Clinicopathological Correlation Research Articles

Prognostic and diagnostic value of circRNA expression in cervical cancer: a meta analysis

IntroductionCervical cancer (CC) is a highly prevalent malignancy of the reproductive system. This study aimed to methodically assess the function of circular RNAs (circRNAs) as possible indicators of CC, with a specific emphasis on their usefulness in the identification, prediction, and correlation with clinicopathological elements.MethodsA comprehensive literature search was conducted using databases such as PubMed, Cochrane Library, Web of Science, Embase, and the China National Knowledge Infrastructure (CNKI). The latest data were extracted on May 3rd, 2024. The diagnostic potential of circRNA expression was evaluated using a range of metrics including sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). The importance of circRNAs was further evaluated in terms of clinical relevance, pathological features, and prognostic value using pooled odds ratios (ORs) and hazard ratios (HRs).ResultsThe meta-analysis included 27 studies, which were categorised based on diagnostic applications (n=3), clinicopathological correlations (n=15), and prognostic evaluations (n=23). Elevated expression levels of oncogenic circRNAs were significantly associated with poor clinical indicators, including tumour size (odds ratio [OR] = 0.425, 95% confidence interval [CI]: 0.267–0.676), International Federation of Gynaecology and Obstetrics (FIGO) stage (OR = 0.315, 95% CI: 0.224–0.443), and lymph node metastasis (OR = 2.975, 95% CI: 1.816–4.872). This upregulation of oncogenic circRNA was also identified as a predictor of worse survival outcomes, with a hazard ratio (HR) of 2.13 (95% CI: 1.73–2.62, P < 0.001). The downregulation of circRNAs with tumour-suppressor properties was similarly associated with poor clinical parameters, such as tumour size (OR = 0.310, 95% CI: 0.102–0.941), FIGO stage (OR = 0.231, 95% CI: 0.101–0.527), and lymph node metastasis (OR = 2.430, 95% CI: 1.156–5.110), and was indicative of a worsened prognosis (HR = 2.20, 95% CI: 1.03–4.70, P = 0.042). In terms of diagnostic value, the pooled sensitivity, specificity, and area under the curve (AUC) were calculated to be 0.85, 0.83, and 0.91, respectively.ConclusionThe results of our meta-analysis indicate that circRNAs have the potential to serve as promising biomarkers for CC diagnosis, prognosis, and clinicopathology.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024544997.

Clinical, Pathologic, and Molecular spectrum of Angioinmmunoblastic T-cell Lymphoma Cutaneous Lesions: Clinical, Pathologic, and Molecular Analysis.

Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive malignancy that frequently presents with extranodal involvement. Cutaneous tropism is clinically and histopathologically variable, which may pose a diagnostic challenge. We conducted a retrospective analysis of 40 samples of 20 cases of cutaneous AITL, focusing on the clinicopathologic and molecular correlations between skin and lymph node (LN) samples. In all cases, cutaneous involvement was concurrent with or followed the diagnosis of nodal AITL, with no cases preceding systemic involvement. Clinically, cutaneous AITL presented in 2 main forms: an evanescent rash and persistent lesions, with histopathology revealing diverse infiltration patterns, including perivascular, nodular, granulomatous, panniculitic, vasculitis, and epidermotropic. Clinical presentation and histologic patterns tend to correlate. Histopathologically, plasma cells were present in 15/22 skin samples, 5 of them being kappa-light restricted but polytypic in corresponding LNs. Epstein-Barr virus+ B cells were present in 10 cutaneous lesions and were already present in corresponding LNs. Molecular studies found correlations in all but one case between LN and skin, particularly in the presence of RHOA and TET2 mutations, which were identified in 8 of 12 cases. Molecular analysis was also informative in 4 cases with low levels of infiltration. The study also highlighted unique cases with distinct clinical and histopathologic patterns coexisting in the same patient over time. One case exhibited simultaneous granulomatous and epidermotropic patterns in different skin lesions. Four cases of cutaneous B-cell lymphomas associated with AITL were identified. Our study underscores the importance of integrating clinical, histopathologic, and molecular data to accurately diagnose cutaneous AITL.

