Turkish Journal of Pathology最新文献

Echinococcus granulosus, also known as the 10.5146/tjpath.2024.13488dog tapeworm, causes echinococcosis or hydatid disease in humans. It is an anthropozoonotic and non-endemic disease. Hydatid cysts are most commonly found in the liver and lungs, but can occur in any other organ, including the brain, kidneys, bones, and peritoneal cavity. Isolated renal hydatidosis is an extremely rare condition, accounting for only 2-4% of all cases of hydatidosis, with its occurrence in children being even rarer. We are reporting a rare case of isolated renal hydatidosis in a 12-year-old boy.

Objective: Oral squamous cell carcinoma is the most common head and neck malignancy reported worldwide. Tumor budding represents a histopathological feature characterized by the presence of isolated single/small clusters of cancer cells dispersed within the stroma at the invasive tumor front. Its prognostic significance has not been studied much in lip and oral squamous cell carcinomas in India. The aim of this study was to investigate the prognostic role of tumor budding in a large single-center retrospective cohort of 333 patients with oral squamous cell carcinoma at a tertiary cancer center in North Kerala, India.

Material and methods: The primary resection slides of 333 patients with oral squamous cell carcinoma from 2018 to 2020 were retrieved from the pathology archives and were evaluated by two independent pathologists for tumor budding and other histopathological parameters. The survival data were collected from the patient files.

Results: We found a significant association between tumor budding and other known histopathological prognosticators using Chi-square analysis. Univariate logistic analysis showed tumor budding, depth of invasion ( > 10 mm), worst pattern of invasion 5, and perineural invasion were significantly associated with locoregional recurrence/distant metastasis. Multivariate logistic regression analysis identified tumor budding as an independent prognostic marker for locoregional recurrence/distant metastasis. Univariate cox proportionality analysis showed that tumor budding, depth of invasion ( > 10 mm), worst pattern of invasion 5, pathological T4 stage, and perineural invasion were associated with decreased overall survival and poor disease-free survival in patients with oral squamous cell carcinoma. Multivariate cox proportionality analysis showed tumor budding as the only independent predictor for decreased overall survival and poor disease-free survival.

Conclusion: Based on this study, we can conclude that tumor budding is a simple and a reliable independent prognosticator that facilitates personalized management in patients with oral squamous cell carcinoma.

Objective: Cytological examination of pleural effusion is minimally invasive and low risk but faces challenges due to the lack of architectural features, low cell counts, and overlapping characteristics among reactive mesothelial cells (RMCs), carcinoma cells, and malignant epithelioid mesothelioma (MPM) cells. The aim of this was study to detect the diagnostic accuracy of the expression of HEG1 and Claudin-4 in distinguishing malignant mesothelioma from lung adenocarcinoma in pleural effusion.

Material and methods: The present study was carried out on 84 cases of pleural effusion. Sixty-four representative cell blocks of the studied malignant cases and twenty control cases were stained with HEG1 and Claudin-4 immunostaining, and the results were recorded.

Results: Positive membranous HEG1 immunoexpression was found in 95% of RMCs in benign effusions. Also, positive membranous HEG1 immunoexpression was found in 96% of cases of MPM, and only 2.6% of lung adenocarcinoma cases. There was a statistically significant difference between benign effusion with RMCs and lung adenocarcinoma immunoreactivity. There was a highly statistically significant difference between HEG1 immunoexpression in MPM and lung adenocarcinoma. On the other hand, all cases of benign effusions and all MPM cases had negative Claudin-4 immunoexpression while positive membranous Claudin-4 immunoexpression was found in 94.9% of lung adenocarcinoma cases. There was a statistically significant difference in immunoexpression of Claudin-4 between benign effusion and lung adenocarcinoma. There was a statistically significant difference in the immunoexpression of Claudin-4 between MPM and lung adenocarcinoma.

Conclusion: HEG1 and Claudin-4 IHC staining is extremely valuable in the differential diagnosis between reactive or malignant mesothelial cells and adenocarcinoma in pleural effusion.

Bone marrow necrosis, albeit an infrequent finding, is usually associated with highly proliferative malignant disorders, such as leukemia, lymphoma, or sickle cell anemia, solid tumor metastasis, and infections. It is also a typical finding in Caisson disease and in divers that developed decompression illness. Herein we report a case of bone marrow necrosis post deep diving in a bone marrow transplant recipient.

Objective: One of the most difficult areas in a surgical pathology practice is intraoperative consultation. In a previous study, we proposed an algorithm that provides a systematic approach to intraoperative consultation for central nervous system tumors. Our aim was to demonstrate the effectiveness of this algorithm.

Material and methods: 102 cases were selected from intraoperative consultation procedures performed at our institution between 2012 and 2020. The algorithm was tested by five observers. The observers examined the smears and frozen sections without the algorithm, and then with the algorithm.

