Department Of Anatomical Pathology Research Articles

Cyclin‐dependent kinase 12‐mediated super‐enhancers as promising targets in cancer therapy

Cyclin‐dependent kinase 12‐mediated super‐enhancers as promising targets in cancer therapy

Discrepancies between clinical diagnoses and autopsy findings: A comparative study conducted in South Africa.

The anatomical pathology autopsy serves several purposes, notably as a quality management tool for evaluation of accuracy in clinical diagnosis. Despite its value, for various reasons there has been an international decline in autopsies conducted. In the modern medical era, with all its advances in technology, diagnostic techniques and interventions, there is still a high discrepancy between clinical diagnoses and postmortem findings. To establish the discrepancies between clinical diagnoses and postmortem findings in anatomical pathology autopsies. A retrospective, descriptive study was conducted over the 4-year-period 2014 - 2017. The clinical diagnoses and postmortem findings of cases referred to the Department of Anatomical Pathology at the University of Pretoria, South Africa, were evaluated and compared using the modified Goldman criteria. A total of 288 cases qualified for the study and were evaluated. The gender distribution was 155 (53.8%) male and 133 (48.2%) female, with the majority of cases in the age group 19 - 60 years (mean 36.4). The majority of the cases were referred by internal medicine, followed by paediatrics. The most common cause of death in major missed diagnoses was pulmonary conditions. Of the cases, 115 (39.3%) had a major discrepancy and 62 (21.5%) a minor discrepancy. This study showed that there is still a high discrepancy between clinical diagnoses and postmortem findings, similar to studies conducted globally. The current COVID-19 pandemic may be a driver for revival of the anatomical pathology autopsy, and future studies are recommended to evaluate whether the decline can be reversed.

Evaluation of PD-L1 expression in vulvar cancer

Background: The PD-1/PD-L1 inhibitory immune checkpoint seems to have a significant prognostic impact in the evolution of certain cancers such as bronchopulmonary cancer, breast cancer, lymphomas etc. Indeed, it has been suggested that PD-L1 expression was associated with a worse prognosis due to its immunosuppressive activity within tumor tissue. Currently, the evaluation of the expression of these biomarkers is of increasing interest in gynecological cancers. Hence, we proposed to study the expression of PDL1 in vulvar cancer. Our aims were to study the expression profile of PD-L1 in vulvar cancer by immunohistochemistry and to correlate its expression with overall and relapse-free survival rates. Methods: This is a retrospective study conducted at the pathological anatomy and cytology department of the Saleh Azaiez Institute, Tunis, Tunisia involving 55 patients followed for vulvar cancer over a period of 13 years from 2008 to 2021. Clinicopathologic data was collected from medical records and pathology reports. Results: PD-L1 expression in vulvar squamous cell carcinoma was observed in 44% of cases. This expression was noted in 33% of cases in tumor cells and in 11% of cases in lymphocytes. The median follow-up period was 40 months. During this period, 30% of patients relapsed. For all recurrence cases, 77% were during the first two years. The overall survival rate was 68.4% at two years and 50.3% at five years. The recurrence-free survival rate was 63.8% at five years. Overall survival as well as recurrence-free survival were more reduced in the case of PD-L1 expression. However, this difference was not significant (p=0.07). Conclusions: These results, although insufficient, emphasize the prognostic value that PDL1 could play in vulvar cancer as described in the literature. Despite the low numbers and the unavailability of data for some cases, our results encourage carrying out this work on larger populations.

Using a Specimen Resource Aid to Reduce Intraoperative Specimen Errors.

Specimen management is a critical component of safe patient care. Incorrect results or misdiagnoses may cause delayed or improper treatment and delayed or adverse outcomes. We piloted a quality improvement project to address labeling errors in a surgical suite at a large Midwestern academic medical center. We created a gynecology-specific source aid to assist intraoperative team members define the tissue source according to anatomic location and pathology department regulations. The aid also provided tips on preparing and transporting specimens. Staff member feedback showed that the source aid was user-friendly and helpful. Most specimen errors after the implementation of the aid were related to nonreportable, fixation delays; and we implemented a second phase to address the delays. Collaboration and education during this project fostered staff member empowerment to manage specimens effectively using the source aid and promote safe patient care.