Incidental Finding of a Persistent Right Vitelline Artery in a 13-Year-Old Boy with Acute Appendicitis: A Case Report with Clinico-Pathological Correlation and a Comprehensive Literature Review.

The persistence of fetal vitelline structures may occur. The primary intestinal arterial supply development happens normally in this scenario, but a vitelline vascular remnant (VVR) persists. A 13-year-old boy with a history of severe and intermittent abdominal pain since early infancy presented to the Emergency Department with clinical, analytical, and ultrasonographic findings suggestive of acute appendicitis. There was no evidence of intestinal obstruction. Surgical treatment was indicated. A thick fibrovascular band from the umbilicus to the terminal ileum's mesentery was identified during laparoscopy. A gangrenous cecal appendix was also identified. A regular appendectomy and surgical excision of the band was performed. The histopathological study confirmed that it was a persistent right vitelline artery (VVR) and that the patient had acute gangrenous appendicitis. The patient evolved favorably and is currently asymptomatic and under follow-up. The literature on VVR is scarce. The present manuscript reviews the main characteristics of this embryological insult based on the preceding literature. Standardization of terminology regarding VVR will help better understand this pathology in the future.

Interplay and clinicopathological correlates of tumor size, multifocality and aggressive variants in patients with operated differentiated thyroid carcinoma: A retrospective cohort study

Objectives: To investigate the interplay and clinicopathological correlates of tumor size, cancer foci (multifocality/bilaterality), and aggressive variants in patients with operated differentiated thyroid cancer (DTC). Methods: A total of 596 patients with operated DTC (median age: 47.0 (range: 18.0-87.0 years, 77.5% were females) were included in this retrospective cohort study. Data on patient demographics, cancer foci, concomitant Hashimoto's thyroiditis, surgery type, DTC subtype (papillary thyroid cancer [PTC], follicular thyroid cancer [FTC]) and variants, tumor size, lymph node metastasis, tumor invasion were recorded. Results: PTC aggressive variant (21.9%, P=0.045), extrathyroidal invasion (24.6%, P=0.012), tall cell PTC variant (60.3%, P=0.043), and widely invasive FTC variants (60.0% P=0.002) rates were significantly higher in the bilateral multifocal tumors than in the unifocal and unilateral multifocal tumors. The rates of Hashimoto's thyroiditis (59.8%, P<0.001) and PTC subtype (99.6%, P<0.001) were significantly higher, while the rates of lymph node metastasis (5.8%, P<0.001), capsule invasion (11.6%, P<0.001), vascular invasion (0.4%, P<0.001) and extrathyroidal invasion (4.5%, P<0.001) were significantly lower in <10 mm than in >10 mm tumors. Presence vs. absence of PTC aggressive variant was associated with significantly higher greatest tumor size (12 mm, P=0.013) and higher rates of multifocal tumor (50.5%, P=0.013) and extrathyroidal invasion (33.0%, P<0.001). Conclusions: Our findings revealed the presence of bilaterality/multifocality and aggressive variants in a considerable proportion of patients with operated DTC, and a multifaceted interplay between bilaterality/multifocality, tumor size, and PTC aggressive variants, in addition to their individual effects on increased risk of tumor invasion, particularly the extrathyroidal invasion.

Comprehensive analysis pinpoints CCNA2 as a prognostic and immunological biomarker in non-small cell lung cancer

