PATHOLOGICA最新文献

Background: Lung cancer is the leading cause of cancer death worldwide and was the most commonly diagnosed cancer in 2022. The Rapid On-Site Evaluation (ROSE) technique allows immediate evaluation of samples collected during needle aspiration and needle biopsy procedures, improving diagnostic accuracy and reducing the need for repeated procedures.

Study design: A pre-post study evaluated the health benefits for patients and improved healthcare costs with ROSE diagnostic support from a public health perspective.

Methods: We compared two groups of patients who underwent TC-guided transthoracic needle aspiration/biopsy from March 2017 to March 2022. In the first group (pre-ROSE) the procedures were performed without the support of ROSE, while in the second group (post-ROSE) the pathologist assisted the radiologist in all cases. The diagnostic advantages, the economic-organizational impact of the procedure, and the related benefits for patients were analyzed.

Results: The pre-ROSE group comprised 97 patients, and the post-ROSE group comprised 67. In the group receiving ROSE diagnostic support, the rate of inadequate diagnostic tests requiring repetition decreased from 29.9% to 9.0% (p = 0.001). This saved time for the radiologist, pathologist, nurse, radiology technician, laboratory technician, and support staff, freeing up diagnostic slots that could be used to reduce waiting lists and improve the quality of patient service.

Conclusions: ROSE support has improved diagnostic efficacy and sample quality, reducing repeat testing and associated costs. This leads to better management of healthcare resources, reduced waiting times, and more accurate diagnoses, improving the quality of patient care and bringing public health benefits.

Over the past two decades, precision oncology has seen unprecedented advances, particularly with the rise of small molecule drugs. These drugs have significantly benefitted patients with cancer harboring somatic genomic alterations, contributing to precision cancer medicine. Despite their early promise, there is a growing concern that major pharmaceutical companies are recently moving away from developing small molecules and tyrosine kinase inhibitors (TKIs) due to market saturation, primary and secondary resistance, and economic factors. The Inflation Reduction Act (IRA) further threatens innovation by reducing incentives for small molecule drug development. Additionally, patient access to comprehensive genomic testing remains a significant barrier. To reverse this trend, a multifaceted approach is urgently needed. Embracing cutting-edge technologies, fostering collaborations, and regulatory innovation are essential. Addressing systemic deficiencies, improving patient access, and ensuring ongoing investment in personalized medicine are crucial for realizing the full potential of small molecule oncology drugs and improving patient outcomes. Collaboration among stakeholders is imperative for advancing effective cancer treatments.

Introduction: The term amyloidoma applies to localized deposits of amyloid in the absence of systemic amyloidosis. Skeletal and soft tissue amyloidomas are very rare and the pathogenesis is usually associated with lymphoproliferative disorders (plasmacytomas or plasmacytoid lymphomas) or as a consequence of local chronic inflammation.

Methods: In this paper we report the histological and immunohistochemical features of four cases of musculoskeletal amyloidoma in association with combined laser capture microdissection (LCM) of Congo Red positive regions with a recent microproteomics workflow that improves the sensitivity of the analysis in order to confirm the nature of the protein deposit.

Results: Proteomic techniques allowed to elucidate the nature of the amyloid protein deposit, improving the results obtained by immunohistochemistry (IHC). IHC results were confirmed in two cases while LCM coupled with bottom-up microproteomics was necessary to type the other two cases, for which IHC was inconclusive.

Conclusions: In conclusion, proteomic techniques were thus confirmed as a fundamental tool for the complete investigation of protein deposits.

Aims: Recently, precision medicine has drastically modified clinical paradigm for the clinical stratification of high-grade serous ovarian cancer (HGSOC) patients. International societies approved poly (ADP-ribose) polymerase (PARP) inhibitors (PARPIs) to treat platinum-sensitive BRCA1/2 defective HGSOC patients. Beyond BRCA1/2, functional defects in homologous recombination repair (HRR) proteins laid the basis for genomic instability evaluation in HGSOC patients. Given that measurement of homologous recombination deficiency (HRD) is extremely complex molecular analysis is outsourced. Of note, this diagnostic algorithm is affected by inconclusive results and high rejection rates. Here, we review the molecular results of BRCA1/2 and HRD analysis from referral institution in predictive molecular pathology.

