Annals of Diagnostic Pathology最新文献_第3页

Spread through air spaces (STAS) in lung adenocarcinoma: Prognostic impact of morphologic patterns, density, and extent 肺腺癌通过空气间隙扩散：形态学模式、密度和范围对预后的影响

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-11-19 DOI: 10.1016/j.anndiagpath.2025.152598

Sinem Eser Polat Ünal , Canan Sadullahoğlu , Hacer Boztepe Yeşilçay , Şencan Akdağ

Spread through air spaces (STAS) has emerged as a distinct invasion pattern in lung adenocarcinoma, but the prognostic implications of its morphologic features remain incompletely defined. In this study, we analyzed STAS presence, morphologic subtypes, density, and extent with clinicopathologic parameters and survival. We analyzed 184 surgically resected lung adenocarcinomas. We histopathologically examined the presence of STAS, STAS morphological subtypes (solid nests, micropapillary clusters, and single-cell spread), STAS extension, STAS density and evaluated the relationship of the findings with clinicopathological parameters. STAS was detected in 67.9 % of the tumors. The most common STAS subtype was solid (53.6 %), followed by micropapillary (30.4 %) and single-cell (16.0 %) subtypes. STAS density was categorized as low (1–4 tumor cell clusters) or high (≥5 clusters) at ×200 magnification, and STAS extent was classified as limited (≤3 alveolar spaces) or extensive (>3 spaces). High-density STAS was observed in 56 %, low-density STAS in 44 %; limited-STAS in 57.6 %, and extensive-STAS in 42.4 %. STAS positivity was significantly associated with predominant tumor pattern (p = 0.002), tumor grade (p < 0.001), pleural invasion (p = 0.004), lymphovascular invasion (LVI) (p < 0.001), recurrence (p < 0.001), metastasis (p < 0.001), pN (p = 0.003), overall survival (OS) (p < 0.001) and recurrence-free survival (DFS) (p < 0.001). Among morphologic subtypes, significant correlations were found with predominant tumor pattern (p < 0.001), grade (p = 0.001) and LVI (p = 0.005). We found STAS density to show a significant difference in OS (p = 0.009). Extensive STAS correlated with surgical resection type (p = 0.002), necrosis (p = 0.049), pN (p = 0.033), OS (p = 0.016) and DFS (p = 0.037). Our study shows that STAS and its features have prognostic significance with clinically meaningful differences in lung adenocarcinomas. These results highlight the potential clinical relevance of STAS subtype, density, and extent in risk stratification.

通过空气间隙扩散（STAS）已成为肺腺癌的一种独特的侵袭模式，但其形态学特征的预后意义仍不完全明确。在这项研究中，我们分析了STAS的存在，形态亚型，密度和范围与临床病理参数和生存率。我们分析了184例手术切除的肺腺癌。我们通过组织病理学检查了STAS的存在、STAS形态亚型（实巢、微乳头状簇状和单细胞扩散）、STAS扩展、STAS密度，并评估了这些发现与临床病理参数的关系。67.9%的肿瘤检出STAS。最常见的STAS亚型为实型（53.6%），其次是微乳头状（30.4%）和单细胞（16.0%）亚型。在×200放大下，STAS密度分为低（1-4个肿瘤细胞簇）和高（≥5个肿瘤细胞簇），STAS范围分为有限（≤3个肺泡间隙）和广泛（>；3个间隙）。高密度STAS占56%，低密度STAS占44%；限制性stas占57.6%，广泛性stas占42.4%。STAS阳性与主要肿瘤类型（p = 0.002）、肿瘤分级（p < 0.001）、胸膜浸润（p = 0.004）、淋巴血管浸润（LVI）（p < 0.001）、复发（p < 0.001）、转移（p < 0.001）、pN （p = 0.003）、总生存（OS）（p < 0.001）和无复发生存（DFS）（p < 0.001）显著相关。在形态学亚型中，与主要肿瘤类型（p < 0.001）、分级（p = 0.001）和LVI （p = 0.005）存在显著相关性。我们发现STAS密度在OS中有显著差异（p = 0.009）。广泛STAS与手术切除类型（p = 0.002）、坏死（p = 0.049）、pN （p = 0.033）、OS （p = 0.016）、DFS （p = 0.037）相关。我们的研究表明STAS及其特征在肺腺癌中具有临床意义的预后意义。这些结果强调了STAS亚型、密度和风险分层程度的潜在临床相关性。

