Common Histopathological Pattern Research Articles

Clinicopathological correlation of patients with lupus nephritis: Data from a tertiary center in Saudi Arabia.

Systemic lupus erythematosus mainly affects young women, and approximately half of systemic lupus erythematosus patients develop lupus nephritis (LN). However, data on the types and remission rates of LN in Saudi Arabia are limited. Therefore, we aimed to highlight the LN remission rates in our population. A retrospective record review was conducted between January 2007 and December 2020 in a tertiary center in the western region of Saudi Arabia to determine the remission rates among patients with biopsy-proven LN who met the EULAR\ACR 2019 classification criteria. We identified 59 patients with biopsy-proven LN, mostly in young women. The common histopathological pattern was Class IV LN in 26 patients (44%). Three induction protocols were identified, along with systemic steroids: the high-dose cyclophosphamide protocol in 21 patients (35.6%), low-dose protocol in 4 patients (6.8%), and mycophenolate mofetil (MMF) in 41 patients (69.5%). Partial response, defined as the reduction of the 24-hour proteinuria by 25% at 3 months and 50% at 6 months, was achieved in 18 patients (33.3%) at 3 months and decreased to 13 patients (24.1%) at 6 months. Complete clinical response, defined as 24-hour urinary protein between 500 and 700 mg at 12 months, was achieved in 44 patients (81.5%). Complete remission was higher among patients with Class IV LN (64.4%). The achievement of partial clinical response at 3 months was significantly lower among patients with hypertension (P = .041). This study presented the LN remission rates in a single center in Saudi Arabia. Similar to previous studies, Class IV LN were the most common histopathological finding in this study. Complete remission at 12 months was achieved in 44 (81%) patients. Delayed remission is associated with hypertension at the time of LN diagnosis.

Evaluation of histopathological patterns of testicular biopsies in azoospermic patients: A study of 3 years in Al-Najaf Center

Abstract Background: Testicular biopsy is still considered the main dependable technique required for the assessment of azoospermic patients. Many studies have been done to explore the main changes that occurred in testicular tissue related to the status of azoospermia. Little has been written and published in our country, so this study has been conducted to look for how much the histopathological pattern plays a role in the assessment of azoospermic testicular biopsy. Objectives: To evaluate the most common histopathological patterns of testicular specimens from male patients in whom the chief complaint is azoospermia and to categorize each case according to the Modified Johnson’s scoring system. Materials and Methods: A cross-sectional study, including a review of 180 male patients with a history of infertility with azoospermia or cryptorchidism, aged 18–60 years, submitted for histopathological examination, in Al-Najaf center for histopathology, during a period of 3 years (2020–2022). Results: A total of 180 cases of testicular biopsy from azoospermic patients were evaluated. The most frequent type is germ cell maturation arrest (84 cases) (46.67%) which is further categorized into early and late arrest with a spermatogenesis score 3–7 according to the Modified Johnson’s score. The second most frequent type is germ cell aplasia/sertoli cell-only syndrome (54 cases) (30%) with spermatogenesis scored as 2. Conclusion: This study has recognized four histopathological patterns of testicular biopsies in the case of azoospermia and identified that germ cell maturation arrest was the most frequent pattern in our population.

Desquamative interstitial pneumonia: If there is smoke there is fire

Desquamative interstitial pneumonia (DIP) is a rare type of idiopathic interstitial lung disease (ILD) predominantly seen in smokers. Connective tissue diseases (CTDs) are one of the important causes of ILD and may have lung involvement antedating their usual manifestations, making the diagnosis difficult. Interstitial pneumonia with autoimmune features (IPAFs) are ILDs having autoimmune features but not fulfilling the criteria for a definite CTD. A small minority of IPAF cases may progress to CTD–related ILD over a period. Usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia are common radiological and histopathological patterns associated with IPAF. DIP is a rare manifestation of IPAF. Patients with IPAF and a non-UIP pattern may benefit from immunomodulation. We present a rare case of DIP in a nonsmoker, who was initially labeled as idiopathic ILD but eventually evolved into IPAF and exhibited a good response to immunosuppressive treatment.

Histopathologic Aspects of Malignancy-Associated Granuloma Annulare: A Single Institution Experience.