BackgroundLung cancer is a leading cause of morbidity and mortality globally. Despite advances in targeted and immunotherapies, overall survival (OS) rates remain suboptimal. Cyclin-A2 (CCNA2), known for its upregulation in various tumors and role in tumorigenesis, has an undefined function in non-small cell lung cancer (NSCLC).MethodsWe analyzed three microarray datasets from the Gene Expression Omnibus (GEO) repository to identify differentially expressed genes. Using STRING, we constructed a protein-protein interaction (PPI) network to pinpoint hub genes. The expression and prognostic relevance of CCNA2 were validated using GEPIA and the Kaplan-Meier plotter. Clinicopathological correlations were assessed via the Human Protein Atlas (HPA) and UALCAN databases. qRT-PCR and immunohistochemistry (IHC) were performed to validate CCNA2 mRNA and protein levels. Loss-of-function assays in lung cancer cell lines evaluated the biological role of CCNA2. Immune infiltration and single-cell sequencing were also explored.ResultsAnalysis of GSE18842, GSE101929, and GSE116959 datasets identified 321 upregulated and 623 downregulated genes in NSCLC. CCNA2 was confirmed to be highly expressed in NSCLC through qRT-PCR and IHC, with overexpression correlating with advanced pathological stages and lymph node metastasis. The area under the curve (AUC) of CCNA2 indicating high diagnostic accuracy. Immune infiltration and single-cell sequencing revealed that CCNA2 expression was significantly associated with immune cell infiltration, particularly in Tprolif cells.ConclusionCCNA2 is upregulated in NSCLC and shows significant correlation with clinicopathological characteristics. Our findings suggest that CCNA2 may serve as a promising biomarker for both the prognosis and diagnosis of NSCLC.

A case series of dermatopathological features in different types of morphea and their clinical correlates.

The dermatopathological features in morphea (localized scleroderma) and their clinicopathologic correlations are not well described in the literature. To describe dermatopathological changes of different types of morphea and to investigate the association between clinical and histopathological features. A total of 18 cases of morphea who attended our tertiary care center in the last four years were evaluated. We noted clinical characteristics of all patients and dermatopathological changes like the pattern of sclerosis, degree of inflammation, cell types and all epidermal-dermal, and appendageal changes. Clinicopathological correlation was performed to interpret the clinical significance of dermatopathological changes in various types of morphea. Morphea was most commonly noted in the third decade and females. A circumscribed plaque was the most common clinical presentation. Full-thickness pattern of sclerosis was significantly associated with various clinical outcomes. Basal pigmentation and a reduced number of appendages were noted in more than 80% of patients. All patients had various grades of inflammation. Severe and moderate-grade inflammation with eosinophils and plasma cells was associated with pruritus and/or pain. The limitations are small sample size and single-centered case series. The dermatopathological examination of morphea may help in better monitoring and treatment of patients, including patterns of sclerosis and grades of inflammation, and cell types in skin pathology reports will aid in proper and better clinical management.

Direct Immunofluorescence in Dermatomyositis and Lupus Erythematosus: Cross-Sectional Diagnostic Accuracy and Correlation With Serologies and Other Features of Systemic Disease.

This is a retrospective cross-sectional diagnostic test accuracy study of direct immunofluorescence (DIF) performed on a group of potential lupus erythematosus (LE)/dermatomyositis (DM) skin biopsies from 2015 to 2020 at a large, academic medical center. For purposes of this study, which was focused primarily on detection of LE/DM-related interface dermatitis, DIF was considered positive for a LE/DM pattern if it showed granular deposition of immunoglobulin G, with or without C3, at the basement membrane zone on the final pathology report. Blinded clinicopathologic correlation was the reference standard. One thousand fifty-eight sequential pairs of skin biopsies obtained from adults and submitted for both DIF and routine histology were screened. Cases were excluded if histopathology did not demonstrate features that could be consistent with LE/DM (broadly predefined as interface dermatitis and/or neutrophilic dermatosis), resulting in 254 cases of possible LE/DM eruptions for further analysis. Sensitivity of DIF with an immunoglobulin G granular pattern at the basement membrane zone was 71.4% (confidence interval 55.4%-84.3%) in LE-related and 59.3% (confidence interval 38.8%-77.6%) in DM-related eruptions. No statistically significant difference was found in sensitivities of DIF between LE and DM (P = 0.3). DIF positivity did not correlate with available key demographic, clinical, and serologic features.

