Pathologe最新文献

Background: In situ follicular neoplasia (ISFN) is a t(14;18)(q32;q21)⁺ precursor lesion of follicular lymphoma (FL), which in turn can transform into diffuse large B‑cell lymphoma (DLBCL). For DLBCL that arise de novo, no precursor lesion is known. Given the high frequency of the t(14;18) translocation in de novo DLBCL as well, we investigated whether they can also arise from ISFN without FL as an intermediate step.

Objectives: To investigate the clonal evolution of ISFN to DLBCL - transformed from FL and de novo.

Materials and methods: Identification of ISFN lesions in patients with DLBCL was performed by BCL2 staining of reactive lymphoid tissues. ISFN and DLBCL were subsequently analyzed by fluorescence in situ hybridization, clonality analyses, sequencing of the t(14;18) breakpoint, and targeted next-generation sequencing.

Results: 10 cases with paired ISFN and DLBCL samples were identified, 6 of which were de novo DLBCL and 4 transformed from FL. 3 DLBCL carried MYC-rearrangements in addition to the t(14;18) and were classified as high-grade B‑cell lymphoma (HGBL). The clonal relationship of ISFN and DLBCL/HGBL was confirmed for all cases. CREBBP, KMT2D, EZH2, TNFRSF14, and BCL2 were the genes most frequently mutated, with the distribution of private and shared mutations pointing to 2 different scenarios of clonal evolution. In most cases, DLBCL/HGBL, ISFN, and, if also present, FL had evolved divergently from a common progenitor, whereas linear evolution was less frequent.

Conclusion: We show for the first time that t(14;18)⁺ DLBCL/HGBL can arise directly from ISFN without FL as an intermediate step and that during this progression, divergent evolution is common.

Background: About 10% of patients develop persistent symptoms after mild/moderate COVID-19. We have previously reported detection of antinuclear autoantibodies/extractable nuclear antigens (ANA/ENA) in patients with severe COVID-19.

Objectives: The aim of this small pilot study was to characterize long-/post-COVID and to evaluate possible similarities between lung involvement in long-/post-COVID and connective tissue disease (CTD).

Methods: We prospectively enrolled 33 previously healthy patients with persistent pulmonal symptoms after mild/moderate COVID-19 without hospitalization (median age, 39 years). We performed clinical evaluation including pulmonary function tests, computed tomography (CT), and serology for ANA/ENA. In 29 of 33 patients, transbronchial biopsies (TBBs) were taken for histopathological assessment.

Results: Most patients presented with disturbed oxygen pulse in spiroergometry and slight lymphocytosis in bronchoalveolar lavage (BAL) fluid. The CT pattern showed bronchial wall thickening and increased low-attenuation volume. Autoantibodies were detected in 13 of 33 patients (39.4%). Histopathological assessment showed interstitial lymphocytosis with alveolar fibrin and organizing pneumonia. Ultrastructural analyses revealed interstitial collagen deposition.

Conclusion: While histopathology of pulmonary long-/post-COVID alone is unspecific, the combination with clinical and radiological features together with detection of autoantibodies would allow for a diagnosis of interstitial pneumonia with autoimmune features (IPAF). Since we observe interstitial collagen deposition and since IPAF/CTD-ILD might progress to fibrosis, the persistence of autoantibodies and possible fibrotic change should be closely monitored in autoantibody-positive long-/post-COVID patients.

Background: Due to the corona pandemic, digital teaching has become especially important in education and has led to a restructuring of teaching, not only in the subject of surgical pathology.

Objectives: In this article, different forms of e‑learning are presented and illustrated using the example of teaching surgical pathology and neuropathology at the University Medical Center Mainz.

Results: Before the onset of the corona pandemic in spring 2020, digitization had already assumed great importance for teaching in the technology- and method-oriented subject of surgical pathology. In particular, the possibility of virtual microscopy via scanned slides with a digital slide server has been used in many pathology institutes. Virtual microscopy often partially or completely replaced conventional microscopy of histologic slide collections. Complementary virtual learning offers are becoming more and more important. These include asynchronously provided lectures or macroscopy videos, video conferences, scripts and communication via learning platforms. In addition, electronic exams have become an indispensable part of teaching. Nevertheless, the corona pandemic revealed how important personal contact with students is to achieve optimal learning success; learning forms with a combination of face-to-face teaching and e‑learning in the sense of blended learning are of particular importance.

Conclusions: As part of blended learning, digital teaching is an ideal complement to face-to-face teaching and is changing teaching in the longer term, not only in the field of surgical pathology. Digital learning formats will remain in the future and will at least partially replace classroom formats such as lectures.