Pathologie (Heidelberg, Germany)最新文献

Neuroendocrine (NE) cells in the prostate are part of the diffuse NE system and are found in both the normal prostate and acinar adenocarcinomas, occasionally exhibiting Paneth cell-like morphology.NE cells produce peptide hormones and biogenic amines that influence the differentiation and growth of the prostate glands through paracrine signaling; however, they do not show proliferative activity and lack androgen receptors (AR).Prostate tumors with NE differentiation are classified into five groups: (1) acinar adenocarcinomas with partial NE differentiation, detectable only by immunohistochemistry, (2) adenocarcinomas with Paneth cell-like differentiation, (3) NE tumors/carcinoids (NET), (4) small cell NE carcinomas (SCNEC), and (5) large cell NE carcinomas (LCNEC).The significance of partial and Paneth cell-like differentiation in adenocarcinomas remains under discussion and plays a minor role in routine diagnostics. NETs are extremely rare and appear to behave similarly to NETs of the gastrointestinal tract. In contrast, SCNECs and LCNECs are aggressive tumors with important clinical relevance, as they have a poor prognosis and require aggressive treatment.Therapy-associated neuroendocrine prostate carcinomas (t-NEPC) are recognized as a distinct entity for the first time in the WHO classification (5th edition, 2022). It arises through transdifferentiation via epigenetic changes following androgen deprivation and is characterized by AR loss and high proliferation, among other features. As with primary NE carcinomas, aggressive therapy is indicated. Therefore, a follow-up biopsy is recommended for castration-resistant progressive prostate cancer to confirm this aggressive phenotype.

Large gland lesions of the prostate encompass a spectrum of entities from benign histoanatomic variation to invasive high-grade carcinoma. Despite overlapping morphologic features, accurate diagnosis is critical because the clinical management of these lesions varies from no additional follow-up to possible definitive resection or radiotherapy. This manuscript provides a concise overview of large gland lesions with a focus on practical diagnostic features and clinical significance. Where necessary, a brief historical perspective is included as many of these entities have diagnostic and molecular criteria which are still being established. Unfortunately, controversies and lack of consensus within urologic subspecialty groups have made this a challenging topic for the broader pathologist community. This paper serves as a snapshot of our current understanding of the spectrum of intraductal lesions of the prostate and their mimics.

Among non-cutaneous head and neck tumours, oral squamous cell carcinoma is one of the most common entities and is clinically characterized by functionally limiting therapies and a high recurrence rate. The majority of oral squamous cell carcinomas arise from potentially malignant diseases of the oral mucosa, which are often biopsied for preventive and diagnostic purposes. This article provides the histological criteria for grading oral epithelial dysplasia, with a scheme to help classify p53 staining and estimate prognosis. As oral cancer is still a morphologically defined entity, the histological subtypes and prognostic parameters that can be determined by light microscopy are presented. Future treatment approaches are outlined, which cannot be compared to other tumour entities due to the lack of therapeutically useful molecular alterations in oral squamous cell carcinoma.

The Gleason grading system is the cornerstone of risk stratification and clinical decision-making in prostate cancer patients. In the last decade, new insights on quantitative grading and the importance of particular growth patterns have further optimized pathological tumor grading. This review provides an update on the latest grading recommendations and discusses contemporary research directions.

A 60-year-old immunocompetent patient presented with painless subcutaneous nodules on the right hand and forearm that progressed over several weeks. Nodules were clinically classified as a soft tissue tumor of primarily mesenchymal origin. After extirpation of two nodules for diagnostic clarification, histology showed a chronic granulomatous inflammation of the dermis and subcutis with central eosinophilic necrosis including cell debris. Light microscopy showed no acid-fast rods, but molecular diagnostics revealed DNA of Mycobacterium haemophilum as a nontuberculoid mycobacterium (NTM). The infection was identified as the cause of the nodules based on the classic histomorphology of necrotizing-granulomatous inflammation in addition to PCR-based pathogen diagnostics. This case illustrates the clinical presence of mycobacterial infections, especially in extrapulmonary and extranodal localizations. In addition to cutaneous foci of infection, NTM infections may cause multisystem disease involving the joint system, depending on the host's immunocompetence, which can be treated with antibiotics.

This review article presents the possibilities and limitations of histopathological diagnostics on the issues of joint diseases, including in the context of the medical insurance inquiries, which consider the important articular, non-osseous compartments, especially of the tendons, ligaments, and meniscus. Essential for expert assessments is the causal clarification of whether the continuity disruption has been induced exogenously by trauma or endogenously based on tissue that is functionally impaired and thus degeneratively altered. The degree of degeneration/texture disorder is determined by means of the degeneration-score, which is set in a semiquantitative, three-stage grading. Grades 1 and 2 are summed up as low-grade degeneration and compared to grade 3, high-grade degeneration. Age determination of continuity disruption is based on the assessment of the morphology of discontinuity and on the assessment of hemosiderin deposits. The tasks of histopathological diagnostics thus consist of the detection and grading of textural disorder (degeneration), the determination of the histopathologic age of existing continuity disruptions, and particularly the diagnosis of clinically/radiologically undiagnosed diseases, which may be relevant for pathogenesis. In the case of contradictory diagnoses from different diagnostic disciplines and in the case of imprecise and potentially even contradictory patient information, purely legal, judicial decisions may be necessary. In this case the legally binding assessment within the framework of legal evidence evaluation then arises.

The article presents the concept of misdiagnosis or malpractice to practising pathologists from a medical and legal perspective and highlights similarities and differences in this respect. In particular, the risk of criminal liability for pathologists in the context of their practice activities is addressed and the relationship between the legal judgements of criminal, civil and professional law is examined in more detail. Due to the lack of an existing reversal of the burden of proof in criminal law, the constellation may arise in practice that a treatment error under civil law is assumed. However, such a qualification does not necessarily lead to a criminal accusation. Furthermore, the field of professional law, which is often pushed into the background for practising lawyers, is also emphasised. Criminal sanctions often hit a practitioner less severely than, for example, the withdrawal of a licence to practise under professional law. Close dovetailing of criminal, civil and professional law advice is essential in this respect. Pathologists are also given tips on how to behave based on many years of criminal defence practice in order to enable an adequate defence at an early stage in the event of a confrontation with criminal charges.