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Diagnostic concordance between traditional and digital workflows. A study on 1427 prostate biopsies. 传统和数字工作流程之间的诊断一致性。1427例前列腺活检的研究。
IF 3.5 Pub Date : 2023-08-01 DOI: 10.32074/1591-951X-896
Evelin Torresani, Maria Adalgisa Gentilini, Stefano Grassi, Luca Cima, Irene Pedrolli, Tommaso Cai, Marco Puglisi, Valentino Vattovani, Bianca Guadin, Matteo Brunelli, Claudio Doglioni, Mattia Barbareschi

Objective: To evaluate intra-observer diagnostic reproducibility using traditional slides (TS) versus whole slide images (WSI).

Methods: TS and WSI of 1427 prostatic biopsies (107 consecutive patients) were evaluated by a single pathologist. Agreement between readings was evaluated with Gwet's Agreement coefficient (AC) and Landis and Koch benchmark scale.

Results: The positive/negative agreement between the readings was almost perfect (AC1= 0.962; 95% CI[0.949,0.974]), with method independent distribution of discrepancies. Among positive biopsies, 212 had identical Gleason score (GS) on TS and WSI and discordant GS in 69 cases (AC2 = 0.932; 95% CI[0.907, 0.956]). Concordant negative and positive patient classification was observed in 39 and 64 cases, respectively; two cases were assigned to the positive group on TS and 2 on WSI configuring an almost perfect agreement (AC1=0.929; 95% C1[0.860, 0.998]). ISUP Grade group (ISUP GG) agreement was evaluated in the 60 concordantly positive cases: in 45 cases it was identical on TS and WSI; in 10 biopsies the discrepancy implied a modification of the assigned ISUP GG of ≤ 1 class and in 5 the discrepancy implied a modification of 2 classes. Gwet's agreement coefficient was (95% CI [0.834, 0.962]), i.e.: almost perfect agreement.

Conclusions: Our data show almost perfect agreement between digital and traditional diagnostic activity in a routine setting, confirming that digital pathology can be safely introduced into routine workflows.

目的:评价传统载玻片(TS)与全载玻片(WSI)在观察者内诊断的可重复性。方法:对连续107例1427例前列腺活检患者的TS和WSI进行单一病理学评估。使用Gwet的一致系数(AC)和Landis和Koch基准量表评估读数之间的一致性。结果:两组读数正/负一致性几乎完美(AC1= 0.962;95% CI[0.949,0.974]),差异分布与方法无关。阳性活检患者TS、WSI Gleason评分一致的212例,不一致的69例(AC2 = 0.932;95% ci[0.907, 0.956])。阴性和阳性患者分型一致的分别为39例和64例;TS阳性组2例,WSI阳性组2例,基本一致(AC1=0.929;95% c1[0.860, 0.998])。在60例一致阳性病例中评估ISUP分级组(ISUP GG)一致性,其中45例TS和WSI相同;在10个活检中,差异意味着指定的ISUP GG的修改≤1级,在5个差异意味着修改2级。Gwet的一致系数为(95% CI[0.834, 0.962]),即:几乎完全一致。结论:我们的数据显示,在常规设置中,数字化和传统诊断活动几乎完全一致,证实了数字化病理学可以安全地引入常规工作流程。
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引用次数: 0
Histology for nephrology, from pre-implantation to post-transplant kidney biopsy. Lesson learned from ReBIrth (Renal BIopsy for Kidney Transplantation Therapy). 肾学组织学,从植入前到移植后肾活检。重生(肾移植治疗的肾活检)的经验教训。
IF 3.5 Pub Date : 2023-08-01 Epub Date: 2023-06-13 DOI: 10.32074/1591-951X-858
Anna Caliò, Antonella Barreca, Stefano Marletta, Maria Italia Sara Achenza, Marianna Alessi, Roberta Angelico, Luca Apicella, Davide Argiolas, Nicola Bossini, Rosa Carrano, Concetta Carriero, Giuseppe Castellano, Giorgia Comai, Caterina Di Bella, Francesco D'Ignoto, Agnese Gallico, Fiorella Gastaldon, Guido Merlotti, Vera Paloschi, Alessandra Panarese, Angelica Parodi, Francesco Perna, Daniela Picciotto, Anna Regalia, Michele Rossini, Enrico Russo, Maria Paola Salerno, Luca Toti, Patrizia Tulissi, Gisella Vischini, Gianluigi Zaza, Albino Eccher