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引用次数: 0

The diagnostic utility and frequency of CD56 expression in plasma cell myeloma CD56在浆细胞骨髓瘤中的表达及诊断价值

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-11-13 DOI: 10.1016/j.anndiagpath.2025.152587

Midori Imai , Asami Nishikori , Tomoka Haratake , Midori Filiz Nishimura , Rio Yamada , Syoma Kato , Mizuha Tabe , Hiroyuki Yanai , Hidetaka Yamamoto , Yasuharu Sato

Plasma cell myeloma (PCM) is a hematological malignancy characterized by systemic proliferation of neoplastic plasma cells within the bone marrow. Diagnosis requires clinical findings and immunohistochemical staining, including CD138, CD79a, cyclin D1, immunoglobulin κ (Igκ), and λ (Igλ). However, CD79a and cyclin D1 have limited sensitivity and specificity, and Igκ/Igλ assessment is often difficult due to overstaining. Therefore, more reliable antibodies are needed to accurately diagnose PCM. In this study, we examined the diagnostic utility of CD56 expression in PCM. We retrospectively performed immunostaining for CD138, CD56, CD79a, cyclin D1, Igκ, and Igλ in bone marrow samples from 116 patients with PCM.

CD56 expression was observed in 85/116 cases (73.3 %), CD79a was downregulated in 46/116 cases (39.7 %), and cyclin D1 expression was observed in 42/116 cases (36.2 %). The expression of CD56 was significantly higher than that of CD79a and cyclin D1 (both p < 0.001). The combination of two antibodies resulted in the highest detection rate when combining CD56 and CD79a (105/116, 90.5 %), which was significantly higher than the detection rates of CD56 and cyclin D1 (93/116, 80.2 %) and CD79a and cyclin D1 (75/116, 64.7 %) (both p < 0.001). In contrast, lymphoplasmacytic lymphoma and marginal zone lymphoma lacked CD56 and cyclin D1 expression. Furthermore, in cases where light chain restriction was undetectable (11/116, 9.5 %), all could be diagnosed as PCM based on CD56, CD79a, and cyclin D1. Among these, CD56 showed the highest detection rate (8/11, 72.7 %).

These findings highlight CD56 as a helpful marker for PCM diagnosis and support further clinical research.

浆细胞骨髓瘤（PCM）是一种血液系统恶性肿瘤，其特征是骨髓内肿瘤浆细胞的系统性增殖。诊断需要临床表现和免疫组织化学染色，包括CD138、CD79a、细胞周期蛋白D1、免疫球蛋白κ (Igκ)和λ (Igλ)。然而，CD79a和cyclin D1具有有限的敏感性和特异性，并且由于过度染色，通常难以评估Igκ/Igλ。因此，需要更可靠的抗体来准确诊断PCM。在这项研究中，我们检测了CD56表达在PCM中的诊断作用。我们回顾性地对116例PCM患者的骨髓样本进行了CD138、CD56、CD79a、细胞周期蛋白D1、Igκ和Igλ的免疫染色。CD56表达85/116例（73.3%），CD79a下调46/116例（39.7%），cyclin D1表达42/116例（36.2%）。CD56的表达显著高于CD79a和cyclin D1 （p < 0.001）。两抗体联合使用CD56与CD79a的检出率最高（105/116,90.5%），显著高于CD56与cyclin D1的检出率（93/116,80.2%）和CD79a与cyclin D1的检出率（75/116,64.7%）（均p <； 0.001）。相比之下，淋巴浆细胞性淋巴瘤和边缘带淋巴瘤缺乏CD56和cyclin D1的表达。此外，在未检测到轻链限制的病例中（11/116,9.5%），基于CD56、CD79a和cyclin D1均可诊断为PCM。其中CD56的检出率最高（8/11,72.7%）。这些发现强调了CD56作为PCM诊断的有用标记物，并支持进一步的临床研究。

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引用次数: 0

Clinicopathological features of hepatic Langerhans cell histiocytosis: report of ten cases and review of the literature 肝朗格汉斯细胞组织细胞增多症的临床病理特点：附10例报告并文献复习。

