Clinicopathological Correlation Research Articles

Prevalence of Clostridioides difficile in dogs (Canis familiaris) with gastrointestinal disorders in Rio de Janeiro

Clostridioides difficile infections (CDI) have a high morbidity and mortality rate and have always been considered a nosocomial disease. Nonetheless, the number of cases of community-acquired CDI is increasing, and new evidence suggests additional C. difficile reservoirs exist. Pathogenic C. difficile strains have been found in livestock, domestic animals, and meat, so a zoonotic transmission has been proposed. ObjectiveThe goal of this study was to isolate C. difficile strains in dogs at a veterinary clinic in Rio de Janeiro, Brazil, and characterize clinical and pathological findings associated with lower gastrointestinal tract disorders. MethodsFifty stool samples and biopsy fragments from dogs were obtained and cultured in the CDBA selective medium. All suggestive C. difficile colonies were confirmed by MALDI-TOF MS and PCR (tpi gene). Vancomycin, metronidazole, moxifloxacin, erythromycin, and rifampicin were tested for antibiotic susceptibility. Biofilm, motility assays, and a PCR for the toxins (tcdA, tcdB, and cdtB), as well as ribotyping, were also performed. ResultsBlood samples and colonic biopsy fragments were examined in C. difficile positive dogs. Ten animals (20%) tested positive for C. difficile by using stool samples, but not from biopsy fragments. Most C. difficile strains were toxigenic: six were A+B+ belonging to RT106; two were A+B+ belonging to RT014/020; and two were A-B- belonging to RT010. All strains were biofilm producers. In the motility test, 40% of strains were as motile as the positive control, CD630 (RT012). In the disc diffusion test, two strains (RT010) were resistant to erythromycin and metronidazole; and another to metronidazole (RT014/020). In terms of C. difficile clinicopathological correlations, no statistically significant morphological changes, such as pseudomembranous and "volcano" lesions, were observed. Regarding hematological data, dogs positive for C. difficile had leucopenia (p = 0.02) and lymphopenia (p = 0.03). There was a significant correlation between senility and the presence of C. difficile in the dogs studied (p = 0,02). ConclusionsAlthough C. difficile has not been linked to canine diarrheal disorders, it appears to be more common in dogs with intestinal dysfunctions. The isolation of ribotypes frequently involved in human CDI outbreaks around the world supports the theory of C. difficile zoonotic transmission.

Role of myofibroblasts in oral plasma cell granuloma: Immunohistochemical evaluation of α-SMA and ALK in a retrospective study of 30 cases

IntroductionOral plasma cell granuloma (OPCG) is a rare reactive lesion with generally benign yet occasionally aggressive behavior. Myofibroblasts are important in many physiologic, and pathologic conditions. The role of myofibroblasts in the clinical behavior of OPCG was assessed as well as its usefulness in differentiating this lesion from the inflammatory myofibroblastic tumor mimicking plasma cell granuloma. Material and MethodsThis retrospective study included 30 paraffin blocks of OPCG. Immunohistochemical evaluation of alpha-smooth muscle actin (α-SMA) and Anaplastic lymphoma kinase (ALK) antibodies was performed. The mean area of positive expression was calculated and scored semiquantitatively with clinicopathologic correlations. ResultsMost of the cases were clinically non-aggressive. Alveolar bone resorption was observed in nine cases, two of them showed severe resorption and stromal fibrosis. Negative α-SMA was observed in 70% of cases showing a predominance of plasma cells in the stroma. All cases of stromal fibrosis revealed positive α-SMA of a weak percentage. A statistically significant difference was observed between α-SMA expression and the clinicopathologic variables. Negative ALK expression was noted in all cases. DiscussionMyofibroblasts were infrequently found in OPCG. Remarkably, the aggressive behavior in cases with intense fibrosis was related to the existence of myofibroblasts even of non-neoplastic nature and minimal amount. The number of myofibroblasts and their nature assessed via α-SMA and ALK immunohistochemical expression respectively might be valuable in predicting the biological behavior of OPCG and may hold diagnostic significance in challenging OPCG cases that might mimic inflammatory myofibroblastic tumor.

Clinical, Pathological and Molecular Insights on KRAS, NRAS, BRAF, PIK3CA and TP53 Mutations in Metastatic Colorectal Cancer Patients from Northeastern Romania.