What are the problems with the current staging of discontinuous tumour nodules (DTNs) in colorectal carcinoma? Is there a better way?

Discontinuous extramural tumour nodules (DTNs) are deposits of metastatic carcinoma in soft tissue not associated with lymph nodes. Although they are established as an adverse prognostic factor in colorectal carcinoma (CRC), under the AJCC eighth edition staging system their presence does not upstage patients who also have lymph node metastases. Counterintuitively, in some situations the presence of lymph node metastases may in effect downstage a patient with DTNs from pN1c to pN1a/b. Therefore, we sought to critically assess the significance of DTNs in a large unselected single institution cohort of patients undergoing surgical resection for CRC. Of 3822 CRC patients undergoing surgical resection from 2005 to 2021, DTNs were present in 686 (18.0%). In univariate (HR=2.687, 95CI 2.355-3.065; p<0.001) and multivariate analysis (HR=1.805, 95CI 1.529-2.132; p<0.001) in a model including age, gender, stage, grade, location, lymph node ratio and apical lymph node status, DTNs were associated with worse overall survival (OS). N1c patients (DTN present but no nodal metastasis) demonstrated worse OS compared to the current pN1a group (p<0.001) and were least different to the current pN2a group (p=0.571). Within the current N1a (p=0.013), N1b (p=0.004) and N2a (p=0.002) groups, patients who also had DTNs had worse OS. DTNs were associated with worse OS for all stage III CRCs combined (p<0.001), and for stage IIIB (p<0.001) and stage IIIC (p=0.007) individually. We conclude that DTNs are an independent adverse prognostic factor that should be considered in the staging system in a way that is additional to (rather than integrated with) the number of involved lymph nodes. We then assess a simple suggestion for how this could be achieved by increasing the overall stage by one group in the presence of DTNs (requiring the creation of a new stage IIID).

Histomorphological and Demographic Profile of Breast Carcinoma in Anatomical Pathology Department FKUI/RSCM 2016-2019

BackgroundInvasive breast carcinoma (IBC) is the most commonly diagnosed cancer in woman in the world and Indonesia. IBC is classified into two main categories: IBC of no special type (NST) and special types. This retrospective study aims to provide histomorphological profile of mastectomy cases of IBC in Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital (PA FKUI/RSCM) 2016-2019.MethodsThis is a descriptive research with cross-sectional design of mastectomy cases, using secondary data from the archives of PA FKUI/RSCM, starting from 2016- 2019. Collecting clinical data as well as observing several histopathologic parameters including histological type, grade, atypical mitotic features, lymphovascular invasion, and lymph node metastases. Tumour classification was made based on the WHO breast criteria in 2019.ResultsDuring the 2016-2019 period there were 144 cases of IBC. 99.3% of cases occurred in female patients, mostly in the age group from 40 to 59 years and unilateral. The majority had tumour sizes ranging &gt;2-5 cm and were stage II. About a third of cases had received neoadjuvant chemotherapy, most commonly in advanced local stage tumors. Most histologic type (65.3%) were IBC of NST and 52.8% of cases were grade 2. There were 92 (63.4%) cases with atypical mitotic features, most commonly found in stage III. Lymphovascular invasion was found in 38.9% of cases and lymph node metastasis was found in 63.2% of cases.ConclusionIBC is the most common cancer in woman, with the most common histologic type were IBC, grade 2, stage II or more. Most of the cases show atypical mitosis, which is most commonly found in stage III. The findings of lymphovascular invasion did not always coincide with the findings of lymph node metastases.

Diagnostic Accuracy and Analysis of Cytomorphological Images of Fine Needle Aspiration Biopsy in Salivary Gland Lesions Based on The Milan System for Reporting Salivary Gland Cytology (MSRSGC) Classification

