Correct Pathological Diagnosis Research Articles

A Unique Case of Cystic Partially Differentiated Nephroblastoma Associated With Botryoid Intralobar Nephrogenic Rests.

Cystic partially differentiated nephroblastoma (CPDN) is a rare pediatric renal tumor composed of multiple cystic spaces divided by septa containing immature nephrogenic elements. The presence of expansile solid areas in the septa of such a lesion indicates an alternative diagnosis of Wilms tumor (WT). We present a unique case of CPDN associated with grossly visible polypoid proliferations, which histologically correspond to botryoid growth of intralobar nephrogenic rests. Correct pathological diagnosis of CPDN and its differentiation from cystic WT can be challenging, but is critical, because of the distinct treatment approaches and prognoses of these entities, since CPDN is a low-risk tumor not requiring further postoperative therapy.

A Case Series of Children With Medulloblastoma Depicting the Disparities in Care and the Challenges in the Detection and Treatment of Pediatric Central Nervous System Tumors in Low-Resource Settings: A Case Study of Uganda

BackgroundPrimary central nervous system tumors are the second most common cancer among children in high-income countries (HICs). These tumors are also the leading cause of cancer-related deaths in children in this setting. Studies from HICs report gliomas as the most common pediatric cancer. However, there is paucity of data from low- and middle-income countries as not many publications have been made in this field. MethodsThe objective was to describe the disparities in detection, treatment, and survival of children with central nervous system tumors in low-income countries (LICs) when compared with HICs, using a case series. A retrospective chart review of three children treated for medulloblastoma in Uganda was done. In addition, a review of the literature about management of pediatric central nervous system tumors in both LICs and HICs was conducted. ResultsThere are no quantifiable results for this case series. ConclusionThere are notable differences in the quality of care for children with pediatric central nervous system tumors in LICs when compared with HICs. In Uganda, the challenges in management of these children include few multidisciplinary specialists, long distance from the neurosurgery centers, and difficulties in making a correct pathologic diagnosis, among others.

Mesothelioma: molecular pathology and biomarkers.

Diffuse mesotheliomas are characterized by recurrent genomic alterations involving tumor suppressors and epigenetic regulators such as BAP1, CDKN2A, MTAP, and NF2. Depending on the differential diagnosis as informed by histologic assessment, one can apply the appropriate immunohistochemical and/or molecular panels to reach the correct pathologic diagnosis, sometimes even in cases with limited tissues. Biomarkers aid in the diagnosis of mesothelioma in the following scenarios: 1)For atumor that is overtly malignant, how can one distinguish mesothelioma from other tumors? 2)For amesothelial proliferation, how can one distinguish mesothelioma from areactive process? To distinguish mesotheliomas from carcinomas, at least two positive and two negative markers are currently recommended. To distinguish sarcomatoid mesothelioma from pleomorphic carcinoma, even more markers-and sometimes molecular testing-are needed. To distinguish mesothelioma from reactive mesothelial conditions, useful immunohistochemical biomarkers include BAP1, MTAP, and merlin, which serve as surrogates for the corresponding gene mutation status. In patients with unusual clinical history, for tumors with apeculiar microscopic appearance, and/or in cases with an equivocal immunophenotypic profile, molecular testing can help to exclude mimics and to confirm the pathologic diagnosis.

Emergency right lower lobectomy for severe pulmonary abscess in a pregnant woman at the 25th week of gestation: a case report