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-11-13 DOI: 10.1016/j.anndiagpath.2025.152586

Qian-Qian Chen , Chun-kui Shao , Yi-wang Zhang , Jian-ning Chen , Hai-feng Li , Qiong Liang

The aim was to evaluate the clinical and histopathological characteristics of hepatic Langerhans cell histiocytosis (LCH). Data from 10 patients with hepatic LCH were collected. The clinicopathological features and immunophenotypes of hepatic LCH were assessed. The study included 6 males and 4 females (median age: 20.5 years). Clinical manifestations and imaging findings were non-specific. Six cases had multisystem involvement, while 4 had isolated hepatic LCH. All lesions were located in the portal area. Histologically, Langerhans cells (LCs) with characteristic nuclear grooves infiltrated the bile duct epithelium. Although one case initially presented as sclerosing cholangitis (SC) without detectable LCs, the patient's history of cutaneous LCH provided a crucial diagnostic clue, and Langerhans cell (LC) foci were later confirmed in the explanted liver. Immunohistochemically, these tumor cells were positive for CD1a, S100, and CD207. BRAF V600E mutations were detected in 30 % (3/10) of cases. Five cases displayed unique morphological patterns: 2 exhibited sclerosing cholangitis, 1 resembled inflammatory myofibroblastic tumor (IMT) or EBV-positive inflammatory follicular dendritic cell sarcoma (EBV+ IFDCS), and 2 showed chronic suppurative cholangitis with abscess formation. Hepatic LCH exhibits diverse morphological features. Bile duct epithelial injury with eosinophil infiltration and a history of extrahepatic LCH are important diagnostic clues. Hematoxylin-eosin staining combined with immunohistochemistry (CD1a, S100, CD207) is essential for definitive diagnosis. LCH should be differentiated from hepatic parasitic infections, primary SC, EBV+ IFDCS, and IMT.

目的是评价肝朗格汉斯细胞组织细胞增多症（LCH）的临床和组织病理学特征。收集了10例肝性LCH患者的资料。评估肝LCH的临床病理特征和免疫表型。该研究包括6名男性和4名女性（中位年龄：20.5岁）。临床表现及影像学表现无特异性。6例为多系统受累，4例为孤立性肝性LCH。所有病变均位于门静脉区。组织学上，具有特征性核沟的朗格汉斯细胞（LCs）浸润胆管上皮。虽然1例患者最初表现为硬化性胆管炎（SC），但未检测到LC，但患者的皮肤LCH病史提供了重要的诊断线索，并且后来在外植肝中证实了朗格汉斯细胞（LC）灶。免疫组化结果显示，这些肿瘤细胞CD1a、S100和CD207阳性。30%（3/10）的病例检测到BRAF V600E突变。5例表现出独特的形态特征：2例表现为硬化性胆管炎，1例表现为炎性肌纤维母细胞瘤（IMT）或EBV阳性炎性滤泡树突状细胞肉瘤（EBV+ IFDCS）， 2例表现为慢性化脓性胆管炎伴脓肿形成。肝脏LCH表现出多种形态特征。胆管上皮损伤伴嗜酸性粒细胞浸润和肝外LCH病史是重要的诊断线索。苏木精-伊红染色联合免疫组织化学（CD1a, S100, CD207）是明确诊断所必需的。LCH应与肝脏寄生虫感染、原发性SC、EBV+ IFDCS和IMT相鉴别。

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引用次数: 0

Immunohistochemical assessment of duodenal mucosal gamma/delta receptor-expressing T-lymphocytes as a diagnostic adjunct for pediatric celiac disease 免疫组织化学评估十二指肠黏膜表达γ / δ受体的t淋巴细胞作为儿科乳糜泻的诊断辅助

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-11-09 DOI: 10.1016/j.anndiagpath.2025.152585

Sara Gamal Mohamed Ouf , Mena Mahfouz , Khadiga Mohamed Ali , Amal Abd El hafez , Khaled Refaat Zalata

