Turkish Journal of Pathology最新文献

Objective: Fine needle aspiration cytology is the first line of investigation for thyroid lesions. Despite standard reporting formats, the diagnostic accuracy varies across institutions. In this study, we have reviewed our discordant cases on cytology and histopathology and analyzed the diagnostic errors.

Material and methods: The thyroid cases with discrepant cytology and histopathology reports for a period of five years were analyzed for diagnostic errors. The papillary thyroid carcinoma (PTC) cases were studied in detail for all diagnostic parameters. Nuclear scoring was used to improve the detection of PTC.

Results: Of the 166 cases, 18 (10%) had discrepant diagnoses. The sensitivity was 65.62% (CI 46.81-81.43%), specificity 94.78%, positive predictive value 75%, negative predictive value 92.03%, positive likelihood ratio 12.56, negative likelihood ratio 0.36, false positive rate 5.2%, false negative rate 34.3% and accuracy 89.16%. False negative (malignant cases diagnosed as benign) was due to inadequate/wrong site sampling, benign clusters/ cyst macrophages, marginal flares, thin colloid, larger fragments of calcification, and subtle nuclear features. An interesting flower head-like structure was observed in PTC cases. Nuclear scoring on false negative cases improved our diagnostic accuracy. False positivity was due to vigorous aspiration and over-interpretation of nuclear features.

Conclusion: Analysis of our discrepant cases highlighted the importance of multiple passes, sampling all nodules, and ultrasound-guided aspiration to reduce sampling error. Application of nuclear scoring reduced overdiagnosis and missing out on PTC. Tissue fragments and hypercellularity were the major misleading factors in false positive cases.

Aim: To document a case of primary cutaneous Adiaspiromycosis.

Introduction: Adiaspiromycosis is a rare emerging fungal infection caused by Chrysosporium Parvum var Crescens now called as `Emmonsia Crescens` belonging to the genus Emmonsia, order Onygenales, family Ajellomycetes.

Case report: A 38-year-old male presented with an ulcerated nodule over the infra-axillary region with itching for 3 months. The lesion began as small nodule slowly growing to attain the present size. His routine investigations were within normal limits. Serological tests such as HBsAg and HIV were nonreactive. Fine needle aspiration cytology showed `suppurative granulomatous` inflammation. The nodule was excised and sent for histopathological examination. Histopathology showed numerous noncaseating granulomas and suppuration. Amidst suppuration, as well as inside the giant cells and within granulomas, numerous varying sized, thick-walled, round to oval `adiaspores` were seen. There was no evidence of budding or septation or endosporulation. They were PAS and GMS positive. He was treated with topical luliconazole and oral fluconazole. There was no recurrence on follow up of one years.

Conclusion: Adiaspiromycosis is a rare fungal infection and primary cutaneous involvement is a rare distinct entity. Detailed morphological assessment in histopathology is essential for its identification as the organisms are difficult to isolate in fungal culture from human clinical material.

Objective: The tumor microenvironment is a heterogeneous and constantly changing territory that plays an active role in tumor formation and progression. It constantly interacts with tumor cells, plays an active role in tumor development, and even appears as a parameter of prognostic importance, and the importance of the tumor microenvironment in breast cancer has been emphasized by recent studies. In this study, we aimed to retrospectively evaluate the relationship between the tumor microenvironment and prognostic parameters in invasive breast carcinomas of no special type.

Material and methods: A total of 271 cases diagnosed as invasive breast carcinoma of no special type from resection materials in our center between 2007 and 2015 were included in the study. Hematoxylin-eosin stained slides with a thickness of 4-5 micrometers were evaluated in terms of tumor infiltrating lymphocytes, peritumoral and intratumoral desmoplastic reaction, intratumoral and peritumoral tumor budding, stromal features, and tumor growth pattern.

Results: When parameters related to the tumor microenvironment were compared with other prognostic parameters, there was a significant relationship between TILs and tumor grade, size, stage, immunohistochemical subgroup and Ki-67 proliferation index. A significant relationship was detected between intratumoral stromal reaction and tumor grade, size, molecular subgroup and the Ki-67 proliferation index (p < 0.05). When stroma and other prognostic parameters were compared, tumors with desmoplastic stroma had higher grades and higher Ki-67 proliferation indexes, and they were observed more frequently in the triple negative molecular subgroup.

Conclusion: We believe that including parameters related to tumor microenvironment in breast cancer reports, which hold a prognostic and predictive importance, will contribute to patient management. Considering the fact that these can be easily evaluated from routinely used hematoxylin-eosin stained slides, this does not cause additional costs or excessive time loss.

Pheochromocytoma and abdominal paraganglioma (PPGL) are rare catecholamine-producing, keratin-negative, non-epithelial neuroendocrine neoplasms characterized by a unique association with syndromic diseases caused by constitutional mutations in a wide range of susceptibility genes. While PPGLs are recognized for their malignant potential, the risk of metastatic disease varies depending on several clinical, histological, and genetic factors. Accurate diagnosis and prognosis of these tumors require a multidisciplinary approach, integrating insights from various medical specialties. Pathologists play a crucial role in this complex task, as numerous morphological, immunohistochemical, and genetic findings can be linked to worse outcomes. Therefore, it is vital to stay informed about the latest advancements in PPGL pathology. This brief review provides an overview of the challenges associated with PPGLs and highlights the most recent developments in tumor prognostication.

Objective: This review which aims to examine the recent and current status of pathology education in medical schools, and covers the publications related to undergraduate pathology education published between 2010 January and June 2023.

