Pub Date : 2022-11-01DOI: 10.1097/PCR.0000000000000531
Yoon Jung Hwang, Haeryoung Kim
Abstract Primary liver cancers comprise a heterogeneous group of neoplasms, with the 2 main entities being hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). Over the past decades, HCC and iCCA have been recognized to be heterogeneous in morphology, molecular features, and biological behavior, and the most recent World Health Organization classification of digestive system tumors describes various histomorphological subtypes of HCC and iCCA, some of which also have characteristic molecular features, clinical correlates, and prognostic implications. In this review, we discuss 4 recently described subtypes of HCC and iCCA—macrotrabecular HCC, steatohepatitic HCC, scirrhous HCC, and small duct iCCA—based on a series of cases.
{"title":"Histomorphological Subtypes of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Review and Update","authors":"Yoon Jung Hwang, Haeryoung Kim","doi":"10.1097/PCR.0000000000000531","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000531","url":null,"abstract":"Abstract Primary liver cancers comprise a heterogeneous group of neoplasms, with the 2 main entities being hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). Over the past decades, HCC and iCCA have been recognized to be heterogeneous in morphology, molecular features, and biological behavior, and the most recent World Health Organization classification of digestive system tumors describes various histomorphological subtypes of HCC and iCCA, some of which also have characteristic molecular features, clinical correlates, and prognostic implications. In this review, we discuss 4 recently described subtypes of HCC and iCCA—macrotrabecular HCC, steatohepatitic HCC, scirrhous HCC, and small duct iCCA—based on a series of cases.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75288563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1097/PCR.0000000000000532
Reiichiro Kondo, J. Akiba, H. Yano
Abstract Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary liver tumor with neoplastic components of both hepatocytic and cholangiocytic differentiation within the same tumor, such as the case reported herein. There is a need to standardize the pathological diagnosis of cHCC-CCA and to improve the concordance of diagnosis among pathologists based on consensus paper because of its histological and phenotypic diversity that leads to confusion in terminology and classification. This case review addresses the terminology, classification, and clinical and pathological characteristics of cHCC-CCA and its differential diagnosis.
{"title":"A Case Review on Combined Hepatocellular Cholangiocarcinoma","authors":"Reiichiro Kondo, J. Akiba, H. Yano","doi":"10.1097/PCR.0000000000000532","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000532","url":null,"abstract":"Abstract Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary liver tumor with neoplastic components of both hepatocytic and cholangiocytic differentiation within the same tumor, such as the case reported herein. There is a need to standardize the pathological diagnosis of cHCC-CCA and to improve the concordance of diagnosis among pathologists based on consensus paper because of its histological and phenotypic diversity that leads to confusion in terminology and classification. This case review addresses the terminology, classification, and clinical and pathological characteristics of cHCC-CCA and its differential diagnosis.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74380878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1097/PCR.0000000000000535
Yuqing Xiong, A. Del Portillo, Ladan Fazlollahi, H. Remotti, Michael J. Lee, S. Lagana
Abstract Hemophagocytic lymphohistiocytosis (HLH) is a rare disease with a high mortality. Liver involvement is common, with most patients demonstrating acute hepatitis. Therefore, liver biopsies are frequently obtained in the setting of suspected HLH. Several studies have described the clinicopathologic manifestations of liver involvement by HLH. The histology is highly variable, as are rates of demonstrated hemophagocytosis. This review summarizes the clinical characteristics of HLH, with particular emphasis on hepatic manifestations thereof. We then describe the histologic patterns that have been commonly and uncommonly reported. Finally, we address difficulties faced by liver pathologists when considering this entity and offer our opinions regarding the worst “pain points.”