Celiac disease (CeD) diagnosis can be challenging in cases with borderline or discrepant serological and histopathological findings. While intraepithelial lymphocytes (IELs) are characteristic of CeD, conventional counting methods lack specificity and overlap with other enteropathies. Gamma/delta (γ/δ) T-lymphocytes quantification was identified to be more specific but require validation in formalin-fixed paraffin-embedded (FFPE) biopsies. This study aimed to assess the IEL using immunohistochemistry (IHC) for anti-CD3 and anti-TCRγ/δ (H-41) antibodies on FFPE duodenal mucosal endoscopic biopsies in pediatric CeD patients versus non-CeD controls. 64 pediatric duodenal biopsies (34 untreated CeD, 30 non-CeD) were retrospectively analyzed for histopathologic features of CeD with special attention to IEL count using H&E (hematoxylin and eosin), anti-CD3, anti-TCRγ/δ IHC. The TCRγ/δ+:CD3+ ratio were assessed. It was found that CeD patients had significantly higher IEL counts by H&E (63.5 ± 13.5 vs. 43.2 ± 10.6), CD3 (83.9 ± 21.0 vs. 48.7 ± 11.8), TCRγ/δ (27.7 ± 11.6 vs. 3.5 ± 5.7) and TCRγ/δ+:CD3+ ratio (33.8 ± 13.2 % vs. 6 ± 8.6 %) compared to non-CeD (P = 0.001). IEL densities increased in higher Marsh-Oberhuber grades, with a significant trend for CD3+ IELs. Diagnostic performance was highest for anti-TCRγ/δ followed by TCRγ/δ+:CD3+ ratio, then anti-CD3 outperforming H&E. Overall, the quantification of TCRγ/δ + IELs and TCRγ/δ+:CD3+ ratio by IHC offers superior diagnostic accuracy for pediatric CeD compared to H&E and CD3. Incorporating TCRγ/δ IHC enhances differentiation of CeD from mimicking enteropathies, particularly with borderline and equivocal histology or serology. Further validation and standardization with larger cohorts is recommended.

乳糜泻（CeD）的诊断可能具有挑战性的情况下，边界或差异的血清学和组织病理学结果。虽然上皮内淋巴细胞（iel）是CeD的特征，但传统的计数方法缺乏特异性，并且与其他肠病重叠。γ/δ (γ/δ) t淋巴细胞定量被认为更具特异性，但需要在福尔马林固定石蜡包埋（FFPE）活检中进行验证。本研究旨在利用免疫组织化学（IHC）对儿童CeD患者与非CeD对照组的FFPE十二指肠黏膜内镜活检中抗cd3和抗tcrγ /δ (H-41)抗体进行评估。回顾性分析64例儿童十二指肠活检（34例未经治疗的CeD， 30例未治疗的CeD）的组织病理学特征，特别关注IEL计数，使用H&E（苏木精和伊红），抗cd3，抗tcrγ /δ IHC。评估TCRγ/δ+:CD3+比值。结果发现，与非CeD患者相比，CeD患者在H&E（63.5±13.5比43.2±10.6）、CD3（83.9±21.0比48.7±11.8）、TCRγ/δ（27.7±11.6比3.5±5.7）和TCRγ/δ+:CD3+比值（33.8±13.2%比6±8.6%）方面的IEL计数均显著高于CeD患者（P = 0.001）。在较高的Marsh-Oberhuber等级中，IEL密度增加，其中CD3+ IEL有明显的趋势。抗TCRγ/δ诊断效能最高，其次是TCRγ/δ+:CD3+比值，然后是抗CD3优于H&E。总体而言，与H&E和CD3相比，IHC量化TCRγ/δ+ IELs和TCRγ/δ+:CD3+比值对儿童CeD的诊断准确性更高。结合TCRγ/δ IHC可以增强CeD与模拟肠病的分化，特别是具有边缘性和模棱两可的组织学或血清学。建议在更大的队列中进一步验证和标准化。

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引用次数: 0

Utility of TRPS1 Compared to GATA3, and SOX10 Immunohistochemistry in Diagnosis and Prognosis of Breast cancer Molecular Subtypes TRPS1与GATA3、SOX10免疫组化在乳腺癌分子亚型诊断和预后中的应用

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-10-22 DOI: 10.1016/j.anndiagpath.2025.152582