BackgroundPulmonary abscess is a severe infection commonly seen in patients with chronic obstructive pulmonary disease, interstitial pneumonia, immune deficiency disease, drug-induced immunocompromised state, and congenital pulmonary disease. The treatment strategy in pregnant women with a pulmonary abscess is considered challenging since adverse effects on the fetus must be avoided to ensure safe delivery.Case presentationA 34-year-old female patient at 24 weeks of gestation (G2P1) was admitted to the Department of Obstetrics and Gynecology due to sudden right chest pain. The patient had no significant medical history, including congenital anomalies, and no history of drug addiction or smoking. Laboratory data indicated high levels of inflammation (white blood cell 12,000/µL, C-reactive protein 16.0 mg/dL), and computed tomography demonstrated a large intrapulmonary cyst located in the middle of the right lower lobe, with some fluid collection. As the patient had no medical history of congenital pulmonary anomalies, she was initially diagnosed with a pulmonary cyst infection and treated with intravenous antibiotics. However, the infection did not resolve for over a week, and a spike in fever developed after admission. There was no definitive evidence concerning the risk of preterm delivery and fetal abortion during non-obstetric surgery. However, to control the severely infected pulmonary abscess that was refractory to antibiotics and obtain a pathological diagnosis while saving the life of both the mother and fetus, we elected to perform an emergent right lower lobectomy by open thoracotomy with a fissureless maneuver after receiving informed consent. Postoperatively, the infection gradually improved, and the patient was discharged on the 16th postoperative day without any major complications in the mother or fetus. Although she later experienced coronavirus disease-19 at 29 weeks of gestation, a boy was born at 40th weeks of gestation without any complications. Pathologically, no infectious agents, malignancies, or congenital anomalies other than lung abscesses associated with the pulmonary infarction were observed. The mother and child were healthy 1 year postoperatively.ConclusionsWe experienced a rare case of a pulmonary abscess in a pregnant woman who needed an emergent right lower lobectomy to control the severe infection and obtain a correct pathological diagnosis. Under cooperation from an obstetrician and anesthesiologist, emergency pulmonary resection can be performed safely for serious abscess formation even for pregnant women who have several months left until delivery.

Mammary myofibroblastoma: a clinicopathological analysis of fifteen cases

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of breast myofibroblastoma. Methods: The clinicopathological data and prognostic information of 15 patients with breast myofibroblastoma diagnosed at the Department of Pathology of the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China from 2014 to 2022 were collected. Their clinical characteristics, histological subtypes, immunophenotypes and molecular characteristics were analyzed. Results: There were 12 female and 3 male patients, ranging in age from 18 to 78 years, with a median and average age of 52 years. There were 6 cases in the left breast and 9 cases in the right breast, including 12 cases in outer upper quadrant, 2 cases in inner upper quadrant and 1 case in outer lower quadrant. Most of the cases showed a well-defined nodule grossly, including pushing growth under the microscope in 13 cases, being completely separated from the surrounding breast tissue in 1 case, and infiltrating growth in 1 case. Among them, 12 cases were classic subtype and composed of occasional spindle cells with varying intervals of collagen fiber bundles; eight cases had a small amount of fat; one case had focal cartilage differentiation; one case was epithelioid subtype, in which epithelioid tumor cells were scattered in single filing or small clusters; one case was schwannoma-like subtype, and the tumor cells were arranged in a significant palisade shape, resembling schwannoma, and one case was invasive leiomyoma-like subtype, in which the tumor cells had eosinophilic cytoplasm and were arranged in bundles, and infiltrating into the surrounding mammary lobules like leiomyoma. Immunohistochemical studies showed that the tumor cells expressed desmin (14/15) and CD34 (14/15), as well as ER (15/15) and PR (15/15). Three cases with histologic subtypes of epithelioid subtype, schwannoma-like subtype and infiltrating leiomyoma-like subtype showed RB1 negative immunohistochemistry. Then FISH was performed to detect RB1/13q14 gene deletion, and identified RB1 gene deletion in all three cases. Fifteen cases were followed up for 2-100 months, and no recurrence was noted. Conclusions: Myofibroblastoma is a rare benign mesenchymal tumor of the breast. In addition to the classic type, there are many histological variants, among which the epithelioid subtype is easily confused with invasive lobular carcinoma. The schwannoma-like subtype is similar to schwannoma, while the invasive subtype is easily misdiagnosed as fibromatosis-like or spindle cell metaplastic carcinoma. Therefore, it is important to recognize the various histological subtypes and clinicopathological features of the tumor for making correct pathological diagnosis and rational clinical treatment.