Mutations in RAS, BRAF, PIK3CA, and TP53 are well-established genetic abnormalities in metastatic colorectal cancer (mCRC). However, limited information is available for patients from Eastern Europe, including Romania. In this retrospective analysis, we investigated 104 mCRC patients from the Northeastern region of Romania to determine the frequency, distribution, coexistence, and clinicopathological and molecular correlations of these mutations. TP53 was the most frequently mutated gene (73.1%), followed by KRAS (45.2%) and PIK3CA (6.7%). Patients with KRAS mutant tumors and wild-type TP53 genotype were found to have no personal history of gastrointestinal cancer (p = 0.02, p = 0.007). KRAS mutations in exon 3 were associated with the female gender (p = 0.02) and the absence of lymph node invasion (p = 0.02). PIK3CA mutations were linked to the absence of lymph node invasion (p = 0.006). TP53 mutations were associated with KRAS mutations in exon 2 (p = 0.006), ulcerated histopathologic type (p = 0.04), and G2 differentiation (p = 0.01). It provides novel insights into genetic variations specific to the population from Northeastern Romania, which has been underrepresented in previous studies within Eastern Europe. Furthermore, our findings enable the development of genetic profiles in a developing country with limited access to specialized genetic tests and facilitate comparisons with other populations.

Bullous Pemphigus: A Comprehensive Review of a Complex Autoimmune Disease of the Skin and Mucous Membranes

Pemphigus bullosus, also known as pemphigus vulgaris, is a rare and potentially serious autoimmune disease affecting the skin and mucous membranes, characterized by the formation of intraepidermal blisters due to the loss of cellular cohesion at desmosomal junctions. In this article, we present a comprehensive review of the entity, covering its epidemiology, etiopathogenesis, clinical manifestations, diagnosis and therapeutic options. We highlight the complexity and diagnostic challenges associated with bullous pemphigus, emphasizing the importance of careful clinicopathologic and immunofluorescent correlation for its proper identification. We also discuss in detail the multidisciplinary therapeutic approach required to achieve disease control, emphasizing the use of systemic immunosuppressants and biological therapies. In addition, we highlight the relevance of local therapy and care management, along with the need for close medical follow-up to assess response to treatment and minimize adverse effects. Finally, we highlight the importance of continued research in this complex clinical entity, in order to improve the understanding of its immunopathological mechanisms and to develop more specific and personalized therapies. In conclusion, this article provides a comprehensive and updated view of bullous pemphigus, with the aim of improving its clinical management and promoting a more efficient and effective therapeutic approach.

Brain Tuberculosis: An Odyssey through Time to Understand This Pathology.

Tuberculosis is a contagious disease that has been a concern for humanity throughout history, being recognized and referred to as the white plague. Since ancient times, starting with Hippocrates and Galen of Pergamon, doctors and scientists have attempted to understand the pathogenesis of tuberculosis and its manifestations in the brain. If, in the medieval period, it was believed that only the touch of a king could cure the disease, it was only in the early 17th and 18th centuries that the first descriptions of tuberculous meningitis and the first clinico-pathological correlations began to emerge. While the understanding of neurotuberculosis progressed slowly, it was only after the discovery of the pathogenic agent in the late 19th century that there was an upward curve in the occurrence of treatment methods. This review aims to embark on an odyssey through the centuries, from ancient Egypt to the modern era, and explore the key moments that have contributed to the emergence of a new era of hope in the history of neurotuberculosis. Understanding the history of treatment methods against this disease, from empirical and primitive ones to the emergence of new drugs used in multi-drug-resistant tuberculosis, leads us, once again, to realize the significant contribution of science and medicine in treating a disease that was considered incurable not long ago.