Granuloma annulare (GA) is a benign, self-limiting granulomatous inflammatory disease that exhibits different histologic patterns. Infrequently, granuloma annulare can be associated with malignancy, the so-called malignancy-associated granuloma annulare (MGA). In this study, we aimed to compare the clinical and histopathological differences between GA and MGA. We retrospectively reviewed patient charts and identified 35 patients diagnosed with GA and concurrent hematological or solid organ malignancies as a case group. Additionally, we identified 33 patients without any known solid organ or hematological malignancy as a control group. MGA is commonly seen in the seventh decade of life, while GA affects the younger population. MGA is most commonly presented in the extremities of the body. The most common malignancy associated with MGA was chronic lymphocytic leukemia. Prostate cancer was the most common type of solid organ malignancy that was associated with MGA. The most common histopathological pattern seen in MGA was interstitial, comprising half of the cases. Multinucleated giant cells were present in half of the MGA cases and in most of the control group. In the literature, there are no established features that distinguish MGA from GA. Although MGA and GA have overlapping features, in our series, we found that the interstitial pattern was more common in MGA, while the necrobiotic pattern was more common in GA.

Histopathologic Patterns of Ovarian Tumors in Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia.

In Ethiopia, there is no national-level cancer registry except capital Addis Ababa, and little research was performed on ovarian tumors. This study is aimed at assessing different histopathologic patterns of ovarian tumors and their distribution based on age, biological behavior, and gross findings at a tertiary-level hospital in Ethiopia. In this study, 187 biopsy-confirmed ovarian tumors from September 2017 to August 2021 were included. All data were collected from the pathology department report format, classified according to the latest World Health Organization (WHO) classification system, and analyzed using SPSS 20.0 and Microsoft Excel 2010 at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia. A total of 187 women with ovarian tumors were included in this study. Of these, 143 (76.5%) were benign, 35 (18.7%) were malignant, and 9 (4.8%) were borderline tumors. Both benign and borderline tumors mostly occur at the age of 20-39 years. Surface epithelial tumors were the most common histopathologic pattern at 57.8% followed by germ cell tumors at 29.4% and sex cord-stromal tumors at 11.7%. Mature cystic teratomas were the most common benign ovarian tumors accounting for 37.8% of them, while serous cystadenocarcinomas were the most common malignant ovarian tumors accounting for 31.4% of malignant neoplasms. In the current study, surface epithelial tumors were the most common ovarian tumors followed by germ cell tumors. Younger age at presentation was observed for malignant ovarian tumors.

POST MENOPAUSAL BLEEDING PATTERNS IN PREDICTION OF ENDOMETRIAL CARCINOMA

Objective: To determine the demographic profile, patterns of bleeding and histopathological patterns of endometrial biopsy in women presenting with postmenopausal bleeding. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, CAIMS, Karimnagar from October 2020 to April 2022. Material and Methods: This descriptive cross-sectional study included women of any parity and age >45 years who had spontaneous cessation of menstruation for the last one year and who presented with abnormal uterine bleeding. Premenopausal women, drug or irradiation induced, or iatrogenic menopause cases were excluded. All patients were admitted, transvaginal ultrasound done (cut off endometrial thickness >4mm) and subjected to dilatation and curettage under anesthesia and endometrial biopsies obtained. Samples were sent for histopathology and followed. Results: A total of 70 women were included. Commonest age group was 61-70 years, and was seen in 38 (54.3%) women, followed by the 52-60 years age group where 18 (25.7%) subjects were observed. Mean age was 62 ± 2.54 years. Twenty-four (35%) women were hypertensive while Type 2 Diabetes Mellitus (T2DM) was seen in 14 (20%). forty (57%) women complained of streaks of blood on the sanitary pad, and in 56 (80%) (P=0.032) there were recurrent episodes. Forty-eight (68.57%) women were multiparous. Atrophic endometrium was the most common benign histopathological pattern, seen in 18 (26%) followed by 16 (23%) chronic endometritis. Endometrial carcinoma was seen in 16 (23%). (p=0.041) Conclusion: Postmenopausal bleeding is an alarming symptom and should be thoroughly investigated with transvaginal ultrasound followed by endometrial biopsy for timely diagnosis and treatment.

