Anatomic Pathology Laboratory Research Articles

The Russian Journal of Oncology and Russian Science Citation Index

The Russian Journal of Oncology is indexed in many databases, including the Russian Science Citation Index (RSCI). The journal is included in the List of peer-reviewed scientific publications for publishing the main scientific results of Ph.D. theses recommended by the Higher Attestation Commission (hereinafter referred to as the HAC List), which is characterized by structuring by scientific branches, scientific fields, and scientific specialties. Since 2021, the journal citation in the RSCI database has been equated in its value to indexing in the Web of Science Core Collection and/or Scopus, which is a criterion for the quality of a publication and a guideline in choosing a scientific journal by the authors for publishing the results of thesis research. Thus, when preparing a thesis paper, the list of publications can include those works of the applicant that are published in scientific journals presented in the HAC List in the relevant specialty, or in scientific journals indexed in RSCI, Web of Science and/or Scopus, regardless of the scientific specialty and relevant fields of science these journals are included in the HAC List, and whether they are included at all.
 Taking into account the changes that have taken place, the editors and the publisher continue to publish articles on molecular biology (1.5.3), genetics (1.5.7), oncology, radiation therapy (3.1.6), radiation diagnostics (3.1.25), surgery (3.1.9), neurosurgery (3.1.10), pediatric surgery (3.1.11), cardiovascular surgery (3.1.15), plastic surgery (3.1.16), maxillofacial surgery (3.1.2), pathological anatomy (3.3.2), and clinical laboratory diagnostics (3.3.8) in the Russian Journal of Oncology.

Deciduosis of the appendix: a case report

Introduction: Ectopic deciduosis refers to decidual tissue outside the uterus. Ectopic decidua appears on the surface of the female reproductive organs and peritoneum; however, rare cases can be found in the appendix, lymph nodes, lungs, kidneys, and skin. Deciduosis is a benign condition that usually does not cause any symptoms and resolves spontaneously 4-6 weeks after delivery. However, an ectopic decidua involving the appendix wall often causes appendicitis and presents with acute abdominal signs. Methodology: The descriptive study of the case report type and the data obtained from the patient's medical record. Case presentation: This paper reports a woman aged 29 years with complaints of abdominal pain, like being stabbed in the pit of the stomach and then to the lower right abdomen for two days. A physical examination revealed tenderness in the lower abdomen with a positive McBurney sign. At that time, the patient was pregnant with a gestational age of 20-21 weeks. The patient underwent an appendectomy with the tissue sent to the anatomic pathology laboratory with the presence of decidual cells in the subserous layer and serous fat, and it was concluded as deciduosis of the appendix. Conclusion: Based on clinical and laboratory findings, the patient was diagnosed with deciduosis of the appendix.

The Pandemic as a Catalyst for Digital Pathology Adoption as an LDT

Abstract Whole-slide images (WSI) are the basis for the application of artificial intelligence/machine learning and other informatics methods to histological diagnosis and will further blur the line separating anatomic and clinical pathology. FDA classified WSI systems for primary diagnosis as class III (highest risk) medical devices until 2017. This discouraged anatomic pathology laboratories at risk-averse domestic institutions like mine from investing in these digital pathology (DP) platforms. In 2017, FDA downgraded WSI to class II (moderate risk) when they de-novo approved a system marketed by Philips. We were not interested in that system at my institution, but the downgrade caused us to reset our perception of the risk of validating a RUO system for primary diagnosis. Cost remained a barrier. In April 2020, FDA issued temporary guidance stating they would not enforce premarket approval of WSI systems to facilitate pathologists working remotely during the SARS-CoV-2 pandemic. The guidance included a statement that “laboratories and hospitals consider performing a validation study.” In January 2021, FDA proposed making the temporary non-enforcement guidance permanent. So, in a little more than three years, WSI for primary diagnosis had gone from class III to exempted from pre-market approval! This nicely aligned the approval framework for WSI with the approval framework for our conventional optical microscopes, which are statutorily exempted from approval, and further reset our perception of risk. In April 2021, FDA withdrew the proposal to make non-enforcement permanent, but the temporary non-enforcement guidance is still in effect at the time of writing. Amid all this FDA activity, the College of American Pathologists updated and reissued their consensus guidelines for validating WSI systems for diagnostic purposes in March 2021. The narrative mentions the FDA’s recent approval of a few WSI systems and anticipates more, but the expert panel recommendations do not include any related to the approval status of systems. The reissue of this document reminded us that, as clinical laboratorians, we are capable of safely validating WSI as a laboratory-developed test and are supported in doing so by consensus guidelines from one of our leading professional organizations. In early 2021 we committed to funding a DP initiative to make WSI part of our routine histological process for 10% of our anatomic pathology cases. The initial capital investment is $1.5M. When realized, the microscope slides for designated pathology services will be transported directly from the cover slipper to a slide scanner and electronically distributed to pathologists using a clinical-grade image management system that we share with our radiology department. We made the decision to fund this in the context of the regulatory (decreased perception of risk), sociological (demand for remote telepathology), and technological (availability of scalable WSI systems) changes that occurred during the pandemic.