BackgroundFine needle aspiration cytology (FNAC) is an effective, simple, and safe method of assessing salivary glandular lesions. The diagnosis of FNAC can be challenging for pathologists because of the heterogeneous morphological spectrum and overlapping of cytomorphologic salivary glands. The aim is to determine the diagnostic accuracy and analyze the cytomorphology of salivary glands aspiration based on The Milan System for Reporting Salivary Gland Cytology (MSRSGC).Methods A search for cytological preparations for salivary gland lesions in 2015-2019 was carried out in the archives of the Department of Anatomic Pathology, FKUI/RSCM. There were 215 cases of cytology of salivary gland lesions which re-evaluated and classified based on MSRSGC. There were 106 cases of cytologic-histopathologic paired data, 25 of which were excluded because the specimens were not filled the criteria for re-examination.ResultsThere were 81 cases of salivary gland lesions since 2015-2019 which were assessed and reclassified based on MSRSGC, consisting of 8 non-diagnostic, 1 non-neoplastic, 1 case of atypical of undetermined significance (AUS), 39 benign tumors, 10 salivary gland neoplasm of undetermined malignant potential (SUMP), 6 suspicious for malignancy (SFM) and 16 malignant tumors. Three of these cases had a different diagnosis result in false-negative on non-diagnostic and benign tumors. The sensitivity value was 91.17%, specificity 97.43%, positive predictive value (PPV) 96.87%, negative predictive value (NPV) 92.68% and 94.52% accuracy.ConclusionThe diagnosis of fine needle aspiration cytology can be accurately achieved by a combination of clinical information and radiologicalexamination, however a histopathologic examination is still required for definitive diganosis. MSRSGC classification is very helpful in the diagnosis of salivary gland cytology.

Relationship between Age and Gender with Histopathological Type of Nasopharyngeal Carcinoma

BackgroundNasopharyngeal carcinoma (NPC) is a malignancy with a high incidence in Indonesia. Recent studies had found several factors that influence the incidence and prognosis of NPC including age, sex, and histopathological type. This study aimed to determine the relationship between age and sex with the histopathological type of NPC.MethodsSubjects were NPC patients diagnosed by the Anatomical Pathology Department of Dr. Kariadi General Hospital Medical Center (RSUP Dr. Kariadi) from 1st January 2017-31st December 2019. Data were collected from the medical record. The relationship between age and sex with the histopathological type of NPC was examined. ResultsThere were 201 NPC patients during 2017-2019 in RSUP Dr. Kariadi. The highest number of NPC incidence was in the range of 54-59 years old. There were more males than females at the ratio of 2.24:1. Undifferentiated non-keratinizing cell carcinoma type NPC was the most common type (90.5% of NPC patients), followed by differentiated non-keratinizing cell carcinoma and squamous cell carcinoma consecutively. Both age and sex had no significant relationship with the histopathological type of NPC (p&gt;0.05).ConclusionThere was no relationship between age and sex with the histopathological type of NPC.

Stromal Tumor Infiltrating Lymphocytes (sTIL) as an Independent Predictor of Pathologic Response to Neadjuvant Chemotherapy in Breast Cancer in Indonesia: A Hospital-based Study.

We aim to describe the sTIL profiles of Indonesian breast cancer patient and its role in predicting neoadjuvant chemotherapy response. This retrospective cohort study used secondary data from the archive of Anatomic Pathology Department FMUI/CMH. We did total sampling of 62 cases of locally advanced breast cancer cases that were biopsied, had neoadjuvant chemotherapy, and operated on from 2015 to 2020. We collected the clinicopathological data of each sample, measured the sTIL intensity in the biopsy specimen and evaluated the chemotherapy response from the mastectomy specimen using residual cancer burden (RCB) scoring method. Multivariate linear regression determined the independent predictors of RCB score. There were 62 female patients, 45.2% were Luminal-HER2-, 43.5% were HER2+, and 11.3% were triple negative (TN). Most sTIL intensity (59.7%) were low (median 10%; 1%-60%). Moderate-high sTIL intensity was associated with HER2+ type, while low sTIL was with luminal-HER2- (p=0.038). Only 8.1% patients achieved pCR. Statistically different median sTIL intensity in minimal, moderate, and extensive burden group were 28%, 20%, and 8%, respectively (p=0.002). sTIL was an independent predictor for better response (lower RCB score), which were 0.07 (95% CI 0.04-0.09) lower for every 1% increase in sTIL intensity. sTIL intensity was mostly low in Indonesian breast cancer patient. However, it can predict neoadjuvant chemotherapy response, with 0.07 lower RCB score for every 1% increase of sTIL intensity.

