Current diagnostic pathology最新文献

Malignant neoplasms of the sinonasal tract encompass a wide variety of epithelial, lymphoid and mesenchymal tumours. The separation and classification of epithelial or neuroepithelial tumours is sometimes challenging, especially when treatment and prognosis are different. Squamous cell carcinoma, keratinizing or non-keratinizing and, usually, the poorly differentiated type need to be separated from sinonasal undifferentiated carcinoma, lymphoepithelial carcinoma, neuroendocrine carcinoma and olfactory neuroblastoma. Whereas melanoma and lymphoma are also included in the broad differential, along with primitive neuroectodermal tumours and rhabdomyosarcomas, the focus of this commentary will be to present the major clinical, radiographical, histological, immunohistochemical, ultrastructural and molecular features which allow for separation of the principle mucosal epithelial neoplasms of the sinonasal tract.

Fibro-osseous lesions are a poorly defined group of lesions affecting the jaws and craniofacial bones. All are characterized by the replacement of bone by cellular fibrous tissue containing foci of mineralization that vary in amount and appearance. Classification and, therefore, diagnosis of these lesions is difficult because there is significant overlap of clinical and histological features. The group includes developmental and reactive or dysplastic lesions as well as neoplasms. Recently a new terminology has emerged that has culminated in the latest WHO classification. The core of this classification is the concept of a spectrum of clinicopathological entities in which the diagnosis can only be made on the basis of a full consideration of clinical, histological and radiological features. This review will describe the salient features of these lesions in an attempt to provide practical guidance for the surgical pathologist.

The histopathology of the salivary glands is a complex and difficult area of diagnostic pathology. In the latest WHO classification there are 40 named neoplasms many of which have variable histological features that can challenge even the most experienced specialist pathologist. In addition, the salivary glands can be affected by a range of non-neoplastic conditions, some of which have only recently been described. These often present clinically like tumours and may have pathological features similar to some of the neoplasms, making diagnosis difficult and errors serious. The purpose of this paper is briefly to review non-neoplastic lesions of the salivary glands and to aid the diagnostic pathologist by describing the key histopathological features of each. The entities covered include: sclerosing polycystic adenosis, cheilitis glandularis, salivary gland hyperplasias, necrotizing sialometaplasia, subacute necrotizing sialadenitis, non-neoplastic oncocytic lesions, salivary gland cysts, lymphoepithelial cysts, polycystic (dysgenetic) disease and HIV associated cystic disease.

This review surveys current practice in lymph node assessment in cancer management. The discussion covers the background to currently prescribed protocols, the dissection and handling of lymph nodes, diagnostic specimens (in particular sentinel node biopsies) and therapeutic dissections. Controversies in current practice are addressed and practice guidance given. The review is intended to cover very practical aspects of these assessments and it is intended that the readership of this article be as wide as possible, reflecting the diversity of the workforce in pathology laboratories and particularly the introduction of biomedical scientists (BMSs) to specimen description and dissection and the increasing integration of BMSs into the diagnostic team.

The oral mucosa is affected by a number of reactive, infective, inflammatory and immune-mediated disorders and distinguishing between them can be challenging. This review will concentrate on two histological patterns: the lichenoid tissue reaction and pseudoepitheliomatous hyperplasia. For each pattern the histological features are described, the differential diagnosis is discussed and the essential diagnostic features are given. Discussion on the lichenoid tissue reaction covers the entities of lichen planus, lichenoid reactions to drugs and dental materials, discoid lupus erythematosus, graft versus host disease and erythema multiforme, while that on pseudoepitheliomatous hyperplasia covers granular cell tumour, chronic hyperplastic candidosis, median rhomboid glossitis, necrotizing sialometaplasia and papillary hyperplasia of the palate.

Many oral cancers are preceded by potentially malignant lesions, which may appear as white or red patches on the oral mucosa. In the absence of validated molecular markers, the histological grading of oral epithelial dysplasia remains the only determinant of potential malignant change. Grading is notoriously unreliable, with wide intra- and inter-observer variability. However, conformity may be achieved between pathologists using similar standards and some objective criteria can be used for diagnosing and grading dysplasia. Oral dysplasia is graded simply as mild, moderate or severe, by an evaluation of a combination of cytological and architectural changes in the oral epithelium. Mild epithelial dysplasia, shows relatively few cytological aberrations involving only the lower third of the epithelium, while at the other end of the scale, severe dysplasia may show significant cytological atypia extending into the involved upper third of the epithelium. At its worst, dysplasia involves the full thickness of the epithelium and may be designated carcinoma in situ. This review describes the clinical and histopathological features of oral epithelial dysplasia and guides the pathologist on diagnosis and key prognostic factors.

The temporomandibular joint (TMJ) is susceptible to all of the conditions that affect other joints in the body. This article provides an overview of the main conditions that particularly affect the TMJ and provides a basic classification. Emphasis is placed on the arthropathies and, in particular, osteoarthrosis.

Molecular genetic and cytogenetic analysis has revealed that many soft tissue tumours, both benign and malignant, carry simple, reproducible karyotypic aberrations that are tumour-specific. Many of these mutations are chromosomal translocations and the resulting fusion gene products have been cloned. Classification, diagnosis and prognostication of soft tissue tumours has already been influenced by these genetic findings. Furthermore, examination of fusion gene products has helped increase our understanding of the molecular pathogenesis of soft tissue tumours and will hopefully aid in the development of new therapeutic agents. However, in current ‘routine’ practice, it remains to be defined when molecular genetic and cytogenetic techniques should be used, which technique should be used and how testing should be performed. Herein we briefly review the impact that cytogenetic and molecular genetic analysis has had on soft tissue tumour pathology and discuss both the benefits and limitations of these techniques in the current practice of diagnostic pathology.

Many tumours show a component of stromal myxoid material. While the presence of a prominent myxoid component prompts consideration of a ‘myxoid tumour’ such a designation does not necessarily progress the diagnostic process since myxoid tumours have a broad potential histogenesis and vary in clinical significance from benign to malignant.

The presence of a prominent myxoid stroma may obscure characteristic architectural and cytological features and may decrease their density in the material available for assessment.

In the light of recent work characterizing many of these entities, this review seeks to provide descriptions of many of the soft tissue myxoid tumours encountered in general surgical pathology and to provide (in the form of algorithms) a suggested approach to the histopathological assessment of them.