Material and method: A search was performed through PubMed, Google Scholar, Semantic Scholar, and Ulakbim search engines for the Science Citation Index, Science Citation Index Expanded, Emerging Sources Citation Index, Directory of Open Access Journals, Scopus, PubMed as well as TR Dizin indexed articles. The findings are categorized into two periods as 2010 January - 2020 April (pre-COVID-19 pandemic) and May 2020 - 2023 June. A total of 24 reviews/editorials/letters to the editor and 63 research articles in the pre-pandemic period and 11 reviews/ editorials/ letters to the editor and 35 research articles between 2020 May and 2023 June are included in the analysis.

Results: Currently, medical education generally depends on core education programs with defined learning objectives and outcomes. Moreover, problem-based, case-based, and team-based interactive learning are being used along with traditional didactic courses. Additionally, digital/ web-based/remote education methods have gained prominence after the COVID-19 pandemic. The virtual or augmented reality and 3D drawing applications are offered as a solution for the autopsy and macroscopy courses. A scarce number of publications are found on measuring and evaluating the effectiveness of learning.

Conclusion: Artificial intelligence in pathology education is a topic that looks likely to become important in the near future. National and international comprehensive standardization is a necessity. A joint effort and collective intelligence are needed to achieve the desired goals in undergraduate pathology education.

Digital papillary adenocarcinoma (DPA) is a rare malignant eccrine tumor. A 62-year-old female presented with a subcutaneous nodular 1.5cm-mass in the thumb. Macroscopically, a poorly circumscribed mass containing cystic and solid components was observed. Microscopically, epithelial neoplasm consisting of tubular-cystic structures with back-to-back arrangements was observed. The lining epithelium was composed of cuboidal/columnar cells with mild atypia, with micropapillary extensions. Immunohistochemistry revealed double-layered neoplastic epithelium containing two different types of cells: basaloid/myoepithelial and luminal. We recommend two out of vimentin, HMWCK, and D2-40 for myoepithelial/basaloid cells, also CK7 and EMA for luminal/columnar cells. As the tumor had infiltrated the surgical margins, the patient underwent axillary sentinel lymph node (SLN) dissection and re-excision with Mohs micrographic surgery (MMS). Two additional MMS stages were required due to suspicious surgical margin positivity in the frozen sections. The operation was continued despite the risk of loss of function. Upon examination of the permanent sections, we observed no tumors in the suspected positive foci. Additionally, no tumor was found in the surgical margins. No metastasis was detected in the sentinel lymph node. We have reached 300 reported cases of DPA in the literature. We discussed the histopathological and intraoperative diagnostic pitfalls of DPA with a literature review and our experience.

Objective: Diagnostic and prognostic biomarkers for malignant melanoma are crucial for treatment and for developing targeted therapies. Malignant melanoma is a highly immunogenic tumor, and its regression, treatment, and prognostic evaluation are directly related to escape from immune destruction. Therefore, we aimed to determine the expression levels of CD80, CD86, and PD -L1 in malignant melanoma tissue samples by immunohistochemistry and to investigate the possible relationship between these proteins and the clinicopathological features in this study.

Material and methods: Hematoxylin and eosin staining and immunohistochemical staining for CD80, CD86, and PD-L1 were evaluated for clinical data, survival, prognosis, tumor location, malignant melanoma subtypes, tumor size, and prognostic findings.

Results: Higher survival rates were observed in patients with lower PD-L1 staining scores in the tumor. The 5-year survival was higher in patients with CD80-positive and CD86-positive biopsies. Mortality was lower in superficial spreading melanoma and Lentigo maligna melanoma types, whereas staining positivity of CD80 and CD86 was higher. Furthermore, a relationship between clinical stage and Breslow thickness ( < 2mm/≥2mm), tumor ulceration, lymph node metastasis, and CD80 and CD86 expression was also identified.

Conclusion: Our findings suggest that PD-L1, CD80, and CD86 expression are essential in malignant melanoma and could be used as prognostic markers.

Objective: This study aimed to determine the standard time required for the performed job and to examine the standard job critically for productivity improvement in the pathology laboratory.

Material and methods: In this study that was conducted at a tertiary teaching hospital, observation, fishbone diagram, and flow charts were used to collect the information about the job process. All employees were observed from September 2017 to June 2018. The observations were recorded by video camera in order to overcome the Hawthorne effect. Nine basic procedure steps were followed for productivity improvement.

Results: Within the scope of the study, the jobs of `trimming tissue blocks` and `sectioning of tissue blocks` was selected. The standard time required was 0.19 minutes for `trimming tissue blocks` and 0.34 minutes for `sectioning of tissue blocks`. The procedure steps, named `Removal of tissue block` and `Fixing the block to the device`, were removed from the flow chart to define the improved method. The implementation of the improved method brought in a gain of 11.28 work days per year.

Conclusion: It is obvious that the pathology laboratory needs to take certain measures to improve working conditions and increase efficiency. Our results demonstrate applying the study techniques could reduce the workload and processing time. This study also shows that the study techniques can be applied in the hospital laboratory. Incorporation of all pathology technicians in the change or innovation process will be important in maintaining the achievements.

Objective: Nasal glioma, also known as nasal glial heterotopia, is a rare tumor-like lesion that often affects newborns or infants with no hereditary predisposition.

Case report: A 4-year-old child with a growth on the nasal dorsum since birth was diagnosed with nasal glial heterotopia/nasal glioma. The lesion showed a sclerotic fibroma/collagenoma-like storiform pattern with entrapped glial tissue that was S100 and GFAP positive.

Conclusion: When a biopsy of the nasal dorsum demonstrates sclerotic microscopic findings with a storiform pattern, nasal glioma should be considered before making a diagnosis in the collagen-rich tissue spectrum (collagenoma or Gardner's fibroma), and an immunohistochemical panel should be requested to demonstrate the presence of an unrecognized light microscopically visible glial component.