Clinicopathological Correlation of Invasive Histological Features in Incidentally Detected Appendiceal Neuroendocrine Tumors (aNETs)

Aim: Appendiceal Neuroendocrine Tumors (aNETs) are rare and mostly detected incidentally patients operated on acute appendicitis. These are indolent tumors and mostly benign, however they carry risk of metastasis. This study aims to identify invasive histological features of aNET cases, that are correlated with aggressive behavior other than stage and grading parameters. Material and Methods: This retrospective study includes patient demographics, surgical margin status and pathological features of tumors. ANETs showing adenocarcinoma features, goblet cell features, and mixed features were not included in our study. Results: The mean age of cases with tumors is 41years (11-61 years). The mean tumor diameter was found to be 6.8 mm. Most of tumors were located in the distal appendix (55.5%). All of the tumors show invasive features. Four cases showed invasion to submucosa (pT₁), four cases to muscularis propria (pT₁), eight cases to subserosa (pT₃), and four cases to mesoappendix (pT₃). Follow-up information was available for only one case with Grade-2 features and MAI, no additional surgical treatment was required, and he has survived at 3-year follow-up with no metastasis. Conclusion: Even if it is grade 1stage 1 tumors, may exhibit invasive features with a risk of metastasis. Although LVI and PNI are not included in ANET staging, they are important factors affecting the course of the disease. The literature lacks consensus on the advisability of performing completion right hemicolectomy in patients exhibiting invasive histological features. We believe it prudent to maintain regular follow-up intervals for these individuals

Diffuse Axonal and Vascular Pathology in the Gyrencephalic Brain after High-Energy Blunt Injury: Clinicopathological Correlations Involving the Brainstem.

Traumatic brain injury (TBI) after high-energy, behind helmet blunt trauma (BHBT) is an important but poorly understood clinical entity often associated with apnea and death in humans. In this study, we use a swine model of high-energy BHBT to characterize key neuropathologies and their association with acute respiratory decompensation. Animals with either stable or critical vital signs were euthanized within 4 h after injury for neuropathological assessment, with emphasis on axonal and vascular pathologies in the brainstem. The majority of cases were characterized by fractures of the cranium at or about the impact site, extensive subarachnoid hemorrhages, coup and contrecoup contusions, and primarily diffuse axonal and vascular lesions throughout the cerebrum, particularly in the brainstem. Absence of spontaneous respiration that was encountered frequently was associated with both severity of impact and the severity of brainstem axonal and vascular lesions. A focused regional examination of brainstem pathology indicated a link between adverse outcomes and diffuse axonal lesions within the medial medulla or vascular lesions within the anteroventral brainstem, a pattern suggesting that injury to brainstem respiratory centers may play a role in apnea following BHBT. In addition, while the overall burden of diffuse axonal and vascular pathologies correlated with each other, we found minimal overlap in their regional distribution. Our findings indicate that high-energy, blunt-force impact TBI causes diffuse lesions in axons and blood vessels associated with poor outcomes. They also suggest that axons and vessels may have distinct responses to tissue deformation and that commonly used markers of vascular pathology, for example, in diagnostic radiology, cannot be used as direct surrogates of diffuse axonal injury. In concert, our study underscores the role of regional axonal and vascular injuries in the brainstem in acute respiratory decompensation after high-rate blunt TBI, even in the presence of head protection; it also emphasizes the importance of detailed clinicopathological work in complex brains in the field of TBI.

Unilateral and Bilateral Recurrent Laryngeal Nerve Palsy in Total Thyroidectomy and Its Clinicopathological Correlation: A Multicentric Cohort study

Unilateral and Bilateral Recurrent Laryngeal Nerve Palsy in Total Thyroidectomy and Its Clinicopathological Correlation: A Multicentric Cohort study

Primary Cutaneous Anaplastic Large Cell Lymphoma With Rare Extracutaneous Disseminated Disease: A Case Report.

