Turkish Journal of Pathology最新文献

Bartholin gland abscesses are typically caused by bacterial agents. Abscesses induced by Enterobius vermicularis are exceptional. We report, here, the case of a 27-year-old woman, whose histopathological examination of the Bartholin gland cyst confirmed the presence of E. vermicularis eggs in the lumen of the cyst.

Objective: Tumor-infiltrating lymphocytes (TILs) have been shown to predict outcomes in several cancers. This study aimed to evaluate the density and location of regulatory T cells (Tregs) using immunohistochemistry (IHC) in urothelial carcinomas (UC) of the bladder and to assess their prognostic value.

Material and methods: We have retrospectively collected all cases of UC of the bladder infiltrating at least the lamina propria, diagnosed in our pathology department between 2011-2021. Specimens were stained for CD3 and CD25. TILs were assessed separately in the tumor core and the stroma. The median TIL count was used as a cut-off to classify cases into low- or high-density groups.

Results: A total of 30 cases were included in the study. The median age of the patients was 65 years, with a male-to-female ratio of 9:1. The distribution of TILs was heterogeneous across locations among patients. CD3+ (p=0.035) and CD25+ (p=0.051) TILs were predominantly observed in the stroma. The density of CD25+ and CD3+ TILs were not associated with clinicopathological features. Multivariate analysis revealed that advanced histological stage and a high density of regulatory CD25+ T lymphocytes were predictive factors of poorer event-free survival (respectively p=0.041 and p=0.052).

Conclusion: Regulatory T cells appear to predict worse survival outcomes. Further studies are needed to confirm their prognostic value.

Objective: Virchow`s node, described in 1848, represents a metastasis to the left supraclavicular lymph node, commonly arising from gastric cancer. However, in regions with lower gastric cancer incidence, the relevance of Virchow`s node and the spectrum of diagnosis associated with supraclavicular lymphadenopathy (SCLAP) needs reevaluation. This study aimed to analyze the spectrum of fine-needle aspiration cytology (FNAC) at a tertiary care institute.

Material and methods: We retrospectively reviewed all supraclavicular lymph node aspirations performed between March 2019 and August 2022. Data were collected from the Department of Pathology`s electronic records and descriptive analyses were performed.

Results: Out of 270 FNAC procedures for SCLAP, 50 were non-diagnostic. Of the 220 patients, cytological diagnosis was categorized as metastatic malignancy in 120 (54.5%) patients, granulomatous lymphadenitis in 57 (25.9%), reactive lymphadenitis in 11 (5.0%), acute suppurative lymphadenitis in 21 (9.5%), and lymphoproliferative disorder in 10 (4.54%) patients. Among the 120 metastatic cases, the most common type was adenocarcinoma (58.3%). The most common primary site was the lung (22.5%), oral cavity (19.2%), breast (12.5%), and gallbladder (10%). Primary gut carcinomas constitute only 9% of supraclavicular lymph node metastases.

Conclusion: The findings suggest a need to reconsider the clinical significance of Virchow`s node, especially in regions with different cancer epidemiology. FNAC remains a critical diagnostic tool in evaluating SCLAP.

Ovarian epithelial tumors are common in adults, and the median patient age at presentation is 55 years. In children, epithelial tumors are rare and mostly benign. Mucinous cystadenocarcinoma is reported in only 11 cases less than 15 years old. This report describes the case of a 15-year-old postmenarchal Omani girl with ovarian mucinous carcinoma. She was admitted with severe epigastric pain and abdomen distension. CT scan showed a huge cystic lesion arising from the left adnexa filling the entire abdominal and pelvic cavity. The patient underwent laparotomy with left ovarian cystectomy and omental biopsy which revealed a 35 x 30 cm left ovarian cyst filled with turbid straw color fluid. Histopathology was reported as mucinous carcinoma. The patient later underwent cytoreductive surgery with left salpingo-oophorectomy, omentectomy, appendicectomy, and lymph node dissection that were negative for malignancy or metastatic disease. During follow-up, she developed a lymphocele in the pelvic cavity that was drained. There were no other significant issues during follow-up, as well as no evidence of recurrence or metastasis. Epithelial tumors of the ovary are rare in young girls, with malignant tumors being exceedingly rare. Fertility-sparing surgery is adopted over radical surgery in these patients, even though the recurrence rates with this treatment protocol are high. All cases should be under follow-up to look for recurrence and timely management.