Evaluation of FNAC Thyroid Smears Using Bethesda System For Reporting Thyroid Cytopathology Nomenclature With Clinicopathological Correlation

Background: The study aimed to interpret thyroid cytology by the Bethesda System for reporting thyroid cytology (TBSRTC) and to analyze the distribution of lesions under various diagnostic categories and subcategories.
 Methodology: This study was conducted as an observational study at tertiary care centre on patients with thyroid lesions. After history taking and detailed local, general and systemic examination, thyroid function tests were conducted. Apart from this, ultrasonography of lesion was done. Patients were subjected to FNAC and after fixation smears were stained with Papanicolaou stain.
 Results: About 53% thyroid lesions were hemorrhagic, followed by 17% blood mixed colloid and 4% colorless serous fluid. Sample adequacy was noted in 93.5% cases in our study. According to Bethesda system of classification, majority of lesions were benign (81.5%) whereas 6.5% lesions were unsatisfactory. Only 6% lesions were categorsied as malignant.
 Conclusion: FNAC is widely accepted as the most accurate, sensitive, specific, and cost- effective diagnostic procedure in the preoperative assessment of thyroid nodules. It is the first line of investigation and can differentiate benign nodules from malignant nodules of the thyroid in 95% cases. Applying a standard reporting system for thyroid cytology may enhance the communication between pathologists and clinicians, assists them to find out the rate of malignancy in each cytological group, and facilitating a more reliable approach for patient management.

Vulvar Lichen Sclerosus Clinical Severity Scales and Histopathologic Correlation: A Case Series.

Several vulvar lichen sclerosus (VLS) clinical severity scales have recently been proposed. In this prospective case series, we characterized histopathology in the context of clinical severity in 6 treatment-naïve postmenopausal patients with VLS. The Vulvar Quality of Life Index (VQLI) and an adaptation of the 2018 International Society for the Study of Vulvovaginal Disease Delphi consensus VLS severity score were administered. Vulvar skin punch biopsies were obtained to measure inflammatory density, constituent inflammatory cells, thickness of the stratum corneum and other epidermal layers, dermal edema, and dermal sclerosis. Clinicopathologic correlations were assessed. Two cases demonstrated sparse inflammatory densities, 1 case demonstrated patchy and nodular inflammatory density, 1 case demonstrated dense lichenoid inflammatory density, and 2 cases demonstrated dense lichenoid and epitheliotropic inflammatory densities. Those patients who reported severe pruritus demonstrated the greatest lymphocytic inflammatory densities on histopathological examination. Both cases of ulceration or erosion were associated with severe VQLI scores. Severe VQLI scores were also associated with trends for higher average thickness of the epidermal layers and of dermal sclerosis. Altogether, histopathologic grading of biopsy sites may reflect clinical severity in patients with VLS.

A review of cutaneous hypersensitivity reactions in dogs: A diagnostician's guide to allergy.

Allergic dermatoses are common in people and domestic animals. Resultant lesions are routinely biopsied and submitted for histological examination to confirm a diagnosis or rule out diseases with overlapping or atypical clinical features. Diagnostic pathologists and clinicians are often faced with the difficult task of determining whether an allergic reaction pattern is present on both the microscopic and macroscopic levels and correlating histopathologic findings with clinical and historical data to achieve a precise clinical diagnosis. The bulk of the current veterinary literature on allergic dermatoses focuses on atopic dermatitis in dogs, distantly followed by cats, horses, and other animals. The objectives of this review are to demonstrate the key histopathologic and clinical diagnostic features of the various allergy-mediated reaction patterns, and to provide diagnosticians with a practical guide for clinicopathological correlations. Current concepts in the pathophysiology of immediate hypersensitivity reactions, with a focus on atopic dermatitis, are discussed. Points of potential histopathologic overlap between the "classic" allergic reaction pattern and less common inflammatory, predominately eosinophilic, conditions that may mimic this pattern will be discussed with the goal of highlighting the critical need for collaboration between pathologists and clinicians in furthering patient care.

Clinicopathological features and correlation analysis of male breast cancer.

To analyze and compare the clinicopathological characteristics of male breast cancer (MBC) among Chinese patients and those from East Asia and other regions. Clinicopathological data from 3 kinds of data sources, including 31 MBC patients in Jiangsu Provincial Hospital (JPH) from 2014 to 2021 in China, 20 literature data on East Asian MBC patients from 2014 to 2021, and 3102 MBC patients registered in the surveillance, epidemiology, and end results (SEER) database from 2014 to 2019, were collected and retrospectively analyzed. The average ages of first-diagnosis MBC patients in JPH and East Asian patients were 59.7 and 62.3 years old, respectively, which were younger than those of SEER patients (66.5 years old). Between East Asian and SEER patients, the status or rates of main breast cancer type, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, breast subtype, and TNM stage were relatively close, and their differences were not statistically significant (P > .05). Differences were observed in chemotherapy, surgery, pathological grade, and lymph node positivity (P < .01). Furthermore, no statistically significant difference was observed between the JPH and East Asian patients (all P > .05). In JPH and SEER, linear regression relationships were observed between the lymph node positivity rate, tumor size, and histological grade. JPH and East Asian MBC patients were younger than SEER patients. Between East Asian and SEER patients, the status of the main breast cancer type, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, breast subtype, and TNM stage were similar, but there were differences in chemotherapy, surgery, pathological grade, and lymph node positivity. The findings of this study should prove to be helpful to deepen our understanding of East Asian MBC.

