Arkhiv patologii最新文献

Breast tumors are one of the most common locations of malignant neoplasms. Every year, new aspects of the pathogenesis of breast cancer are discovered; along with genetic, hormonal and other factors, the issue of implantation and metastatic damage to the organ by tumors of other localizations is being increasingly discussed. With evolving diagnostic methods, more and more reports are emerging indicating that sometimes a breast tumor is not a primary lesion, but a site of metastasis. In this paper, the authors present a clinical case of metastasis of endometrioid adenocarcinoma of the endometrium to the breast. In this paper, the authors present a clinical case of metastasis of endometrioid adenocarcinoma of the endometrium to the mammary gland. The final diagnosis was made through analysis of a combination of morphological and immunohistochemical features. This clinical case is unique from a clinical and pathological perspective.

Dimethylarginine Dimethylaminohydrolase 1 (DDAH1) is an essential enzyme capable of degrading asymmetric dimethylarginine, which is an endogenous inhibitor of nitric oxide synthase. Increased expression of DDAH1 and subsequent increased NO production are associated with carcinogenesis. In particular, DDAH1 is involved in the creation of a vascular network by tumor cells, vasculogenic mimicry, which is closely associated with tumor progression and poor patient prognosis. This is the reason why DDAH1 may be a potential therapeutic target for the treatment of cancer.

Granulomatosis with polyangiitis (Wegener's granulomatosis, ANCA-associated vasculitis) is a rare systemic disease with unclear etiology, raising many questions in the interpretation of changes in internal organs during computed tomography and the assessment of diagnostic signs during pathohistological examination of biopsy/autopsy material. This paper describes a rare clinical observation of granulomatosis with polyangiitis in a 62-year-old patient with lung, kidney, and prostate lesions.

Objective: To compare the structure of causes of death among men and women of different age groups in 2019 and 2023 (using the Moscow Region as an example).

Material and methods: Anonymized personalized data from medical death certificates (MDC) of the database of the Main Civil Registry Office in the Moscow Region. A total of 87.555 MDCs in 2019 and 92.182 in 2023 of persons aged 18 years and older. The absolute number of deaths (total and in ten-year age groups), the contribution of disease classes according to ICD-10 were determined, a comparison of unstandardized mortality rates (UR) and the structure of causes of death was carried out.

Results: The mortality rate for men (18 years and older) was 1499 per 100.000 men in 2019 and 1434 in 2023; for women - 1367 and 1344, respectively. The UR of men is higher than that of women up to the age of 80, with the greatest differences at the age of 18-39 years. An increase in the number of deaths, UR and contribution to the mortality structure in men and women was noted for 5 ICD classes (E, J, K, N and S-T in men); a decrease was found for class F, for women - for 2 classes (G and R). The most significant differences in the UR and structure of causes of death in men and women are associated with four classes (S-T, J, E and G). The smallest changes were recorded for the class of neoplasms (about 15% of deaths in both men and women in 2019 and in 2023). A high proportion of poorly defined codes was noted (for example, more than 80% in the class of nervous diseases are accounted for by 3 codes G31.1, G93.0 and G93.4). The differences and changes identified in the structure of causes of death in 10-year age groups of men and women are likely largely due to controversial issues regarding the determination of the underlying cause of death.

Conclusion: Mortality reduction strategies should take into account age-sex characteristics of causes of death. Significant changes in UR from individual causes and a sharp increase in the proportion of deaths with codes that have no clinical analogues in old age require improvement of approaches to indicating and coding causes of death.

The epidemiological data on the incidence of gastric cancer and its mortality make it a challenge for oncologists to find new and improve existing diagnostic methods and therapies. Despite the active change of modern realities in the practice of pathomorphologist for 60 years remains unchanged authority of the P.Laurén classification of histological main types. This does not leave it without attention from the scientists of our time, so there are published works refuting or confirming its prognostic significance, as well as studies in which its modifications are proposed. In this regard, the purpose of this review is to briefly systematise the currently available information on P.Laurén classification and to provide an opportunity to review the content of the original article by Pekka Laurén in Russian.

Thyroid transcription factor 1 (TTF1) is the most common and reliable marker for immunohistochemical diagnostics of various thyroid tumors and lung adenocarcinoma. At the same time, some of scientific studies have been published that describe aberrant expression of TTF1 by cells of various tumors, including lymphomas. Researchers reported the possibility of TTF1 expression in diffuse large B-cell lymphoma, angioimmunoblastic T-cell lymphoma, and T-cell leukemia. However, there were no reports of this marker expression in anaplastic large cell lymphoma, which, due to its morphological characteristics, may resemble a metastatic process.

Objective: To assess the frequency of aberrant expression of TTF1 in anaplastic large cell lymphoma cells.

Material and methods: The study was performed on 47 cases of anaplastic large cell lymphoma. The expression of TTF1 was assessed using two different platforms (Ventana BenchMark ULTRA and BondMAX) and two different, commercially available, clones (SP141, SPT24), including the use of a double chromogenic label.

Results: The study detected the expression of TTF1 by tumor cells in five cases (10.6%) of nodal ALK-negative anaplastic large cell lymphoma in patients with a median age of 66 years, with a TTF1 expression gradient from 100% to 15% of tumor cells.

Conclusion: The study demonstrated for the first time the possibility of aberrant expression of TTF1 by anaplastic large cell lymphoma cells. In one case, intense expression of TTF1 was observed in 100% of tumor cells, in the rest - in no more than 15%. Moreover, expression was observed both in cases of using clone SP141 and clone SPT24. In our opinion, the identified aberrant expression of TTF1 in anaplastic large cell lymphoma, may cause an error in the morphological diagnosis of the metastatic process and requires additional attention from the pathologist.