{"title":"Hemophagocytic Lymphohistiocytosis: A Practical Review for Liver Pathologists","authors":"Yuqing Xiong, A. Del Portillo, Ladan Fazlollahi, H. Remotti, Michael J. Lee, S. Lagana","doi":"10.1097/PCR.0000000000000535","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000535","url":null,"abstract":"Abstract Hemophagocytic lymphohistiocytosis (HLH) is a rare disease with a high mortality. Liver involvement is common, with most patients demonstrating acute hepatitis. Therefore, liver biopsies are frequently obtained in the setting of suspected HLH. Several studies have described the clinicopathologic manifestations of liver involvement by HLH. The histology is highly variable, as are rates of demonstrated hemophagocytosis. This review summarizes the clinical characteristics of HLH, with particular emphasis on hepatic manifestations thereof. We then describe the histologic patterns that have been commonly and uncommonly reported. Finally, we address difficulties faced by liver pathologists when considering this entity and offer our opinions regarding the worst “pain points.”","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82418131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1097/PCR.0000000000000527
Geunyoung Jung, Yongjun Liu
Abstract Hepatocellular adenoma (HCA) is a benign liver neoplasm that typically arises in the noncirrhotic liver. Based on molecular findings, HCA can be subclassified into the following subtypes: hepatocyte nuclear factor 1α–inactivated HCA, inflammatory HCA, β-catenin–activated HCA, sonic hedgehog-activated HCA, and unclassified HCA. Mixed β-catenin–activated inflammatory HCA may rarely occur. We report a case of HCA that was initially diagnosed as inflammatory HCA on a biopsy but finally was confirmed to be β-catenin–activated inflammatory HCA on the resection specimen. Most recent updates on molecular classification, key histologic features of each subtype, and common diagnostic pitfalls are discussed.
{"title":"Hepatocellular Adenoma: A Case Report, Current Updates on Subtyping, and Diagnostic Pitfalls","authors":"Geunyoung Jung, Yongjun Liu","doi":"10.1097/PCR.0000000000000527","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000527","url":null,"abstract":"Abstract Hepatocellular adenoma (HCA) is a benign liver neoplasm that typically arises in the noncirrhotic liver. Based on molecular findings, HCA can be subclassified into the following subtypes: hepatocyte nuclear factor 1α–inactivated HCA, inflammatory HCA, β-catenin–activated HCA, sonic hedgehog-activated HCA, and unclassified HCA. Mixed β-catenin–activated inflammatory HCA may rarely occur. We report a case of HCA that was initially diagnosed as inflammatory HCA on a biopsy but finally was confirmed to be β-catenin–activated inflammatory HCA on the resection specimen. Most recent updates on molecular classification, key histologic features of each subtype, and common diagnostic pitfalls are discussed.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82576188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-01DOI: 10.1097/PCR.0000000000000534
Matthew Gosse, D. Bosch
Abstract We describe a case of congestive hepatopathy due to altered circulation with a Fontan procedure. Congestive hepatopathy is characterized microscopically by sinusoidal dilation and congestion, interstitial edema, and hepatocyte atrophy. Congestive hepatic fibrosis typically exhibits pericentral pattern fibrosis at an early stage, progressing to bridging fibrosis and cirrhosis. Fibrosis scoring systems have recently been described for Fontan-associated liver disease and congestive heart disease–associated hepatopathy. The clinical differential diagnosis for congestive hepatopathy is broad and includes right-sided heart failure (“cardiac hepatopathy”), hepatic vein obstruction (such as Budd-Chiari syndrome), and intrahepatic vessel or sinusoidal obstruction (such as sinusoidal obstructive syndrome). Treatment of congestive hepatopathy is primarily directed toward the etiology of congestion.
{"title":"Congestive Hepatopathy: A Case of Fontan-Associated Liver Disease and Review of Literature","authors":"Matthew Gosse, D. Bosch","doi":"10.1097/PCR.0000000000000534","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000534","url":null,"abstract":"Abstract We describe a case of congestive hepatopathy due to altered circulation with a Fontan procedure. Congestive hepatopathy is characterized microscopically by sinusoidal dilation and congestion, interstitial edema, and hepatocyte atrophy. Congestive hepatic fibrosis typically exhibits pericentral pattern fibrosis at an early stage, progressing to bridging fibrosis and cirrhosis. Fibrosis scoring systems have recently been described for Fontan-associated liver disease and congestive heart disease–associated hepatopathy. The clinical differential diagnosis for congestive hepatopathy is broad and includes right-sided heart failure (“cardiac hepatopathy”), hepatic vein obstruction (such as Budd-Chiari syndrome), and intrahepatic vessel or sinusoidal obstruction (such as sinusoidal obstructive syndrome). Treatment of congestive hepatopathy is primarily directed toward the etiology of congestion.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75174918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1097/PCR.0000000000000525
Yow-Shan Lee, Cheng-Han Lee
Abstract Undifferentiated/dedifferentiated endometrial carcinoma is clinically highly aggressive, particularly when it is defined by inactivation of core SWI/SNF proteins (co-loss of ARID1B, loss of SMARCA4, or loss SMARCB1 expression). We report here the case of a 37-year-old woman who presented with menorrhagia and the subsequent pathologic and clinical workup showed an advanced-stage ARID1A/ARID1B-deficient mismatch repair–proficient undifferentiated endometrial carcinoma. Despite pelvic external beam radiation and platinum/taxane-based chemotherapy (4 of 6 planned cycles), the patient experienced disease progression with osseous metastasis to her left elbow and died of her disease 7 months after clinical presentation. This case highlights the diagnostic and treatment challenges associated with such undifferentiated/dedifferentiated cancer types of the endometrium.
