Turkish Journal of Pathology最新文献

The presence of signet-ring cells in the ovary is almost always associated with metastatic mucinous carcinomas known as Krukenberg tumors. Here we report a primary ovarian mucinous carcinoma with signet-ring cells, which is scarcely encountered, and a review of the literature to summarize the clinical and morphological features of these tumors. The patient was a 26-year-old female who had a large multicystic lesion in the right ovary. Macroscopic examination of the cyst revealed a 30 cm-sized multicystic lesion filled with mucinous material. The capsule was intact, and there was no surface involvement. Microscopically, a multicystic mucinous tumor with a predominantly borderline background and three well-demarcated nodules composed of signet ring cells without desmoplastic stroma were noted in the cyst wall. There was only one invasive focus seen. Immunohistochemically, conventional mucinous areas were diffusely positive for Keratin 7 and Keratin 20, and focally positive for PAX8, while negative for CDX2. Signet ring cells were positive for Keratin 20, CDX2, and Keratin 7, while negative for PAX8. In the systemic examinations, no potential primary site was found. The patient has not received any adjuvant treatment and has been followed for six years without disease, which is the longest follow-up time among previously reported cases. Signet ring cells can be present in primary ovarian mucinous carcinomas. The distinction from the more frequently seen metastatic carcinomas needs a complete evaluation of clinicopathological findings. Early-stage primary mucinous carcinomas having localized signet-ring cell nodules seem to have favorable prognosis without adjuvant treatment.

Objective: The use of molecular pathology is critical in diagnostics and theranostics. Today, cytological smears are utilized for molecular testing more often than ever. Accurate tumor cell percentage estimation is essential for reliable molecular testing, but its consistency remains uncertain. This study evaluates the reliability of tumor cell percentage estimations among an expert cytopathologist, a molecular cytopathologist, and a molecular pathologist.

Material and methods: Digital images from May-Grünwald-Giemsa (MGG)-stained smear slides of ten EBUS-guided mediastinal lymph node samples were selected. Five regions per slide were evaluated (50 areas from 10 patients). Three pathologists independently estimated tumor cell percentages using predefined categories (0-10%, 11-20%, 21-50%, etc.). Cells were also counted manually as the gold standard.

Results: The molecular cytopathologist (Observer 1 -) showed the highest consistency (Kappa = 0.69), followed by the expert cytopathologist (Observer 3 -, Kappa = 0.64), both demonstrating substantial agreement with the gold standard. The molecular pathologist (Observer 2 -) displayed moderate consistency (Kappa = 0.52). Agreement was most significant in the 71-100% category, aligning in over 95% of cases. The lowest value occurred in the 11-20% category. In this category, tumor proportions were frequently overestimated compared to the gold standard.

Conclusion: Variability in tumor percentage estimations shows the need for standardized protocols and training. Substantial agreement was reached in specific categories. However, discrepancies in borderline cases highlight the importance of accurate assessments. More research is needed to improve estimation methods.

Objective: Tartrazine (TZ) is an anionic azo dye widely used to color food products, pharmaceuticals, and cosmetics; however, its harmful effects on the kidneys are still unclear and need to be confirmed. Meanwhile, taurine (TA) is a natural antioxidant amino acid that can provide protection against various forms of glomerulonephritis. Our aim was to study the structural, and biochemical effects of TZ on the kidney and evaluate the potential protection provided by taurine.

Material and methods: We used 28 adult male albino rats equally divided into 4 groups. The control group did not receive TZ or TA. The TA group received 100 mg/kg/day of TA. The TZ group received 100 mg/kg/day of TZ dissolved in distilled water. The TZ/TA group received both TZ and TA. Animal blood samples were obtained to estimate blood urea, creatinine, and random glucose levels. Kidneys samples were examined for structure as well as oxidative enzymes and kidney injury molecule 1 (KIM-1).

Results: Compared to the control group, the TZ group showed hyperglycemia, increased markers of oxidative stress, and shrunken, lobulated glomeruli with mesangial expansion, pyknosis, and vacuolation in the tubular lining. There was also strong immunoreactivity for PCNA and caspase-3, a thickened glomerular capillary basement membrane lacking fenestrations, swollen mitochondria with destructed cristae, and increased expression of the KIM-1. In the TZ/TA group, the convoluted tubules mostly retained the normal histological structure, but some tubules still showed a wide lumen and nuclear pyknosis of lining cells. Oxidative markers and random blood glucose levels were significantly reduced.

