021更新和切除状况

Diagnostic Histopathology

Pub Date : 2025-12-09 DOI: 10.1016/j.mpdhp.2025.11.004

Clara Lightner-Ferrer, Louise Burke

The WHO Classification of Thoracic Tumours 2021 has continued to advance definition of thoracic tumour diagnostics with broader emphasis on the importance of molecular genetic analysis and its association with pathogenesis, progression and importantly treatment of adenocarcinoma. This review article highlights some of the major changes from the previous 2015 edition, particularly those relating to surgically resected cases. As indicated previously, another important component of a pathology report post-surgical resection is the determination of R status (residual tumour classification). R-factor definitions are not well understood and the importance of good communication between members of the multidisciplinary team in their determination is imperative.

世卫组织《2021年胸部肿瘤分类》继续推进胸部肿瘤诊断的定义，更广泛地强调分子遗传分析的重要性及其与腺癌发病机制、进展和重要治疗的关联。这篇综述文章强调了与2015年版本相比的一些主要变化，特别是那些与手术切除病例有关的变化。如前所述，术后病理报告的另一个重要组成部分是确定R状态（残余肿瘤分类）。r因子的定义还没有被很好地理解，多学科团队成员之间良好沟通的重要性在他们的决定是必不可少的。

引用次数: 0

Pathology of the oesophagus and stomach: precursors of malignancy 食道和胃的病理：恶性肿瘤的前兆

Diagnostic Histopathology

Pub Date : 2025-12-09 DOI: 10.1016/j.mpdhp.2025.11.005

James A. Cotton, Klaudia M. Nowak, Stefano Serra, Runjan Chetty

Incidence rates of oesophageal adenocarcinoma (OAC) and proximal gastric adenocarcinoma (PGA) have risen in tandem in recent decades. Patients are often diagnosed at advanced stages, resulting in poor prognoses despite aggressive treatment. Cancer screening programs aim to detect early-stage cancer or precancerous conditions, such as dysplasia, in asymptomatic individuals to improve patient outcomes and reduce mortality rates. Precursor lesions can potentially transform into malignancy; however, accurate diagnosis is challenging. This article examines the causes, clinical symptoms, pathological characteristics, and diagnostic complexities of precursor lesions for adenocarcinoma in the oesophagus and stomach.

近几十年来，食管腺癌（OAC）和近端胃腺癌（PGA）的发病率呈上升趋势。患者通常在晚期被诊断出来，尽管进行了积极的治疗，但预后却很差。癌症筛查项目旨在检测无症状个体的早期癌症或癌前病变，如发育不良，以改善患者的预后并降低死亡率。前驱病变有可能转化为恶性肿瘤；然而，准确的诊断是具有挑战性的。本文探讨食管和胃腺癌前体病变的病因、临床症状、病理特征和诊断复杂性。

引用次数: 0

Cardiac amyloidosis: a clinical and pathological review 心脏淀粉样变：临床和病理回顾

Diagnostic Histopathology

Pub Date : 2025-12-09 DOI: 10.1016/j.mpdhp.2025.11.001

Joseph J. Maleszewski

Amyloidosis is a broad class of diseases all of which result in deposition of misfolded extracellular protein that result in organ dysfunction. Once considered a rare condition, cardiac amyloidosis is increasingly being identified in the ageing population and is responsible for significant morbidity and mortality, often mediated through heart failure. Our understanding of the disease, both from epidemiologic and pathobiologic perspectives has improved tremendously over the last decade, owing to greatly improved screening techniques as well as highly specific proteomic means of amyloid classification. Along with these advances, has come a host of revolutionary treatment strategies that have the potential to change the prognosis in heart failure patients. This review provides an overview of the relevant clinical issues that surround cardiac amyloidosis and is intended to update the reader on the contemporary diagnostic and therapeutic strategies for these patients.

淀粉样变性是一类广泛的疾病，所有这些疾病都导致错误折叠的细胞外蛋白沉积，导致器官功能障碍。心脏淀粉样变性曾经被认为是一种罕见的疾病，现在越来越多地在老龄化人口中被发现，它是造成严重发病率和死亡率的原因，通常通过心力衰竭介导。在过去的十年中，由于筛查技术以及淀粉样蛋白分类的高度特异性蛋白质组学手段的大大改进，我们对这种疾病的理解，无论是从流行病学还是病理生物学的角度都有了极大的提高。随着这些进步，出现了许多革命性的治疗策略，这些策略有可能改变心力衰竭患者的预后。这篇综述提供了围绕心脏淀粉样变性的相关临床问题的概述，旨在更新读者对这些患者的当代诊断和治疗策略。

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Cardiac sarcoidosis, a cause of sudden cardiac death 心脏结节病，心脏性猝死的一种原因