Gambaran Klinikopatologik Lupus Nefritis di RSUP Sanglah Denpasar tahun 2016-2020


 
 ABSTRACT
 
 Systemic lupus erythematosus (SLE) is one of the most common autoimmune diseases in the community. One of common clinical manifestations of SLE is Lupus Nephritis (LN). The World Health Organization (WHO) notes that there are five million people with lupus in the world and there are 100,000 more new sufferers every year. In Indonesia in 2016 it was reported that 2,166 patients were hospitalized with a diagnosis of SLE and 550 of them died. This study aims to determine the characteristics of LN patients at Sanglah Hospital Denpasar in 2016-2020 based on age, gender, histopathological class (categorized according to ISN/RPS), and proteinuria level and to determine the relationship between proteinuria level and histopathological class and the relationship between age and histopathological class. This research was conducted at the Anatomical Pathology (PA) laboratory of Sanglah Hospital Denpasar in 2021 with a cross-sectional method, using secondary data that available at the PA laboratory of Sanglah Hospital Denpasar, then processed using SPSS ver. 26. The results showed that the total number of LN patients at Sanglah Hospital Denpasar in 2016-2020 was 28 cases. Most cases were found at age range of 26-35 years (11 cases or 39.3%) and most were female (23 cases or 82.1%). The most common proteinuria level found was +3 (8 cases or 28.6%) and the most common histopathological class was class IV (13 cases or 46.4%). Chi square test showed no significant relationship between proteinuria level and LN histopathological class (p=0.069) nor between age and LN histopathological class (p=0.202). It was concluded that LN patients at Sanglah Hospital in 2016-2020 were mostly women, aged 26-35 years, with a proteinuria level of +3 and included class IV LN. Since there is no correlation between age or proteinuria level with histopathological class, it is recommended that histopathological biopsy be performed in all cases of suspected LN so that patients receive adequate therapy based on the level of kidney damage.
 Keywords : Lupus nephritis, age, gender, proteinuria level, histopathological class according to ISN/RPS

Histopathological Features of the Lung Parenchyma in a 64-Year-Old Male Patient with Post-COVID-19 Infection with Spontaneous Pneumothorax Dextra Due to AlveolarPleural Fistula (APF): A Case Report

Introduction: Histopathological features of the lung parenchyma due to the Alveolar-Pleural Fistula (APF) in a patient with post-COVID-19 infection have not been reported. APF usually occurs after a spontaneous pneumothorax. Spontaneous pneumothorax is an abnormal traumatic accumulation of air within the pleural space. It is classified as primary or secondary pneumothorax based on multiple risk factors.Case Presentation: A sixty-four-year-old patient was referred from one of the remote hospitals in the west of Bali due to spontaneous simple pneumothorax dextra. A week after being diagnosed with COVID-19 infection, the patient underwent a bullectomy procedure and was clinically diagnosed with recurrent spontaneous pneumothorax dextra due to APF. Then, the bullectomy specimen was sent to the anatomical pathology laboratory. Histopathology test revealed extensive areas of necrosis and fibrosis with scattered lymphocytes and emphysematous alveoli found in APF lesions. Conclusions: In conclusion, the evidence of extended fibrosis, which destroys the pulmonary parenchymal septum and dilated alveoli with diffuse fibrosis in the subpleural and intraparenchymal areas, may cause impairment of both perfusion and ventilation. Unfortunately, viral cytopathic like-changes related to COVID-19, such as multinucleated cells with large nuclei, amphophilic cytoplasm, and prominent nucleoli in alveolar spaces with intranuclear inclusions, were not found in this case. In this case, surgery is needed in case of fistula, either related or unrelated to infection of the pleural cavity indicating the patient’s functional recovery.

