Arkhiv patologii最新文献

Current data of the prognosis of signet ring cell gastric carcinoma (SRC) are contradictory, and our knowledge of other subtypes of poorly cohesive carcinoma is poor.

Objective: To study the prognosis of poorly cohesive gastric carcinoma depending on the amount of the signet ring cells and depth of tumor invasion in comparison with other types of gastric cancer (GC) according to the classification of P. Lauren.

Material and methods: In 315 patients with GC after surgical treatment, pathological tissue samples were reviewed by using a semi-quantitative assessment of the proportion of diffuse and intestinal components of the tumor to clarify the type of GC according to the P. Lauren classification, as well as the proportion of signet ring cells.

Results: In pT1-T2 tumors, 5-year overall survival (5-OS) in patients with diffuse and intestinal types of gastric cancer has demonstated no differences. In cases of serous membrane invasion (pT4a-T4b), the 5-OS rates in patients with poorly cohesive gastric carcinoma worsens sharply compared to the intestinal type (28.6% versus 49.7%, p=0.006) and becomes comparable with 5-OS in mixed type of gastric cancer (15.2%, p=0.644). As the depth of invasion increases, the amount of signet-ring cells in poorly cohesive cancer decreases. The highest percentage of signet ring cells was found when the tumor was localized within the mucous and submucous layers (27.5% for pT1a, 43.0% for pT1b). For pT2, the proportion of signet ring cells was 12.0%, for pT3 - 11.2%, pT4 - 8.3%. This feature explains the high percentage of early cancer in patients with signet ring cell (SRC) GC. No significant differences in 5-OV was found with poorly cohesive carcinoma depending on the amount of signet ring cells (≥1%, ≥10%, ≥50%, ≥90%).

Conclusion: Invasion of the serous membrane of the stomach contributes to the rapid implementation of the tendency of poorly cohesive gastric carcinoma to peritoneal dissemination of the tumor. The proportion of signet ring cells in poorly cohesive gastric carcinoma does not affect to aggressive properties of the tumor.

Objective: This study explores the immunohistochemical and prognostic characteristics of gastric cancer (GC).

Material and methods: The research analyzed surgical samples from 310 GC patients who had not received chemotherapy or radiotherapy prior to surgery. Each sample was immunohistochemically stained for 23 markers (MSH2, MSH6, MLH1, PMS2, MUC2, CDX2, MUC5AC, CD10, E-cadherin, β-catenin, Claudin-1, Claudin-3, Claudin-4, CD44, p53, PD-L1 (SP142), PD-L1 (SP236), HER2, CD4, CD8, CD68, CD1a, LMP-1), and in situ hybridization for Epstein-Barr virus RNA (EBER) was also conducted.

Results: The analysis led to the development of a molecular classification of gastric cancer, comprising five molecular subtypes: MMR-deficient, EBER-positive, E-cadherin aberrant, CDX2-positive, and CDX2-negative. The CDX2-positive subtype occurs in 49.7% of GC cases; it includes papillary and mucinous GC with less depth of invasion, no lymph node involvement, and lower clinical stage and has a relatively favorable prognosis (median survival 47 months). The CDX2-negative subtype occurs in 16.1% of GC cases; it includes tumors of diffuse and intermediate type by P. Lauren, primarily located distally in the stomach, with a greater depth of invasion and a higher clinical stage. The CDX2-negative subtype is characterized by positive expression of MUC5AC and unfavorable prognosis (median survival 23 months).

Conclusion: A new five-tier molecular classification of gastric cancer has been developed. Two of the five subtypes have been identified and characterized for the first time. The identified subtypes have promising implications for the targeted therapy of gastric malignancies.