Manar Moustafa , Mohamed I. Abdelhamid , Kareem Amgd , MennatAllah H. Fikry

The sensitivity and specificity of immunohistochemical markers are important in the accurate identification of the tissue of origin in breast cancer (BC). The aim of our study was to identify the diagnostic utility and pattern of expression of TRPS1, GATA3, and SOX10 immunohistochemistry in a cohort of breast cancers of diverse molecular subtypes. 184 breast carcinomas cases, including luminal A (n = 61), luminal B (n = 68), HER2+ (n = 30), and triple-negative breast cancer (TNBC) (n = 25) MOLECULAR subtypes, were subjected to immunohistochemical (IHC) analyses using TRPS1, GATA3, and SOX10 antibodies. TRPS1 exhibited high positivity rates uniformly across all molecular subtypes, ranging from 92.0 % in TNBC to 94.4 % in Luminal B. GATA3 was also frequently positive in the luminal subtypes (96.7–97.2 %) but had significantly lower expression rates in TNBC (40.0 %). SOX10, in contrast, was most frequently positive in TNBC (72.0 %) and less so in the luminal subtypes (3.3–16.7). Statistical analyses did not reveal any significant difference in the rates of TRPS1 expression between the subtypes (χ² = 1.84; p = 0.62). It is concluded that TRPS1 is the most sensitive breast lineage marker across molecular subtypes, with nearly uniform expression. GATA3 and SOX10 are limited by subtype-dependent sensitivity and thus require a subtype framework for selecting the best immunohistochemical markers.

免疫组织化学标志物的敏感性和特异性对于准确识别乳腺癌（BC）的起源组织至关重要。本研究的目的是确定TRPS1、GATA3和SOX10免疫组织化学在不同分子亚型乳腺癌队列中的诊断效用和表达模式。采用TRPS1、GATA3和SOX10抗体对184例乳腺癌患者进行免疫组化（IHC）分析，包括luminal A （n = 61）、luminal B （n = 68）、HER2+ (n = 30)和三阴性乳腺癌（TNBC）（n = 25）分子亚型。TRPS1在所有分子亚型中均表现出高阳性率，在TNBC中从92.0%到94.4%不等。GATA3在Luminal亚型中也经常呈阳性（96.7 - 97.2%），但在TNBC中表达率明显较低（40.0%）。相比之下，SOX10在TNBC中最常见（72.0%），在腔内亚型中较少（3.3 - 16.7%）。TRPS1在不同亚型间的表达率差异无统计学意义（χ2 = 1.84; p = 0.62）。综上所述，TRPS1是跨分子亚型最敏感的乳腺谱系标记，其表达几乎一致。GATA3和SOX10受到亚型依赖敏感性的限制，因此需要一个亚型框架来选择最佳的免疫组织化学标志物。

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引用次数: 0

Chromosomal alterations in 7, 17, and Y demonstrate comparable sensitivity and superior specificity to diffuse strong AMACR immunostaining for papillary renal cell carcinoma 7、17和Y的染色体改变显示出弥漫性强AMACR免疫染色对乳头状肾细胞癌的相当敏感性和优越特异性。

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-10-22 DOI: 10.1016/j.anndiagpath.2025.152583

Yang Liu , Jun Yuan , Haimin Xu , Xianwei Yang , Chaofu Wang , Luting Zhou , Xiaoqun Yang

The diagnostic criteria for papillary renal cell carcinoma (PRCC) include diffuse strong AMACR and retained FH expression. Although chromosomal alterations in 7/17/Y are frequent molecular findings in PRCC, they are not included in its diagnostic criteria. This study analyzed 154 PRCC cases and 120 PRCC mimics using AMACR immunostaining and chromosomal analyses. Positive AMACR expression demonstrated the highest sensitivity (98.1 %), while a combination of diffuse strong AMACR expression and ≥2 chromosomal alterations achieved optimal specificity (93.3 %). Detection of ≥1 chromosomal alteration provided comparable sensitivity (86.4 % vs. 83.8 %) to diffuse strong AMACR expression alone but with significantly enhanced specificity (73.3 % vs. 48.3 %). Non-PRCC tumors demonstrating both diffuse strong AMACR expression and ≥2 chromosomal alterations predominantly included TFE3-rearranged RCC (3/29) and FH-deficient RCC (3/13) cases, with rare cases in clear cell RCC (1/10) and SMARCB1-deficient RCC (1/2). Collecting duct carcinoma occasionally showed multiple chromosomal alterations but usually showed negative or focal AMACR expression. These findings indicated that chromosomal alterations demonstrated comparable sensitivity and superior specificity compared to diffuse strong AMACR immunostaining for PRCC diagnosis. We propose incorporating chromosomal alterations in 7/17/Y as a desirable diagnostic criterion for PRCC. In addition, unclassified metastatic RCCs with papillary architecture should not be definitively diagnosed as PRCC based solely on chromosomal alterations. A definite diagnosis of metastatic PRCC requires exclusion of these histological and molecular mimics.