Objective: The Papanicolaou (PAP) smear remains the cornerstone of early detection and prevention in cervical cancer screening, Today, liquid-based cytology (LBC) techniques are more widely used for this purpose. ThinPrep is one of the most effective of these methods. In this study, we aimed to investigate the contributions of the cell block method when using ThinPrep liquid-based cervical samples.

Material and methods: We retrospectively reviewed a total of 453 cases in which we applied cell block to assist in correct diagnosis in terms of four criteria we determined from ThinPrep LBC samples accepted to our department between 2020 and 2023. We investigated the benefits of cell block according to the four criteria we defined in these cases; these criteria were adequacy, determination of cellular origin based on atrophy, and correct diagnosis of squamous cell lesions and glandular cell lesions. Cell blocks were re-evaluated by 3 experienced pathologists, and the results were analyzed.

Results: The cell block method contributed significantly to the adequacy in 97 of the 136 samples. It contributed to understanding the cellular origin and correct diagnosis of atrophic background in 113 of the 165 samples. It also contributed to the correct diagnosis of squamous cell lesions in 26 of the 107 samples and glandular cell lesions in 40 of the 45 samples. Overall, it was detected to be useful in 272 out of 453 cases.

Conclusion: The cell-block method represents powerful contributions for each parameter, especially if it is used selectively, particularly in evaluating glandular cell lesions and atrophic background. Additionally, it facilitates ancillary testing in the field of cervical cancer screening and management.

Objective: Loss of mismatch repair (MMR) protein expression, assessed via immunohistochemistry (IHC), and microsatellite instability (MSI) status, determined through molecular methods, are two tumor-agnostic predictive biomarkers for immunotherapy eligibility. However, there remains no consensus on the preferred testing method, nor on the type and extent of molecular testing required for optimal patient selection. This study investigates the correlation between MMR protein loss detected by IHC and MSI status identified through next-generation sequencing (NGS) to evaluate the concordance and potential complementary roles of these methods.

Material and methods: A total of 139 tumor samples were analyzed for MSI using NGS. The cohort included colorectal carcinoma (n=51), pancreatic ductal adenocarcinoma (n=22), cholangiocarcinoma (n=9), non-small cell lung carcinoma (n=6), adenoid cystic carcinoma (n=6), gastric adenocarcinoma (n=6), high-grade serous ovarian carcinoma (n=5), and 34 other tumor types. IHC was performed to assess MLH1, MSH2, MSH6, and PMS2 protein expression. The correlation between MSI status and MMR protein loss was evaluated.

Results: Twelve tumors (8.6%) were classified as MSI-High (microsatellite instable). Among them, ten exhibited MMR protein loss, whereas two MSI-High tumors (a mucinous adenocarcinoma of omental origin and a mucinous colon adenocarcinoma) retained MMR protein expression. No MMR-deficient tumors were identified as MSI-Low (microsatellite stable/MSS).

Conclusion: A strong correlation exists between IHC-based MMR loss and NGS-based MSI detection. IHC remains widely used due to its accessibility and cost-effectiveness, whereas NGS offers higher accuracy and broader genomic insights. With its ability to detect multiple alterations simultaneously, NGS is particularly valuable when tissue is scarce. Combining both methods can improve diagnostic accuracy and guide optimal immunotherapy selection.

Objective: A growing body of evidence suggests a correlation between endothelial cell dysfunction and cancer, as well as facioscapulohumeral dystrophy, both of which are DUX4-related diseases. However, the endogenous expression of DUX4 within endothelial cells (ECs) remains unexplored. This study aims to investigate DUX4 expression in ECs and examine the presence of DUX4-counteracting proteins named PAX3 and PAX7.

