Turkish Journal of Pathology最新文献

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: The past ten years have seen an increase in gabapentin (GBP) overuse and abuse in Egypt after pregabalin scheduling. Numerous studies have demonstrated the detrimental effects of pregabalin; nonetheless, GBP`s effects are minimal. The objective of this investigation is to study GBP-induced neurotoxicity in rats and the protective benefits of alpha-tocopherol (vitamin E `Vit E`).

Material and methods: Forty (40) adult male albino rats were randomly split into four groups: (10 rats each): Group I, which was subdivided into group Ia (5 rats), received a regular diet as a negative control; group Ib (5 rats) received corn oil as a positive control; group II received alpha-tocopherol; group III (GBP misuse); and group IV received GBP + alpha-tocopherol. The corresponding medicines were administered to every rat for fifty days. Neurobehavioral tests were performed on the day of scarification. Hippocampal tissues were collected for immunohistochemical and histological analysis.

Results: Weight gain rose considerably by the end of the research in the drug-treated groups. In neurobehavioral tests, controls performed better and had higher locomotor indices. The group that misused GBP showed more deteriorated cells and more negative effects on hippocampal tissues. These histological alterations dramatically decreased with alpha-tocopherol therapy.

Conclusion: GBP in high doses had neurotoxic effects, disrupted hippocampal tissues, and increased the number of degenerated cells. Alpha-tocopherol treatment significantly attenuated the deleterious effects induced by GBP.

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.

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.

We report a case of young female in her 20s who presented with a supraclavicular soft tissue mass. Diagnostic biopsy showed a malignant round cell tumor with areas of spindling and hyalinized stroma. The utilization of an immunohistochemistry panel revealed positive results for NKX2.2 and CD99 expression. This positivity led to the consideration of a differential diagnosis of Ewing sarcoma, EWSR1::NFATC2- rearranged sarcoma, and mesenchymal chondrosarcoma for further assessment. On further immunohistochemistry with NKX3.1 and EWSR1 break-apart fluorescent in situ hybridization analysis, a diagnosis of mesenchymal chondrosarcoma was rendered which was later on confirmed with biphasic histology on excision specimen. NKX3.1 is a useful immunohistochemistry marker to resolve the differentials when dealing with undifferentiated small round cell sarcoma of bone and soft tissue, especially on a needle biopsy.

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.