The Correlation of E-cadherin Expression with Tumor Gradeand Tumor Budding in Endometrioid Endometrial Carcinoma

BackgroundEndometrial carcinoma is the fourth most common malignancy among women worldwide with increasing incidence and death rate every year. One of the types of endometrial carcinoma is endometrioid carcinoma, originated from atypical hyperplasia and develop into carcinoma. Lack of intercellular cohesiveness in the epithelial tumors such as endometrioid carcinoma occur due to lack of expression of E-cadherin. It can also causetumor invasion and metastatic through the epithelial-mesenchymal transition (EMT) process. Tumor differentiation and tumor budding are presumed to be histopathologic representations due to lack of cohesiveness and the occurrence of the EMT process so that these two things need to be related with the expression of E-cadherin on tumor cells.MethodsAn observational study was conducted using a cross-sectional approach with 46 cases of endometrioid endometrial carcinoma.Samples were obtained from 4 Anatomical Pathology Laboratories in West Sumatra during 2016-2019 in the form of paraffin blocks and HE slides that obtained from hysterectomy surgery. Reevaluation of tumor grade and tumor budding in HE slides was performed. E-cadherin expression in tumor cells was seen by immunohistochemical staining. Bivariate statistical analysis was performed using Fisher's Exact test and the results were considered significant if the p value was <0.05.ResultsSpecimens with negative E-cadherin expression were more common in grade 2 tumors (41.7%) and grade 3 tumors (50.0%) and in specimes with positive tumor budding (91.7%). Statistical analysis revealed a significant correlation between E-cadherin expression with tumor grade (p=0.000) and tumor budding (p=0.000).ConclusionExpression of E-cadherin has a significant correlation with the tumor grade and tumor budding in endometrioid endometrial carcinoma.

Clinicopathological Features of Neoadjuvant Chemotherapy Response to Triple Negative Breast Cancer in Dr. Hasan Sadikin General Hospital

BackgroundTriple Negative Breast Cancer (TNBC) accounts for 9-17% of all breast cancer diagnoses. TNBC has a high proliferation index and a poor prognosis with a higher response rate to neoadjuvant chemotherapy, but does not correlate with Overall Survival (OS) due to chemoresistence in more than 50% of TNBC. Neoadjuvant chemotherapy with anthracycline (doxorubicin) based regimens in combination with fluorouracil and cyclophosphamide (FAC) is still an option for TNBC. The aim of this study was to determine association between clinicopathological profile and response to neoajuvan chemotherapy in TNBC at Dr. Hasan Sadikin Bandung which is a referral hospital in West Java.MethodsThis study used an analytic observational method with a cross-sectional design. The research sample consisted of 40 TNBC cases from January 2017 to December 2019 at Dr. Hasan Sadikin hospital. Data obtained from medical records and archives of the Anatomical Pathology Laboratory consist of clinical response to neoadjuvant chemotherapy, age, tumor size, lymph node metastases and distant metastases, clinical stage, type of histopathology and lymphovascular vessel invasion.ResultsIn 40 cases of TNBC, 20 cases responded and 20 cases did not respond to neoadjuvant chemotherapy. In the non-response group, there were 90% of cases with histopathologic type invasive carcinoma of no special type and 75% showed invasion of lymphovascular vessels. There were no significant differences in age, tumor size, lymphovascular vessel invasion, stage, or histopathological type in the response and non-response groups.ConclusionThere is no correlation between clinicopathological features and neoadjuvant chemotherapy response in the case of Triple Negative Breast Cancer (TNBC). This can be caused by other factors including high heterogeneous tumor microenvironment (TME).

