Ceskoslovenska patologie最新文献

A histopathological examination of the surgical specimen of the aorta usually follows a surgical reconstruction of the aortic aneurysm or dissection. Among the adults, the frequent cause of the aneurysm development is a severe atherosclerosis, while in children the aneurysm or dissection usually come as a complication of genetic syndromes. The common microscopical denominator of those diseases is a medial degeneration of variable degree. For a long time, a terminology of microscopical structural alterations used to be subjective and unsettled. In 2016, the first international guidelines for the histopathological assessment of the non-inflammatory degenerative diseases of the aorta were established. They introduced unified nomenclature, defined individual microscopic alterations and implemented a three-tier grading system. This work aims at practical aspects of the microscopical assessment and interpretation of the degenerative processes in the aorta with regards to the aforementioned consensus.

In a brief review is presented a summary of news in the classification of neuroendocrine neoplasms of the digestive system, as they were introduced in the 5th edition of the WHO Classification of Digestive System Tumors published in summer 2019.

Amoebic colitis represents a common parasitic infection in developing countries. In western world, it is encountered only sporadically. The clinical presentation is usually non-specific, non-invasive laboratory tests are often false negative and endoscopic and histopathological appearance may mimic other illnesses, especially Crohns disease. The disease therefore harbours a huge risk of misdiagnosing and a proper diagnosis is usually challenging. We present a case of an amoebic colitis with Crohn-like features and negative parasitological testing in a 53-years-old woman, in which the final diagnosis was established on the basis of its histopathological examination.

ANCA positive vasculitis (AAV) is a serious autoimmune disease mainly affecting small vessels in various organ systems, accompanied by the presence of ANCA antibodies in serum. AAV represents a group of the most common systemic vasculitis in adulthood, and based on clinical manifestations this disease entity includes 3 phenotypes, namely: granulomatosis with polyangiitis (formerly Wegeners granulomatosis), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome). Similar to other autoimmune diseases, AAV develops in patients with a predisposing genetic background who have been exposed to causative environmental factors, such as infections. The mechanisms by which ANCA antibodies cause vasculitis involves excessive neutrophil activation, that subsequently leads to release pro-inflammatory cytokines, reactive oxygen species and lytic enzymes. In addition, activated neutrophils induce the formation of neutrophil extracellular traps in a process called NETosis. The released neutrophil antigens are exposed to the immune system via antigen presenting cells, which further stimulates antibody production and creates a vicious circle with tissue destruction. Understanding the pathogenesis of AAV represents the key which provides not only optimal diagnosis and treatment, but also gives the pathologist a tool for deeper insight into the morphological features of disease progression, including the various stages of development and healing.

Echinococcus multilocularis causes an aggressive form of hydatidosis whose histomorphological picture is generally not well recognized. We report a case of 39-year-old women presenting with poorly circumscribed nodules in the right hepatic lobe. Owing to the clinical suspicion of focal nodular hyperplasia and hepatocellular adenoma, a core biopsy was performed. The histological findings of necrotic fibrous tissue infiltrated by narrow epithelial cords and small cysts containing cytokeratin positive material were in concordance with the diagnosis of cholangiocarcinoma. Subsequent examination of the surgically resected necrotic nodules with a vital tissue at the periphery corresponded to a reparative fibrosis accompanied by a striking ductular proliferation. Serological and molecular genetic work-up led to the diagnosis of Echinococcus multilocularis. The aim of this report is to point out the unusual histological features of the solid foci of alveolar hydatidosis, which consisted of necrotic fibrous tissue with ductular reaction. Such findings in a core biopsy may simulate regressively altered carcinoma.

There is no ideal marker or established immunohistochemistry panel to confirm urothelial differentiation. Immunohistochemistry must be always indicated in concrete differential diagnostic consideration. In this review article, immunohistochemistry will be discussed in the three different settings - distinction of benign and malignant changes of urothelium, the most frequent pitfalls and non-urothelial neoplasms of urinary tract.

The diagnosis of prostatic adenocarcinoma is based on a combination of histological features, none of which is absolutely sensitive and specific. Immunohistochemical examination is therefore sometimes necessary in difficult cases for confirmation of the diagnosis and distinction of mimickers. The second major indication of immunohistochemical staining in prostatic pathology is metastatic prostatic adenocarcinoma.

Adenoid cystic carcinoma (ACC) is one of the most common salivary gland malignancies. In rare cases, ACC undergoes high-grade transformation, which is associated with poor prognosis, in contrast to relatively long survival in the conventional ACC. Conventional ACC is characterized by typical histopathology showing glandular arrangement with sharply demarcated lumina, the tumor cells have sparse cytoplasm and angulated hyperchromatic nuclei. ACCs undergoing high-grade transformation lack these morphological features. In this paper we present a case of 46 years old female patient presenting with locally advanced tumor of the parotid gland and neck lymphadenopathy, coming for surgery. A suspect lymph node was sent to freeze section histology. Large non-cohesive cells with vesicular nuclei and prominent nucleoli along with well persevered lymph node architecture were seen in the frozen slide. This finding lead to suspicion of a lymphoma, the surgery finished in the extent of superficial parotidectomy and selective neck dissection of regions II-IV. Subsequent histopathological examination of formalin-fixed lymph node proofed epithelial nature of the atypical cells by p63 positivity. In the parotid gland resection specimen, an ACC with high-grade component was indentified. The high-grade ACC shared cell morphology with the lymph node metastasis. 17 from 20 lymph neck nodes contained metastases of high-grade ACC. Interestingly, there was strong CD117 expression in the high-grade ACC, whereas the conventional part was fully negative. To the best of our knowledge, the high-grade ACC of the parotid gland was reported only in 10 cases in the medical literature.

The new 2019 WHO classification of digestive system tumors reflects some important advancements in our understanding of etiopathogenesis and molecular background of selected neoplastic diseases of the gastrointestinal tract, offers more integrated review of non-epithelial neoplasms and updates the spectrum of genetic tumor syndromes of the digestive system. Recently recognized conditions, such as gastroblastoma and “gastric adenocarcinoma and proximal poly-posis of the stomach” are described, including molecular alterations associated with these entities. On the other hand, the new interpretation of some topics, mainly grading of serrated lesions or ICD-O coding of adenomas and dysplasia, is rather controversial. Last but not least, the definition of pTis in the large intestine according to WHO conflicts its definition according to AJCC/UICC TNM classification, 8th edition, issued in 2017.

By term „vasculitis“ inflammatory disease of blood vessels is designated that leads to vessel wall destruction followed by proliferation and occlusion of their lumina. Basic condition for this diagnosis is that vessel wall is a primary site of the pathological process. Clinical syndromes are a consequence of this process resulting into ischaemia of tissues supplied by the affected vessels and with constitutional symptoms associated to the inflammatory disease. Vasculitis can occur de novo as a primary involvement of vessel wall of unknown aetiology or it develops secondary to other diseases. The diagnosis of vasculitis is usually based on pathological findings from biopsy or abnormalities detected by imaging methods. This review describes the common primary vasculitides, their diagnostics and management.