Material and methods: This is a cell study in which human umbilical vein endothelial cells (HUVECs) were selected as an in vitro representative of the EC population. The presence of the DUX4, PAX3 and PAX7 proteins in the HUVECs was examined using immunofluorescence staining. The mRNA levels of these proteins were investigated using qPCR with specific primers for each transcript.

Results: It was observed that 51% of HUVECs expressed the DUX4 protein whereas only a small number of cells were stained with PAX3/PAX7 antibody. At the mRNA level, HUVECs exhibited expression of DUX4, PAX3 and PAX7. The mRNA levels of PAX3 and DUX4 were lower compared to PAX7 mRNA.

Conclusion: The high rate of DUX4 protein expression observed in HUVECs is the first positive data and suggests a potential role for DUX4 protein in endothelial cells. Further analyses including the functional analyses of DUX4, PAX3 and PAX7 in ECs could improve our understanding of a vascular pathogenesis in DUX4-related diseases, particularly in the contexts of cancer and facioscapulohumeral dystrophy.

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: Preeclampsia is a pregnancy-specific disorder characterized by impaired maternal-fetal immune tolerance. The maternal immune system plays a crucial role in maintaining pregnancy, and its dysfunction is believed to contribute to preeclampsia. Immune checkpoint molecules such as programmed cell death protein 1 (PD-1) and its ligand, programmed death ligand 1 (PD-L1), may play a key role in this process. This study evaluated PD-L1 expression in the placentae of patients with pre-eclampsia (PE) and eclampsia (EC). We also compared PD-L1 expression with histomorphological features and fetal outcomes.

Material and methods: A prospective case-control study was conducted, including fifty pre-eclampsia cases, twenty-five eclampsia cases, and twenty-five normal pregnancy controls. Detailed clinicopathological data, histomorphological features of the placenta, and fetal outcomes were collected. PD-L1 expression was assessed using immunohistochemistry, with a semi-quantitative scoring system. The relationship between PD-L1 expression, histopathological scores, and fetal outcomes was also evaluated.

Results: In this study, a lower expression of PD-L1 was observed in pre-eclampsia and eclampsia as compared to a normal pregnancy. Adverse fetal outcomes were associated with lower PD-L1 expression and with reduced placental weight and high histopathological scores ( > 5).

Conclusion: Lower PD-L1 expression was observed in pre-eclampsia and eclampsia compared to normal pregnancies. Reduced PD-L1 expression correlated with histomorphological changes in the placenta and adverse fetal outcomes.

Objective: Lung cancer, the second most common type of cancer, is the leading cause of cancer-related mortality, with non-small-cell lung carcinoma (NSCLC) being the most prevalent subtype. The presence of EGFR mutations in NSCLC influences tumor behavior and treatment response. The prevalence of EGFR mutation in Iranian patients is limited. This study investigated the frequency of EGFR mutation and its association with PD-L1, ALK, and ROS1 expression in patients with NSCLC from Northwest Iran.

Material and methods: A retrospective analysis was conducted on 647 cases of NSCLC from April 2018 to August 2024 at Imam Reza Hospital in Tabriz, Iran. Histologic diagnoses were confirmed, and patient data were collected. EGFR mutation testing targeted exons 18-21 using Sanger sequencing and Real-Time PCR. ALK and ROS1 rearrangements were assessed using fluorescence in situ hybridization (FISH), while PD-L1 expression was evaluated through immunohistochemistry (IHC). The statistical analysis was performed using SPSS version 27.0.

Results: The cohort comprised 430 males and 217 females, with a median age of 62 years (IQR: 54-70). EGFR mutations were identified in 171 (26.4%) cases, more frequently in females (33.6% vs. 22.8%; p = 0.003). The most common mutation was exon 19 deletion (56.7%), followed by L858R (21.6%). No significant association was found between EGFR mutations and ALK (p = 0.126) or PD-L1 expressions ( p = 0.29). ROS1 mutations were not detected.

Conclusion: This study confirmed the mutual exclusivity of EGFR and ALK mutations and found no significant association with PD-L1. Comprehensive EGFR testing remains crucial to guide targeted therapies. Broader studies are needed to include diverse populations and additional clinical factors to improve personalized treatment.