The Histopathological Patterns of Ovarian Neoplasms in Different Age Groups: A Retrospective Study in a Tertiary Care Center.

Objectives Ovarian cancer is one of the most prevalent neoplasms worldwide and it affects women of all ages. This study aimed to identify the common histopathological patterns of ovarian cancer among different age groups in the western region of Saudi Arabia. Methods This was a retrospective study that reviewed all ovarian specimens diagnosed as "ovarian tumors" by the Pathology Department from January 2016 to December 2020 at King Abdulaziz University Hospital, Saudi Arabia. The frequencies of ovarian neoplasm subtypes and their frequencies in different age groups were calculated. Results Out of 565 ovarian specimens studied, 63.2% were ovarian neoplasms while 36.8% were non-neoplastic functional cysts. Benign neoplasms 64.4% were more common than borderline 6.2% and malignant ones 29.4% in all age groups, except above the age of 60. Collectively as a category, surface epithelial neoplasms were the most common (59.4%). However, germ cell tumor in the form of mature cystic teratoma was the most common benign neoplasm 33.9% and the most common malignant was serous cystadenocarcinoma (40%). Conclusion Documenting new trends of histopathological patterns of ovarian neoplasms helps to detect variation among different age groups and to understand probable predisposing factors. This study found that the percentage of ovarian malignancy has increased over the years in the western region of Saudi Arabia. This signifies the need to increase awareness in order to achieve timely diagnosis and management.

Testicular histopathology and associated factors in men with non-obstructive azoospermia

The testicular histopathological characteristic in azoospermic men can significantly help in the diagnosis, prognosis and treatment of infertile patients. This study assessed the pathology specimens of 88 azoospermic infertile men seen at Hanoi Medical University Hospital. The most common histopathological pattern was Sertoli cell-only syndrome (40.9%), followed by hypospermatogenesis (29.5%) and Germ cell maturation arrest (18.1%). There were significant differences in the mean testicular volume and serum concentrations of LH and FSH among patients with different histopathology patterns. Analysis using multinomial logistic regression model showed only FSH was significantly associated with the severity of histopathological pattern. Each unit increase in the level of FSH was associated with a 7.1% increase in the odds of a more severe histopathology (95%CI: 1.01 - 1.12).

Transbronchial Lung Cryobiopsy for Diagnosing Interstitial Lung Disease: A Retrospective Single-Center Experience.

Background An accurate diagnosis in patients with interstitial lung diseases (ILDs) by multidisciplinary discussion (MDD) based on histopathologic information is essential for optimal treatment. Transbronchial lung cryobiopsy (TBLC) has increasingly been used as a diagnostic alternative to surgical lung biopsy. This study aimed to evaluate the appropriate methods of TBLC in patients with ILD in Korea.Methods A total of 27 patients who underwent TBLC were included. TBLC procedure details and clinical MDD diagnosis using TBLC histopathologic information were retrospectively analyzed.Results All procedures were performed under general anesthesia with the fluoroscopic guidance in the operation room using flexible bronchoscopy and endobronchial balloon blocker. The median procedure duration was less than 30 minutes, and the median number of biopsies per participant was 2. Most of the bleeding after TBLC was not severe, and the rate of pneumothorax was 25.9%. The most common histopathologic pattern was alternative (48.2%), followed by indeterminate (33.3%) and usual interstitial pneumonia (UIP)/probable UIP (18.5%). In the MDD after TBLC, the most common diagnosis was idiopathic pulmonary fibrosis (33.3%), followed by smoking-related ILD (25.9%), nonspecific interstitial pneumonia (18.6%), unclassifiable-ILD (14.8%), and others (7.4%).Conclusion This first single-center experience showed that TBLC using a flexible bronchoscopy and endobronchial balloon blocker with the fluoroscopic guidance under general anesthesia may be a safe and adequate diagnostic method for ILD patients in Korea. The diagnostic yield of MDD was 85.2%. Further studies are needed to evaluate the diagnostic yield and confidence of TBLC.