A meeting entitled Renal BIopsy for Kidney Transplantation Therapy (ReBIrth) took place on May 31st, 2022 in Bologna, Italy. The meeting drew together nephrologists, surgeons, and pathologists and recognized as experts in the field of kidney transplantation in Italy. In this paper, we present our experience working with kidney transplants in the current era of immunosuppression therapy. The primary aim is to report the histopathological characteristics of failed kidney allografts after a consensus of experts reviewed the cases on a wholeslide imaging digital platform. Regardless of the cases discussed, digital pathology was reliable in identifying all the morphological and immunohistochemical features required to improve the correct use of immunosuppressive therapy to prevent graft failure and optimize patient management.

2022年5月31日,在意大利博洛尼亚召开了肾移植治疗肾活检(ReBIrth)会议。会议汇集了肾内科医生、外科医生和病理学家,并被公认为意大利肾移植领域的专家。在本文中,我们介绍了我们在当前免疫抑制治疗时代的肾移植工作经验。主要目的是报告失败的同种异体肾移植的组织病理学特征后,专家一致审查的情况下,在一个整体的成像数字平台。无论所讨论的病例如何,数字病理学在识别所有形态学和免疫组织化学特征方面是可靠的,这些特征有助于提高免疫抑制治疗的正确使用,以防止移植物衰竭和优化患者管理。
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引用次数: 0
Ovarian schistosomiasis: challenges of a neglected ectopic involvement of blood flukes. Case report and review of literature. 卵巢血吸虫病:被忽视的异位参与血吸虫的挑战。病例报告及文献复习。
IF 3.5 Pub Date : 2023-08-01 DOI: 10.32074/1591-951X-891
Edrick Elias, Valeria Silvestri, Vivian Mushi, Martina Mandarano
Summary Introduction Female genital schistosomiasis (FGS), infection of Schistosoma spp. trematode in the gynaecological apparatus, is the most neglected sexual and reproductive health condition in sub-Saharan Africa with an estimated of 20-120 million cases. The ectopic entrapment of Schistosome eggs after oviposition can occur in 0.5% of cases in fallopian tubes and ovaries. The case We report a case of 38-years-old woman assessed for a 10 year history of infertility. On ultrasound, multiple cystic formations were observed in the ovary. Histology after oophorectomy to exclude malignancy showed granulomatous formations surrounding Schistosoma spp. eggs in proximity of corpus luteus and haemorragicum. Discussion Ectopic Schistosome oviposition, seen in the ovary and fallopian tubes as in our case, can be a potential cause of reproductive organ damage and complications such as infertility, ectopic pregnancy, miscarriage, premature birth, low birth weight, and even maternal death. Conclusions More studies are needed on ovarian FGS and its impact on women fertility to guide specific interventions targeting vulnerable population of childbearing age, contributing to the NTD WHO 2030 aim of eliminating schistosomiasis as a matter of public health.
导言:女性生殖器血吸虫病(FGS),即在妇科装置中感染血吸虫,是撒哈拉以南非洲最被忽视的性和生殖健康疾病,估计有2000万至1.2亿例。在输卵管和卵巢中,产卵后血吸虫卵异位夹持发生率为0.5%。病例:我们报告一例38岁的妇女评估10年的不孕症史。超声示卵巢多发囊性形成。卵巢切除排除恶性肿瘤后的组织学显示黄体和出血附近血吸虫卵周围有肉芽肿形成。讨论:异位血吸虫产卵,见于卵巢和输卵管,如本病例,可能是生殖器官损伤和并发症的潜在原因,如不孕症、异位妊娠、流产、早产、低出生体重,甚至产妇死亡。结论:需要对卵巢FGS及其对妇女生育能力的影响进行更多的研究,以指导针对育龄弱势人群的具体干预措施,促进实现世卫组织2030年将消除血吸虫病作为公共卫生问题的目标。
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引用次数: 0
Author's reply to the Letter to the Editor from Mungunpuntipantip and Wiwanitkit. 作者对Mungunputiantip和Wiwanitkit给编辑的信的回复。
IF 3.5 Pub Date : 2023-08-01 DOI: 10.32074/1591-951X-917
Ilaria Girolami
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引用次数: 0
Livedoid skin reaction and mRNA Covid-19 vaccine: correspondence. 活皮肤反应与mRNA新冠肺炎疫苗:对应关系。
IF 3.5 Pub Date : 2023-08-01 DOI: 10.32074/1591-951X-806
Rujittika Mungunpuntipantip, Viroj Wiwanitkit
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引用次数: 0
Antepartum unscarred uterine rupture caused by placenta percreta: a case report and literature review. 先天性胎盘致产前无瘢痕子宫破裂1例并文献复习。
IF 3.5 Pub Date : 2023-08-01 DOI: 10.32074/1591-951X-882
Eleonora Nardi, Viola Seravalli, Isabella Abati, Francesca Castiglione, Mariarosaria Di Tommaso

