Diagnostic Histopathology最新文献

Endometrial carcinoma is the most common gynaecological malignancy in the UK and its incidence is increasing worldwide. The classification of endometrial carcinoma (EC) has been based on cell type (histotype) for decades, and this, together with grade, lymphovascular space invasion (LVSI) and stage of the tumor was used for risk assessment, guiding decisions about the extent of surgery and the need for post-surgical adjuvant treatment. There has been, and remains, considerable variation in clinical practice worldwide, with respect to both the extent of surgery (lymph node dissection, omentectomy, pelvic washings) and use of adjuvant therapy (radiation, chemotherapy, or both) for patients with identical risk factors but treated at different centers. Furthermore, EC has tended to be treated as a single disease, irrespective of histotype. In the past five years there has been a significant move to more personalized risk assessment and treatment with the introduction of routine molecular assessment of EC, and diagnosis of molecular subtype. The four EC molecular subtypes differ with respect to molecular pathology, genetic and environmental risk factors, precursor lesions, prognosis and response to specific treatments. This review will discuss the assessment of EC molecular subtype in clinical practice and how this information impacts on risk assessment and treatment.

Pulmonary pathologists often must make a diagnosis based on small specimens derived from aspirated or solid tissue fragments, extracted under radiological guidance, containing limited diagnostic material. This poses a diagnostic challenge. Advances in treatment also demand tissue is analysed for multiple molecular anomalies therefore pathologists must be judicious in their use of ancillary tests such as immunohistochemistry. Whilst the majority of tumours encountered are non-small cell lung carcinomas, the lungs and thorax are a common metastatic site and can display a wide variety of different tumour types. Some tumours can closely mimic the appearances of non-small cell carcinomas and failure to recognise these can result in misdiagnosis and incorrect treatment and management for the patient. In this article we specifically focus on a variety of different tumours that can masquerade as non-small cell carcinomas. This includes both benign and malignant primary lung tumours, sarcomas, melanomas and germ cell tumours. We describe how to approach and recognise these entities, with specific focus on the histological and immunohistochemical appearances, and identify potential pitfalls to avoid in routine practice.

Targeted therapies have revolutionised the management of patients with lung cancer over the last 20 years. A crucial role for pulmonary pathologists is to provide high quality and timely analysis of predictive biomarkers that guide the use of these targeted treatments. Protein-based biomarkers, alongside nucleic acid analyses, are mostly used to predict response to therapies that inhibit oncogenic stimulation or utilise immune checkpoint inhibition. Despite the protein-based mechanism of action of targeted therapies, development of biomarkers for lung cancers have been chiefly focused on genomics. With ongoing expansion of targeted treatments, including novel classes of therapeutics such as antibody drug conjugates, and an increasing requirement for effective biomarkers, however, immunochemistry and related techniques may still continue to play a valuable and crucial role in predictive profiling. This review will focus on current and future protein-based biomarkers in pulmonary malignancies alongside the assays, underlying biology and appropriate clinical context required to effectively utilise them. This will provide an overview of the role of the pathologist in effectively guiding targeted treatments for lung cancer patients.

The number of targeted therapies licenced for non-small cell lung cancer (NSCLC) has increased substantially in recent years, resulting in a major increase in demand for genomic testing of tissue specimens. The range of different alteration types that are now actionable in NSCLC is reflected in the complexity of current testing approaches. Cellular pathologists hold a key role in triaging tissue specimens for genomic biomarker testing and should be familiar with the genomic alterations seen in NSCLC, the testing strategies utilised and how to interpret molecular pathology reports in order to effectively support the management of NSCLC patients.

We present an autopsy case of a rare and often undiagnosed cause of sudden cardiac death in young women - spontaneous coronary artery dissection. This is a challenging diagnosis at post-mortem and an autopsy pathologist should be aware of its macroscopic and microscopic features.

A 52-year old female presenting with an ovarian mass underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intra-operatively there was large volume ascites containing mucin and hair. Subsequent pathological examination of the ovarian mass revealed a low-grade mucinous neoplasm arising within a mature cystic teratoma (MCT). This was associated with pseudomyxoma peritonei (PMP) and is a rare entity recognized by the World Health Organisation. These tumours resemble their appendiceal counterpart and therefore diagnosis is achieved with immunohistochemistry and thorough morphological assessment to exclude a collision tumour. Additionally, the appendix should be examined to confirm ovarian origin. Identification of these neoplasms is crucial as reasonable outcomes can be achieved following appropriate referral for ongoing management which includes complete surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC).

While morphological assessment remains the primary cornerstone in tumor diagnostics, immunohistochemical (IHC) analyses hold immense value in surgical pathology. This is particularly true in endocrine pathology, which encompasses a multitude of tumors from various organs, often presenting with several morphological mimics. In many cases, IHC proves to be invaluable for practicing pathologists in reaching accurate diagnoses. Furthermore, IHC plays a pivotal role in prognosticating endocrine tumors, aiding pathologists in grading and assessing the risk associated with these lesions. Additionally, the identification of specific markers has enabled the recognition of subsets of endocrine tumors suitable for tailored therapies. Consequently, IHC assumes a crucial role in the comprehensive management of endocrine neoplasia, encompassing diagnosis, prognostication, and treatment. This review article comprehensively explores the fundamentals of IHC in the clinical workup of endocrine and neuroendocrine tumors, with a specific emphasis on what pathologists in training should be familiar with, encompassing both its strengths and potential pitfalls.

This review article describes nuclear features of a range of thyroid lesions to enable confident diagnosis in a multidisciplinary thyroid cancer setting. It is hoped that this will serve as a handy aide-mémoire when faced with diagnosis of thyroid FNA (fine needle aspiration) cytology in day-to-day practice. The existing literature has been reviewed to give the reader an overview of the classification systems in thyroid cytology and various entities described therein. The lesions are broadly categorised as benign, malignant, and indeterminate. The comparison to ultrasound imaging classification is given, with a view to have a broader understanding of the clinico-radiological context. Photographs with descriptions in each category are included together with a detailed description of nuclear features, pitfalls, and challenges in diagnosis. This article is designed for practising and trainee cytopathologists as a useful tool for everyday practice.

Artificial intelligence (AI) is of considerable interest in the healthcare community including its diagnostic applications for thyroid nodules in assisting both radiology and FNA assessment. Fine-needle aspiration (FNA) helps distinguishing benign from malignant thyroid nodules and is a crucial step in the initial diagnosis of cancer. The classification of some lesions can be challenging, and the use of AI in some cases may become essential in order not to give an indeterminate result to the lesion. In this review, we summarize the available evidence regarding the application of AI in thyroid imaging and cytopathology. There are now considerable applications in digital waiting to be approved that will save time and cut costs. The published literature to date has shown promising results. However, future work is required to better define how this technology can be exploited in routine cytopathology practice.

Gastric heterotopia can occur in any part of the gastrointestinal tract but is rare in the rectum. This case of rectal gastric heterotopia is novel as the heterotopic mucosa contained fundic gland polyps, and there were histological changes in the gastric glands characteristic of proton pump inhibitor-related changes. These changes included apocrine-like luminal cytoplasmic protrusions in cystically dilated oxyntic gland parietal cells. These are well described in the native stomachs of PPI treated patients, but this is the first report of these changes in heterotopic gastric mucosa to our knowledge. The lesion was removed via transanal endoscopic operation (TEO) without prior biopsy due to its unusual irregular nodular appearance mimicking a high-risk rectal neoplasm.