Methods: From May 2023 to Jan 2024 molecular records from 147 HGSOC patients simultaneously tested for BRCA1/2 and HRD measurement were inspected. A commercially available next-generation sequencing (NGS) panel (Amoy Diagnostics Co Ltd, Xiamen, Fujian, China) was adopted to internally perform molecular analysis on formalin-fixed paraffin-embedded (FFPE) samples. In a subset of patients clinical records were matched with molecular results.

Results: Overall, 2 out of 147 (1.3%) cases were morphologically classified as inadequate. Simultaneous BRCA1/2 - HRD analysis was successfully assessed in 112 out of 145 (77.2%) patents. Molecular analysis revealed 7 out of 112 (6.2%) and 2 out of 112 (1.8%) pathogenetic or likely pathogenetic (class I-II) and variants of uncertain significance (VUS) (class III) BRCA1/2 molecular alterations, respectively. HRD score was positive in 48 out of 112 (42.8%) HGSOC patients.

Conclusions: HRD testing is a reliable method for the clinical management of HGSOC patients.

Objective: The absolute and relative quantification of tumor cell fraction (TCF) in tissue samples for molecular pathology testing is time-consuming and poorly reproducible.

Methods: Here we report the results of an international survey on non-small cell lung cancer (NSCLC), validating the Qupath Analysis of Nuclei from Tumor to Uniform Molecular tests (QuANTUM) automated computational pipeline for TCF quantification.

Results: The TCF obtained with QuANTUM is reliable, as demonstrated by the comparison with the manual counting of cells (ground truth, GT) in cell blocks, small biopsies and surgical specimens (overall correlation of 0.89). The visual evaluation of QuANTUM-processed images increased the pathologists' agreement with GT and QuANTUM of +0.16, +0.21, +0.09 and +0.17, +0.29, +0.21 across the three sample types, respectively. An overall increase in cases classified as containing ≥100 tumor cells for all sample types was noted after QuANTUM (from 75 cases, 63% to 96 cases, 80% among cell blocks, p = 0.003).

Conclusions: QuANTUM is an easy-to-use and reliable tool for the TCF assessment and its employment significantly modifies the visual estimation by pathologists, improving the assessment of NSCLC cases for molecular analysis.

According to the current WHO classification, urothelial tumors consist of non-invasive urothelial neoplasms and invasive urothelial carcinoma which is supposed to include all tumors with invasion regardless of extent and pattern. Some pathologists are uncomfortable about such all-inclusive definition of invasive urothelial carcinoma and it is questionable whether invasiveness is a valid defining feature for primary distinction of urothelial tumors. Considering that most pathologists understand urothelial tumors based on the dual-track pathway model, we would like to raise concern that it may be necessary to rethink the validity of the current WHO classification compared to the restructuring into papillary vs non-papillary tumors. In our opinion, such restructuring would align the WHO classification with the pathogenesis model and could clarify the diagnostic terminology regarding invasiveness. The term of urothelial carcinoma in situ may also be reconsidered.

Objective: Therapeutic landscape of metastatic renal cell carcinoma (mRCC) has transformed over the last 2 decades, particularly with the advent of immune checkpoint inhibitors (ICI). While ICI offer therapeutic benefits, they can also provoke immune-related adverse events (iRAEs). Vasculitis as a clinical iRAE from ICI is rare in association with RCC treatment.

Methods: This study included patients treated at our institution with ICI for mRCC (2019-2024). We collected clinicopathologic data and type and duration of immunotherapy. Histologic sections of tumors were re-reviewed by two pathologists to determine pathologic response and features of ICI-related renal injuries.