Diagnostic Histopathology

Pub Date : 2025-12-03 DOI: 10.1016/j.mpdhp.2025.11.006

Katrina Z Freimane, Kenal Patel, Kathryn J Griffin

A 35-year-old white male with no medical history was found unresponsive. A postmortem examination revealed an enlarged heart showing left ventricular thickening and diffuse pale areas. Hilar lymphadenopathy was noted, and numerous white-tan nodules were present throughout the lungs and spleen, and, focally, in the liver. Postmortem toxicology testing revealed no significant findings. Histology demonstrated extensive non-caseating granulomas with multinucleated giant cells, asteroid bodies, Schaumann bodies and lymphocytic inflammation within the heart, lungs, spleen, lymph nodes and the liver. Sections of the heart also showed widespread fibrosis. A diagnosis of systemic sarcoidosis with cardiac involvement was offered, which likely lead to a fatal cardiac arrhythmia. This case highlights the importance of meticulous postmortem evaluation in suspected sudden cardiac deaths, as this will inform whether genetic testing for inherited cardiac conditions should be offered to the family of the deceased. A comprehensive work-up of a case with suspected sudden cardiac death should include histology, toxicology and consideration of the need to retain spleen for future genetic testing.

一名35岁白人男性，无病史，无反应。尸检显示心脏增大，左心室增厚，弥漫性苍白。肝门淋巴结病变，肺和脾可见大量白褐色结节，局部可见肝脏。死后毒理学测试没有发现什么重大发现。组织学表现为广泛的非干酪化肉芽肿伴多核巨细胞、小行星体、邵曼体及心、肺、脾、淋巴结和肝脏淋巴细胞炎症。心脏切片也显示广泛的纤维化。诊断为系统性结节病累及心脏，可能导致致命的心律失常。该病例突出了对疑似心源性猝死进行细致的尸检评估的重要性，因为这将告知是否应向死者家属提供遗传性心脏病的基因检测。对疑似心源性猝死病例的全面检查应包括组织学、毒理学和考虑是否需要保留脾脏以备将来进行基因检测。

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引用次数: 0

Gestational trophoblastic disease tumours and mimics: an up-to-date review of morphology and immunocytochemistry to aid the diagnosis 妊娠滋养细胞疾病肿瘤和模拟：形态学和免疫细胞化学的最新回顾，以帮助诊断

Diagnostic Histopathology

Pub Date : 2025-11-28 DOI: 10.1016/j.mpdhp.2025.10.007

Katie McDonald

Gestational trophoblastic disease is an umbrella term for a rare group of lesions which range from benign to malignant. Even experienced gynaecological pathologists encounter these entities infrequently, underscoring the importance of a clear and systematic diagnostic approach. This article outlines the morphology and immunocytochemical staining of trophoblast in normal gestations then malignant tumours and their mimics in depth. The differential diagnoses are split into three sub-sections. Firstly, the lesions with three trophoblast cell lineages: choriocarcinomas, molar disease, mixed tumours and their benign mimics. Secondly, tumours resembling implantation-type intermediate trophoblast: placental site trophoblastic tumour and various mimics, both primary and secondary. Thirdly, tumours resembling chorionic-type intermediate trophoblast: epithelioid trophoblastic tumours, placental site nodules, atypical placental site nodules and some rarer malignant differential diagnoses. For the patients, precise diagnosis of these different entities can allow optimal management including monitoring, chemotherapy and immune modulators, and can preserve future fertility. Ongoing and future research is discussed at the end, and a brief mention of the centralised system in the UK. This article offers a clear diagnostic approach towards trophoblastic tumours, for training and practising pathologists.

妊娠滋养细胞疾病是一组罕见病变的总称，其范围从良性到恶性。即使是经验丰富的妇科病理学家也很少遇到这些实体，强调了明确和系统诊断方法的重要性。本文详细介绍了正常妊娠、恶性肿瘤及其类似物中滋养细胞的形态和免疫细胞化学染色。鉴别诊断分为三个小节。首先，具有三种滋养细胞系的病变：绒毛膜癌、磨牙病、混合性肿瘤及其良性模拟。其次，类似于植入型中间滋养细胞的肿瘤：胎盘部位滋养细胞肿瘤和各种模拟肿瘤，包括原发性和继发性。第三，类似绒毛膜型中间滋养细胞的肿瘤：上皮样滋养细胞肿瘤、胎盘结节、不典型胎盘结节和一些罕见的恶性鉴别诊断。对于患者来说，精确诊断这些不同的实体可以允许最佳的管理，包括监测，化疗和免疫调节剂，并可以保留未来的生育能力。最后讨论了正在进行的和未来的研究，并简要提到了英国的集中式系统。本文提供了一个明确的诊断方法，对滋养细胞肿瘤，培训和执业病理学家。

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引用次数: 0

Gastric glomus tumour with positive DOG1 and synaptophysin expression: a diagnostic challenge 胃球囊肿瘤伴DOG1和突触素阳性表达：一个诊断挑战