Conclusion: TZ is suggested to cause adverse kidney effects in rats, including kidney injury and structural changes, which can be mitigated by co-administration with TA.

Objective: Progesterone receptor (PR) expression is a well-recognized marker in meningiomas, but manual immunohistochemical assessment is subjective and prone to variability. Digital pathology offers objective and reproducible quantification. Despite the availability of FDA-cleared digital PR scoring algorithms in some tumors like those of the breast, their implementation in meningiomas and systematic evaluation of their correlations with clinicopathological features remain scarce.

Material and methods: We retrospectively analyzed 129 meningioma cases resected between 2018 and 2024. Digital PR expression was quantified using the FDA-cleared Ventana uPath PR 1E2 algorithm, originally developed for breast carcinoma. Subsequently, tumors were stratified by age, sex, WHO grade, histological subtype, and localization, while Ki-67 index and mitotic counts were also recorded. Associations with digital PR H-scores were evaluated using non-parametric tests, correlation analysis, and ordinal logistic regression.

Results: Digital PR H-scores progressively decreased across WHO grades, with Grade 1 tumors showing the highest values, followed by Grade 2 and Grade 3 (p=0.002). PR expression was inversely correlated with proliferative markers, including Ki-67 index (ρ = -0.42, p < 0.001) and mitotic count (ρ = -0.35, p < 0.01). No significant differences were observed by age or sex. Convexity meningiomas tended to have higher scores than skull base and spinal tumors.

Conclusion: Digital PR H-score assessment confirmed the inverse association between PR expression and WHO grade, as well as its correlation with proliferative activity. Using an FDA-cleared algorithm originally developed for breast carcinoma, this method provides objective and reproducible evaluation in meningiomas.

Interdigitating dendritic cell sarcoma (IDCS) is a rare and aggressive neoplasm classified within the M-group of malignant histiocytoses. Its diagnosis poses a significant challenge. This article aims to describe a rare clinical case of IDCS and to illustrate the differential diagnostic process undertaken by the authors in establishing this diagnosis. A 60-year-old woman was admitted for the resection of a retroperitoneal mass discovered via CT scan. Morphological examination revealed a 7.5×5.5×5.0 cm tumor, encapsulated by a thin fibrous capsule. The tumor was composed of 90-95% inflammatory infiltrate with lymphocyte-like cells showing mature nuclear morphology (CD3+ and CD20+ cells) mixed with histiocytes and plasma cells, and 5-10% large polymorphic spindle-shaped cells expressing expression of CD45, CD68, CD1a, CD21, CD35, CD31, and CD34. An extensive immunohistochemical panel was performed to exclude various other tumors. Based on the morphology and immunophenotype, a diagnosis of IDCS was established. Further literature analysis indicated the nonspecificity of symptoms in patients with this tumor localization and variability in CD45 and CD68 staining in tumor cells, with consistent lack of expression of CD21, CD23, CD35, CD1a, and specific T- and B-cell antigens. IDCS is a rare and poorly understood tumor with a poor prognosis. The nonspecificity of clinical symptoms and the need for extensive morphological differential diagnosis render this entity a diagnosis of exclusion, requiring significant diligence from the pathologist.

Objective: Despite the legal requirement to complete a thesis during residency training in Türkiye, the extent to which these theses are translated into high-quality scientific publications remains unclear. Disciplinary differences in research culture, resource availability, and clinical workload may influence these outcomes.

Material and methods: This cross-sectional study analyzed 1245 open access residency theses completed between 2018 and 2022 in the fields of pathology (n=344), endocrinology (n=525), and urology (n=376). Theses were retrieved from the National Thesis Center of the Council of Higher Education. Their publication status was identified via searches in PubMed and Google Scholar. Data collected included journal index status (SCI-E, ESCI, ULAKBIM), Journal Impact Factor™ (JIF), citation count, and time to publication. Statistical comparisons were made using chi-squared and Kruskal-Wallis tests with p < 0.05 considered significant.