Primary cutaneous anaplastic large cell lymphoma (pcALCL) is a CD30+ lymphoproliferative disorder with generally favorable outcomes and infrequent extracutaneous spread, usually limited to local lymph nodes. However, there may be extensive histologic overlap with more aggressive CD30+ lymphomas, such as large cell transformation of mycosis fungoides or secondary skin involvement by anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma. Definitive diagnosis relies on clinicopathologic correlation. We report on a 26-year-old woman who presented to our institution with progressive lower extremity wounds for several months, previously treated with antibiotics and vacuum-assisted closure dressings. Consultation with dermatology and 2 separate biopsies eventually led to the diagnosis of pcALCL. Subsequent imaging revealed stage IV disease with innumerable intensely fluorodeoxyglucose (FDG)-avid subcutaneous, intramuscular, and visceral foci, but paucity of lymph node involvement. The patient's condition deteriorated, and she died during her hospitalization. This case reviews the clinicopathologic findings of pcALCL, emphasizes the importance of clinicopathologic correlation in differentiating between CD30+ lymphoproliferative disorders, highlights the extremely rare phenomenon of systemic intramuscular and visceral disseminated disease occurring in pcALCL, and discusses implications for prognosis.

Clinicopathological Characterization and Correlation of Breast Tumor with Receptor Status at Tertiary Care Centre, Dahod, Gujarat

Clinicopathological Characterization and Correlation of Breast Tumor with Receptor Status at Tertiary Care Centre, Dahod, Gujarat

DEMOGRAPHIC PROFILE OF ORAL LICHEN PLANUS PATIENTS IN THE BULGARIAN POPULATION. CLINICOPATHOLOGICAL CORRELATION IN THE DIAGNOSIS OF THE DISEASE

Oral lichen planus (OLP) is a relatively common mucosal disease that mainly affects middle-aged women, yet the epidemiological characteristics of this condition in the Bulgarian population are poorly studied. OLP is considered a clinic-pathological diagnosis that is sometimes challenging to make. Aim. The aim of the present study was to determine the prevalence of OLP among the Bulgarian population and to evaluate the clinico-pathological correlation in the diagnosis of the disease. Materials and Methods. The files of the patients with diseases of the oral mucosa consulted in the Department of Periodontology and Oral Mucosa Diseases, Medical University of Plovdiv, between 2012-2016, were retrospectively reviewed. A comparison was also made of the clinical and histopathological diagnoses retrieved from the archived pathohistological records for the same cohort of patients. Results. Out of a total of 714 patients with mucosal diseases, 141 have been diagnosed with OLP, with the disease accounting for the largest proportion (20%) among the analyzed group. Male to female ratio was 1:4, and most patients were over 51 years of age. Histological confirmation of the clinical diagnosis OLP has been obtained in 84.1%, and there were additional 10.84% ​​cases with a histological diagnosis of OLP that were clinically misdiagnosed. Conclusion. OLP seems to be of great clinical importance in our country. There is a clinic-pathological discrepancy in the diagnostic evaluation of the disease in a relatively high percentage of cases. Therefore, stricter diagnostic criteria need to be introduced and followed to obtain a more reproducible diagnosis of OLP.

P12 Paradoxal adalimumab induced palmoplantar pustulosis in a patient with Crohn’s disease

Abstract In November 2023, a 25-year-old man presented with pustular lesions on his palms and soles bilaterally. The pustules were sterile and the biopsy was compatible with psoriasiform dermatitis. In the following days, the patient developed erythematous, scaly, indurated, plaques on his trunk. From the clinicopathological correlation, the diagnosis was palmoplantar pustular psoriasis. The patient was under the treatment of adalimumab from the summer of 2021 for Crohn’s disease (40 mg/2 weeks, subcutaneously), until he proceeded to our clinic with palmoplantar pustulosis. Adalimumab was discontinued. The patient was treated with topical cortisone and keratolytics, in combination with ustekinumab for Crohn’s disease, with a gradual improvement of his symptoms. Tumour necrosis factor (TNF) is a pro-inflammatory cytokine. Adalimumab is a fully human immunoglobulin G1 antibody, blocking TNF activity. In our case, we have another paradoxical adverse reaction of adalimumab. Despite the effectiveness of adalimumab in the treatment of psoriasis and Crohn’s d, our patient developed palmoplantar pustular psoriasis, though he was under adalimumab for his Crohn’s d. Ustekinumab is a biological agent targeting interleukine-12 and 23 and is widely used in the management of both psoriasis and Crohn’s d. Our patient switched from adalimumab to ustekinumab, which kept his Crohn’s d stable and improved his palmoplantar pustular psoriasis, after 1 month