Clinical Features of Pituitary or Parasellar Tumor Onset with Cranial Nerve Palsy: Surgical Intervention Considerations

This study aimed to clarify the symptoms of pituitary or parasellar tumor onset with cranial nerve palsy (CNP) and to improve our knowledge of this rare symptom and its most appropriate treatment. Among 1281 patients with pituitary or parasellar tumors surgically treated from 2003 to 2020, 30 cases (2.34%; 15 men and 15 women; mean age: 55.6years, range: 6-83years) first presenting with CNP were reviewed to evaluate the neurological symptoms, histological diagnosis, interval from onset to surgery, and time before complete CNP recovery. Pathological diagnoses comprised 17 pituitary adenomas, including 10 pituitary apoplexies and 4 adrenocorticotropic hormone-positive adenomas, and 13 other tumors, including 3 chordomas, 2 xanthogranulomas, 2 malignant lymphomas, 2 metastatic tumors, 1 Rathke cleft cyst, 1 plasmacytoma, 1 craniopharyngioma, and 1 neuroendocrine carcinoma. The mechanisms causing CNP were pituitary apoplexy (n= 10), cranial nerve compression or involvement (n= 17), and inflammatory changes (n= 9). As the first manifestation, 20 (66.7%) patients presented with oculomotor nerve palsy, 2 (6.7%) with trochlear nerve palsy, and 13 (43.3%) with abducens nerve palsy. Full recovery of CNP was obtained in 25 patients (83.3%) after surgery alone and in 2 patients (6.7%) after adjuvant therapy. Early surgery provided no significant difference in full recovery rates although it reduced the time to reach full recovery. It is critical to determine the mechanisms of CNP and intervene surgically to improve symptoms, shorten the duration of the disorder, prevent relapses, and obtain the correct pathological diagnosis to select the proper adjuvant therapy.

Low-grade papillary Schneiderian carcinoma with TP53 mutation: a case report and review of the literature

BackgroundLow-grade papillary Schneiderian carcinoma (LGPSC) is a relatively new entity of the sinonasal tract and is characterized by a bland morphology simulating sinonasal papilloma, invasive growth pattern with pushing borders, and aggressive clinical behavior with multiple recurrences and metastatic potential. Recently, DEK::AFF2 fusions were identified in LGPSC. However, some LPGSCs lack DEK::AFF2 fusion, and the molecular features of these tumors have not been clarified.Case presentationA 69-year-old man presented with a discharge of pus from his left cheek. Computed tomography revealed a mass involving the left maxillary sinus, ethmoid sinus, and nasal cavity with the destruction of the orbital wall. The biopsy specimens showed that the tumor had a predominantly exophytic, papillary growth and did not have an apparent stromal invasion. The tumor was composed of multilayered epithelium that showed bland morphology with a round to polygonal shape, abundant eosinophilic cytoplasm, and uniform nuclei. Dense neutrophilic infiltrates were focally present. Immunohistochemically, CK5/6 was strongly and diffusely positive, and p16 was negative. p63 was mainly positive in the basal layer, and EMA was predominantly expressed in the outermost cell layer. DNA-based targeted sequencing showed TP53 R175H mutation, whereas neither EGFR nor KRAS mutation was identified. Reverse transcription polymerase chain reaction and fluorescence in situ hybridization revealed no DEK::AFF2 fusion.ConclusionsWe describe the first case of TP53-mutant LGPSC and review the literature. LGPSC is a genetically heterogeneous entity, and the recognition of this rare entity and comprehensive assessment of clinicopathological and molecular findings are crucial for the correct pathological diagnosis and clinical management.

Breast Sarcomas-How Different Are They from Breast Carcinomas? Clinical, Pathological, Imaging and Treatment Insights.

Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease in the form of a retrospective case series study including discussion of clinical, imaging, and pathological features and treatment. We also compare the main clinical and biological features of six cases of BS (phyllodes tumors were excluded) with a cohort of 184 patients with unilateral breast carcinoma (BC) from a previous study performed at our institution. Patients with BS were diagnosed at a younger age, presented no evidence of lymph node invasion or distant metastases, had no multiple or bilateral lesions, and underwent a shorter length of hospital stay versus the breast carcinoma group. Where recommended, adjuvant chemotherapy consisted of an anthracycline-containing regimen, and adjuvant external radiotherapy was delivered in doses of 50 Gy. The comparison data obtained from our BS cases and the ones with BC revealed differences in diagnosis and treatment. A correct pathological diagnosis of breast sarcoma is essential for the right therapeutic approach. We still have more to learn about this entity, but our case series could add value to existing knowledge in a meta-analysis study.