乳头状肾细胞癌（PRCC）的诊断标准包括弥漫性强AMACR和保留FH表达。虽然7/17/Y染色体改变是PRCC中常见的分子发现，但不包括在其诊断标准中。本研究使用AMACR免疫染色和染色体分析分析了154例PRCC病例和120例PRCC模拟病例。AMACR阳性表达表现出最高的敏感性（98.1%），而弥漫性强AMACR表达和≥2染色体改变的组合达到最佳特异性（93.3%）。检测≥1染色体改变对弥漫性强AMACR单独表达具有相当的敏感性（86.4%对83.8%），但特异性显著增强（73.3%对48.3%）。具有弥漫性强AMACR表达和≥2染色体改变的非prcc肿瘤主要包括tfe3重排的RCC（3/29）和fh缺陷的RCC(3/13)，在透明细胞RCC（1/10）和smarcb1缺陷的RCC（1/2）中有罕见病例。收集管癌偶尔表现为多染色体改变，但通常表现为阴性或局灶性AMACR表达。这些发现表明，与弥漫性强AMACR免疫染色相比，染色体改变对PRCC的诊断具有相当的敏感性和更高的特异性。我们建议将7/17/Y染色体改变作为PRCC的理想诊断标准。此外，具有乳头状结构的未分类转移性rcc不应仅根据染色体改变明确诊断为PRCC。转移性PRCC的明确诊断需要排除这些组织学和分子模拟物。

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引用次数: 0

In reply: Letter to the editor: “p63 immunohistochemical expression in tumor cells of high-grade invasive breast carcinomas on core biopsy: a potential diagnostic pitfall” 回复：致编辑的信：“p63免疫组织化学在高级别浸润性乳腺癌核心活检肿瘤细胞中的表达：一个潜在的诊断缺陷”

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-10-22 DOI: 10.1016/j.anndiagpath.2025.152581

Serena Salzano, Giuseppe Broggi

引用次数: 0

Histopathologic characterization of Morel-Lavallée lesion: Report of 6 cases and review of the literature morel - lavallsamade病变的组织病理学特征：附6例报告并文献复习。

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-10-20 DOI: 10.1016/j.anndiagpath.2025.152580

Melissa D. Hruby , Laura M. Warmke , Carina A. Dehner , Iván A. González

Morel-Lavallée lesions (MLLs) are trauma-induced soft tissue injuries that can clinically mimic neoplasms, yet the pathologic features have only been reported for four cases. To address this, a retrospective case search was conducted at our institution from 2015 to 2022, yielding six cases. The combined ten patients presented with a mean age of 46 years (range: 13–72 years) with an equal gender distribution. Half of these cases resulted from motor vehicle accidents, while the other half were sports-related or due to mechanical falls. The median interval from injury to presentation was 6 months (range: <1 month −17 years), and from injury to MLL diagnosis was 12 months (range: 1.5 months – 25 years). These lesions most frequently involved the thigh (5/10, 50 %), hip or buttock (4/10, 40 %), and less commonly the lower leg (1/10, 10 %). Clinically, the majority of cases (8/10, 80 %) presented as tender, palpable mass-like lesions, while the remainder (2/10, 20 %) presented in association with a cellulitic wound or fistula. Histologically, most cases exhibited fibroconnective tissue with reactive myofibroblasts, fat necrosis, and fibrin deposition (9/10, 90 %), as well as pseudocyst or cystic components (6/10, 60 %). All ten patients underwent surgical excision with complete resolution and no complications. Given the surgical management of these lesions and their potential morphologic overlap with benign and malignant neoplasms, further histopathological documentation is warranted to improve recognition and prevent misdiagnosis.