Identification and construction of prognostic clusters and risk-prognosis model based on aging-immune related genes in bladder cancer

BackgroundFaced with the current global ageing situation, advanced age has become a risk factor for bladder carcinogenesis progression and immunotherapy. Exploring the common mechanisms of aging and immune in bladder cancer and finding new prognostic markers and immunotherapeutic targets has become an urgent issue.MethodAging-immune related genes (AIGs) were collected from the public databases MSIGDB, HAGR and ImmPort, and hub AIGs were finally identified in the TCGA-BLCA disease cohort by expression, prognosis, and clinicopathological correlation analysis, and the correlation of hub AIGs with immune microenvironment, immunotherapeutic response, ferroptosis and m6A methylation was verified. Subsequently, prognostic clusters and risk-prognosis models for AIGs was constructed by cluster analysis and multifactorial Cox regression analysis, and the gene mutation and immune infiltration characteristics of the different clusters were explored. Finally, the expression level of related genes was verified by immunohistochemical experiments using patient samples from our medical center.Result145 potential prognostic AIGs were collected in bladder cancer and finally clarified NFKB1 and IL7 with significant expression differences, prognostic value and age correlation. By single gene analysis, hub AIGs were explored to be significantly correlated with immunotherapeutic response, immune microenvironment, ferroptosis and m6A methylation. Subsequently, the risk-prognosis model was constructed with Riskscore = (0.0581)*NFKB1 + (− 0.2285)*IL7. And prognostic clusters based on hub AIGs was performed by cluster analysis, which clarified that the high-risk group was the pro-cancer group, which had a lower mutation rate of hub genes and higher of neutrophil infiltration. Finally, immunohistochemistry of patients confirmed that IL7 and NFKB1 were underexpressed in bladder cancer, and the proliferation and migration ability of tumor cells were significantly decreased after overexpression of these genes.ConclusionThis study is the first to identify NFKB1 and IL7 as hub AIGs in bladder cancer, which provide new prognostic markers and immunotherapeutic targets.

Differentiating mycosis fungoides lesions from their mimickers clinically and histologically: A single tertiary center retrospective analysis in Saudi Arabia.

To identify the clinical and histological features of MF that can assist in distinguishing MF from MF-mimicking cases. Although mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma, clinicopathological correlations are required to establish an accurate diagnosis, which are currently lacking. This retrospective observational study evaluated the clinical presentations, characteristics, and histological features of 56 patients with suspected MF who presented to our clinic between January 2018 and August 2022. Immunohistochemistry was performed, and the loss of CD5 and CD7T-cells and T-cell receptor rearrangement was evaluated. Overall, 34 patients were diagnosed with MF, whereas 22 were not. Clinical erythroderma, poikiloderma, and nodular presentations were more commonly associated with a histological diagnosis of MF than macular presentations. Erythema and pruritus were significantly more common in MF cases than in MF-mimicking cases (p<0.05). Epidermotropism and parakeratosis were the key histological features for diagnosing MF. Additionally, Pautrier's microabscesses correlated with the clinical presentation of plaques in MF. Loss of CD7 expression on the T-cell surface was observed even in early-stage MF cases. Our proposed diagnostic features are statistically valid and, along with those previously reported, can aid in identifying and distinguishing MF cases from MF-mimicking cases.

Lupus erythematosus and dermatomyositis.