Reducing misdiagnosis of Alzheimer’s Disease pathology utilizing CSF and amyloid PET

AbstractBackgroundUtilizing cognitive tests alone, including the Mini‐Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), cannot detect the presence of amyloid plaques and tangles in Alzheimer’s disease (AD). While in late stages of AD clinical diagnosis relying primarily on cognitive testing is correct 70‐90% of the time, in MCI accuracy is reduced to 50‐60%. Although autopsy is the gold standard for AD diagnosis, amyloid PET imaging and more recently the Lumipulse Gβ‐Amyloid Ratio (Aβ1‐42/Aβ1‐40) are validated to determine amyloid pathology. With the upcoming availability of disease modifying therapies targeting amyloid in MCI and early AD, and anti‐tau drugs in the pipeline, it is necessary to have true measures of AD pathology for a clinical evaluation early in the disease process. Here we examine the performance of cognitive testing alone for identification of amyloid positivity in MCI patients from the ADNI study when compared to amyloid PET and CSF testing.MethodA subset of 170 CSF samples from the ADNI biobank (all MCI; ≥ 50 years old; amyloid PET negative (n=74) or amyloid PET positive (n=96)) was used to examine correlation of PET, CSF and MMSE/MoCA scores. Amyloid PET images were derived from an FDA approved tracer (Florbetapir F18) and method. CSF Aβ1‐42 and Aβ1‐40 were measured using the LUMIPULSE G1200 (Fujirebio).ResultAt a set cutoff of 0.058, Aβ1‐42/Aβ1‐40 demonstrated a PPA and NPA of 85.9% and 93.5% respectively for identifying amyloid PET status in individuals suffering from cognitive complaints. When examining the Aβ1‐42/Aβ1‐40 ratio of the MCI patients compared to amyloid PET in ADNI, Aβ1‐42/Aβ1‐40 achieved an AUC of 0.90. Alternatively, the MMSE score and MOCA score had AUCs with amyloid PET of 0.61 and 0.63 respectively and exhibited poor correlation with CSF.ConclusionCSF measurements or amyloid PET provide greater accuracy in determining amyloid status than cognitive screening tests. MMSE or MoCA as standalone tests give low confidence in a correct pathological diagnosis for MCI patients. Moving forward it will be important to consider PET or CSF results to determine underlying pathology in patients with MCI to ensure proper treatments and avoid unwanted side effects.

ALK rearrangement-associated renal cell carcinoma morphologically mimicking mucinous tubular and spindle cell carcinoma: a case report

BackgroundAnaplastic lymphoma kinase rearrangement-associated renal cell carcinoma (ALK-RCC) is an extremely rare tumor and ALK-RCC that mimics mucinous tubular and spindle cell carcinoma (MTSCC) has been very reported only in one instance.Case presentationA 42-year-old Japanese woman was admitted to our hospital for the treatment of a left renal tumor measuring 5 cm in maximum dimension. She underwent a laparoscopic left nephrectomy. Histologically, the tumor formed tubular or focally papillary structures with a small amount of spindle-shaped tumor cells against the background of prominent extracellular mucin. Although the tumor cells were negative for immunohistochemistry (IHC) of alpha-methylacyl-CoA racemase (AMACR) and lymph node metastasis was presented (these are atypical findings for MTSCC), we initially diagnosed the tumor as MTSCC based on its morphological characteristics with mucin deposition. However, an additional IHC analysis revealed that the tumor cells were diffusely positive for ALK-IHC. In addition, TPM3 exon 8 – ALK exon 20 fusion gene was detected by RNA sequencing. The tumor was thus correctly diagnosed as ALK rearrangement-associated renal cell carcinoma (ALK-RCC).ConclusionsSince the use of molecular targeted therapy with an ALK inhibitor for ALK-RCC is promising, the correct pathological diagnosis of ALK-RCC is quite important. We strongly recommend that ALK-IHC be routinely performed for renal tumors with negative AMACR staining that mimic MTSCC.

Myofibroblastoma of the Breast: Diagnosis, Pathology, and Management.

Myofibroblastomas are rare benign spindle cell tumors that occur within both male and female breasts. They are composed of fibroblasts and myofibroblasts and are not associated with malignant potential. On mammographic and sonographic imaging, these tumors may present as oval circumscribed masses that overlap with the appearance of many benign entities, including fibroadenomas. Occasionally, the tumors may demonstrate interval growth or mimic imaging features of malignancy and require biopsy. Correct pathologic diagnosis is important because many morphologic variants exist, which complicates pathologic interpretation. The purpose of this article is to review the range of imaging manifestations and histopathological findings and to discuss current management.