The main risk for uterine rupture is the presence of a uterine scar due to prior cesarean delivery or other uterine surgery. However, rupture in an unscarred uterus is extremely rare, and risk factors include multiple gestations, trauma, congenital anomalies, use of uterotonics and placenta accreta spectrum.

Placenta accreta spectrum, also known as morbidly adherent placenta, is becoming increasingly common and is associated with significant maternal and neonatal morbidity and mortality.

We report a case of unscarred uterine rupture due to placenta percreta in a multiparous woman that required emergency peripartum hysterectomy.

子宫破裂的主要风险是由于先前剖宫产或其他子宫手术造成的子宫疤痕。然而,无瘢痕子宫破裂极为罕见,其危险因素包括多胎妊娠、外伤、先天性异常、使用子宫强直术和胎盘增生谱。胎盘增生谱,也被称为病态附着性胎盘,正变得越来越普遍,并与显著的孕产妇和新生儿发病率和死亡率相关。我们报告一例无瘢痕子宫破裂,由于percreta胎盘在多胎妇女需要紧急围产期子宫切除术。
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引用次数: 0
The ideal reporting of RAS testing in colorectal adenocarcinoma: a pathologists' perspective. 结直肠腺癌RAS检测的理想报告:病理学家的观点。
IF 3.5 Pub Date : 2023-06-14 DOI: 10.32074/1591-951X-895
Umberto Malapelle, Valentina Angerilli, Francesco Pepe, Gabriella Fontanini, Sara Lonardi, Mario Scartozzi, Lorenzo Memeo, Gianfranco Pruneri, Antonio Marchetti, Giuseppe Perrone, Matteo Fassan

RAS gene mutational status represents an imperative predictive biomarker to be tested in the clinical management of metastatic colorectal adenocarcinoma. Even if it is one of the most studied biomarkers in the era of precision medicine, several pre-analytical and analytical factors may still impasse an adequate reporting of RAS status in clinical practice, with significant therapeutic consequences. Thus, pathologists should be aware on the main topics related to this molecular evaluation: (i) adopt diagnostic limit of detections adequate to avoid the interference of sub-clonal cancer cell populations; (ii) choose the most adequate diagnostic strategy according to the available sample and its qualification for molecular testing; (iii) provide all the information regarding the mutation detected, since many RAS mutation-specific targeted therapeutic approaches are in development and will enter into routine clinical practice. In this review, we give a comprehensive description of the current scenario about RAS gene mutational testing in the clinic focusing on the pathologist's role in patient selection for targeted therapies.

在转移性结直肠癌的临床治疗中,RAS基因突变状态是一种重要的预测性生物标志物。即使它是精准医学时代研究最多的生物标志物之一,一些分析前和分析因素可能仍然会阻碍临床实践中RAS状态的充分报告,并产生重大的治疗后果。因此,病理学家应该意识到与这种分子评估相关的主要主题:(i)采用足够的诊断检测限制,以避免亚克隆癌细胞群的干扰;(ii)根据可获得的样本及其分子检测资格选择最适当的诊断策略;(iii)提供有关检测到的突变的所有信息,因为许多针对RAS突变的靶向治疗方法正在开发中,并将进入常规临床实践。在这篇综述中,我们对目前临床中RAS基因突变检测的情况进行了全面的描述,重点是病理学家在患者选择靶向治疗中的作用。
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引用次数: 1
The slow-paced digital evolution of pathology: lights and shadows from a multifaceted board. 慢节奏的数字化病理学进化:多面板上的光和影。
IF 3.5 Pub Date : 2023-06-01 DOI: 10.32074/1591-951X-868
Alessandro Caputo, Vincenzo L'Imperio, Francesco Merolla, Ilaria Girolami, Eleonora Leoni, Vincenzo Della Mea, Fabio Pagni, Filippo Fraggetta