Results: We identified 8 patients (median age 61.5 years) of which six (75%) presented with metastases at multiple sites, while two had recurrent oligometastatic disease post-partial nephrectomy. All patients were treated with ICI for a duration ranging from 6 to 20 months; 7 patients received combination therapy (CT) [iplimumab & nivolumab (n = 3), pembrolizumab & lenvatinib (n = 2), nivolumab & carbozantinib (n = 1), pembrolizumab & axitinib (n = 1)], while one received monotherapy (MT) (pembrolizumab). Patients were poor surgical candidates at diagnosis (25% Stage 3, 75% stage 4). Six (75%) patients had clear cell RCC (CCRCC), 2 patients had RCC with papillary and eosinophilic features. Tumor necrosis was noted in 75% of cases. Partial tumor response occurred in 7 (87.5%) patients, with 3 (37.5%) achieving tumor downstaging. One patient showed stable primary disease despite resolution of metastatic burden and none of the patients achieved complete response. Three patients (37.5%) had histopathological confirmed renal iRAEs. Two (25%) patients displayed vascular lymphocytic infiltrates, consistent with medium vessels vasculitis; they received CT for 6 months. One patient, who received CT for 20 months, showed a non-necrotizing granuloma.

Conclusions: This study highlights the potential of ICIs for tumor downstaging and disease control in mRCC, though further investigation is warranted to optimize management of iRAEs and long-term outcomes. ICI-associated renal vasculitis is likely underrecognized and underreported highlighting the need for thorough pathological evaluation of non-neoplastic renal tissue in patients receiving ICI.

Lung neuroendocrine neoplasms (NENs) make up a variegated ensemble of malignancies encompassing typical carcinoid (TC) and atypical carcinoid (AC). These are low to intermediate grade neuroendocrine tumors (NETs), and large cell neuroendocrine carcinoma (LCNEC) and small cell lung carcinoma (SCLC), which are full-fledged high-grade neuroendocrine carcinomas (NECs) showing similar clinical outcomes. Through a peer interaction between oncologist and pathologist, we herein constructed a practical approach based on questioning and answering regarding 8 practical issues aimed to provide shared solutions for clinical decision-making. These issues were itemized as sequential steps guided by clinical reasoning and concerned differential diagnosis, combined subtypes, primary and metastatic tumors, small diagnostic material, predictive biomarkers, tumor staging and, lastly, standardizing terminology. This study takes advantage of the close interaction between oncologists and pathologists as a tool to better delineate the decision-making on lung NENs.

With the advent of personalized medicine, it has become increasingly clear that histological preparations stored in the archives of Pathological Anatomy Departments, from simple "residues" of a diagnostic process, have become containers of large quantities of biopathological information, useful to the patients themselves and to scientific research. For these reasons, taking inspiration from a "near disaster" recently published in Pathologica, we propose a different way of conceiving, managing and protecting these archives.

The introduction of immunotherapy has dramatically changed the paradigm of solid tumor treatment with the creation of novel therapeutic opportunities even for tumors that currently lack valid therapeutic options in the advanced or metastatic setting. Initially, the role of deficient mismatch repair status (dMMR)/microsatellite instability (MSI) as a predictive biomarker was confined to colorectal cancer. In 2017, MSI/dMMR became the first true agnostic biomarker to stratify patient response to immune checkpoint inhibitors. MSI/dMMR evaluation is a crucial point in diagnostic-therapeutic decision-making for most gastrointestinal cancer patients and the pathologist must be responsible for the delivery of reliable reporting in this setting. The aim of this review is to summarize the current methods available in routine diagnostics for the evaluation of MSI/dMMR status, their limitations, and potential pitfalls that can be encountered. The authors also give an overview of the role of MSI/dMMR as a prognostic and predictive biomarker in gastrointestinal cancers, with a focus on non-colorectal malignancies.