Results: The percentage change in the rate of correct diagnoses made by the four observers (O) increased after using the algorithm (O2: 8%, O3: 5%, O4: 8% and O5: 13%), but decreased for only one observer (O1) (5%). The most common error made by the four observers was `grading of glial tumors` (O1: 40%; O2: 23%; O4: 40% and O5: 27.5%), and this group of errors was mostly corrected by using the algorithm (O1: 33%; O2: 3.8%; O4: 23% and O5: 10%). For two observers (O2 and O5), a statistically significant change in diagnostic levels was observed after using the algorithm (p=0.024 and p=0.040; respectively). In addition, thanks to the use of the algorithm, a high degree of agreement was found between the observers` diagnoses (77.7%, p < 0.001).

Conclusion: In the intraoperative consultation of central nervous system lesions, algorithms can help to increase the accuracy of the diagnosis and reduce interobserver variability. This study demonstrates that an algorithmic approach is an effective method for pathologists in intraoperative consultation procedures.

Objective: To study and correlate the clinicopathological findings of Solitary Rectal Ulcer Syndrome (SRUS) in 10 pediatric patients.

Material and methods: This study is a retrospective study of patients from January 2017 to June 2024. The clinical records were reviewed for details of the clinical presentation, colonoscopic findings, associated local and systemic diseases, and other investigations.

Results: The mean age of presentation was 10±1 years, and the youngest child was 6 years old. The most common clinical presentation was rectal bleeding and a single ulcer on endoscopy. Histological findings included crypt distortion, crypt branching, and fibromuscular obliteration of the lamina propria. Immunohistochemistry (IHC) for Smooth Muscle Actin (SMA) and special staining with Masson Trichrome (MT) were used to highlight fibromuscular areas whenever in doubt.

Conclusion: The pathogenesis of SRUS is not well understood. It may be associated with chronic mucosal and hypoperfusion-induced ischemic injury to the rectal mucosa due to trauma or increased rectal pressure during straining. Solitary rectal ulcer is a misnomer, as the patient may present with multiple or no ulcers. Endoscopy and histopathology help to diagnose SRUS. Timely and correct diagnosis reduces the morbidity associated with this entity.

Objective: To highlight two cases mixed neuroendocrine non-neuroendocrine tumors (MINEN) of the liver and to review the literature till date. To present two cases of MINEN of the liver diagnosed in our centre with clinical & diagnostic workup, the treatment modalities, and follow up. Extensive review of the literature and compilation of the presentation and treatment modalities used in those cases.

Case reports: Thirty-three cases of MINEN of the liver have been reported till date including ours. Our cases presented as incidental masses in liver during workup for other symptoms. AFP levels were normal in both cases but PIVKA (Protein induced by vitamin K absence) levels were increased. Resection was done in one of the cases while the other patient had to undergo transplantation. A diagnosis of MINEN was made on H&E, and confirmed on IHC. One patient was unfit for systemic chemotherapy whereas the other patient received cisplastin and etoposide based chemotherapy. Both patients developed metastasis on follow up but are still alive after 12-15 months.

Conclusion: MINEN is an uncommon tumor of the liver with a poor prognosis as shown by the few studies available. Recurrence and distant metastases are often described even after complete resection and the course is fatal. The role of adjuvant chemotherapy following surgical resection is not fully elucidated. Mean survival in the cases reported ranged from 1 month to 33 months. However, no significant differences were seen in the clinicopathologic profile of the cases described so far. Further multiinstitutional studies and follow up will help to further characterize this subtype for appropriate treatment.

Objective: This study aimed to identify the expression profile and prognostic significance of inflammation-associated lncRNAs in chronic viral hepatitis (CVH) and CVH-associated hepatocellular carcinoma (CVH-HCC).

Material and methods: In the first step, lncRNA expression analysis was performed by real-time polymerase chain reaction (RT-PCR) using an array panel of 84 inflammation-associated lncRNAs in 48 formalin-fixed paraffin-embedded (FFPE) tissue samples (12 CVH-HCC, 12 peritumoral cirrhotic parenchyma, 12 nontumoral cirrhotic CVH parenchyma, 12 normal liver samples). In the second step, 7 lncRNAs (DLEU2, HOTAIR, LINC00635, LINC00662, RP11-549J18.1, SNHG16 and XIST) were chosen for RT-PCR assay testing in 72 samples (24 CVH-HCC, 24 peritumoral cirrhotic parenchyma, 24 nontumoral cirrhotic CVH parenchyma samples).

Results: Fifty-six inflammation-associated lncRNAs were significantly up-regulated in the peritumoral cirrhotic parenchyma compared to the normal liver. Expression of 71 lncRNAs was significantly higher in peritumoral cirrhotic parenchyma compared to cirrhotic CVH parenchyma. DLEU2 and SNHG16 were up-regulated both in the tumor and peritumoral cirrhotic parenchyma compared to cirrhotic CVH parenchyma. Expression of LINC00662 was significantly higher in CVH-HCC than in cirrhotic CVH parenchyma. Expression of XIST was also increased in both tumor and peritumoral parenchyma samples, albeit without statistical significance. No significant association was found between lncRNA expressions and survival.

Conclusion: Inflammation-associated lncRNAs DLEU2, SNHG16, LINC00662, and XIST are candidate diagnostic biomarkers in CVH-HCC. More evidence is needed to prove their utility as prognostic markers.

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.