Role of NF-κB p65 and hsp70 in colorectal adenocarcinomA

Free radicals and inflammation in tumor microenvironment are important aspects of tumor biological activity. They activated NF-κB p65 transcription factor pathway. HSP70 is chaperone protein that regulated host of imune response to cancer cells. NF-κB p65 and HSP70 expression is associated with poor prognosis and new targeted therapy in colorectal adenocarcinoma. This study aims to analyze correlation between NF-κB p65 expression in macrophages and HSP70 in tumor cells with various T stages of colorectal adenocarcinoma. This cross-sectional study was performed on 48 paraffin blocks from colorectal adenocarcinoma at the Anatomical Pathology Laboratory of Dr. Soetomo General Academic Hospital Surabaya from January 2015 to December 2019. The samples were divided into four groups based on T stages of colorectal adenocarcinoma. Immunohistochemical staining was performed to detect NF-κB p65 expression in nucleus or cytoplasm of macrophages and HSP70 in cytoplasm of tumor cells. There was no significant difference of NF-κB p65 expression percentage in macrophages at four groups (p=0.31). There was significant differences of HSP70 expression percentage in tumor cells at four groups (p=0.014). There was no correlation between NF-κB p65 expression in macrophages and HSP70 expression in tumor cells with various T stages of colorectal adenocarcinoma (rs=0.05, p=0.97).

AN UNUSUAL INTRAORAL LIPOMA: A CASE REPORT

Intraoral lipoma is a relatively rare painless benign tumor derived from mesenchymal connective tissue. A 58-year-old White male patient in good health was examined for a slow growing painless nodule on the palate which had been present for 6 years. There were no changes in the extraoral clinical examination. The intraoral examination revealed a sessile nodule of soft consistency on the right side of the hard palate covered by an intact mucosa and measuring approximately 2 × 2 cm. Radiographic examination showed no signs of bone changes. The clinical differential diagnosis included benign salivary gland tumor and mesenchymal tumor. Excisional biopsy was performed under local anesthesia, and the surgical specimen was sent to an anatomic pathology laboratory. Microscopic examination showed collections of mature adipocytes and scarce fibrous connective tissue stroma. The diagnosis of lipoma was established. After 5 months of follow-up, satisfactory wound healing and no recurrences were detected.

Current Developments of Artificial Intelligence in Digital Pathology and Its Future Clinical Applications in Gastrointestinal Cancers.

Simple SummaryThe rapid development of technology has enabled numerous applications of artificial intelligence (AI), especially in medical science. Histopathological assessment of tissues remains the gold standard for diagnosis of gastrointestinal (GI) cancers for subsequent management. In a traditional anatomical pathology (AP) laboratory, histopathologists are required to manually assess, quantify and classify diseases under a microscope in a semiquantitative or qualitative manner. The conversion of analogue-to-digital pathology is on the rise, conforming with trends toward digitalization. The rapid adoption of digital pathology (DP) is driven by factors such as the worldwide shortage of pathologists and medical technologists, the increasing incidence of cancer and the critical need to improve laboratory efficiency. In this review, we aim to provide a comprehensive summary of algorithms for AI detection and classification of GI cancer. We will also provide critical insight into the application of algorithms for routine care in clinical practice.The implementation of DP will revolutionize current practice by providing pathologists with additional tools and algorithms to improve workflow. Furthermore, DP will open up opportunities for development of AI-based tools for more precise and reproducible diagnosis through computational pathology. One of the key features of AI is its capability to generate perceptions and recognize patterns beyond the human senses. Thus, the incorporation of AI into DP can reveal additional morphological features and information. At the current rate of AI development and adoption of DP, the interest in computational pathology is expected to rise in tandem. There have already been promising developments related to AI-based solutions in prostate cancer detection; however, in the GI tract, development of more sophisticated algorithms is required to facilitate histological assessment of GI specimens for early and accurate diagnosis. In this review, we aim to provide an overview of the current histological practices in AP laboratories with respect to challenges faced in image preprocessing, present the existing AI-based algorithms, discuss their limitations and present clinical insight with respect to the application of AI in early detection and diagnosis of GI cancer.

Quality and performance indicators in Portuguese anatomical pathology laboratories: a panel validation by qualitative Delphi technique

BackgroundIn laboratory medicine, quality and performance indicators (QPIs) are essential tools to ensure the quality of healthcare services and patient safety. QPIs allow comparison of outcomes, favouring accountability and transparency....

