Turkish Journal of Pathology最新文献

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.

Objective: ALK-related superficial soft tissue tumors represent an emerging category of neoplasms in daily pathology practice. We report the case of a 49-year-old Caucasian woman with an ALK-related neoplasm who presented with a 1,5 cm nodule on her left thigh.

Case report: The lesion was excised and histopathologically evaluated. Microscopic examination revealed a well-circumscribed nodule composed of epithelioid and oval-to-spindle cells. Although some morphological features were shared with epithelioid fibrous histiocytoma (EFH), there were no epidermal collarettes. In addition, significant storiform architecture and also foamy histocyte groups were detected in the lesions. ALK positivity was observed in both the immunohistochemical and FISH studies. Superficial ALK-rearranged Myxoid Spindle Cell Neoplasms (SAMS) were first considered in the differential diagnosis due to their prominent storiform structures. The lesion shared both EFH and SAMS morphology. Finally, we reported the case as `EFH with SAMS-like features`. The patient showed no evidence of recurrence during a 10-month follow-up.

Conclusion: This case presents the diagnostic challenges in ALK-positive neoplasms. Superficial soft tissue tumors associated with ALK include a heterogeneous group of lesions that may share similar morphological features. We believe that a generic term, ALK-Rearranged Superficial Mesenchymal Neoplasms (ARSMN), may serve as a more inclusive diagnostic label for these entities in routine pathology practice.

A 28-year-old female patient presenting with complaints of shortness of breath was diagnosed with diffuse pulmonary lymphangiomatosis based on radiological examinations and pathological analyses. This rare disease is characterized by the abnormal proliferation and dilation of lymphatic vessels. Although it is typically observed at younger ages in the literature, it can also be rarely diagnosed in adults. Our case emphasizes the importance of differential diagnosis for diffuse pulmonary lymphangiomatosis. The clinical, radiological, and pathological findings of the disease are discussed in detail.

Objective: Anemia is a common complication in kidney transplant patients, often attributed to viral infections. Our objective was to describe a rare case of severe anemia secondary to Parvovirus B19 infection in a kidney transplant recipient, highlighting diagnostic and therapeutic challenges in the immunosuppressed setting.

Case report: We present a 43-year-old woman with end-stage renal disease secondary to polycystic kidney disease who received a living-kidney transplant from her husband. Seven months after transplantation, she presented with severe anemia, fatigue, and palpitations. Laboratory findings demonstrated severe normocytic, normochromic anemia (Hb: 5.8 g/dL). Parvovirus B19 serology tests were negative twice, while PCR testing revealed a significant viral load (25×10⁶ copies/mL). Bone marrow biopsy findings included giant proerythroblasts with characteristic viral nuclear inclusions. The patient received intravenous immunoglobulin (IVIG, 100 mg/kg/day for 4 days), and mycophenolate mofetil was discontinued. After therapy, hemoglobin levels and viral load improved significantly, leading to successful resolution of anemia.

Conclusion: This case emphasizes the importance of considering Parvovirus B19 in the differential diagnosis of anemia in transplant patients. In immunosuppressed individuals, PCR and bone marrow analysis can be essential for diagnosis, especially when serologic tests are inconclusive. Timely intervention can lead to favorable outcomes.

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.

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.