Kidney outcomes of immune-complex associated mesangiocapillary glomerulonephritis in patients with and without HIV

Introduction: HIV-associated kidney diseases continue to be a major problem in South Africa. Objectives: We aimed to determine the kidney outcomes of immune-complex associated mesangiocapillary glomerulonephritis (MCGN) in patients with and without HIV. Patients and Methods: A retrospective cohort study was conducted on all adult patients with a kidney biopsy diagnosis of immune-complex associated MCGN from 1 January 2000 to 31 December 2016. We compared the proportion of HIV-positive and HIV-negative patients that reached the composite endpoint of either doubling of the serum creatinine or end-stage kidney disease. Cox proportional hazards models were employed to examine the association between the composite endpoint and predictor variables. Results: A total of 79 patients were included of which 20 (25.3%) were HIV-positive. Twentyfour patients (30.4%) reached the composite endpoint. The cumulative proportions reaching the composite endpoint at one and four years were 25.3% and 30.4% with no difference between HIVpositive and HIV-negative patients (45.0% versus 25.4%, respectively; P= 0.10). Multivariable Cox proportional hazards model identified estimated glomerular filtration rate at biopsy (hazard ratio [HR] = 0.92; 95% confidence interval [CI]: 0.84-1.00, P=0.04) and proteinuria at follow-up (HR = 1.60; 95% CI: 1.21-2.11, P<0.01) as predictors of the composite endpoint at one-year. On survival analysis, there was no difference in the composite endpoint for HIV status (P=0.09; log-rank). Conclusion: Immune-complex associated MCGN continues to be a common histopathological pattern of injury at our center. Due to late presentation, kidney outcomes remain poor, regardless of HIV status.

Histomorphological Spectrum of Endometrial Tissue in Abnormal Uterine Bleeding

Introduction: Abnormal Uterine Bleeding (AUB) is a very common presenting complaint in patients visiting the gynaecologists all over the world. Though common, AUB can cause tremendous physical as well as emotional distress to the patient. Aim: To study the histomorphological pattern of endometrium in patients with AUB. Materials and Methods: This study was a retrospective study conducted during a six month period from October 2021 to March 2022 in the Department of Pathology at Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India, on 210 endometrial tissue samples of women who presented with AUB. Specimens that were received during a one year period between March 2019 and February 2020 were processed routinely and stained using Haematoxylin and Eosin stain. Detailed microscopic evaluation was done and eleven different histopathological diagnoses were made. The data collected was entered into Microsoft Excel sheet and percentages were analysed manually. Results: Maximum number of cases of AUB were seen in the 41-50 years age group. The most common histopathological pattern in this study was proliferative phase seen in 67 cases (31.90%) followed by endometrial hyperplasia which was seen in 42 cases (20.00%). The other important patterns included pregnancy related complications, 32 (15.24%), secretory phase, 24 (11.43%), disordered proliferative endometrium, 14 (6.67%), chronic endometritis 11 (5.24%) and hormonal/pill endometrium, 8 (3.81%). Endometrial malignancy was diagnosed only in one case (0.48%). Conclusion: A wide variety of histopathological patterns were found in endometrial samples in AUB across different age groups. Histopathological examination of endometrium is an important tool in the diagnosis and management of AUB.

Correlation of Histopathological Metastatic Invasive Prognosticators with Five Years Survival of Oral Squamous Cell Carcinoma

Background: OSCC is the 3rd widespread malignancy in India followed by cervical and breast cancer. Histopathological findings in the tumor are the most prominent factors identified for OSCC progression. Clinical and histopathological prognosis in OSCC like perineural invasion, vascular invasion, lymph node invasion have been studied extensively by many researchers separately or in combination since many years. Bone invasion, muscle invasion and salivary gland invasion are explored less. In order to collectively correlate the role of all prognosticators with 5 years survival, the later prognosticators are included in our study in isolation which may predict accurately the probability of 5 year survival of OSCC. Also we have to search role of the prognosticator which is most commonly affecting 5 years survival of OSCC cases so that it may modify the potential consequence of management of OSCC.
 Objectives: The aim of this study is to assess the relevance of histopathological invasive prognosticators on 5 years survival of oral squamous cell carcinoma (OSCC) patients visiting Sharad Pawar Dental College and Hospital, Sawangi, Wardha (MS).
 Methodology: Departmental reports will be screened and specimen mounted slides of histopathologically diagnosed 200 OSCC patients, who undergone surgical resection will be observed under binocular microscope. Data of dead and survived OSCC patients undergone surgery 5 years back will be collected by telecommunication. Histopathological invasive prognosticators will be analyzed and correlated with 5-years survival after treatment.
 Expected Results: 
 
