Arkhiv patologii最新文献

Objective: To evaluate the MMR system proteins and the MSI status of regenerative (indefinite for dysplasia) and pronounced (epithelial dysplasia) gastric mucosa precancerous lesions in the comparison with cancer to determine their possible potential as a diagnostic markers of gastric mucosa dysplasia.

Material and methods: The study included 2 groups of gastric mucosa specimens: (1) 150 biopsy gastric mucosa specimens: 43 with low-grade dysplasia, 32 with high-grade dysplasia, 75 - indefinite for dysplasia; (2) 155 cancer tissue specimens from resected stomachs. Gastric mucosa specimens were examined histologically, immunohistochemically using mouse monoclonal antibodies to the MMR system proteins: MLH-1, MSH2, MSH6, PMS2 (Diagnostic BioSystems, USA). MSI was studied with multiplex PCR evaluation of DNA microsatellites (NR-21, NR-24, NR-27, BAT-25, BAT-26) from paraffin sections, their analysis with capillary electrophoresis. The obtained data were processed with the Statistica 10.0 (StatSoft, USA), presented using descriptive, analytical statistics.

Results: MSI was detected by immunohistochemistry in 8% (n=6) of the studied cases of low/high grade dysplasia, which does not have statistically significant differences from the distribution of MSI in the gastric cancer group (12% of microsatellite-unstable cases (n=18)) (p=0.49). MSI was not detected in any indefinite for dysplasia case.

Conclusion: Detection of microsatellite instability in gastric mucosa dysplasia indicates the likelihood of its occurrence at the early stages of the carcinogenesis cascade and makes it possible to use it to assess the risk of gastric cancer associated with microsatellite instability. The absence of instability in cases indefinite for dysplasia determines the possibility of its use for differential diagnosis of truly neoplastic and regenerative/reactive changes in the gastric mucosa.

Objective: To characterize the immunophenotypic features of the inflammatory infiltrate cell composition and the morphometric features of muscle fibers in skeletal muscle biopsies from patients with hereditary and inflammatory myopathies, and to develop an integral coefficient to aid in the differential diagnosis of these conditions.

Material and methods: The material is represented by biopsy specimens of m. tibialis anterior, m. vastus lateralis, m. gastrocnemius med, m. peroneus longus et brevis, m. deltoideus, m. biceps femoris and m. latissimus dorsi of patients with polymyositis (n=7), dermatomyositis (n=3), dysferlinopathy (n=10) and calpainopathy (n=3), established on the basis of molecular-genetic, clinical-instrumental and morphological data. All biopsies underwent pathohistological and immunohistochemical examination.

Results: The number of necrotic muscle fibers was significantly higher in polymyositis compared to dermatomyositis (p=0.008), dysferlinopathy (p=0.003), and calpainopathy (p=0.009), showing a diffuse pattern. In dermatomyositis, necrotic muscle fibers were predominantly perifascicular. In dysferlinopathy, a positive correlation between CD68⁺-macrophages and CD4⁺-T-helpers in the perimysium (p=0.04) were observed. The number of CD8⁺-T-killer cells invading muscle fibers was higher in polymyositis compared to dysferlinopathy (p=0.034). Increased numbers of CD138⁺-plasma cells was also noted in polymyositis. The MICE coefficient was lower in hereditary myopathies.

Conclusion: Immunophenotyping of the inflammatory infiltrate and quantitative morphometry using the integral MICE coefficient provide criteria for the differential diagnosis of myopathies of different origins. The established differences in the cellular composition of the infiltrate (particularly, the predominance of invasion by CD8⁺-T-killers in polymyositis) and in the degree of morphological homogeneity of muscle fibers (higher in hereditary forms) represent objective differential diagnostic criteria. Thus, the integrated application of these approaches can significantly improve the accuracy of verifying the differential diagnosis in myopathies of various origins.