Dr. Irwin Braverman, a luminary in our field of dermatology, united his love of internal medicine with dermatology to pioneer our understanding of the cutaneous manifestations of systemic disease. His meticulous documentation of physical examination findings in his book Skin Signs of Systemic Disease became fundamental to the training of dermatologists worldwide for decades. In the context of autoimmune connective tissue diseases, Dr. Braverman's powerful observation skills proved pivotal in charting the clinical signs and symptoms of systemic lupus erythematosus and dermatomyositis. His legacy as a trailblazer in clinicopathologic correlation continues to influence younger dermatologists, emphasizing the crucial role of connecting pathologic findings in the skin to systemic pathology in providing outstanding patient care. We highlight some of Dr. Braverman's personal interests and contributions to lupus erythematosus and dermatomyositis.

Benign Nevi Mimicking Melanoma: A Diagnostic Dilemma.

The incidence of melanoma is increasing worldwide and is not restricted as previously to fair-skinned individuals and one of the main contributing factors is the drastic development of diagnostic approach to the melanocytic lesions. Additionally, melanomas are often misdiagnosed (underdiagnosed and overdiagnosed) as many benign melanocytic lesions such as Spitz nevus, deep penetrating nevus (DPN), compound nevus, and regenerating nevi exhibit some features of melanoma. Clinico-pathological correlation is of utmost importance in the diagnosis of such lesions. Cytological details should be carefully studied in addition to a good "low power" assessment of the growth pattern. Appropriate immunohistochemistry (IHC) is necessary whenever needed as misdiagnosis has deleterious consequences for both the patient and the pathologist.

How Automation in Electronic Medical Records Can Lead to Errors in Dermatology

The integration of electronic health records has revolutionized healthcare by facilitating communication among providers, but it has also introduced significant challenges. In dermatology, a particular issue arises with the use of electronic medical record (EMR) systems that employ auto-populated fields on digital pathology requisition forms (RFs) for skin biopsies. These systems allow for the rapid selection of pre-set descriptions and differential diagnoses, which, while timesaving, frequently lead to diagnostic inaccuracies and potentially detrimental impacts on patient care. Dermatopathologists often receive biopsy specimens with RFs that list multiple provisional diagnoses based on generic, EMR-generated descriptions, which may not accurately represent the patient’s condition. This practice hampers the ability of dermatopathologists to perform effective clinicopathologic correlation, crucial for accurate diagnosis. We highlight that the convenience of EMR systems can discourage clinicians from recording detailed, accurate clinical observations. Consequently, this lack of detailed documentation prevents dermatopathologists from making informed diagnoses by correlating histologic features with clinical appearances. The current practice of using EMRs without consideration for their clinical relevance not only wastes healthcare resources but also poses a significant medico-legal risk. Therefore, refining EMR practices and integrating more comprehensive clinical data will ensure greater accuracy in dermatological diagnoses.

Prognostic role of Androgen Receptor splice variant 7 (AR-V7) in the pathogenesis of breast cancer

BackgroundThe Androgen Receptor (AR) has emerged as an endocrine therapy target in Breast Cancer, exhibiting up to 80% expression in clinical cases. AR-V7, a constitutively activated splice variant of AR with a truncated ligand-binding domain (LBD), demonstrates ligand-independent transcriptional activity and resistance to nonsteroidal antiandrogens like Bicalutamide or Enzalutamide, targeting the LBD. In metastatic prostate cancer, elevated AR-V7 levels lead to therapeutic resistance and increased metastasis.MethodsIn this study, we evaluated the expression of AR and AR-V7 in cell lines and a cohort of 89 patients undergoing surgical intervention for treatment-naïve breast cancer. Further clinicopathological correlations and survival analysis were performed to evaluate the relationship between the AR and AR-V7 expression and clinical outcomes.ResultsAR-V7/AR-FL ratio was elevated in the TNBC cell line and downregulation of AR-FL upon AR antagonists’ treatment led to a compensatory increase in AR-V7. Clinical samples showed significantly elevated expression of AR and AR-V7 in tumors compared to control cases. Further clinicopathological correlation revealed aggressive clinical traits, higher pathological grades, and poor survival with AR-V7 expression.ConclusionsOur study unravels AR-V7 as a marker for poor clinical outcomes, predicting breast cancer aggressiveness, and encourages consideration of AR-V7 as a probable target for therapeutic intervention.