Chronic endometritis is widespread among women of reproductive age, it can be the cause of menstrual disorders, abnormal uterine bleeding and, finally, infertility of uterine genesis. The issue of impaired immune status of the glandular-stromal component in chronic endometritis has not been deeply investigated. Violation of the ratio of immune system cells is a fundamental link in the development of imbalance of the immunological status of the endometrium.

Objective: To present a comparative analysis of the immune status of the endometrium in patients with abnormal uterine bleeding associated with chronic endometritis of varying severity.

Material and methods: A comparative analysis of clinical data, histological and immunohistochemical results of endometrial examination in 95 patients of reproductive age was carried out. Diagnosis of chronic endometritis was performed in histological sections: immunohistochemical reaction with CD138 antibodies with assessment of the number of plasma cells. In addition, the presence or absence of endometrial stromal fibrosis was recorded using Mallory staining. The following markers of endometrial lymphocytes were counted: CD4, CD8, CD20, CD56, and the CD4/CD8 ratio was estimated.

Results: The morphological sign indicating changes in the immune status in patients with abnormal uterine bleeding associated with chronic endometritis is a significant increase in the number of lymphocytes characterised by increased expression of CD4, CD8, CD20, CD56 markers, and a disruption of the CD4/CD8 ratio, directly proportional to the degree of severity of chronic endometritis.

Conclusion: The study demonstrates statistically significant differences in immune status in patients with abnormal uterine bleeding associated with chronic endometritis of varying severity. Local immunity cells in the endometrium coordinate the menstrual cycle, and their imbalance leads to the activation of pathological mechanisms of endometrial immunoregulation, which is probably a pathogenetic factor of functional failure of the endometrium and menstrual disorders in women.

Sex cord tumor with annular tubules is a rare type of ovarian tumor, which seems to arise from Sertoli cells. Most tumors are associated with Peutz-Jeghers syndrome and have a benign course and favorable prognosis; however, about 20% of sporadic sex cord tumors with annular tubules have a high risk of developing metastases. We present a case report about 18-year-old patient who presented with irregular menstruation and abdominal pain. Based on the histological features and immunohistochemical results, the diagnosis of a sex cord tumor with annular tubules was confirmed. The above-described ovarian tumor is rare in childhood and adolescence compared to the general population, which, combined with nonspecific clinical manifestations, can result certain diagnostic difficulties in this age group of patients.

Sinonasal papillomas are a group of benign, relatively rare tumors of the sinonasal tract with varying clinical courses. In the modern WHO classification, it is customary to distinguish three subtypes of sinonasal papillomas: the most common inverted type (ISP), oncocytic type (OSP) and exophytic type (ESP). Recently, the concept has emerged that the different types of sinonasal papillomas may not be variants of a single tumor, but rather separate tumors. Thus, OSP demonstrates KRAS mutations, and the pathogenesis of ISP is associated with EGFR mutations.

Objective: To provide a comparative description of the EGFR gene (exon 20) based on the results of Sanger sequencing in sinonasal papillomas of inverted and oncocytic types.

Material and methods: Sanger sequencing of the EGFR gene (exon 20) was performed in 83 cases of sinonasal papillomas, of which 17 were of OSP and 66 were ISP cases. In 20 cases, an additional immunohistochemical study with an antibody to EGFR was also performed.

Results: When sequencing by Sanger of exon 20 of the EGFR gene in the ISP group, missense mutations were identified in 16 out of 66 cases, leading to a change in the value of the coding sequence of the gene, ultimately determining the formation of a different amino acid; this type of mutation was not identified in the OSP group. The most common mutation was at position 2622 in the form of G to A transition: in 47 cases of ISP (70%) and in 12 cases of OSP (71%). This mutation was synonymous and did not lead to an amino acid replacement in the synthesized protein. Thus, we did not find any significant differences in exon 20 of the EGFR gene between the ISP and OSP groups. In the ISP group, in 48 of 66 cases, multiple and single point mutations were noted, which we characterize as genetic heterogeneity.

The new coronavirus infection is characterized not only by pronounced cytokine and autoimmune reactions in the acute period, but is also an inducer of a whole spectrum of chronic immunoinflammatory conditions, which differ in varying degrees of specificity from general manifestations of the so-called post-COVID syndrome to single-organ diseases (including myocarditis) and nosologically defined systemic autoimmune diseases and vasculitis. Isolated post-COVID aortitis is one of the rarest complications of SARS-CoV-2 infection. We present a clinical observation of a patient with myocarditis and aortitis simultaneously developing 1 month after COVID-19 with damage to the infrarenal section and formation of an aortic aneurysm. Myocarditis was verified by MRI, manifested by severe dysfunction of the left ventricle with a drop in the ejection fraction to 30% and was of an autoimmune nature (a 4-fold increase in the titers of anticardiac antibodies was revealed). At the same time, MSCT revealed an aortic aneurysm with thickening of its walls. Therapy with medium doses of corticosteroids resulted in clinical remission of myocarditis, but progression of the aortic aneurysm required surgical treatment. The diagnosis of chronic immune inflammation associated with SARS-CoV-2 was morphologically confirmed (nucleocapsid and spike proteins of the virus were detected in macrophages, lymphocytes of infiltrates and endothelium of microvessels). The combination of post-COVID myocarditis and chronic aortitis has not been described previously. The issues of pathogenesis, diagnostics, and nosological nature of combined immune-inflammatory damage to the heart and blood vessels after a new coronavirus infection are discussed.