Articulo traducido] Serie de 69 dermatosis relacionadas con la COVID-19 con biopsia, estudio inmunohistoquímico con anti-spike 3, hibridación in situ y PCR: Una revisión crítica de la afectación cutánea relacionada con la COVID-19

BackgroundDespite the large number of articles published on skin lesions related to COVID-19, clinicopathological correlation has not been performed consistently and immunohistochemistry to demonstrate spike 3 protein expression has not been validated through RT-PCR. Material and methodsWe compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies. ResultsAfter a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism.IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated. ConclusionsDespite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions.

Spectrum of Glomerular Diseases in North India and its Clinicopathological Correlation – An Observational Study

Abstract Introduction: Glomerular diseases (GDs) have varied presentations in adults. The spectrum varies from benign to aggressive presentations. Materials and Methods: We conducted an observational prospective study at a tertiary care teaching hospital in North India from July 2020 to June 2022 to evaluate GD’s spectrum and clinicopathological correlation. All kidney biopsies conducted during this period were considered as per inclusion and exclusion criteria, and detailed history and clinical examination were done. Results: One hundred and twenty-six kidney biopsies were evaluated as per inclusion and exclusion criteria. The mean age was 37.77 ± 17.73 years. Overall, the male-to-female ratio was 2.3:1 while the male-to-female ratio in lupus nephritis (LN) is 0.37:1. Primary GD (PGD) dominated among males whereas secondary GD (SGD) was more common in females. Nephrotic syndrome (NS, 44.5%) and acute kidney injury 27% were the most common clinical syndromes. The most common symptoms were edema and frothuria in NS (70%), and hematuria in acute nephritic syndrome 59%, whereas fatigue and gastrointestinal symptoms (44%) dominated in SGDs. The PGD-to-SGD ratio was 61.1:38.9. The most common PGD was immunoglobulin A nephropathy (IgAN, 22.1%), followed by minimal change disease (MCD, 20.8%), whereas LN (22.5%) was the prominent SGD, with Class IV + V (36.4%) being most common. Conclusion: GDs have a multitude of presentations – from asymptomatic urinary abnormalities to crescentic ones. IgAN and MCD were the most common of PGD whereas LN was the most common SGD.

Differential association of hedgehog pathway in development of cervical carcinoma and its chemo-tolerance

Cervical carcinoma (CACX) is still a dreadful threat to women in developing countries. Available conventional chemo-radiation therapies are not sufficient to restrict the disease recurrence. To unravel the mechanism of the disease recurrence, alteration of hedgehog self-renewal pathway was evaluated during development of CACX and in chemo-tolerance of the tumor. We have analyzed the alterations (expression/methylation/deletion) of some key regulatory genes (HHIP/SUFU/SHH/ SMO/GLI1) of hedgehog self-renewal pathway in cervical lesions at different clinical stages and compared with different datasets, followed by their clinico-pathological correlations. The changes in expression/methylation of the genes were then evaluated in two CACX cell lines (SiHa/HeLa) after treatment with chemotherapeutic drug cisplatin at different concentrations. Down regulation (mRNA/protein) of the antagonists HHIP and SUFU due to promoter methylation and/or deletion along with upregulation (protein) of agonists SHH, SMO and GLI1 was seen in early invasive lesions and subsequent clinical stages. Reduced protein expression of HHIP and SUFU showed significant association with high/intermediate expression of agonists SHH, SMO, GLI1 in the tumors and also poor prognosis of the patients. It was evident that cisplatin could restrict the growth of HeLa and SiHa cells through significant upregulation of antagonists HHIP and SUFU due to their promoter hypomethylation and down regulation of SHH in a concentration dependent manner without any significant changes in expression of SMO and GLI1, leading to the tumor cells in a dormant state. Thus, interplay of the agonists and antagonists has important role in activation of hedgehog pathway during development of CACX, whereas inactivation of the pathway due to upregulation of the antagonists is an important phenomenon in chemo-tolerance of the tumor. This suggests importance of epigenetic modification in chemo-resistance of CACX.