Objective: The digital revolution in pathology represents an invaluable resource fto optimise costs, reduce the risk of error and improve patient care, even though it is still adopted in a minority of laboratories. Barriers include concerns about initial costs, lack of confidence in using whole slide images for primary diagnosis, and lack of guidance on transition. To address these challenges and develop a programme to facilitate the introduction of digital pathology (DP) in Italian pathology departments, a panel discussion was set up to identify the key points to be considered.

Methods: On 21 July 2022, an initial conference call was held on Zoom to identify the main issues to be discussed during the face-to-face meeting. The final summit was divided into four different sessions: (I) the definition of DP, (II) practical applications of DP, (III) the use of AI in DP, (IV) DP and education.

Results: Essential requirements for the implementation of DP are a fully tracked and automated workflow, selection of the appropriate scanner based on the specific needs of each department, and a strong commitment combined with coordinated teamwork (pathologists, technicians, biologists, IT service and industries). This could reduce human error, leading to the application of AI tools for diagnosis, prognosis and prediction. Open challenges are the lack of specific regulations for virtual slide storage and the optimal storage solution for large volumes of slides.

Conclusion: Teamwork is key to DP transition, including close collaboration with industry. This will ease the transition and help bridge the gap that currently exists between many labs and full digitisation. The ultimate goal is to improve patient care.

目的:病理学的数字革命代表了优化成本,降低错误风险和改善患者护理的宝贵资源,即使它仍然在少数实验室中采用。障碍包括对初始费用的担忧,对使用整个幻灯片图像进行初步诊断缺乏信心,以及缺乏过渡指导。为了应对这些挑战并制定一项计划,以促进在意大利病理学部门引入数字病理学(DP),建立了一个小组讨论,以确定需要考虑的关键点。方法:2022年7月21日,在Zoom上举行了首次电话会议,以确定面对面会议期间要讨论的主要问题。最后的峰会分为四个不同的会议:(I)数据处理的定义,(II)数据处理的实际应用,(III)人工智能在数据处理中的应用,(IV)数据处理与教育。结果:实施DP的基本要求是完全跟踪和自动化的工作流程,根据每个部门的具体需求选择合适的扫描仪,以及与协调的团队合作(病理学家,技术人员,生物学家,IT服务和行业)相结合的坚定承诺。这可以减少人为错误,从而将人工智能工具应用于诊断、预后和预测。开放的挑战是缺乏对虚拟幻灯片存储的具体规定,以及对大量幻灯片的最佳存储解决方案。结论:团队合作是DP转型的关键,包括与行业的密切合作。这将简化过渡,并有助于弥合目前许多实验室与完全数字化之间存在的差距。最终目标是改善对病人的护理。
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引用次数: 0
Clinical implications of Cytokeratin 19 expression in patients with oral squamous cell carcinoma. 口腔鳞状细胞癌细胞角蛋白19表达的临床意义。
IF 3.5 Pub Date : 2023-06-01 DOI: 10.32074/1591-951X-842
Nur Rahadiani, Sarwanti Sarwanti, Diah Rini Handjari, Marini Stephanie, Ening Krisnuhoni

Objective: This study was done to quantify the prevalence of high cytokeratin (CK) 19 expression in Indonesian oral squamous cell carcinoma (OSCC) patients and explore the prognostic role of CK19 in OSCC.

Methods: Clinical data and samples from 61 patients diagnosed with OSCC at a tertiary national referral hospital in Jakarta, Indonesia were analyzed in this retrospective cohort study. Immunohistochemical staining of CK19 was performed on all patients and its expression was scored using the H system. All patients were followed up for a minimum of 36 months after diagnosis. Comparative and survival analyses were performed.