The Magnitude of Medicolegal Postmortem That Turned Out to Be Natural Deaths at the University of Benin Teaching Hospital: A 3-Year Study.

The periodic determination of the degree to which coroner's postmortems done for medicolegal purpose turns out to be natural death is desirable because of its usefulness to health administrators in making policies that may ultimately help in focusing on the prevention/management of the causes of natural death at that particular point in time. The objective of the study was to determine the causes of natural death by a retrospective analysis of coroner's postmortem cases carried out on patients ages 19 years and above who died from natural causes. A 3-year period, retrospective postmortem study was carried out at the Department of Anatomic Pathology, University of Benin Teaching Hospital on 530 medicolegal postmortem cases ages 19 and above who died from natural causes. Natural deaths were observed in 530 cases of medicolegal postmortems. Their age ranged from 19 years to 104 years with a mean age and standard deviation of 52.82 ± 16.71 years. Cardiovascular system diseases were the most common causes of natural deaths with hypertensive heart disease being the most common underlining cause. Infections and diseases of the respiratory, gastrointestinal system/hepatic, central nervous and endocrine systems were also noteworthy. Most causes of natural deaths were in the middle ages with the noncommunicable diseases (NCDs) accounting for a significant proportion. To reduce premature death from NCDs by 2030, the World Health Organization (WHO) is promoting its prevention and management. It is our desire that our health administrators would adopt this WHO model incorporating postmortem-based data for planning of medical services.

Discordance between clinical and post-surgical staging of patients with operable non-small cell lung cancer: a retrospective audit of lung cancer surgery with curative intent from a single pathology practice

Clinical staging of non-small cell lung cancer (NSCLC) by CT and PET, with or without endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes (EBUS-TBNA), is essential for prognostication and to direct treatment. Clinical understaging can lead to inappropriate radical excision of the primary tumour with no clinical benefit, whereas overstaging might deprive patients of beneficial or potentially curable treatments. Although not widely documented, several reports have indicated a suboptimal concordance between clinical and post-surgical staging. This study has investigated the incidence of discordance between clinical and post-surgical staging of operable NSCLC cases evaluated at PathWest Fiona Stanley Hospital (Perth, WA, Australia). The study formed part of an approved Quality Improvement Activity and included patients with NSCLC who underwent lobectomy between Jan 1, 2016, and Dec 31, 2021, at hospitals serviced by the PathWest anatomical pathology department at Fiona Stanley Hospital. Data from pathology, imaging, and EBUS-TBNA or biopsy reports were retrieved from digital medical records databases and multidisciplinary meeting notes. A project database designed and established in REDCap was used to collect and analyse data. 419 patients (216 [52%] women, 203 [48%] men) in the age range of 20·5-85·8 years (median 69·2 years [IQR 63·3-74·5]) were included. EBUS-TBNA was done for 121 (29%) patients and imaging results (from CT, PET, or both) were available for 406 (97%) patients. Discordant clinical and post-surgical T and N staging were evident; post-surgical T stage was higher in 96 (23%) cases and lower in 54 (13%) cases. Eight tumours staged post-surgically as N1 had been clinically staged as N0. For ten cases with unforeseen N2 involvement, clinical staging was N0 (n=4), N1 (n=3) or not available (n=3); surgery might not have been necessary for these patients. Median times between CT and lobectomy (105 days [IQR 77·0-143·0]), PET and lobectomy (79 days [56·0-109·0]), and EBUS-TBNA and surgery (59 days [42-94]) were outside of Australian guidelines, which recommend a time to start of treatment for lung cancer of less than 42 days from initial referral. Time intervals between final screening study (imaging or EBUS-TBNA) and lobectomy before and during the COVID-19 pandemic (2016-19 and 2020-21, respectively) were significantly different (p=0·019). It is noteworthy that Western Australia had not recorded high numbers of COVID-19 cases during that time. This study has identified substantial disagreement between clinical and post-surgical staging of NSCLC. Discordance between clinical and post-surgical T and N staging might have led to different treatment pathways for some patients. To improve the accuracy of clinical staging of NSCLC, the sensitivity, specificity, and interpretation of imaging and lymph node cytology, as well as the timeliness of treatment (clinical care pathway) would each need to be evaluated. Strengths of this study include the large number and lack of selection of cases, and the small number of medical service providers. Weaknesses include the absence of outcomes data for these patients. Overall results are consistent with previous and historical investigations of hospital and clinical trial cohorts. OT is the recipient of a student scholarship from the Royal College of Pathologists of Australasia that funded this work.