Implementación de la medicina de precisión en el diagnóstico anatomopatógico

he precision medicine has to be based on 3 pillars: 1. In a correct pathological diagnosis. 2. In precise tumor staging.3. In the application of biomarkers associated with targeted therapy. Therefore, for the first step to implement a correct precision medicine is mandatory to optimize the pathological diagnosis, which goes through the digitization of the images, which allow telepathology and the application of computational pathology algorithms to objectify the quantification of biomarkers in tissue sections. In relation to molecular studies, it is mandatory to study NGS in most lung, colon and melanoma tumors, as well as sarcomas and brain tumors for their differential diagnosis. To implement NGS technology and extend it to the largest possible number of patients, it is essential to concentrate molecular studies in a few centers that can allow more experience for biologists and pathologists, and also optimize the cost per sample. In Catalonia, by government decision, 5 pathological anatomy laboratories have been selected to carry out all the molecular sequencing studies of a community of almost 8 million inhabitants. The hospitals which depend on our Institution send us the samples and we return the molecular study in a week The results obtained must be integrated into the pathological diagnosis of the referral hospital. Joint molecular committees are held weekly with the reference centers. This network concentration of pathological and molecular studies allows this molecular study to be extended to the entire population with a similar quality, regardless of their place of residence.

Spindle cell tumors of the pleura and the peritoneum: pathologic diagnosis and updates.

A diverse group of both benign and malignant spindle cell tumors can involve the pleura or the peritoneum. Due to their rarity and overlapping morphologic features, these tumors can pose considerable diagnostic difficulty in surgical pathology. As these tumors differ in their prognosis and clinical management, their correct pathologic diagnosis is critical. In addition to histologic assessment, select immunohistochemical and molecular tools can aid the distinction among these tumors. In this review, we consider some of the major histologic differential diagnosis of spindle cell tumors involving these serosal membranes. This list of tumors includes solitary fibrous tumor, inflammatory myofibroblastic tumor, desmoid fibromatosis, synovial sarcoma, sarcomatoid carcinoma, spindle cell melanoma, dedifferentiated liposarcoma, epithelioid hemangioendothelioma, and sarcomatoid mesothelioma. We describe their salient clinicopathologic and genetic findings, with a review on some of the recent discoveries on their molecular pathogenesis.

Odontogenic Keratocyst Is Frequently Misdiagnosed for a Lateral Periodontal Cyst in Premolar and Anterior Tooth-Bearing Areas

IntroductionRadiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of odontogenic keratocyst (OKC) in a location preoperatively favoring a lateral periodontal cyst (LPC) with similar clinical and radiographic appearance. MethodsA retrospective analysis of biopsies received from 2011 and 2019 was performed, and the number of LPC and OKC cases was assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed, and the number of OKC cases preoperatively misdiagnosed as LPCs was identified. ResultsA total of 79,257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histologic diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions. ConclusionsRadiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

Primary Tumors of the Pituitary Gland: Radiologic-Pathologic Correlation.

Primary tumors of the pituitary gland are the second most common histologic category of primary central nervous system tumors across all age groups and are the most common in adolescents to young adults, despite originating from a diminutive endocrine gland that is often described as "about the size of a pea." The vast majority of these represent primary tumors of the adenohypophysis, specifically pituitary adenomas, which can be either functional or silent with regard to hormone hypersecretion. According to the fourth edition of the World Health Organization classification of endocrine tumors, published in 2017, cellular lineage and immunohistochemical stains for pituitary hormones and/or transcription factors help with making the correct pathologic diagnosis. From a radiologic standpoint, microadenomas pose challenges for accurate detection and avoiding false-negative or false-positive results, while macroadenomas pose challenges from local mass effect on surrounding structures. Pituitary carcinoma and pituitary blastoma also arise from the adenohypophysis and are characterized by metastatic disease and infantile presentation, respectively. While primary tumors of the adenohypophysis are common, a second category comprising primary tumors of the Rathke pouch (ie, craniopharyngioma) are uncommon, and a third category comprising primary tumors of the neurohypophysis (eg, pituicytoma) are rare. The authors review all three categories of pituitary tumors, with emphasis on radiologic-pathologic correlation, including the typical neuroimaging, histologic, and molecular features that may point toward a specific diagnosis. Work of the U.S. Government published under an exclusive license with the RSNA.