A case report of pulmonary sarcoidosis with fibrosis after COVID-19 is presented. Morphologic and immunohistochemical analysis of lung biopsies for Sars-Cov2 nucleocapsid and adhesion proteins was performed. Virus proteins were detected in alveolar macrophages, second-order pneumocytes and bronchiolar epithelium, also in granuloma-associated macrophages, multinucleated Pirogov-Langhans cells, indicating Sars-Cov2 persistence. Meanwhile, release of pro-inflammatory cytokines by granuloma cells and interstitial macrophages resulted in tissue damage and pulmonary fibrosis.

Placenta increta is a pathological condition characterized by an invasion of placental tissue into the myometrium. The placenta doesn't detach naturally after delivery and cannot be separated without pathological hemorrhage. Previous cesarean section represents the main risk factor for the occurrence of placenta accreta. Pregnancy-related tissue changes complicate the identification of co-existing diseases of the cervix and uterine body. This case report discusses the characteristics and diagnostic methods of placenta increta in combination with cervical high-grade intraepithelial neoplasia in a 35-year-old female patient.

Endometriosis continues to be a significant problem for women of childbearing age, with between 6 and 10 percent of women suffering from this condition. Despite its high prevalence, the diagnosis of endometriosis can be difficult due to its different localization and morphological characteristics. This article presents a case of endometriosis affecting the diaphragm and pleura, without a glandular component. The immunohistochemical examination was instrumental in confirming the diagnosis.

Breast cancer (BC) with triple-negative molecular profile is characterized by special and rather serious problems in terms of clinical management of patients compared to other types. On the one hand this is due to the fact that tumors with such a status often do not respond to routine targeted therapy and only a minimal number of drugs are currently available for their treatment. On the other hand, cases of triple-negative BC (TNBC) are often diagnosed against the background of an extensive metastatic process, in which confirmation of the metastases histogenesis to breast tissue is a difficult task due to the low sensitivity of such carcinomas to specific organ markers. It is known that about 40-50% of all TNBC cases are characterized by the achievement of complete pathomorphological regression of the primary tumor as a result of neoadjuvant chemotherapy courses, which determines a favorable prognosis of the disease. In other cases (also up to 50%), TNBC do not respond to chemotherapy and exhibit persistent drug resistance, such tumors are more aggressive, have the highest relapse rate and a high risk of metastasis. For this group of patients, the issue of finding predictive markers and new therapeutic methods remains unresolved. The presented literature review reflects the data of the analysis of publicly available results of scientific studies devoted to potentially promising molecular markers, including IDO1, DCLK1 and FOXC1, their significance in BC, including TNBC is described. Based on the analysis of literary data, it can be argued that IDO1, DCLK1 and FOXC1 are promising objects for further research in the context of TNBC. Each marker has unique characteristics that make them important both for disease prognosis and for the development of new therapeutic approaches.

Squamous cell carcinomas of the vulva are divided into human papillomavirus (HPV)-associated and HPV-independent. There is a need to determine the most effective methods for determining the HPV status of a tumor. Differences in the morphological structure of carcinomas have been shown, but the histological type of tumor does not fully reflect the differences in cell size for understanding the mechanisms of carcinogenesis.

Objective: To compare the morphometric and histological characteristics of HPV-associated and HPV-independent vulvar carcinomas and to calculate the specificity of histological, immunohistochemical methods and detection of viral DNA in establishing the HPV status of the tumor.

Material and methods: The study retrospectively included 74 patients. HPV typing was performed by real-time PCR, expression of p16 and p53 was determined by immunohistochemical method. The total area of tumor cells, the area of the cytoplasm and the nucleus were measured, and the nuclear-cytoplasmic ratio was calculated.

Results: HPV-independent carcinomas are predominantly keratinizing (94.3%). HPV-associated carcinomas are of basaloid histotype in 57.1% of cases and keratinizing in 42.9%. (42.9%). HPV-associated tumor cells are smaller (Me 223.89) compared to HPV-independent carcinoma cells (Me 525.95). The nuclear-cytoplasmic ratio was higher in HPV-associated carcinomas (Me 0.46 vs 0.18). The specificity of determining HPV status using histological characteristics of the tumor was 80.65%, immunohistochemical method - 96.36%, detection of viral DNA in the tumor - 75.47%.