morel - lavallsamac病变（mls）是一种创伤性软组织损伤，临床上可模拟肿瘤，但其病理特征仅报道了4例。为了解决这一问题，我们对我院2015年至2022年的6例病例进行了回顾性病例检索。10例患者的平均年龄为46岁（范围：13-72岁），性别分布均匀。这些病例中有一半是由机动车事故造成的，而另一半则与运动有关或由于机械跌倒。从受伤到出现的中位时间间隔为6个月(范围：

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引用次数: 0

Characterizing thyroid carcinomas in the elderly: Histological subtypes and TERT promoter mutation analysis based on the latest WHO classification 老年人甲状腺癌的特征：基于WHO最新分类的组织学亚型和TERT启动子突变分析

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-10-19 DOI: 10.1016/j.anndiagpath.2025.152578

Myoung Ju Koh , Songmi Noh , Jin Kyong Kim , Gi Jeong Kim

While most thyroid cancers have a favorable outcome, their presentation in the elderly (≥70 years) is often aggressive, leading to a poor prognosis and creating a clinical dilemma in balancing treatment intensity against comorbidities. A more precise understanding of the biological drivers is crucial for optimal management. This study aimed to characterize these aggressive tumors by correlating high-risk histological subtypes—specifically poorly differentiated (PDTC) and differentiated high-grade thyroid cancer (DHGTC)—with the presence of telomerase reverse transcriptase (TERT) promoter mutations.

We conducted a retrospective analysis of 293 consecutive patients, aged 70 or older, who underwent thyroidectomy between 2019 and 2023. Comprehensive clinicopathological data, including TNM and AJCC staging, were collected, and molecular analysis for TERT mutations was performed via pyrosequencing.

PDTC/DHGTC accounted for 6.1 % of tumors in this cohort, while TERT promoter mutations were detected in 15.0 % of cases. Importantly, results revealed a statistically significant association between TERT promoter mutations and established markers of poor prognosis. TERT-mutated tumors were larger and presented at a more advanced T stage. These patients had a significantly higher incidence of both regional lymph node involvement and distant metastatic disease or recurrence, resulting in a higher overall AJCC stage. On a histological level, the TERT mutation was a strong predictor of aggressive PDTC/DHGTC subtypes and was closely linked to increased mitotic activity and tumor necrosis.

In conclusion, our findings demonstrate that PDTC/DHGTC subtypes are not uncommon in elderly patients and that TERT promoter mutations occur at a relatively high frequency. The strong association of TERT mutations with aggressive tumor characteristics suggests that combined histological and molecular assessment may provide enhanced prognostic precision in this high-risk group.

虽然大多数甲状腺癌有良好的预后，但其在老年人（≥70岁）中的表现往往是侵袭性的，导致预后不良，并在平衡治疗强度和合并症方面造成临床困境。更精确地了解生物驱动因素对于优化管理至关重要。本研究旨在通过将高危组织学亚型-特异性低分化（PDTC）和分化高级别甲状腺癌(DHGTC) -与端粒酶逆转录酶（TERT）启动子突变的存在联系起来，来表征这些侵袭性肿瘤。我们对293名在2019年至2023年期间接受甲状腺切除术的70岁或以上的连续患者进行了回顾性分析。收集包括TNM和AJCC分期在内的综合临床病理数据，并通过焦磷酸测序对TERT突变进行分子分析。在该队列中，PDTC/DHGTC占肿瘤的6.1%，而TERT启动子突变在15.0%的病例中检测到。重要的是，结果显示TERT启动子突变与预后不良标志物之间具有统计学意义的关联。tert突变的肿瘤更大，出现在更晚期的T期。这些患者的区域淋巴结受累和远处转移性疾病或复发的发生率明显更高，导致AJCC的总分期更高。在组织学水平上，TERT突变是侵袭性PDTC/DHGTC亚型的一个强有力的预测因子，并且与有丝分裂活性增加和肿瘤坏死密切相关。总之，我们的研究结果表明，PDTC/DHGTC亚型在老年患者中并不罕见，TERT启动子突变的发生频率相对较高。TERT突变与侵袭性肿瘤特征的强烈关联表明，结合组织学和分子评估可以提高这一高危人群的预后准确性。