 Collectively correlating the role of histopathological invasive prognosticators in our study may predict the probability of 5 years survival of OSCC cases more accurately.
 Discovering diversed histopathological patterns of all metastatic prognosticators and their correlation with 5 years survival.
 Identification of most effective histopathological invasive prognosticator predicting 5 year survival.
 
 Conclusion: The most commonly found prognosticators in OSCC patients who died within 5 years versus others who survived for 5 years will be discovered.
 In addition the most common histopathological pattern related to dead and survived patients after 5 years will be found which can modify the potential consequence of management of OSCC.

Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study

BackgroundCutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized.MethodsWe evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns.ResultsOf 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym “V-REPP” (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5).LimitationsCases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence.ConclusionClinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.

Renal Involvement and HBV Infection Are Common in Chinese Patients With Cryoglobulinemia.

Objectives: This study aimed to describe the main characteristics of Chinese patients with cryoglobulinemia, especially the characteristics of patients with different causes of cryoglobulinemia.Methods: Eighty inpatients diagnosed with cryoglobulinemia from different wards in Peking Union Medical College Hospital were included in this study. Demographic, clinical, biological, and renal pathological data were collected. We analyzed the characteristics of 61 patients with different causes of cryoglobulinemia.Results: Most patients (36/80, 45%) were diagnosed between 40 and 60 years of age. The male: female ratio was 1:1.5. Mixed (II + III) cryoglobulinemia accounted for the majority (43.8%) of cases. Renal involvement (87.5%), cutaneous involvement (57.5%), and fever (27.5%) were the most common clinical manifestations, while other manifestations included serositis and pulmonary and gastrointestinal involvement. The most common renal histopathological pattern was membranoproliferative glomerulonephritis (25/42, 59.5%). The secondary causes of cryoglobulinemia included infectious diseases (26/61, 32.5%), such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and connective tissue diseases (22/61, 27.5%), such as lupus and hematologic tumors (13/61, 16.3%). Patients with hematologic tumors were diagnosed at an older age (P = 0.044) and mostly had type I cryoglobulinemia (P < 0.001). No significant difference in clinical or biological manifestations was found among patients with different causes of cryoglobulinemia.Conclusions: This is the largest cohort of Chinese patients with cryoglobulinemia. We found that renal involvement and HBV infection might be more common in Chinese patients with cryoglobulinemia.

Cutaneous malignant melanoma in skin of color individuals

Cutaneous malignant melanoma (CMM) is a malignancy with a worldwide incidence. Literature is replete in the Caucasian population, but in skin of color, there is a dearth of literature. Documented reports of the epidemiology of cutaneous melanoma reveal a low incidence in the skin of colour individuals (SCIs). However, this incidence is rising. It is also documented that when CMM does occur, it is commonly acral, unlike in Caucasians in whom it is truncal, and the most common histopathological pattern is acral lentiginous melanoma. There are as yet no observed differences in the histopathology of melanoma in individuals with skin of color and that in Caucasians. SCIs have a low awareness of CMM with consequently advanced lesion presentation, ulcerated lesions, and poor survival compared to Caucasians. The genetics of CMM in the skin of color has not been well studied. The only available study of the genetics of melanoma reveals a difference in melanoma genetics between SCIs and Caucasians. In SCIs, due to the low incidence of cutaneous melanoma, cutaneous melanoma is commonly misdiagnosed. This misdiagnosis can be both clinical and histopathological. Awareness of the features of cutaneous melanoma and sun protection practices is poor in individuals with skin of color. A high index of suspicion should be entertained of any hyperpigmented lesion in any SCI, especially if it is acral and a histopathological assessment should be made as early treatment improves survival.