NCOA7 Regulates Growth and Metastasis of Clear Cell Renal Cell Carcinoma via MAPK/ERK Signaling Pathway.

NCOA7 is a nuclear receptor coactivator that is downregulated in a variety of cancers. However, the expression and prognostic significance of NCOA7 in clear cell renal cell carcinoma (ccRCC) remain unknown. The expression of NCOA7 in ccRCC tissues was analyzed using bioinformatics analysis, Western blotting, and immunohistochemistry. Kaplan-Meier analysis, the receiver operating characteristic (ROC) curve, and clinicopathological correlation analysis were used to assess the predictive power of NCOA7. Overexpression function tests were conducted in cells and mouse models to clarify the function and mechanism of NCOA7 in inhibiting the progression of ccRCC. NCOA7 expression was downregulated in all three subtypes of renal cell carcinoma, and only had significant prognostic value for patients with ccRCC. NCOA7 overexpression inhibited the proliferation, invasion, and metastasis of ccRCC cells in vivo and in vitro. Mechanistically, NCOA7 inhibited the MAPK/ERK pathway to regulate epithelial-mesenchymal transformation (EMT) and apoptosis, thereby inhibiting the progression of ccRCC. NCOA7 inhibits tumor growth and metastasis of ccRCC through the MAPK/ERK pathway, thus indicating its potential as a prognostic marker and therapeutic target for ccRCC.

Case of Generalized Granuloma Annulare Treated with Low Dose Naltrexone + PUVA

Granuloma annulare (GA) is a common, noninfectious granulomatous skin condition that usually presents in its localized form, characterized by flesh-colored to erythematous papules coalescing into annular plaques without scale, commonly on the dorsal hands. Lesions can be pruritic and often resolve without treatment in two years. However, the generalized form of GA has a lower incidence and presents with similar morphology, but with &gt;10 lesions in a widespread distribution. Generalized GA is known to be more symptomatic, longer-lasting, and recalcitrant to treatment. The diagnosis is made based on clinicopathological correlation with palisading granulomas around degenerated collagen in the dermis, mucin, and infiltrative lymphocytes and histiocytes. Treatment remains challenging as evidence is limited to case reports, case series, and a few retrospective studies. Here we present the case of a 59-year-old Caucasian female with pruritic rash that began on her abdomen and spread to her extremities over two months. Biopsy revealed superficial histiocytic infiltrates palisading around eosinophilic areas of altered collagen, multiple multinucleate giant cells with elastophagocytosis and lymphohistiocytic perivascular infiltrates, and mucin in the dermis on colloidal iron staining. Overall, this was consistent with generalized GA. The patient was started on a combination of low dose naltrexone (LDN) and psoralen and ultraviolet A (PUVA) therapy. At a five-month follow up visit, she demonstrated near complete resolution of symptoms without any serious adverse effects.

Establishment of a novel signature to predict prognosis and immune characteristics of pancreatic cancer based on necroptosis-related long non-coding RNA.