Complete mesocolonectomy (CME) is the current standard of treatment for colon cancer patients. At the same time, there are currently no clear standards for the pathomorphological assessment of CME quality, allowing for a comprehensive and independent assessment of the quality of surgical treatment.

Objective: Creation of a standardized system of pathomorphological assessment of the quality of TMCE based on the developed set of universal criteria.

Material and methods: The prospective study included the results of treatment of patients with adenocarcinomas of the right half of the colon, who underwent surgical interventions in the volume of right-sided hemicolectomy (RSHE) in the period from 2022 to 2024. The method of pathomorphological examination included mandatory photo documentation, as well as mesocolonectomy quality assessment using the classification of N. West et al., visual assessment of CME quality using the classification of S. Benz et al., standard microscopic examination to determine the presence of metastatic lymph nodes (LN) lesions, dividing them into groups according to the Japanese classification.

Results: The study included 142 patients, 116 (81.7%) of whom underwent laparoscopic interventions, while 105 (73.9%) had D3 lymphodissection. According to the pathomorphological study, the most common (65 cases - 45.8%) tumors were located in the ascending section of the transverse colon, multicentric tumor growth within the colon was detected in 3 (2.1%) cases. The overwhelming majority of patients had stage III (92 patients - 64.9%) and IV (25 patients - 17.6%) clinical stages of the disease.

The median of the studied LN was 48 (12-225), affected - 3 (1-51) LN. LN lesion was detected in 79 patients (55.6%). Damage to the apical LN was found in 9 (6.3%) cases. Unfavorable prognosis factors (perineural growth, lympho- and angiovascular invasion, the presence of tumor deposits and metastases in the lung) were identified in 92 (64.7%) patients.

Good quality of mesocolic fascia isolation (Grade 3) according to West was found in 101 cases (71.1%), true CME (Type 0 according to Benz) was performed in 74 cases (52.1%).

Conclusion: The quality assessment of the removed specimen after RSHE should be based on a detailed examination of all removed lymph nodes with division into groups in accordance with the Japanese Clinical Classification, assessment of the plane of intestinal resection according to N. West and the quality of CME according to S. Benz.

Objective: To detect the presence or absence of correlations between the degree of tumor budding (TB) and pMMR/dMMR (proficient Mismatch Repair System/deficient Mismatch Repair System) and PD-L1 status in gastric cancer (GC).

Material and methods: Surgical material from 173 patients with verified gastric cancer of the tubular histological subtype, where the invasive edge of the carcinoma was examined, tumor budding were identified and counted by three methods: H. Ueno, L. Wang and, E. Karamitopolou. Patients with GC were divided into two groups - with low and high degree of tumor budding (LG-TB and HG-TB). dMMR and PD-L1 status were identified by immunohistochemical staining.

Results: Using the H. Ueno method, a predominance of low-grade TB was found in the group of dMMR carcinomas (90.5% of dMMR cases were associated with LG-TB, p=0.035). According to the L. Wang method, 85.7% of dMMR cases were identified that were associated with LG-TB, p=0.028. According to the E. Karamitopolou method, it was found that 76.2% of dMMR cases were associated with LG-TB, p=0.106. When analyzing the relationship between tumor budding and PD-L1 expression, no statistically significant differences were found (p>0.05).

Conclusion: The low degree of tumor budding, estimated by the methods of H. Ueno and L. Wang, correlates with the dMMR status of tumor tissue. No statistically significant association was found when counting tumor budding using the E. Karamitopolou method. The degree of tumor budding determined by any of the methods does not correlate with the PD-L1 status of GC.

Various benign processes in the endometrium are the cause of vascular changes. Endometrial cancer is also accompanied by changes in the density of microvessels. The detection of vascularization of the hyperplastic endometrium without signs of atypia, expressed significantly more than described in the literature, served as the basis for this work.

Objective: To assess the state of the vascularization of the simple endometrial hyperplasia without atypia and to compare the obtained results with literary data.

Material and methods: Vascularization of the endometrium in its simple hyperplasia without atypia was studied in 31 women by light microscopy using an immunohistochemical reaction with antibodies to the CD34 antigen and morphometry.