Hypoxia-regulated carbonic anhydrase IX (CAIX) protein is an independent prognostic indicator in triple negative breast cancer

BackgroundThe effect of extracellular microenvironment (hypoxia and pH) has been regarded as a key hallmark in cancer progression. The study aims to investigate the effects of carbonic anhydrase IX (CAIX), a key hypoxia-inducible marker, in triple-negative breast cancer (TNBC) in correlation with clinicopathological parameters and predicting survival outcomes.MethodsA total of 323 TNBC cases diagnosed at the Department of Anatomical Pathology, Singapore General Hospital from 2003 to 2013 were used. Immunohistochemical staining (IHC) was performed using CAIX antibody and digital mRNA quantification was performed using NanoString assays. CAIX membranous expression was correlated with clinicopathological parameters using Chi-squared test or Fisher’s exact tests. Disease-free survival (DFS) and overall-survival (OS) were estimated using Kaplan–Meier analysis and compared between groups with the log-rank test.ResultsForty percent of TNBCs were observed to express CAIX protein and demonstrated significant association with larger tumour size (P = 0.002), higher histological grade (P < 0.001), and significantly worse disease-free survival (DFS) and overall survival (OS) (after adjustment: HR = 2.99, 95% CI = 1.78–5.02, P < 0.001 and HR = 2.56, 95% CI = 1.41–4.65, P = 0.002, respectively). Gene ontology enrichment analysis revealed six significantly enriched cellular functions (secretion, cellular component disassembly, regulation of protein complex assembly, glycolytic process, cellular macromolecular complex assembly, positive regulation of cellular component biogenesis) associated with genes differentially expressed (CAIX, SETX, WAS, HK2, DDIT4, TUBA4α, ARL1). Three genes (WAS, SETX and DDIT4) were related to DNA repair, indicating that DNA stability may be influenced by hypoxia in TNBC.ConclusionsOur results demonstrate that CAIX appears to be a significant hypoxia-inducible molecular marker and increased CAIX protein levels are independently associated with poor survival in TNBC. Identification of CAIX-linked seven gene-signature and its relationship with enriched cellular functions further support the implication and influence of hypoxia-mediated CAIX expression in TNBC tumour microenvironment.

Expression of Bax Protein as A Prognosis Factor of Radiotherapy Response to Decreased Tumor Size in Stage IIB-IIIB Cervical Cancer

Background: Cervical cancer plays a role as the leading cause of cancer death for women in developing countries. Radiation therapy kills cancer cells through double strand breaks and the apoptotic process. Bax protein is one of the regulators of apoptosis. This study analyzed the role of Bax expression as a prognostic factor in radiation therapy response in reducing tumor size in patients with advanced cervical cancer (IIB-IIIB). Subjects and Method: This research is a retrospective cohort observational analytic study from January 2021 to April 2021 in the Department of Obstetrics and Gynecology in collaboration with the Department of Anatomical Pathology, Dr. Moewardi Hospital, Surakarta, Indonesia. This study involved 30 cervical cancer stage IIB-IIIB patients. The level of Bax expression was determined by immunohistochemical examination. ROC curve analysis was used to find cut-off points and evaluate the sensitivity and specificity of Bax in the prognosis of radiotherapy in patients with advanced cervical cancer (IIB-IIIB). Chi square test was used to determine the relationship between Bax expression and changes in tumor size in cervical cancer patients. Results: The ROC curve analysis showed that the AUC Bax score in prognosis of radiation therapy was 0.575 (CI 95%= 0.32 to 0.83) and the cutoff point was 62.5%. Based on the analysis of the ROC curve, the Bax expression of 62.5% shows a sensitivity of 56.5% and a specificity of 71.4%. Analysis of the relationship between Bax protein expression on changes in tumor size using the Chi Square test showed a P value of 0.390 (p&gt; 0.05). Conclusion: The expression of Bax protein cannot play a role as a prognostic factor in the response of radiation therapy to the reduction in tumor size in stage IIB-IIIB uterine cervical cancer.