{"title":"Undifferentiated Endometrial Carcinoma—Diagnostic and Therapeutic Challenges","authors":"Yow-Shan Lee, Cheng-Han Lee","doi":"10.1097/PCR.0000000000000525","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000525","url":null,"abstract":"Abstract Undifferentiated/dedifferentiated endometrial carcinoma is clinically highly aggressive, particularly when it is defined by inactivation of core SWI/SNF proteins (co-loss of ARID1B, loss of SMARCA4, or loss SMARCB1 expression). We report here the case of a 37-year-old woman who presented with menorrhagia and the subsequent pathologic and clinical workup showed an advanced-stage ARID1A/ARID1B-deficient mismatch repair–proficient undifferentiated endometrial carcinoma. Despite pelvic external beam radiation and platinum/taxane-based chemotherapy (4 of 6 planned cycles), the patient experienced disease progression with osseous metastasis to her left elbow and died of her disease 7 months after clinical presentation. This case highlights the diagnostic and treatment challenges associated with such undifferentiated/dedifferentiated cancer types of the endometrium.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76275559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1097/PCR.0000000000000529
M. Köbel
Abstract The establishment of 4 endometrial carcinoma molecular subtypes by The Cancer Genome Atlas project and their surrogates (POLE mutated, mismatch repair–deficient, p53 abnormal, and no specific molecular profile) invigorated a debate on how to integrate these within the traditional histotype/grade classification. Specific issues of contradicting histotype/grade and molecular subtype diagnoses will be discussed with illustrated examples. The hierarchy of histotype/grade and molecular subtype is interdependent. Pathologists should aim to integrate histotypes/grades and molecular subtypes to provide one consistent and clinically relevant diagnosis.
Cancer Genome Atlas项目建立了4种子宫内膜癌分子亚型及其替代品(POLE突变、错配修复缺陷、p53异常和无特异性分子谱)，引发了如何将这些亚型整合到传统的组织型/分级分类中的争论。与组织型/分级和分子亚型诊断相矛盾的具体问题将通过举例来讨论。组织型/等级和分子亚型的层次是相互依赖的。病理学家应致力于整合组织型/分级和分子亚型，以提供一个一致的和临床相关的诊断。
{"title":"Counterpoint: Integration of Molecular Subtype and Histotype/Grade Into One Classification System for Endometrial Carcinoma","authors":"M. Köbel","doi":"10.1097/PCR.0000000000000529","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000529","url":null,"abstract":"Abstract The establishment of 4 endometrial carcinoma molecular subtypes by The Cancer Genome Atlas project and their surrogates (POLE mutated, mismatch repair–deficient, p53 abnormal, and no specific molecular profile) invigorated a debate on how to integrate these within the traditional histotype/grade classification. Specific issues of contradicting histotype/grade and molecular subtype diagnoses will be discussed with illustrated examples. The hierarchy of histotype/grade and molecular subtype is interdependent. Pathologists should aim to integrate histotypes/grades and molecular subtypes to provide one consistent and clinically relevant diagnosis.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89775535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1097/PCR.0000000000000524
N. Singh, A. Tinker, C. Gilks
Abstract A proportion of endometrial and adnexal carcinomas have concurrent involvement of the other site. In the case of high-grade serous carcinomas involving the tubal epithelium as well as endometrium, distinction of tubo-ovarian high-grade serous from endometrial serous carcinoma can have implications for surgical as well as nonsurgical treatment approaches, including targeted therapies and referral to clinical genetics services. The other situation is involvement of the endometrium and ovary by low-grade endometrioid carcinoma; here separation of high-stage endometrial carcinoma from 2 low-stage, low-grade tumors determines adjuvant treatment decisions. These challenging scenarios are illustrated with case presentations and criteria for pathological reporting while acknowledging uncertainty where this is warranted. It is accepted that these are areas in transition, and any criteria offered are likely to change in the light of new information.