Results: Different patients had different degrees of expression, but always large, vascularization of the endometrium with simple endometrial hyperplasia without atypia. The vessels accounted 5.97±4.18% of the section area, while their number per 1 mm² was 391±180. These data significantly exceed most of the results of other studies presented in the literature, which differ several times even from each other.

Conclusion: Endometrium with simple endometrial hyperplasia without atypia is characterized by different, often very high levels of vascularization, the real average values much exceed most of the literary data, which are also very contradictory. A very critical attention to the results describing the features of angiogenesis and vascularization of hyperplastic endometrium without atypia is necessary.

Dysplastic nevus is one of the most common tumors in the practice of a dermatologist and pathologist. However, despite this and the presence of a large number of published studies, since the late 1970s and to this day, the diagnosis and treatment of dysplastic nevi have been controversial.

Objective: To determine the accuracy and reproducibility of morphological findings in the group of dysplastic nevi.

Material and methods: A total of 178 skin resection specimens for 2023 were used in our study, which can be conditionally divided into three groups according to the correct clinical diagnosis: (1) with suspected dysplastic nevus/melanoma - 56% (99/178), (2) dysplastic nevus - 35% (62/178), (3) without dysplastic nevus/melanoma - 9% (7/178). Of the 178 observations, 31 cases were selected for further review. The selection criteria were the following morphological findings: (1) DN with moderate/severe atypia, (2) DN with any degree of atypia without clinical suspicion for it, (3) melanoma without clinical suspicion for it. Agreement between pathology reports and the original diagnosis was measured by the proportion of the same reports in the same educational category, using Wilson 95% confidence interval.

Results: There were 72 dysplastic nevi after first pathology report: 77.8% (56/72) with mild atypia, 18.1% (13/72) with moderate atypia, 4.2% (3/72) with severe atypia. The agreement between the clinical and primary morphological diagnoses was 58.4% (104/178), and in the dysplastic nevus group - 40.3% (25/62). When reviewing the 31 cases, the percentage of agreement for a simple nevus was 100%, for dysplastic with mild atypia - 70.8%, for dysplastic nevus with severe atypia - 33.3%, for melanoma - 48.4%. The coincidence of the initial and repeated diagnoses was 54.8% (14/31), 51.6% (16/31) and 29.0% (9/31) for each of the doctors.

Conclusion: Our study revealed low accuracy and reproducibility of morphological conclusions in the group of dysplastic nevi. The determination of similar lesions by different pathologists and deviations from the initial diagnoses can primarily be explained by insufficiently reproducible diagnostic criteria.

Lung adenocarcinoma (LAC) is one of the leading causes of cancer mortality, which is most likely due to the presence of cancer stem cells (CSC) in the tumor, which form a heterogeneous hierarchy and are responsible for the occurrence and progression of carcinoma, as well as its unfavorable prognosis. The ability of CSC to form heterogeneous tumor populations in lung cancer has not been sufficiently studied.

Objective: Detection of cancer cells with signs of stemness in LAC and establishment of their heterogeneity by expression of ALDH1, CD133 and CD34 markers in surgical material depending on the histological type, degree of malignancy and stage of the tumor process, as well as in the A549 cell culture.

Material and methods: Clinical and morphological analysis of surgical material of LAC from 32 patients was performed, and the culture of lung adenocarcinoma cells A549 was studied. Stem cell markers ALDH1, CD133 and CD34 were detected in the analyzed material by immunohistochemistry. The percentage of positively stained cells was calculated in the preparations.

Results: In all cases of ALCL, CSCs containing ALDH1, CD133 and CD34 were found both in the surgical material and in the A549 cell culture. Heterogeneity of CSCs for the studied markers was established. In patients with early stages of cancer without metastases in the lymph nodes, the number of ALDH1+ CSCs predominated in the primary tumor tissue. With the appearance of metastases in the regional lymph nodes, a significant increase in the number of cells with positive staining in reactions with antibodies to CD34 was found in the ALCL tissue. In patients with metastatic cancer, staining of the overwhelming majority of tumor cells was detected in reactions with all markers - ALDH1, CD133 and CD34.