Endometrial pathology in postmenopausal women: Analysis of 112 cases in tertiary care centre

Background: Postmenopausal bleeding is a frequent finding accounting for 5-10% of women in gynaecology clinic. About 10% of these patients have primary or secondary malignancy. Aim: The histopathological patterns of endometrium, in postmenopausal women presenting with bleeding were studied along with the frequency of endometrial cancer. Materials and Methods: It was both a prospective and retrospective, observational study carried out over a period of one and half year in tertiary care teaching hospital on 112 postmenopausal women, above 40 year of age with history of one year of amenorrhoea without hormone replacement therapy. The samples were obtained by dilatation and curettage and endometrial pipelle procedure. Results and Discussion: Maximum patients belonged to age group of 46-50 year. The most common histopathological pattern observed was atrophic endometrium in 42 (37.5%) patients followed by simple hyperplasia in 13(11.6%) and endometrial polyp in 7(6.25%) cases. Irregular shedding of endometrium was diagnosed in 8 case (7.14%). The maximum patients of endometrial carcinoma (5.35 %) were noted in 61-65 age groups. Inflammatory pathology was found in 4(3.56%) and atypical hyperplasia was seen a single case (0.89%). In 8 cases, the opinion could not be offered due to inadequacy of sample. Conclusion: As the incidence of malignancy in postmenopausal period remains sufficiently high, it requires immediate investigation in the form of endometrial sampling for early diagnosis, prompt treatment and vigilant follow up. Keywords: Postmenopausal bleeding, Histopathology, Endometrial cancer.

Increasing BMI is a risk factor for developing pre diabetes hyperglycemia and Diabetes

Background: Postmenopausal bleeding is a frequent finding accounting for 5-10% of women in gynaecology. About 10% of these patients have primary or secondary malignancy. Aim: The histopathological patterns of endometrium, in postmenopausal women presenting with bleeding were studied along with the frequency of endometrial cancer. Materials and Methods: It was both a prospective and retrospective, observational study carried out over a period of one and half year in tertiary care teaching hospital on 112 postmenopausal women ,above 40 year of age with history of one year of amenorrhoea without hormone replacement therapy. The samples were obtained by dilatation and curettage and endometrial pipelle procedure. Results and Discussion: Maximum patients belonged to age group of 46-50 year. The most common histopathological pattern observed was atrophic endometrium in 42(37.5%) patients followed by simple hyperplasia in 13(11.6%) and endometrial polyp in 7(6.25%) cases. Irregular shedding of endometrium was diagnosed in 8(7.14%). The maximum patients of endometrial carcinoma (5.35 %) were noted in 61- 65 age groups. Inflammatory pathology was found in 4(3.56%) and atypical hyperplasia was seen a single case (0.89%). In 8 cases, the opinion could not be offered due to inadequacy of sample. Conclusion: As the incidence of malignancy in postmenopausal period remains sufficiently high, it requires immediate investigation in the form of endometrial sampling for early diagnosis, prompt treatment and vigilant follow up. Keywords: Postmenopausal bleeding, Histopathology, Endometrial cancer.

Direct comparison of magnetic resonance imaging and pathological shrinkage patterns of triple-negative breast cancer after neoadjuvant chemotherapy

BackgroundWe aimed to investigate the usefulness of magnetic resonance imaging (MRI) and histopathological shrinkage patterns to formulate a predictive equation for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC) patients.MethodsWe enrolled 34 TNBC patients who underwent MRI before and after NAC. The MRI and histopathological shrinkage patterns were analyzed and classified into five categories—types I and II (concentric shrinkage without or with surrounding lesions, respectively), type III (shrinkage with residual multinodular lesions), type IV (diffuse contrast enhancement in the entire quadrant), and non-visualization. The residual tumor sizes following MRI and histopathological examination were also compared.ResultsThe most common MRI and histopathological shrinkage pattern was type I (41.2% and 38.2%, respectively), followed by non-visualization (26.5% and 32.4%, respectively); the concordance rate between MRI and histopathological shrinkage patterns was 41.2%. There was a strong correlation between MRI tumor size and pathological tumor size (r = 0.89). Based on these findings, a predictive equation for pathological tumor size was formulated as follows: pathological tumor size (mm) = 1.1502 × (MRI tumor size [mm]) + 8.4277.ConclusionsOur equation may aid accurate preoperative assessment. Further studies are needed to determine its predictive value and applicability.