Histopathology of Non-IBD Colitis. A practical approach from the Italian Group for the study of the gastrointestinal tract (GIPAD).

SummaryNon-IBD colitides (NIBDC) are intestinal diseases clinically and endoscopically overlapping with Inflammatory Bowel Diseases (IBD), sometimes with a similar histological picture. NIBDC include entities such as infectious colitis, ischemic colitis, pseudomembranous colitis, eosinophilic colitis, autoimmune enterocolitis, segmental colitis associated with diverticulosis, drug-induced colitis, radiation-induced colitis, diversion colitis, and microscopic colitis, this last including two entities: collagenous and lymphocytic colitis. The knowledge of the most useful histological features and the main clinical data for each entity is mandatory in daily clinical practice, for correct pathological diagnosis and clinical management.

Ovarian Neoplasms: Clinicopathological Spectrum in Tribal Rajasthan, India

Introduction: Ovarian neoplasms have increased in incidence in leading sites of cancer in five old population based cancer registries on comparing first ten and last ten years data. All three germ layers are afflicted in process of ovarian neoplasm- ceolomic epithelium, germ cell and sex chord/stromal cells. Due to this, ovarian masses are spread widely over all age groups. However, a correct pathological diagnosis goes a long way in management of the disease and consequent benefit to patient. Aim: To assess the histopathological pattern, age, laterality and distribution of ovarian tumours in a tertiary care centre of tribal part of Rajasthan. Materials and Methods: Retrospective hospital based study wherein 157 ovarian specimens received in Department of Pathology of Geetanjali Medical College and Hospital, Udaipur, Rajasthan over a period of three years were studied after obtaining permission from ethical committee. Details such as age, signs and symptoms, laterality were retrieved from patient file. Only benign, borderline or malignant ovarian neoplasm specimens removed surgically were included. Physiological cysts were excluded. Descriptive statistics were used and results were expressed as percentages. Results: Out of 157 ovarian neoplasms, 42 (26.75%) were from hysterectomy specimen, 44 (28.03%) from planned cystectomy for mass, 71 (45.22%) from cytoreductive surgery or tissue obtained from Exploratory Laparotomy. A 63.06%, 33.76% and 3.18% of neoplasms were benign, malignant and borderline, respectively. Extremes of age lied between 14 to 84 years. Mean age for benign, malignant and borderline tumours respectively was 38.60 years (SD=15.21), 47.79 years (SD=14.53) and 38.4 years (SD=14.04), respectively. Unilateral tumours were clearly in abundance with 85.35%. Right-sided tumours were more (49.04%). Surface Epithelial Tumours (SET’s), Germ Cell Tumour (GCT’s) and Sex Chord Stromal Tumours (SCSCT’s) were 59.24%, 34.39% and 6.37%, respectively. Out of 10 cases, 60% were malignant (Granulosa cell tumour). No metastatic tumour was seen during the study period. Conclusion: To effectively reverse the trend in a developing country like India each and every gynaecologist should be aware and well versed with histo-morphological pattern of ovarian neoplasms specific to a region.

Metastases to the Stomach: Clinicopathologic Features of Metastases Mimicking Gastric Primaries.

Metastatic involvement of the stomach is a rare event. Our aim in this study was to document the clinicopathological findings in patients with gastric metastases and find out if there are any potentially significant features to be used in the differential diagnosis. Our cohort consisted of 17 histologically verified gastric metastasis cases. Clinical, endoscopic and microscopic features were retrospectively analyzed. The primary sites were the breast, skin, lungs, ovaries, colon, and gluteal soft tissue. Three patients were symptomatic because of the metastatic involvement of the stomach and 9 patients had concomitant metastasis in other sites. Invasive lobular breast carcinoma and malignant melanoma were the most common metastatic malignancies. The most common macroscopic appearance was the diffuse infiltrative type (Borrmann Type 4). Most of the metastatic lesions endoscopically mimicked primary gastric cancer. Furthermore, some of the metastatic lesions, particularly invasive lobular carcinoma of the breast and malignant melanoma, displayed histopathologic features similar to the primary gastric malignancies to a certain extent. The possibility of metastatic involvement of stomach must be kept in mind while dealing with a gastric mass lesion in a cancer patient, even though the clinical and endoscopic features suggest primary gastric cancer. Our study points out the importance of conveying the information about medical history and clinical findings of the patients for correct pathologic differential diagnosis.