Correlation of the expression of PD-L1 and Cyclin and Histopathological Grading in Colorectal Adenocarcinoma

One of the prognosis factors of colorectal adenocarcinoma is histopathological grading. The expression of programmed death-ligand (PD-L1) and cyclin D1 has the potential to become one of the predictive and prognostic factors for tumor cells in colorectal cancer. This study aimed to identify the relationship between the expression of PD-L1 and cyclin D1 and histopathological grading in colorectal adenocarcinoma. It is an analytic observational study with a cross-sectional approach using a sample of 34 paraffin blocks of colorectal adenocarcinoma preparations at the Anatomical Pathology Laboratory, RSUD Dr. Soetomo Surabaya for the period January 2016 to December 2020. The parameter of the assessment was the percentage of PD-L1 and cyclin D1 antibodies that were positively stained on the membrane and nucleus of tumor cells which was subjected to histopathological grading assessment based on hematoxylin-eosin (HE) staining. The data were analyzed using Spearman’s correlation. PD-L1 expression was positively correlated with histopathological grading in colorectal adenocarcinoma (p=0.006). Cyclin D1 expression did not correlate with histopathological grading in colorectal adenocarcinoma (p=0.891). Statistical analysis showed no significant correlation between PD-L1 and cyclin D1 expressions (r = 0.188; p = 0.286).

Histopathology and Immunohistochemical profile of mediastinal lymphoma in Dr. Soetomo General Hospital

Mediastinal lymphoma is a rare tumor. Approximately 10% of primary mediastinal lymphoma occur in mediastinum. In this study we look for sex and age characteristics, histopathology and immunohistochemical profile of mediastinal lymphoma. Data were collected from the Anatomical Pathology laboratory Dr. Soetomo archives from January 2016 to August 2018. Seventeen cases of mediastinal lymphoma were found predominantly in males (76.47 %). The age range was between 17 and 64 years old. Distribution of tumor type was as follows: Non-Hodgkin’s Lymphoma, B-cell type high grade (Ki67 > 30%) 17.65 % and Non-Hodgkin’s Lymphoma, B-cell type low grade (Ki67 <30%) 11.76%, Non-Hodgkin’s Lymphoma, T-cell type high grade 11.76%, Non-Hodgkin’s Lymphoma unknown subtype 35.29%, Classical Hodgkin’s Lymphoma (CHL) 17.65%, T-cell Lymphoblastic Lymphoma (T-LBL) 5.88%. Histologically, Non-Hodgkin’s Lymphoma showed a diffuse pattern consisting of anaplastic lymphoid cells, pleomorphic nuclei, coarse chromatin, thin cytoplasm between fibrotic stroma and the immunohistochemistry profile showed positive for CD20 in NHL B-cell type. CD3 were positive in Peripheral T-cell Lymphoma and T-Lymphoblastic Lymphoma (T-LBL). Classical Hodgkin’s Lymphoma showed large cells (reed-stenberg cells) and Hodgkin’s cells dispersed between an inflammatory background, CD30 were positive in CHL cases. Tdt was positive in T-LBL cases.

Correlation of molecular alterations with pathological features in hepatocellular carcinoma: Literature review and experience of an Italian center

Hepatocellular carcinoma (HCC) represents the primary carcinoma of the liver and the fourth leading cause of cancer-related deaths. The World Health Organization estimates an increase in cases in the coming years. The risk factors of HCC are multiple, and the incidence in different countries is closely related to the different risk factors to which the population is exposed. The molecular mechanisms that drive HCC tumorigenesis are extremely complex, but understanding this multistep process is essential for the identification of diagnostic, prognostic, and therapeutic markers. The development of multigenic next-generation sequencing panels through the parallel analysis of multiple markers can provide a landscape of the genomic status of the tumor. Considering the literature and our preliminary data based on 36 HCCs, the most frequently altered genes in HCCs are TERT, CTNNB1, and TP53. Over the years, many groups have attempted to classify HCCs on a molecular basis, but a univocal classification has never been achieved. Nevertheless, statistically significant correlations have been found in HCCs between the molecular signature and morphologic features, and this leads us to think that it would be desirable to integrate the approach between anatomic pathology and molecular laboratories.