{"title":"Carcinomas With Concurrent Involvement of the Endometrium and Uterine Adnexa—Implications for Pathological Diagnosis and Clinical Management in Current Practice","authors":"N. Singh, A. Tinker, C. Gilks","doi":"10.1097/PCR.0000000000000524","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000524","url":null,"abstract":"Abstract A proportion of endometrial and adnexal carcinomas have concurrent involvement of the other site. In the case of high-grade serous carcinomas involving the tubal epithelium as well as endometrium, distinction of tubo-ovarian high-grade serous from endometrial serous carcinoma can have implications for surgical as well as nonsurgical treatment approaches, including targeted therapies and referral to clinical genetics services. The other situation is involvement of the endometrium and ovary by low-grade endometrioid carcinoma; here separation of high-stage endometrial carcinoma from 2 low-stage, low-grade tumors determines adjuvant treatment decisions. These challenging scenarios are illustrated with case presentations and criteria for pathological reporting while acknowledging uncertainty where this is warranted. It is accepted that these are areas in transition, and any criteria offered are likely to change in the light of new information.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85215297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1097/PCR.0000000000000523
Sandra Lee
Abstract Chronic endometritis (CE) is a controversial clinical and pathological entity. Although the presence of plasma cells (PCs) is the most frequently used diagnostic criterion for CE, the minimal diagnostic criteria remain controversial and undefined. The clinical setting of CE (asymptomatic, pelvic inflammatory disease, infertility) is an important consideration regarding the clinical significance of endometrial PCs. In the setting of infertility, specifically recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL), CE may have a negative impact on endometrial receptivity, resulting in higher rates of implantation failure. The proposed pathophysiology is that a subclinical intrauterine infection alters the local inflammatory milieu resulting in a shift of the normal inflammatory cell profiles toward responses associated with implantation failure and poorer reproductive outcomes. Cure rates following antibiotic treatment are reported to be high (up to 90%). The results of meta-analyses describing the effect of CE on reproductive outcomes are mixed. There is evidence supporting CE as a treatable factor with improved reproductive outcomes following treatment and there are also results showing no differences in reproductive outcomes. Variable diagnostic criteria for CE, inclusion criteria, and treatment regimens between studies are the main limitations, hampering the ability to compare results across studies. Results regarding the optimal diagnostic criteria in the setting of RIF and RPL are also variable, with some authors recommending a cutoff of 1 or more CD138+ PCs per high-power field and some recommending a cutoff of 5 or more CD138+ PCs per high-power field. There are some studies indicating CE as a negative prognostic factor in patients with RIF and RPL, which may be reversible with antibiotic treatment. The optimal diagnostic criteria for CE in this clinical setting are undefined. For the investigation of infertility patients whom clinicians intend to treat, a descriptive diagnosis (indicating the presence/number of PCs and method of identification) is a reasonable approach. Routine use of CD138 immunohistochemistry is of limited value for the diagnosis of CE.