Results: Twenty six point two percent of Indonesian OSCC patients had high CK19 expression. There were no differences in clinicopathological characteristics between patients with low and high CK19 expression. The 3-year overall survival (OS) of our cohort was 11.5%. Patients with high CK19 expression had lower 3-year OS compared to patients with low CK19 expression, even if the difference in OS was not statistically significant. Keratinization was an independent prognostic factor for survival in multivariate regression analysis.

Conclusions: Data obtained here indicate a possible prognostic role of CK19 in OSCC. This prognostic role should be confirmed in larger series.

目的:本研究旨在量化印尼口腔鳞状细胞癌(OSCC)患者中细胞角蛋白(CK) 19高表达的患病率,并探讨CK19在OSCC中的预后作用。方法:回顾性队列研究分析了印度尼西亚雅加达一家三级国家转诊医院61例OSCC患者的临床资料和样本。对所有患者进行CK19免疫组化染色,并用H系统对其表达进行评分。所有患者在确诊后至少随访36个月。进行了比较分析和生存分析。结果:26.2%的印尼OSCC患者CK19高表达。CK19低表达与高表达患者的临床病理特征无差异。我们队列的3年总生存率(OS)为11.5%。与CK19低表达患者相比,CK19高表达患者的3年OS较低,即使OS差异无统计学意义。在多变量回归分析中,角化是一个独立的预后因素。结论:本文获得的数据表明CK19在OSCC中可能具有预后作用。这种预后作用应在更大的系列中得到证实。
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引用次数: 0
Intratumoural metastasis of primary lung adenocarcinoma to non-invasive follicular thyroid neoplasm with papillary-like nuclear features. 原发性肺腺癌向具有乳头状核特征的非侵袭性滤泡甲状腺肿瘤的瘤内转移。
IF 3.5 Pub Date : 2023-06-01 DOI: 10.32074/1591-951X-780
Subhash Yadav, Suman Kumar Ankathi, Asawari Patil, Rajiv Kaushal

Metastasis to the thyroid gland is very uncommon with an incidence of 2-3% of all thyroid malignancies. A higher incidence is noted in autopsy studies indicating incidental detection. However, tumour-to-tumour metastasis is extremely uncommon with a handful of cases published in the literature to date. Also, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFT-P) is a rare neoplasm; diagnosis requires meticulous sampling of the entire capsule and fulfilment of other diagnostic criteria. We report a case of primary adenocarcinoma of lung in a 57-year-old female who additionally had a left thyroid nodule which appeared suspicious on ultrasonography. Histology of lung tumour was conventional papillary adenocarcinoma while aspiration cytology from the thyroid raised suspicion of metastatic adenocarcinoma. On hemithyroidectomy, the thyroid nodule showed metastatic adenocarcinoma in the centre of the nodule, while the peripheral portion showed non-invasive follicular thyroid neoplasm with papillary-like nuclear features; the diagnosis of which was confirmed with complete sampling of the thyroid capsule. The immunoprofile also supported the above dual histology. This is an extremely uncommon occurrence and metastasis within a NIFT-P has not been reported to the best of our knowledge.

甲状腺转移是非常罕见的,发病率为2-3%的所有甲状腺恶性肿瘤。在尸检研究中注意到较高的发病率,表明偶然发现。然而,肿瘤到肿瘤的转移极为罕见,迄今为止文献中仅发表了少数病例。此外,具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤(NIFT-P)是一种罕见的肿瘤;诊断需要对整个胶囊进行细致的采样,并满足其他诊断标准。我们报告一个57岁女性的原发性肺腺癌病例,她同时有左侧甲状腺结节,超声检查显示可疑。肺肿瘤组织学为常规乳头状腺癌,甲状腺细胞学检查怀疑为转移性腺癌。半甲状腺切除术中,甲状腺结节中心为转移性腺癌,周围部分为无浸润性滤泡性甲状腺肿瘤,核呈乳头状;甲状腺包膜的完整取样证实了其诊断。免疫图谱也支持上述双重组织学。这是一种非常罕见的情况,据我们所知,在NIFT-P内转移尚未报道。
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引用次数: 0
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PATHOLOGICA
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