Conclusion: A smaller cell area and a nuclear-cytoplasmic ratio shift toward the nucleus characterize HPV-associated carcinomas. With HPV-independent carcinogenesis, tumor cells more often retain the ability to differentiate and mature the epithelium. Immunohistochemical determination of p16 and p53 expression is a more accurate method for determining the HPV status of vulvar carcinoma.

Gastric cancer remains the fifth most common malignant neoplasm in the world and ranks fifth among the causes associated with cancer. The TNM system remains the gold standard for predictive stratification of patients with gastric cancer, but the search for new sensitive, specific and reproducible biomarkers to develop a personalized approach to the management of patients with gastric cancer does not lose its relevance. The phenomenon of tumor budding is a well-established independent prognostic factor in colorectal cancer. In 2017, the first guideline on the method of calculating tumor budding for colorectal cancer was published. Despite the promising potential of using tumor budding in gastric cancer this parameter is still not evaluated in everyday practice. This lection provides data on various methods of counting tumor budding in gastric carcinomas, describes the molecular mechanisms of interaction between tumor cells and the immune microenvironment, and summarizes the available data on the relationship of clinical and morphological characteristics of gastric cancer with the degree of tumor budding. The relationship between the degree of tumor budding and the prognostic characteristics of gastric cancer and the prospects for its use is also described.

Objective: To study the microenvironment features of MMR-proficient (pMMR) and MMR-deficient (dMMR) endometrial cancer.

Material and methods: The study included 34 patients with pMMR endometrial cancer and 10 patients with dMMR endometrial cancer. Using the method of multiplex TSA-associated (tyramide signal amplification) immunofluorescence, phenotyping of the tumor microenvironment was performed with an assessment of stromal and intratumor cell localization and PD-1 expression.

Results: In pMMR endometrial tumors, the predominant cell population was CD163+ macrophages, and in tumors with dMMR, CD163+ macrophages were found equally with CD8+ T lymphocytes and CD20+ B lymphocytes. In dMMR tumors, the number of CD8+ T lymphocytes and CD20+ B lymphocytes (as well as CD20+ B lymphocytes expressing PD-1) is higher compared to pMMR tumors, while the number of FoxP3+ T lymphocytes was significantly lower. The number of CD163+ macrophages did not differ depending on the MMR status, while the number of CD163+ macrophages was higher in the stroma compared to the number of these cells located intraepithelially. In patients with dMMR tumors, the number of CD8+ T lymphocytes was higher in the stroma, and did not differ in pMMR tumors.

Conclusion: In this study, it was found that dMMR endometrial tumors are characterized by an increase in the proportion of CD8+ T lymphocytes and CD20+ B lymphocytes, which may be associated with a better response to immunotherapy. The differences in spatial distribution of CD8+ T lymphocytes and CD163+ macrophages confirmed the importance of immune cell localization for prognosis and treatment efficacy. These results highlight the need for further study of the endometrial cancer microenvironment in order to personalize therapy.

Polyposis rhinosinusitis (CRSwNP) is a heterogeneous proliferative disease characterized by inflammatory hyperplasia of the nasal mucosa with dysregulation of apoptosis and cell differentiation. The review summarizes data on the molecular cellular mechanisms of CRSwNP and presents the concept of intercellular signaling during polyposis growth. Various factors that form a specific endotype are involved in the development of a polyp. Features of morphogenesis make it possible to distinguish edematous, eosinophilic and fibrous NP. In all cases, markers of neurogenic inflammation, impaired expression of proinflammatory cytokines, NO synthase, BMP-2 and other morphogenetic molecules arerecorded. The growing polyp and the inflammatory reaction damage the epithelium of the mucous membrane and bone wall of the nasal cavity. Interleukin-1β and BMP-2 are an integrative link in the pathogenesis of these events.