{"title":"Chronic Endometritis: Diagnostic Considerations in Patients With Infertility","authors":"Sandra Lee","doi":"10.1097/PCR.0000000000000523","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000523","url":null,"abstract":"Abstract Chronic endometritis (CE) is a controversial clinical and pathological entity. Although the presence of plasma cells (PCs) is the most frequently used diagnostic criterion for CE, the minimal diagnostic criteria remain controversial and undefined. The clinical setting of CE (asymptomatic, pelvic inflammatory disease, infertility) is an important consideration regarding the clinical significance of endometrial PCs. In the setting of infertility, specifically recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL), CE may have a negative impact on endometrial receptivity, resulting in higher rates of implantation failure. The proposed pathophysiology is that a subclinical intrauterine infection alters the local inflammatory milieu resulting in a shift of the normal inflammatory cell profiles toward responses associated with implantation failure and poorer reproductive outcomes. Cure rates following antibiotic treatment are reported to be high (up to 90%). The results of meta-analyses describing the effect of CE on reproductive outcomes are mixed. There is evidence supporting CE as a treatable factor with improved reproductive outcomes following treatment and there are also results showing no differences in reproductive outcomes. Variable diagnostic criteria for CE, inclusion criteria, and treatment regimens between studies are the main limitations, hampering the ability to compare results across studies. Results regarding the optimal diagnostic criteria in the setting of RIF and RPL are also variable, with some authors recommending a cutoff of 1 or more CD138+ PCs per high-power field and some recommending a cutoff of 5 or more CD138+ PCs per high-power field. There are some studies indicating CE as a negative prognostic factor in patients with RIF and RPL, which may be reversible with antibiotic treatment. The optimal diagnostic criteria for CE in this clinical setting are undefined. For the investigation of infertility patients whom clinicians intend to treat, a descriptive diagnosis (indicating the presence/number of PCs and method of identification) is a reasonable approach. Routine use of CD138 immunohistochemistry is of limited value for the diagnosis of CE.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72823959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1097/PCR.0000000000000526
David B. Chapel, Kay J. Park
Abstract Mesonephric-like adenocarcinomas are endometrial and ovarian neoplasms of müllerian origin with morphologic, immunophenotypic, and molecular evidence of mesonephric-type transdifferentiation, as well as considerable homology with endometrioid tumors. First described in 2016, mesonephric-like adenocarcinomas are morphologically indistinguishable from “true” mesonephric adenocarcinomas of the uterine cervix, but the latter are distinguished by (1) primary localization to the cervical wall, (2) frequent association with mesonephric remnants, and (3) in some cases, lack of mucosal involvement. Despite an overall low-grade morphology, mesonephric-like adenocarcinoma follows an aggressive clinical course, characterized by frequent and early recurrences, most often in the lung. Accordingly, accurate distinction of mesonephric-like adenocarcinoma from morphologic mimics—especially low-grade endometrioid adenocarcinoma—is critical. However, available evidence indicates that endometrial mesonephric-like adenocarcinomas are significantly underdiagnosed, likely due to their relative novelty, rarity, and considerable overlap with endometrioid neoplasia. Prospective recognition of characteristic morphologic features, a low threshold for application of diagnostic immunohistochemistry, and judicious use of molecular studies will permit accurate diagnosis in almost all cases.
{"title":"Mesonephric-Like Adenocarcinoma of the Endometrium: Review of the Literature and Practical Diagnostic Recommendations","authors":"David B. Chapel, Kay J. Park","doi":"10.1097/PCR.0000000000000526","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000526","url":null,"abstract":"Abstract Mesonephric-like adenocarcinomas are endometrial and ovarian neoplasms of müllerian origin with morphologic, immunophenotypic, and molecular evidence of mesonephric-type transdifferentiation, as well as considerable homology with endometrioid tumors. First described in 2016, mesonephric-like adenocarcinomas are morphologically indistinguishable from “true” mesonephric adenocarcinomas of the uterine cervix, but the latter are distinguished by (1) primary localization to the cervical wall, (2) frequent association with mesonephric remnants, and (3) in some cases, lack of mucosal involvement. Despite an overall low-grade morphology, mesonephric-like adenocarcinoma follows an aggressive clinical course, characterized by frequent and early recurrences, most often in the lung. Accordingly, accurate distinction of mesonephric-like adenocarcinoma from morphologic mimics—especially low-grade endometrioid adenocarcinoma—is critical. However, available evidence indicates that endometrial mesonephric-like adenocarcinomas are significantly underdiagnosed, likely due to their relative novelty, rarity, and considerable overlap with endometrioid neoplasia. Prospective recognition of characteristic morphologic features, a low threshold for application of diagnostic immunohistochemistry, and judicious use of molecular studies will permit accurate diagnosis in almost all cases.","PeriodicalId":72144,"journal":{"name":"AJSP: reviews & reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76534924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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