Histopathologic Factors Affecting Metastases to Lymph Nodes in Laryngeal Squamous Cell Carcinoma in the Department of Anatomical Pathology FKUI/RSCM 2015-2019

BackgroundLaryngeal squamous cell carcinoma (LSCC) is the second most common epithelial carcinoma of the head and neck. This carcinomahas a poor prognosis if there have been metastases in the neck lymph nodes and did not get proper therapheutical management.The aims of the study is to determine the histopathologic characteristics of LSCC with partial or total laryngectomy and neckdissection, as well as its relationship with the incidence of metastases to lymph nodes.MethodsAnalytical descriptive study with cross-sectional design of secondary data on LSCC cases obtained through total or partiallaryngectomy accompanied by neck dissection from the archives of the Department of Anatomic Pathology FKUI / RSCM fromJanuary 2015 to December 2019. The histopathological data obtained were analyzed by comparative statistical test.ResultsKSSL was more frequently found in men as much as 155 cases (94.5%) with the most common age was over 60 years old. In thisstudy, LSCC with lymph nodes metastases was found in 65 cases, the most common was tumor size &gt;4 cm in 40 cases (61.5%),medium differentiated tumors in 47 cases (72.3%), pT3-pT4 in 57 cases. (87.7%). There was a significant association betweenmetastasis to cervical lymph nodes with tumor size, poorly differentiated tumors, lymphovascular invasion and pT3-pT4.ConclusionHistopathologic factors including tumor size, pT3-pT4, poor differentiation, lymphovascular invasion are factors that play a role in theoccurrence of metastases to cervical lymph nodes in LSCC

Sinonasal Papilloma and Its Associated Malignancy: Study from a Tertiary Referral Hospital in Indonesia

Background&#x0D; Sinonasal papilloma is a benign tumor arising from Schneiderian epithelia in sinonasal mucosa. It has the propensity towards malignant transformation. This preliminary study aims to report clinicopathological aspects of sinonasal papilloma and its malignant transformation rate.&#x0D; Methods&#x0D; A descriptive, cross-sectional study was conducted in Anatomical Pathology Department, FKUI/RSCM over a period of 2014-2019) A total of 127 histologic specimens with diagnosis of sinonasal papilloma obtained from 80 cases.&#x0D; Results&#x0D; The prevalence of sinonasal papilloma among all sinonasal neoplasms is 17.6%. Inverted papilloma was the most common histologic type 91.3%, exophytic papilloma 6.3% and oncocytic papilloma 2.5%, among male (70%), age rate 50 years old. Malignant transformation of squamous cell carcinoma 12.5%, and recurrence 21.3%, nasal congestion was the most complaint 50%. Cases were usually in T3 of Krouse stage 37.5% and managed with functional sinus endoscopic surgery 51.3%. Histological parameters were grade II 54.4%, surface keratinization 17.5%, bony trabeculae 41.3%, nasal polyps 20% and dense lymphocytic infiltrates 53.8%, foam cell infiltrates 2.5%. Mild to moderate dysplasia 8.8% and severe dysplasia 18.8%.&#x0D; Conclusion&#x0D; Sinonasal papilloma was rare sinonasal benign tumor. Inverted papilloma type was local aggressive, recurrence, dysplastic and malignant transformation, among male, age 50 years old, main complaint of nasal congestion, in Krouse stage T3, and managed by Functional Sinus Endoscopy Surgery (FSES

Association between Clinicopathological Profile and Recurrence of Invasive Breast Carcinoma in Anatomical Pathology FKUI/RSCM