Necroptosis plays an important role in tumorigenesis and tumour progression. Long noncoding RNAs (lncRNAs) have been proven to be regulatory factors of necroptosis in various tumours. However, the real role of necroptosis-related lncRNAs (NRLs) and their potential to predict the prognosis of pancreatic cancer (PC) remain largely unclear. The goal of this study was to identify NRLs and create a predictive risk signature in PC, explore its prognostic predictive performance, and further assess immunotherapy and chemotherapy responses. RNA sequencing data, tumour mutation burden (TMB) data, and clinical profiles of 178 PC patients were downloaded from The Cancer Genome Atlas (TCGA) database. NRLs were identified using Pearson correlation analysis. Then, patients were divided into the training set and the validation set at a 1:1 ratio. Subsequently, Cox and LASSO regression analyses were conducted to establish a prognostic NRL signature in the training set and validation set. The predictive efficacy of the 5-NRL signature was assessed by survival analysis, nomogram, Cox regression, clinicopathological feature correlation analysis, and receiver operating characteristic (ROC) curve analysis. Furthermore, correlations between the risk score (RS) and immune cell infiltration, immune checkpoint molecules, somatic gene mutations, and anticancer drug sensitivity were analysed. Finally, we used quantitative reverse transcription polymerase chain reaction (qRT-PCR) to validate the 5-NRLs. A 5-NRL signature was established to predict the prognosis of PC, including LINC00857, AL672291.1, PTPRN2-AS1, AC141930.2, and MEG9. The 5-NRL signature demonstrated a high degree of predictive power according to ROC and Kaplan‒Meier curves and was revealed to be an independent prognostic risk factor via stratified survival analysis. Nomogram and calibration curves indicated the clinical adaptability of the signature. Immune-related pathways were linked to the 5-NRL signature according to enrichment analysis. Additionally, immune cell infiltration, immune checkpoint molecules, somatic gene mutations and the half-maximal inhibitory concentration (IC50) of chemotherapeutic agents were significantly different between the two risk subgroups. These results suggested that our model can be used to evaluate the effectiveness of immunotherapy and chemotherapy, providing a potential new strategy for treating PC. The novel 5-NRL signature is helpful for assessing the prognosis of PC patients and improving therapy options, so it can be further applied clinically.

Elderly and Patients with Large Breast Volume Have an Increased Risk of Seroma Formation after Mastectomy-Results of the SerMa Pilot Study.

The collective of the SerMa pilot study included 100 cases of primary breast cancer or Carcinoma in situ who had undergone a mastectomy procedure with or without reconstruction of the breast using an implant or expander at Augsburg University Hospital between 12/2019 and 12/2022. The study aimed to investigate possible causes of seroma formation; reported here are the clinicopathological correlations between seroma formation and tumor biology and surgical procedures. Seroma occurred significantly more often in patients with older age (median patient age in cases with seroma was 73 years vs. 52 years without seroma; p < 0.001). In addition, patients with larger mastectomy specimen were significantly more likely to develop seroma (median ablation weight in cases with seroma 580 g vs. 330 g without seroma; p < 0.001). Other significant parameters for seroma formation were BMI (p = 0.005), grading (p = 0.015) and tumor size (p = 0.036). In addition, with insertion of implant or expander, a seroma occurred significantly less frequently (p < 0.001). In a binary logistic regression, age in particular was confirmed as a significant risk factor. In contrast, tumor biological characteristics, number of lymph nodes removed or affected showed no significant effect on seroma formation. The present study shows the need for patient education about the development of seroma in particular in older patients and patients with large breast volumes within the preoperative surgical clarification. These clinicopathological data support the previously published results hypothesizing that seroma formation is related to autoimmune/inflammatory processes and will be tested on a larger collective in the planned international multicenter SerMa study.

The lupus band test: A review of the sensitivity and specificity in the diagnosis of lupus erythematosus.

The lupus band test (LBT) is a direct immunofluorescence (DIF) technique which shows a band of localised immunoglobulins at the dermo-epidermal junction in lesional, non-sun-exposed skin of patients with both systemic and cutaneous lupus erythematosus (LE), and in perilesional skin of patients with systemic LE. However, low sensitivity and poor concordance between histological and clinical diagnoses warrant a review of the application of the LBT in the diagnosis of LE. To assess the sensitivity and specificity of the LBT in diagnosing LE following clinico-pathological correlation (CPC). All cases sent to our pathology department between 2011 and 2018 for DIF with a clinical query of LE were reviewed. Data collection included demographic details, pathology requests, histology and DIF reports, clinical reports and diagnoses, and serology. Of 256 histology requests, 9% (n=23) had a positive LBT. This was discordant with the prevalence of LE diagnosis, as 46.3% were diagnosed with LE following CPC. The sensitivity and specificity of the LBT for LE was 17.6% and 98.8% respectively, with a positive predictive value of 92.9% and negative predictive value of 58.2%. The LBT is not a sensitive diagnostic test for LE, but is highly specific, and should be considered as a supportive diagnostic tool for LE. This is the largest reported case series evaluating the efficacy of the LBT in the diagnosis of LE.

