PATHOLOGICA最新文献

Objective: Stain normalization is a technique used to standardize the color appearance of digital whole slide images (WSIs). This study aimed to assess the impact of digital stain normalization on prostate cancer diagnosis by pathologists.

Methods: A multi-institutional board of four pathologists evaluated 407 hematoxylin and eosin (H&E) prostate WSIs before and after stain normalization. The presence/absence of prostate adenocarcinoma, the Grade Groups as well as color quality perception and time required for diagnosis were recorded.

Results: After normalization, color quality improved significantly for all pathologists (median scores increased from 4-6 to 7-8/10). Average diagnosis time decreased from 50s to 35s (p < 0.001). Inter-pathologist reproducibility for Gleason risk group showed a fair to good level of agreement, with an improvement after normalization.

Conclusions: Stain normalization enhanced pathologists' diagnosis of prostate cancer by improving color standardization, reducing diagnosis time, and increasing inter-observer reproducibility. These findings highlight the potential of stain normalization to improve accuracy and efficiency in digital pathology.

Objective: This study aimed to understand the dynamics of including Pathologists' Assistants in a surgical pathology department.

Methods: A qualitative ethnographic study employed covert participant observation and semi-structured interviews. Field notes and interview transcripts were descriptively analysed to identify categories.

Results: We developed three cross-cutting categories: (i) a testing welcome, (ii) recognising the added value, and (iii) open issues. Initially, disagreements existed regarding the integration of Pathologists' Assistants, but over time, clearer role definitions promoted collaboration. The study revealed the recognised value of Pathologists' Assistants, particularly in time-saving and professional growth opportunities.

Conclusions: Despite initial challenges, recognising the value of Pathologists' Assistants is crucial for effective collaboration and optimal utilisation of their skills. Addressing unresolved issues, such as institutionalising their role and improving academic training, is essential. Creating a community of practice and fostering effective communication and professional development are key to successful integration. Further research and stakeholder collaboration are needed to integrate Pathologists' Assistants into the healthcare system fully.

A 46-year-old female complained of cough and dyspnea. A chest X-ray and CT scan showed a solitary subpleural pulmonary nodule in the left upper lobe. Surgical resection was performed. The frozen examination was presumptive of a benign/low grade lesion, likely a carcinoid. Definitive histology revealed uniformly sized eosinophilic cells arranged in solid nests, immunoreactive for epithelial membrane antigen and progesterone receptors. The diagnosis of grade 1 meningothelial meningioma was finally achieved. This case of a meningioma mimicking a carcinoid tumor highlights its rarity and warns diagnostic specialists of the potential for misdiagnosis and overtreatment.

Invasive lobular carcinoma of the breast is the most common special type breast cancer. It has been defined using morphological features, has a characteristic immunophenotype associated with the loss of E-cadherin mediated intercellular adhesion, and the background of this immunohistochemistry and morphology is generally a biallelic genetic alteration of the CDH-1 gene coding E-cadherin. However, the morphology may often deviate from the classical, and immunohistochemistry may also deviate from the typical, and then the diagnosis of invasive lobular carcinoma becomes less straight forward. Eventually, the definitions of this histological type, although similar, are not identical and this may also give ground to occasional different interpretations. This review summarizes different approaches to invasive lobular carcinomas and the deviations from what is considered normal.

Objective: Prostate cancer (PCa) is the most common cause of cancer-related deaths in men worldwide. BRCA1/2 genes are reported altered in approximately 1% and 8% of PCa cases, respectively. To date, formalin-fixed paraffin-embedded (FFPE) tissues have a consolidate use in the clinical practice, but with a significant drawback related to DNA/RNA degradation during the pre-analytical process. The purpose of this study is to evaluate the feasibility of detecting BRCA1/2 alterations in DNA extracted from FFPE tissues collected from PCa patients after various years of storage in seven Italian hospitals.

Methods: A total of 241 DNA samples were extracted from FFPE tissue with different storage times (1-12 y) and sequenced with NGS technology. BRCA1/2 evaluability was assessed performing data analysis with a chi-square test to study the impact of the storage time on the DNA degradation.

Results: The data collected showed a strict relation not only between the storage time and the BRCA1/2 evaluability, but even between the storage time and DNA degradation (DIN). Taken together, all the parameters considered decrease with an increase in the storage time.

Conclusions: Excessive FFPE tissues storage time (more than 3 years) can harshly affect DNA analysis and evaluability, hindering the achievement of a result useful in the clinical practice. Hence, it should be considered to perform the analysis as soon as possible to increase the evaluability of the test.

P53-abnormal endometrial carcinomas are high-grade and aggressive tumors which should be treated with chemo-/radiotherapy. In low-grade endometrioid carcinoma (LGEC), abnormal expression of p53 is an exceptional finding and is typically accompanied by patchy p16 positivity and diffuse hormone receptor expression.

Herein, we report a case of LGEC exhibiting both p53 and p16 overexpression, highlighting the diagnostic pitfalls related to such phenotype.

A 60-year-old woman underwent hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy due to a deeply myoinvasive endometrial mass. The tumor showed glandular architecture, low-grade nuclei and glandular differentiation. Focal lymphovascular space invasion and no lymph node metastases were observed. Immunohistochemically, the tumor showed p53 overexpression, p16 block-type positivity, diffuse hormone receptors positivity and retained mismatch repair proteins expression. No POLE mutations were identified. A diagnosis of p53-abnormal LGEC was eventually made.

A glandular neoplasm with p53 and/or p16-overexpression on endometrial biopsy specimens may raise the concern of other entities such as serous carcinoma, HPV-related endocervical adenocarcinoma, and gastric-type adenocarcinoma. An immunohistochemical panel including hormone receptors, p53, p16 and mismatch repair proteins appears necessary for an accurate diagnosis of uterine adenocarcinomas.

According to the recently published paper by the Lancet Commission on prostate cancer (PCa) ¹, the projections of new cases of PCa will rise from 1.4 million in 2020 to 2.9 million by 2040. Such a rise cannot be prevented by public health interventions and lifestyle changes. Late diagnosis of PCa is "widespread worldwide but especially in low-income and middle-income countries" ¹. The best way to cope with the harm due to the increase in case numbers is to develop systems for earlier diagnosis. Early diagnosis systems will have to integrate the growing power of artificial intelligence (AI), including digital pathology (DP) diagnostics, to aid the interpretation of prostate tissue specimens ¹. This contribution aims to point out how DP and AI can help pathologists for the prostate cancer "tsunami" about to come.

An asymptomatic 79-year old woman presented with a 40 mm pancreatic cystic lesion, located in the pancreatic body-tail and consistent with branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) without "high risk stigmata". During a 4-year follow-up period, imaging showed no mural nodules or main pancreatic duct dilation, and serum CEA and CA19.9 were within normal range. Later, computed tomography showed a rapid increase in cyst size up to 59 mm, which led to a clinical suspicion of malignant transformation. The patient underwent distal pancreatectomy, and final histology revealed the presence of three distinct pancreatic neoplasms: serous cystadenoma (SCA), BD-IPMN, and well-differentiated G1 neuroendocrine tumour (PanNET-G1). The co-occurrence of pancreatic neuroendocrine and exocrine tumours is exceedingly rare. To the best of our knowledge, this is the first reported case of the concomitant presence of three different pancreatic tumors in the same pancreatic specimen arose adjacent one to each other within the same macroscopic lesion.