ABSTRACTBackgroundBreast cancer is the most common malignancy and the leading cause of death in women. Invasive breast carcinoma is a breastmalignancy originating from the glandular epithelium of the breast. Approximately 40% of invasive breast carcinomas had recur.There are several factors that influence the occurrence of recurrence, such as age, tumor size, lymphovascular invasion, incisionmargins, hormonal status and therapy. This study aims to determine the clinicopathological profile associated with recurrence 5years after therapy for invasive breast carcinoma.MethodsThis study is a retrospective study with data collection carried out through the archives of the Department of Anatomical Pathology,Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital within a period of 2 years (2014-2015). Theclinicopathological data was searched for up to 5 years of therapy.ResultsFrom the 54 cases of invasive breast carcinoma in this study, all were women with mean age 48.3 years. A total of 18 cases(33.3%) experienced recurrence, especially in patients aged ≤50 years, tumor mass size more than 2 cm and luminal B moleculartype. Tumor margin is difficult to evaluate because many review cases do not submit the tumor margin section. Therapy received bypatients was in accordance with standard procedures’ hospital, both neoadjuvant and adjuvant chemotherapy. From the statisticalanalysis, there was no significant relation between all profiles that studied with recurrence. It is because the comparison of numberof recurrent and non-recurrent cases is not equal.ConclusionOne third of advanced invasive breast carcinomas treated with neoadjuvant and showing a partial response have recurrence,whereas no complete response has recurrence. Tumor size, histologic grade, molecular type and adherence to routine follow-uptreatment influenced the recurrence within 5 years of treatment.

Diagnostic Accuracy and Cytomorphological Analysis of Biliary Brush and Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) of the pancreas based on The Papanicolaou Society of Cytopathology System

BackgroundEndoscopic ultrasound guided fine needle aspiration (EUS-FNA) of the pancreas and biliary brushes is a minimally invasive method ofcytology sampling. The purpose of this study was to determine the sensitivity, specificity, and accuracy of examination of biliary brushcytology and EUS-FNA pancreas based on the System of standardized terminology and nomenclature for pancreatobilliary cytology(STNPC) as well as cytology characteristics of pancreatic malignancy.MethodsA search of the biliary brush preparation and EUS-FNA pancreatic in 2017-2020 was carried out in the Archives section of the Department ofAnatomical Pathology FKUI / RSCM. 506 cases of biliary brush cytology and EUS-FNA pancreatic, conducted a search of histopathologicalpreparations and re-categorized based on STNPC.ResultsCytological cases of biliary brushing and pancreatic EUS-FNA paired with histopathology in 2017-2020 151 cases, 85 cases of biliarybrushing and 66 cases of pancreatic EUS-FNA, were re-categorized based on STNPC with results of biliary brushing 27 non-diagnosticcases, 24 atypical cases, 7 suspicious for malignancy (SFM) cases and 17 malignant cases. Meanwhile, for pancreatic EUS-FNA cytology16 non-diagnostic cases, 2 negative cases, 16 atypical cases, 3 other neoplasms, 4 SFM cases and 25 malignant cases. Twenty sevencases of false negative biliary brushes on non-diagnostic and atypical preparations and 4 cases of false negative on pancreatic EUS-FNA onnon-diagnostic and atypical preparations. Biliary brushing diagnostic test results: sensitivity 82.35%, specificity 100%, positive predictivevalue (PPV) 100%, negative predictive value (NPV) 84.21% and accuracy 90.9%. In pancreatic EUS-FNA: sensitivity 84.21%, specificity100%, PPV 100%, NPV 986.67% and accuracy 92.86%.ConclusionCytological diagnosis of biliary brushing and pancreatic EUS-FNA has good specificity, sensitivity and accuracy, but definitive diagnosisrequires histopathological examination

A Confirmed Case of Idiopathic Pulmonary Fibrosis - Probable Usual Interstitial Pneumonia Pattern through Lung Biopsy

Background: Although classified as a rare disease, the global burden of disease study reports showed that interstitial lung disease is ranked 40th in the diseases with high mortality, and its prevalence had increased by 86% since 1990. The most common interstitial lung disease”idiopathic pulmonary fibrosis (IPF)”has low survival rates”2-3 years after diagnosis”and is irreversible. Establishing a definite diagnosis of IPF is very difficult because it needs a multidisciplinary approach, as an establishment based on the description of HRCT and lung biopsy is needed. The goal of therapy is to prevent the progression of fibrosis. Case: We report a case of an adult woman, 46 years old with idiopathic pulmonary fibrosis (IPF) with Probable Usual Interstitial Pneumonia (UIP) pattern at dr. Saiful Anwar Hospital. History taking, physical examination and laboratory and chest Xray examination of the patient found a suspicion of ILD. CT-scan showed fibrosis in both lungs, honeycomb appearance with pulmonary bronchiectasis traction, which fit the description of IPF, and thus suspended the diagnosis of ILD. VATS pulmonary biopsy confirmed the diagnosis of IPF. The patient experienced a decrease in clinical conditions, as her complaint was worsening in the last month, in accordance to the state of acute exacerbations. Conclusion: In this patient, the diagnosis of IPF with Probable UIP pattern was made through a multidisciplinary approach, including the pulmonology, radiology and anatomical pathology department. Keywords: IPF, IPF, Probable UIP Pattern, IPF Diagnosis