RELATIONSHIP OF DIRTY NECROSIS WITH HISTOPATHOLOGICAL GRADING IN COLORECTAL ADENOCARCINOMA

Background: Dirty necrosis (Intraacinar necrosis/garland necrosis) is defined as the presence of cell remnants in the lumen of the gland. Dirty necrosis consisting of an eosinophilic mass, which is a mass originating from the cytoplasm of dead cells mixed with the remnants of the cell nucleus. The remnants of the cell nucleus are blue and the eosinophilic mass is pink in the background. Dirty necrosis results from the breakdown of carcinoma cells, which usually accumulate in the lumen of intact tubular glands, and may be associated with spontaneous events involving insufficient tumor vascular supply. Assessment of the presence of a dirty necrosis is considered a characteristic of colorectal carcinoma. Objective: This study was conducted to analyze the relationship between dirty necrosis and histopathological grading of colorectal adenocarcinoma. Methods: The study used 55 paraffin block samples of colorectal adenocarcinoma cases that had been diagnosed at the Anatomical Pathology Laboratory, H. Adam Malik Hospital, Medan and at the Anatomical Pathology Laboratory, Faculty of Medicine, Universitas Sumatera Utara, since 2019-2020. Dirty necrosis was assessed using H&E staining with 400x magnification assessed over the entire lumen of the gland, if <10% was considered absent and if >10% was considered present. Results: The results showed that there were 47 samples (85.4%) of dirty necrosis, while 8 samples (14.6%) did not. For the most histopathological grading, 42 samples (73.4%) were low grade, while the high grade was 13 samples (23.6%). Statistical tests between dirty necrosis and colorectal adenocarcinoma histopathological grading showed no significant relationship with p value = 0.376 (p >0.05). Conclusion: There was no statistically significant relationship between dirty necrosis and histopathological grading in colorectal adenocarcinoma.

The Value and Challenges of Internal Error Tracking in Anatomic Pathology Quality Management

Abstract A case of a sudden increase in reports of a specific error in the anatomic pathology laboratory is evaluated, yielding insights into the value, challenges, and limitations of using error reports as a quality management tool. The discussion considers the utility of a robust error-reporting system for anatomic pathology laboratories and identifies key factors at each step to improve success. Initial reporting must be easy and rewarding to reporters, and they must have confidence that reporting will not result in adverse impacts on coworkers. Categorization of common errors simplifies reporting, investigation, tracking, and data presentation. Response to errors should focus on addressing system design failures, while also providing nonjudgmental, nonpunitive feedback to individuals. Error categories can be chosen for systematic quality improvement projects based on severity and frequency of the error. When monitoring trends in error data, it is important to remember that the data are very sensitive to changes in reporting rates as well as changes in error rates, so they must be interpreted with great caution.

Surviving a Cyberattack in Anatomic Pathology: Disaster Response and Creation of an Incident Command System

Abstract Laboratories are increasingly reliant on networked electronic health information systems and therefore especially vulnerable to prolonged downtimes for a variety of reasons, which can be planned or unanticipated events. Our hospital was the victim of a cyberattack causing a complete shutdown of all computer systems, a downtime that lasted 25 days. The effects were devastating for patients, hospital employees, financials, public opinion, and hospital operations. After a week of downtime in the anatomic pathology laboratory, it became evident that our laboratory needed to rethink our organizational structure in order to regain operational status. It was then that we developed an Incident Command System, which allowed for 2-way communication and provided the adaptability and support needed to respond to the rapid process changes needed during the crisis.

Efek Pemberian Seduhan Teh Hitam (Camellia sinensis L) Dan Cokelat (Theobroma cacao L) Terhadap Gambaran Histopatologis Hepar Rattus norvegicus