Differential diagnoses of benign eyelid tumors in children and adolescents

The clinical diagnosis as well as the treatment approach of periocular tumors in childhood and adolescence can be challenging. Knowledge of the most important differential diagnoses and their clinicopathological correlation is helpful for the treatment approach. The clinical and histological characteristics of various eyelid tumors in childhood and adolescence are presented taking the excision frequencies into consideration. The frequencies and clinicopathologic correlation of the most important eyelid tumors (n = 485) are presented based on the data of the ophthalmopathology laboratory of the University Eye Hospital Bonn from 1998-2023. The most frequent tumor in childhood and adolescence is chalazion (57.3%), followed by dermoid cysts (16.7%) and molluscum contagiosum (9.6%). Other lesions of childhood and adolescence include pilomatrixoma (2.1%), hemangioma and other vascular malformations (4.7%) and rare differential diagnoses, such as subcutaneous calcifying nodules and xanthogranuloma. Guidance on the approach in different age groups is presented in the form of adecision tree. Tumors in children and adolescents are mostly benign, yet there are important indications for excision. A histological examination of any excised tissue in childhood and adolescence is obligatory because unexpected findings are not uncommon and the spectrum of lesions also differs from that in adulthood. Knowledge of the histological picture can be very helpful in the preoperative clinical classification and for planning further procedures.

Assessment of Intratumoural and Stromal Infiltrating Lymphocytes In The Various Subtypes of Breast Carcinoma Patients who have Received Neoadjuvant Chemotherapy.

Breast cancer comprises a highly heterogeneous subset of tumours that respond well to Neoadjuvant Chemotherapy (NAC). Tumour Infiltrating Lymphocytes (TIL) act as a means to an end by shedding light on the treatment response as well as predictive factors to the clinicopathological features for the same. Therefore, this article attempts to shift the attention to the relevance of TIL in the aforementioned aspects by bringing to notice the contrasting traits displayed by them in the different immunohistochemical subtypes of breast carcinoma. 75 triple-negative breast cancer (TNBC) patients, 25 human epidermal growth factor receptor (HER2BC) positive patients and 77 hormone receptor (HRBC) positive breast cancer patients were included in this study who received NAC before surgical excision of the tumour which was then stained using routine Haematoxylin and Eosin techniques. Standardised guidelines were used to evaluate TIL in the stroma and the tumour. In TNBC, a significant association between Intratumoural (IT) TIL (p=0.0288) and Intrastromal (IS) TIL (p=0.0250) with pathological complete response (pCR). IS TIL and age at operation (p=0.0494) showed significant values but no correlation was found with IT TIL. In HER2BC, IS TIL revealed a significant association with the tumour response(p=0.0229). A strong association was found between IT TIL and the age of menopause(p=0.0441). In HRBC, no significant associations were found between IT and IS TIL scores and the clinicopathological features. The predictive factors of TIL and complete response post-neoadjuvant chemotherapy can be a strong indicative factor for immunohistochemical markers. It also helps throw light on further studies which can be carried out to determine the clinicopathological features and TIL correlation in the various subtypes of breast carcinoma.

DP09 The lupus band test: a review of the sensitivity and specificity in the diagnosis of lupus erythematosus

Abstract The lupus band test (LBT) is a direct immunofluorescence (DIF) technique which shows a band of localized immunoglobulins at the dermoepidermal junction in lesional, non-sun-exposed skin of patients with both systemic (SLE) and cutaneous lupus erythematosus and in the perilesional skin of patients with SLE. However, low sensitivity and poor concordance between histological and clinical diagnoses warrant a review of the application of the LBT in the diagnosis of lupus erythematosus (LE). The aim of this study was to assess the sensitivity and specificity of the LBT in diagnosing LE following clinicopathological correlation (CPC). All cases sent to our pathology department between 2011 and 2018 for DIF with a clinical query of LE were reviewed. Data collection included demographic details, pathology requests, histology and DIF reports, clinical reports and diagnoses and serology. Of 256 histology requests, 9.0% (n = 23) had a positive LBT. This was discordant with the prevalence of LE diagnosis, as 46.3% were diagnosed with LE following CPC. The sensitivity and specificity of the LBT for LE were 17.6% and 98.8%, respectively, with a positive predictive value of 92.9% and negative predictive value of 58.2%. The LBT is not a sensitive diagnostic test for LE, but is highly specific and should be considered as a supportive diagnostic tool for LE. This is the largest reported case series to evaluate the efficacy of the LBT in the diagnosis of LE.