THE IMPORTANCE OF THE STUDENT SCIENTIFIC CLUB "PATHOLOGICAL ANATOMY" IN THE PROCESS OF FORMING A MODERN DOCTOR

The article represents the main aspects of the student research club at the Department of Pathological Anatomy of Ivano-Frankivsk National Medical University.&#x0D; In today's world, the institution of higher education aims not only to impart professional skills, but also to develop the creative potential of the students. This is achieved by actively involving students in the research activities. Research work of the students outside the academic syllabus is one of the most important tools to become a highly qualified specialist, which is performed in scientific societies and student research club at the department. An important factor that contributes to the professional training of future professionals is the possibility of close cooperation of the student with the scientific and pedagogical staff of the department. It is the teacher who has an immense responsibility not only to impart the student knowledge, but also for the ability to operate, analyze and apply it in various complex situations, which plays a major role in the formation of clinical thinking. In turn, the teacher must meet certain criteria: to show a deep interest in the learning process, discuss errors and solutions, have relevant and up-to-date knowledge and an individual approach to each student.&#x0D; The purpose of the student research club at the Department of Pathological Anatomy is to identify the most capable and talented students who are inclined to research work, to acquire scientific skills and involve them in research activities. The main tasks of the student scientific club "Pathological Anatomy" are as follows: assistance in improving the level of scientific training of students; strengthen research on the issues of scientific activity of the Department of Pathological Anatomy with the participation of students; in-depth study of the chosen discipline by students; development of scientific thinking and analytical skills, acquisition of research skills and broadening horizons and erudition; preparation of reports and speeches of members of the club with the results of their own research in scientific and practical conferences, seminars, round tables and competitions. The activities of the scientific club "Pathological Anatomy" are aimed at developing the creative abilities of students in order for them to acquire professional, personal, cognitive competencies, as well as experience in acquiring knowledge and skills through research.&#x0D; Thus the student scientific club "Pathological Anatomy" creates conditions for self-realization of students in research work and support for gifted students. The development of their intellectual potential makes it possible to significantly intensify and improve the curriculum of medical students, to make it diverse and interesting. The student's research work helps to ensure that each student has the opportunity to exercise their right to creative development of the individual in accordance with their abilities and needs. The club is such a "tool" that allows to actively develop both future doctors for practical medicine and future researcher and teaching staff for the university. Many years of experience of the Department of Pathological Anatomy shows that students tend to master the theoretical knowledge, practical and professional skills if they are involved in such scientific club.

CD44 expression as a potential favorable marker for prognosis in mucoepidermoid carcinoma of salivary gland

Background: Cluster of differentiation 44 (CD44) is one of the markers of cancer stem cells belonging to the cell adhesion molecule family, which may play a role in tumorigenesis of mucoepidermoid carcinoma (MEC) of the salivary gland. The histological grade is one of the most important factors for prognosis. This study was aimed to investigate the association between CD44 expressions with histological grade in MEC of the salivary gland.Methods: In A cross-sectional study, 34 cases diagnosed with MEC in the Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia from 2012 to 2017 were included. Histological grade was classified into low-, moderate-, and high-grade. CD44 expression was done by immunohistochemistry staining and classified into weak and strong expressions.Results: Eighteen cases (52.9%) were high-grade, 3 cases (8.8%) were moderate, and 13 cases (38.2%) were low-grade. Perineural invasion was found in 7 cases (20.6%) and mostly in high-grade tumors. CD44 expression was significantly associated with histological grade (p = 0.002, OR=0.09, 95%CI=0.02–0.48). Strong CD44 expression was found more in low-grade MEC.Conclusions: This study suggests that strong CD44 expression may act as a potential favorable predictive factor for prognosis in the MEC of the salivary gland.