Results: Among the 1245 residency theses analyzed, 344 (27.6%) were in pathology, 525 (42.2%) in endocrinology and metabolic diseases, and 376 (30.2%) in urology. The conversion rate to publication significantly differed across specialties (p = 0.0002): 86 of 344 pathology theses (25.0%), 115 of 525 endocrinology theses (21.9%), and 139 of 376 urology theses (37.0%) were published. Urology theses had the highest representation in SCI-E indexed journals (72.7%), while endocrinology demonstrated the highest mean Journal Impact Factor (2.3; p < 0.0001). The average number of citations per publication was also highest in urology (4.5), although this difference was not statistically significant (p = 0.0673). Median time to publication ranged from 2.3 to 2.7 years, with no significant difference between specialties (p = 0.1287). Differences in the distribution of Q2, Q3, and Q4 journal publications were statistically significant between specialties.

Conclusion: Endocrinology had the highest number of theses, whereas urology had the highest publication rate and number of citations per publication.

Objective: Oncocytic cells are commonly detected on FNA reports but little is known regarding the relationship between the degree of oncocytic cell features and the rate of malignancy (ROM). In this study, we aimed to investigate the importance of oncocytic cells in thyroid FNA with a diagnosis of atypia of undetermined significance (AUS). Additionally, we sought to ascertain if the prevalence of oncocytic cells in FNAs with oncocytic cells is linked to neoplasm and malignancy.

Material and methods: 187 cases belonging to 144 patients diagnosed with AUS in thyroid FNA were re-evaluated for the oncocytic cells, nuclear atypia and microfollicles and then classified as AUS-nuclear with or without oncocytic cells and AUS-other with or without oncocytic cells. The cases that had oncocytic cells were scored according to the proportion of oncocytic cells.

Results: ROM was higher in the AUS-nuclear group (28.1%) compared to the AUS-other group (12.2%). AUS-nuclear cases without oncocytic cells had higher ROM compared to the AUS-nuclear cases with oncocytic cells. Rate of neoplasm (RON) was significantly higher in the cases containing 75% or more oncocytic cells than the other cases (p < 0.0001). (26.3% for cases with 1-75% oncocytic cells, 81.3% for those with 75% or more oncocytic cells).

Conclusion: This study showed that the AUS cases with a dominant oncocytic cell population might be more specific for neoplastic processes. Presence of oncocytic cells in the AUS-nuclear cases causes a decrease in ROM. Emphasizing oncocytic cells in the report may contribute to patient follow-up and treatment in AUS.

Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms that can arise in various anatomical locations, including the female genital tract, with the uterus being the most affected site. Malignant uterine PEComas are extremely uncommon and pose significant diagnostic challenges, particularly when they lack conventional immunohistochemical (IHC) marker expression. This report presents a rare case of a high-grade, TFE3-rearranged malignant PEComa of the uterus that defied routine diagnostic approaches. This case underscores the diagnostic complexity of TFE3-rearranged PEComas, which can lack smooth muscle marker expression and mimic other high-grade uterine malignancies. Recognition of the nested vascular arrangement and utilization of melanocytic and TFE3 markers are key for diagnosis.

Objective: ALK-positive large B-cell lymphoma is an aggressive form of lymphoma characterized by the expression of the ALK protein alongside the loss of pan-B-cell and pan-T-cell markers. Unfortunately, there is no established standard treatment for this subtype, resulting in a poor prognosis. Understanding the expression of aberrant markers is essential for accurate diagnosis and improved patient management.

Case report: A 13-year-old male presented with intestinal obstruction to pediatric surgery and subsequently underwent exploratory laparotomy. Histopathological examination of the specimen revealed the presence of monomorphic tumor cells with plasmablastic morphology, which expressed CD45, CD79a, and CD3. Considering the patient's age and the tumor`s morphology, further analysis showed the loss of other B-cell and T-cell markers, along with the expression of ALK, CD138, CD38 and lambda light chain restriction. Thus, the current case emphasizes the necessity of a comprehensive immunohistochemical analysis to accurately diagnose ALK-positive large B-cell lymphoma with aberrant CD3 expression, thus preventing misdiagnosis as T-cell lymphoma.

Conclusion: It is crucial to recognize the uncommon ALK-positive large B-cell lymphoma that exhibits aberrantly expressed CD3 to prevent misdiagnosis. Identifying this condition may allow for the incorporation of ALK inhibitors, potentially improving patient outcomes.