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引用次数: 0

Investigation of mismatch repair protein expression in glioma 错配修复蛋白在胶质瘤中的表达研究。

IF 1.4 4区医学 Q3 PATHOLOGY

Annals of Diagnostic Pathology

Pub Date : 2025-10-18 DOI: 10.1016/j.anndiagpath.2025.152579

Khouloud Abdessamie , Sarra Limam , Ahlem Bdioui , Yosra Suiden , Zaineb Lajmi , Syrine Moussa , Oussama Belkacem , Amal Bouazzi , Sarra Mestiri , Iadh Ksira , Wafa Mokni , Sihem Hmissa , Nabiha Missaoui

Mismatch repair (MMR) proteins are essential for maintaining genomic stability, and their dysfunction contributes to tumorigenesis in several malignancies. However, their role in glioma remains insufficiently defined. This study evaluated MMR protein expression in Tunisian glioma patients and examined its clinicopathological and prognostic significance. Ninety-five glioma samples were retrospectively analyzed. MMR protein expression was assessed by immunohistochemistry on formalin-fixed, paraffin-embedded tissues. Survival outcomes were evaluated using Kaplan–Meier analysis with Log-Rank testing. MMR expression was retained in 65 tumors (68.4 %) and lost in 30 (31.6 %). Loss of MLH1/PMS2 was observed in 16 tumors, MSH2/MSH6 loss in 12, and complete loss of all MMR proteins in two tumors. The distribution of MMR deficiency varied by histological subtype. Among pilocytic astrocytomas, 7 cases exhibited MMR deficiency, predominantly MLH1/PMS2 (n = 5). Two astrocytomas IDH mutant showed either MLH1/PMS2 or MSH2/MSH6 loss. Altered MMR profiles were also identified in oligodendroglioma IDH-mutant, 1p/19q co-deleted (n = 3), oligoastrocytoma NOS (n = 1), and anaplastic oligodendroglioma NOS (n = 1). In glioblastoma, IDH-wildtype, 14 cases showed heterodimer loss (MLH1/PMS2 or MSH2/MSH6), and two tumors demonstrated complete loss of all MMR proteins. Survival analysis revealed a significant prognostic effect exclusively in glioblastomas IDH-wildtype, where MMR deficiency was associated with worse survival (Log-rank test, p < 0.0001). MMR deficiency is relatively frequent in gliomas and carries prognostic significance, particularly in glioblastoma IDH-wildtype. Incorporating MMR status into molecular profiling may enhance risk stratification and inform therapeutic decision-making in glioma management.

错配修复（MMR）蛋白对维持基因组稳定性至关重要，其功能障碍有助于几种恶性肿瘤的发生。然而，它们在神经胶质瘤中的作用仍不明确。本研究评估了MMR蛋白在突尼斯胶质瘤患者中的表达，并探讨了其临床病理和预后意义。回顾性分析95个胶质瘤样本。免疫组化法检测福尔马林固定、石蜡包埋组织中MMR蛋白的表达。生存结果采用Kaplan-Meier分析和Log-Rank检验进行评估。65例（68.4%）肿瘤保留MMR表达，30例（31.6%）肿瘤表达缺失。16例肿瘤中MLH1/PMS2缺失，12例肿瘤中MSH2/MSH6缺失，2例肿瘤中MMR蛋白完全缺失。MMR缺乏症的分布因组织学亚型而异。在毛细胞星形细胞瘤中，7例出现MMR缺陷，主要是MLH1/PMS2 （n = 5）。两个星形细胞瘤IDH突变体表现为MLH1/PMS2或MSH2/MSH6缺失。在少突胶质细胞瘤idh突变、1p/19q共缺失（n = 3）、少星形细胞瘤NOS （n = 1）和间变性少突胶质细胞瘤NOS （n = 1）中也发现了MMR谱的改变。在idh -野生型胶质母细胞瘤中，14例显示异源二聚体丢失（MLH1/PMS2或MSH2/MSH6）， 2例肿瘤显示所有MMR蛋白完全丢失。生存分析显示，仅在idh野生型胶质母细胞瘤中，MMR缺乏与较差的生存相关(Log-rank检验，p

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引用次数: 0