Black tea and chocolate are plants that contain caffeine. Chocolate is a commodity that generates foreign exchange for the country and is the main ingedient for making chocolate which also contains caffeine. Caffeine damages the liver by inhibiting the gowth of connective tissue in liver cells. The purpose of this study was to determine the histopathological effect on the liver organs of white rats given black and chocolate tea steeping and the damage that occurs when given in a predetermined dose and time. The research was conducted experimentally at the Anatomical Pathology Laboratory of the Sekolah Tinggi Ilmu Kesehatan Nasional. The study was divided into 7 treatment groups. Liver organs were observed macroscopically and microscopically from the results of histopathological preparations with Hematoxylin Eosin staining. The results of macroscopic observations there were no differences in the control and treatment goups. The results of microscopic observations in the black tea steeping goup 3 and 6 mg/200 g/day, and chocolate steeping 3, 6, and 12 mg/200 g/day there was degeneration, black tea steeped 12 mg/200 g/day there was necrosis. The results of the Mann Whitney test showed a significant difference in the black tea steeping goup at the three doses and 12 mg/200 g/day chocolate steeping, while 3 and 6 mg/200 g/day chocolate steeping did not show a significant difference. Based on the research, it can be seen

The Relationship of SRY Determining Region Y Box 2 (SOX2) Immunohistochemical Expression with Stromal and Intratumoral TILs (Tumor Infiltrating Lymphocytes) in Patients with Ovarian Serous Tumors

Background: Ovarian serous tumors are the most common epithelial tumors in premenopausal and postmenopausal, 60% of the most common cases are ovarian cystadenoma, 25% of low grade and highgrade serous carcinoma. Tumor infiltrating lymphocytes (TILs) is used to predict the prognosis some solid tumors. SRY (sex determining region Y)-box 2 (SOX2) is a transcription factor. High SOX2 in ovarian tumors associated with reduced disease-free survival. Research Objective: To determine the relationship between SOX2 expression and TILs in patients with a diagnosis of ovarian serous tumor at the Anatomic Pathology Laboratory, USU Medical Faculty and RSUP. H. Adam Malik Medan. Materials and Methods: 39 samples histopathological slides with a diagnosis of ovarian serous tumor, slide review was performed and TILs assessed and then SOX2 immunohistochemical staining and then analyzed for correlation between variables using Eta test (p<0.001) and Somer'sd test (p=0.120). Results: The highest expression of SOX2 high was in the highgrade serous carcinoma subtype in 9 (23.1%) cases. Most cases were also found in low SOX2 expression with low iTILs in 20 (51.3%) cases and low SOX2 expression with low sTILs in 16 (41.0%) cases. There was a significant relationship between subtypes and SOX2 expression (p < 0.001) and the Somers'd correlation showed no significant relationship between SOX2 and TILs (p = 0.120). Conclusion: In this study, there was a correlation between tumor subtypes and SOX2 expression and there was no correlation between SOX2 expression and TILs in ovarian serous tumors.

Using American Type Culture Collection Cell Lines to Evaluate Interlaboratory Variables for Estrogen Receptor and Human Epidermal Growth Factor Receptor 2 Immunostaining.

Most laboratories currently use patient tissues for validating immunohistochemical stains. To explore advantages of using cell lines with known antigenicity as a validation method. Five American Type Culture Collection (ATCC) cell lines with known negative, low positive, and moderate to strong estrogen receptor (ER) expression as well as negative, equivocal, and positive human epidermal growth factor receptor 2 (HER2) expression were cultured and made into cell blocks. One block from each cell line was fixed in formalin and another in ethanol before cell block preparation. Two sets of paired unstained slides from each block were sent to 10 different laboratories for HER2 and ER staining to be stained on runs from different days according to each laboratory's defined protocol. The 10 study participants evaluated 40 slides in a blinded fashion. For ER expression, all 80 interpretations for the ER strong and moderate positive cell lines had the target ER-positive result, and 74 of 80 ER-negative cell lines (92.5%) had agreement with the intended negative result. The ER low positive cell line showed varied but positive expression among all observers. The HER2 (3+)-positive cell lines yielded a target interpretation of 3+ in 65 of 80 interpretations (81.2%). For the HER2-negative cell line 69 of 78 interpretations (88.5%) were consistent with the target response (0 or 1+). No significant variation was observed between the ethanol- and non-ethanol-exposed cell lines, or between runs by the same laboratory. Variation from target results clustered within laboratories. This study indicates that variability between laboratories can be identified by using cell lines for quantitative or semiquantitative immunohistochemistry when using cultured cell lines of known antigenicity. These cell lines could potentially play a role in aiding anatomic pathology laboratories in validating immunohistochemistry tests for formalin- and ethanol-fixed tissues.