Conclusion: In ACL, both in the surgical material and in the A549 culture, CSCs expressing the stemness markers ALDH1, CD133 and CD34 were detected. An increase in the number of CSCs expressing the stemness markers ALDH1, CD34 and CD133 in the tumor tissue occurs with carcinoma progression. In ACL, heterogeneity of CSCs by the studied markers is noted: at early stages in patients without metastases in the lymph nodes, ALDH1+ CSCs predominate in the tumor tissue, while with the appearance of metastatic lesions of the lymph nodes, CD34+ CSC populations dominate. Quantitative heterogeneity is also observed in the A549 cell culture: the largest number was CD34+ CSCs, slightly less ALDH1+ CSCs and a minimum number of cells with CD133+ CSCs.

Objective: To evaluate the degree of tumor budding by three methods in gastric cancer and to study its relationship with clinical and morphological characteristics and its impact on overall survival. Choose the best way to determine the tumor budding in gastric cancer.

Material and methods: In the surgical material from 172 patients with verified gastric cancer of the tubular histological subtype, tumor budding was identified and counted using three methods: H. Ueno, L. Wang, E. Karamitopolou. Histological samples stained with H&E, as well as using antibodies to the immunohistochemical marker PanCK, were studied. The calculation was carried out in the zone of maximum budding "hot spot" with an assessment of 5-10 visual fields and a choice of the average value. The results of calculating the tumor budding were compared with the main clinical and morphological characteristics of gastric cancer using statistical analysis. Overall survival data were obtained for 144 patients.

Results: The degree of tumor budding determined by any of the methods is significantly associated with the macroscopic form according to the classification of R. Bormann (p=0.023/p=0.047/p=0.039), morphological type according to the classification of P. Lauren (p=0.001/p=0.000/p=0.001), the presence/absence of signet-ring cells (p=0.008/p=0.008/p=0.017), with the differentiation level (p=0.000/p=0.000/p=0.001), with the presence/absence of tumor emboli in the vascular lumen (p=0.020/p=0.022/p=0.019), TNM classification parameters and the clinical stage of the oncological process (p=0.000/p=0.000/p=0.000). With an increase of tumor budding, the risk of death increases in 1.77/2.12/1.81 the time (p=0.03/p=0.01/p=0.02) set by any of the methods.

Conclusion: When using any of the methods for assessing the degree of tumor budding, it has been shown that it is a strong negative prognostic factor in stomach cancer. Although the L. Wang method has the greatest negative predictive value (RR=2.12), we believe that the H. Ueno method should be used, since it is the least labor-intensive.

Solitary fibrous tumor (SFT) is a rare mesenchymal tumor. SFT was first described by Klemperer and Rabin in 1931. They described a fibrous tumor of the pleura. Currently, isolated cases of SFT of the gallbladder and common bile duct have been described in the world. SFT is characterized by nuclear expression of STAT6 and the formation of chimeric genes NAB2-STAT6. A case report of a rare SFT of the common bile duct in a 66-year-old patient is presented. The description contains data from radiation and ultrasound diagnostic methods, macro- and microscopic characteristics of the tumor and immunohistochemical characteristics.

Primary central nervous system lymphoma is a rare type of extranodal non-Hodgkin's lymphoma that occurs primarily in the central nervous system and represented by diffuse B-cell large cell lymphoma. Despite the fact that this tumor has been known for almost 100 years, studying it is difficult due to the rarity and, consequently, the limited number of statistically significant samples for research. This review analyzes the available literature data on the biological features of primary central nervous system lymphomas, pathogenesis and tumor microenvironment. In addition, we analyzed prognostic factors and current treatment strategies. The objective of this review is to determine the prospects for further study of this tumor.