Dedicated Cytopathologists vs Community Pathologist Significantly Affects Overall Diagnostic Accuracy of Endoscopic Ultrasound Guided Sampling of Solid Pancreatic Lesions: Outcomes From a Large Healthcare System

Endoscopic ultrasound (EUS) is the most sensitive modality in detecting solid lesions of pancreas and is commonly performed for staging, and tissue acquisition. Correct pathologic diagnosis is crucial for timely diagnosis and initiation of therapy in cases of pancreatic adenocarcinoma and could preclude surgery for conditions (i.e. autoimmune pancreatitis) that mimic pancreatic cancer. Aim of our study was to evaluate overall impact of dedicated cytopathologists (DC) versus community pathologists (CP) on overall diagnostic accuracy of EUS guided tissue sampling. EUS fine needle aspiration (FNA) or biopsy (FNB) is currently performed in 6 out of 14 hospitals in our health care system. In only one of the academic tertiary care hospital, EUS FNA is being interpreted by 4 dedicated cytopathologist. In the remaining 5 hospitals, EUS FNA is being interpreted by community pathologists. Total 19 endosonographers performed over 3000 EUS between 2015 to 2019. From this prospective maintained database, we retrospectively reviewed EUS FNA cases for pancreatic solid lesions (PSLs) and collected data regarding patient demographics, PSL size, needle gauge, needle type, adequacy of the obtained sample, the percentage of diagnostic samples and diagnostic accuracy. A total of 575 procedures were performed across the entire hospital system. Mean age of the study population was 65+14. Total of 259 EUS FNA cases were reviewed by CP compared to 316 by DC. EUS FNA samples were more frequently reported as inadequate by CP 63/259 (24.3%), compared to DC 46/316 (14.6%) (p < 0.01). Similarly, overall diagnostic accuracy of EUS FNA was much lower when evaluated by CP 182/259 (70.3%), compared to DC 256/316 (81%) (p < 0.01). In one of the community hospitals, 16 EUS FNA were performed by academic endosonographers and interpretation was done by CP. For the same academic endosonographers, diagnostic yield with CP was 11/16 (68.7%) compared to 270/316 (85.5%) with DC. Our study concludes that EUS-FNA/FNB procedures when performed with dedicated cytopathologist not only improves the diagnostic accuracy but also reduces the chances of inadequate sampling or non-diagnostic results. This approach thereby avoids the necessity of repeating the invasive procedure as well as the delay in accurate diagnosis. Based on this results, further quality improvement initiative will be undertaken to improve overall diagnostic accuracy of EUS-FNA/FNB across the entire hospital system.Tabled 1Table 1DiagnosticCPDCTotalp-valueNo77 (29.7%)60 (14.6%)137 (16.9%)<0.01Yes182 (70.3%)256 (81%)438 (76.2%)Total259316575AdequateCPDCTotalp-valueNo63 (24.3%)46 (14.6%)109 (18.9%)<0.01Yes196 (75.7%)270 (85.4%)466 (81,1%)Total259316575 Open table in a new tab

Concurrent m\xfcllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding: a rare case report and review of the literature

BackgroundMüllerianosis is a very rare neoplasm composed of two or three Müllerian derived tissues (endosalpinx, endometrium and endocervix). We report the first case of concurrent müllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding.Case presentationA 43-year-old Asian premesopausal female, gravida 1, para 1, presented with intermittent umbilical bleeding. An umbilical nodule and a bladder tumor on the posterior wall of the urinary bladder were identified. She underwent transurethral resection of the bladder tumor and excision of the umbilical nodule successively. Diagnosis of müllerianosis was confirmed by the histological and immunological features. No tumor recurrence was noted at 6 months of follow-up.ConclusionsMüllerianosis is extremely rare and mainly reported in the urinary bladder, and generally affects women of reproductive age. Despite the common presentations of müllerianosis of the urinary bladder including irritative voiding symptoms, abdominal/pelvic pain and gross hematuria, our rare case had no symptom except umbilical bleeding. The possibility of concurrent bladder müllerianosis should be considered when müllerianosis is found at other location. We suggest a surgical intervention to establish the correct pathological diagnosis because it is essential to exclude malignant neoplasms of the urinary bladder. The majority of patients have a favorable prognosis.