Diagnostic Histopathology

Pub Date : 2025-11-28 DOI: 10.1016/j.mpdhp.2025.11.007

Tariq Marsh-Henry, Sarah Grenfell, Tim Bracey

Gastric glomus tumours can mimic gastrointestinal stromal tumour (GIST) clinically and histologically. We present a case of gastric glomus tumour which was positive for DOG1 and synaptophysin, markers typically associated with GIST and neuroendocrine tumour respectively, diagnoses far more common than the final diagnosis highlighting a potential pitfall for pathologists. The otherwise characteristic morphological features of glomus tumour, as well as molecular detection of CARMN::NOTCH2 fusion enabled confident diagnosis but emphasises the importance of comprehensive morphological, immunohistochemistry, and molecular testing to avoid misdiagnosis, particularly given that glomus tumours are at least 100 times less frequent than GIST in the stomach. The excellent prognosis following complete surgical excision underscores the clinical significance of accurate diagnosis.

胃球瘤在临床和组织学上与胃肠道间质瘤（GIST）相似。我们报告了一例胃球瘤，DOG1和synaptophysin阳性，这两种标记分别与GIST和神经内分泌肿瘤相关，诊断远比最终诊断更常见，为病理学家突出了一个潜在的陷阱。肾小球瘤的其他特征形态特征以及CARMN::NOTCH2融合的分子检测使诊断更加可靠，但强调了综合形态学、免疫组织化学和分子检测的重要性，以避免误诊，特别是考虑到肾小球瘤在胃中的发生率至少比GIST低100倍。完全手术切除后的良好预后强调了准确诊断的临床意义。

引用次数: 0

Placental pathology: what not to miss 胎盘病理：什么不能错过

Diagnostic Histopathology

Pub Date : 2025-11-24 DOI: 10.1016/j.mpdhp.2025.10.005

Eleanor McTaggart, Sophie Stenton

The placenta has long been one of the most misunderstood and neglected areas in surgical pathology. Whilst some groups have at times questioned the importance of the placenta in the medical management of pregnancy, it is now generally accepted that a fully functioning placenta is required for successful pregnancy and there has been an uptick in interest for placental examination. This article shall not only evaluate the pathological findings of some of the more common placental disorders, but it shall provide an overview of the most up to date understanding of disease processes and offer some practical advice on sampling and grading these lesions. Herein we focus on the following common entities: maternal vascular malperfusion, fetal vascular malperfusion, acute chorioamnionitis and chronic villitis of unknown aetiology. The article shall also address the placental lesion chronic histiocytic intervillositis (CHI), as, whilst rare, it can have particularly devastating consequences. CHI is present in first trimester products of conception and may be encountered by general pathologists inexperienced in placental pathology.

长期以来，胎盘一直是外科病理学中最被误解和忽视的领域之一。虽然有些团体有时会质疑胎盘在妊娠医学管理中的重要性，但现在人们普遍认为，一个功能完整的胎盘是成功妊娠所必需的，并且对胎盘检查的兴趣有所上升。本文不仅将评估一些更常见的胎盘疾病的病理结果，而且还将提供对疾病过程的最新理解的概述，并就这些病变的抽样和分级提供一些实用的建议。在这里，我们重点关注以下常见实体：母体血管灌注不良，胎儿血管灌注不良，急性绒毛膜羊膜炎和病因不明的慢性绒毛炎。本文还将讨论胎盘病变慢性组织细胞绒毛间炎（CHI），因为，虽然罕见，它可以有特别毁灭性的后果。CHI存在于妊娠前三个月的产物中，可能会被没有胎盘病理学经验的普通病理学家遇到。

引用次数: 0

Hydatidiform moles and mimics: an up-to-date review on morphology and immunocytochemistry to aid the diagnosis 包虫体痣和模拟物：最新的形态学和免疫细胞化学综述，以帮助诊断

Diagnostic Histopathology

Pub Date : 2025-11-22 DOI: 10.1016/j.mpdhp.2025.10.006

Lesley Christie, Lesley M McMahon

Sporadic miscarriages occur in 10–20% of all pregnancies and affect one in four women. Products of conception (POC) are one of the commonest specimens submitted to the histopathology laboratory. The pathologist's role is to adequately sample, confirm a pregnancy and identify or exclude a molar pregnancy. This review summarises the genetic basis of the disease, key diagnostic features and ancillary investigations that can be employed to classify a gestation. Accurate and timely diagnosis of molar pregnancy ensures appropriate follow up and favourable outcomes.

零星流产发生在所有怀孕的10-20%，影响到四分之一的妇女。受孕产物（POC）是提交给组织病理学实验室的最常见的标本之一。病理学家的作用是充分取样，确认妊娠，并确定或排除臼齿妊娠。本文综述了该疾病的遗传基础，主要诊断特征和辅助调查，可用于分类妊娠。准确和及时的诊断可以确保适当的随访和良好的结果。

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Diagnostic Histopathology

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