A Clinicopathologic Review of 21 Cases of Head and Neck Primary Tuberculosis

A diagnosis of tuberculosis (TB) of the head and neck has been a dilemma for clinicians, because the clinical and pathologic features tend to mimic different pathologies. Our study aimed to identify the demographic, clinical, and pathologic features of head and neck TB to help healthcare providers in the early detection of the disease. We performed a retrospective analysis using the medical archives at the pathology laboratory. Twenty-one patients with a clinical and pathologic diagnosis of head and neck TB were identified from 2010 to2019. The age distribution was broad, with 28.5% of the patients younger than 15years old. Seven patients had oral TB, with the most common sites affected the labial vestibule (3 cases) and buccal vestibule (3 cases), followed by 1 case in the tongue. The predominant clinical presentation was ulceration, and the most common entity in the clinical differential diagnosis was squamous cell carcinoma. The most common histopathologic pattern of oral TB was a noncaseating granuloma. Most of the tuberculous lymphadenitis was located in the submandibular and submental areas. TB of the head and neck region is not, as previously thought, a rare condition. Head and neck TB, in general, and oral TB, in particular, are great mimickers of different pathologic entities. In particular, the absence of the typical histopathologic pattern of TB granuloma has made the diagnosis more complicated. Healthcare providers must be vigilant and consider all the demographic, clinical, and histopathologic features to detect the disease earlier, because an early diagnosis can result in better outcomes.

P0506PATTERNS AND OUTCOMES OF GLOMERULAR DISEASES IN ADULTS PRESENTING TO MANSOURA UNIVERSITY HOSPITAL: A SINGLE-CENTER PROSPECTIVE STUDY

Abstract Background and Aims Glomerular diseases (GDs) impose a substantial burden on patients and health care systems, and they are considered a major cause of end-stage renal disease (ESRD) worldwide. Morbidity and mortality have shown to be substantially higher in patients with GDs than in the general population. In Egypt, there is yet no available national registry for GDs, and GDs outcome is not adequately studied. Therefore, it is of considerable interest to study patterns and outcomes of GDs in our locality. Method Patients with features suggesting GDs presenting to Mansoura nephrology and dialysis unit (MNDU) were recruited in this study between 1 July 2017 and 30 June 2018, and those with biopsy-proven GDs were prospectively followed up for a minimum of 6 months or until either death or reaching ESRD. ESRD was defined as initiation of long-term dialysis or eGFR persistently &amp;lt;15 ml/min per 1.73 m2 during follow up visits. Enrolled patients were subjected to through history taking and clinical examination. Biopsies were independently examined by two pathologists blinded to the clinical data. The study outcomes were to identify the GDs subtype frequencies, and to identify the frequency of those achieving either renal recovery, progression to ESRD or death from all-cause mortality. Logistic regression analysis was carried out to identify the potential predictors for renal recovery. Results Sixty-six patients (21 males and 45 females) with biopsy-proven GDs were included and completed the required period of follow up. The median age of the studied patients was 32 years (IQR 23 - 46.45). Fifty percent of the cases had hypertension and only one patient had was diabetic. The main indications for renal biopsy were unexplained kidney function decline (62%) followed by subnephrotic (23%) and nephrotic presentation (15%). Diffuse proliferative GN followed by MPGN and sclerosing GN were the most frequently encountered histopathological patterns. Primary and secondary GDs constituted 30.3% and 69.7% respectively. Lupus nephritis (LN) was the most common cause of secondary GDs and class IV LN was the most frequently encountered class accounting for 16 cases (51.6%) of patients with lupus. By the end of 6-month follow up, renal recovery was achieved in 30 patients (45.5%), 21 patients (31.8%) progressed to ESRD and 7 patients (10.6%) had died. Urban residency and total renal chronicity score were the most significant predictors of renal recovery. Conclusion Diffuse proliferative GN is the most common histopathological pattern, and secondary GDs, particularly those related to lupus, are more frequently encountered than primary GDs in our center. Unfortunately, quick complete recovery is not the rule and is possibly predictable by less chronic changes in biopsy.