Diagnosis In Difficult Cases Research Articles

Management of Pediatric Bilateral Vocal Fold Paralysis: A State-of-the-Art Review of Etiologies, Diagnosis, and Treatments.

This paper reviews the current literature about epidemiology, etiologies, diagnosis, and management of pediatric bilateral vocal fold paralysis (PBVFP). According to PRISMA statements, a narrative review of the current literature was conducted through the PubMed, Scopus, and Cochrane Library databases about the epidemiology, etiologies, diagnosis, and management of PBVFP. PBVCP is the second most common congenital laryngeal anomaly in the pediatric population, accounting for 10% to 20% of pediatric laryngeal conditions. PBVCP is related to idiopathic (42.2%), congenital (19.7%), and neurological (16.9%) conditions. A tracheotomy is required in 60% of cases regarding stridor and dyspnea, which are the most prevalent symptoms. The diagnosis is based on the etiological features, clinical presentation, laryngoscopic findings, and objective examinations. Laryngeal electromyography may be used to support the diagnosis in difficult cases, but its reliability depends on the practitioner's experience. The primary differential diagnosis is posterior glottis stenosis, which needs to be excluded regarding therapeutic and management differences with PBVCP. Transient surgical procedures consist of tracheotomy or laterofixation of the vocal fold. Current permanent procedures include uni- or bilateral partial arytenoidectomy, posterior transverse cordotomy, cricoid splits, and laryngeal selective reinnervation. There is no evidence of the superiority of some procedures over others. PBVCP is the second most common laryngeal disorder in the pediatric population. Diagnosis is based on etiological and clinical findings and may require the use of laryngeal electromyography. Therapeutic management may involve several transient or permanent surgical procedures that are associated with overall subjective improvements in symptoms, laryngeal findings, and low complication rates.

Comparison of the passive mast cell activation test with the basophil activation test for diagnosis of perioperative rocuronium hypersensitivity

BackgroundRocuronium is a major cause of perioperative hypersensitivity (POH). Skin tests (STs) and quantification of specific immunoglobulin E antibodies (sIgEs) can yield incongruent results. In such difficult cases, the basophil activation test (BAT) can be helpful. Here, we evaluated the passive mast cell activation test (pMAT) as a substitute of BAT as part of the diagnostic tests for rocuronium allergy. MethodsSera from patients with a suspected POH reaction potentially related to rocuronium were included. All patients had a complete diagnostic investigation, including STs, quantification of sIgEs to morphine and rocuronium, and BAT. For execution of pMAT, human mast cells were generated from healthy donor peripheral blood CD34+ progenitor cells and sensitised overnight with patient sera. ResultsIn total, 90 sera were studied: 41 from ST+sIgE+ patients, 13 from ST–sIgE– patients, 20 from ST+sIgE– patients, and 16 from ST–sIgE+ patients. According to BAT results, patients were further allocated into subgroups. Of the 38 BAT+ patients, 25 (66%) showed a positive pMAT as well. Of the 44 BAT– patients, 43 (98%) also showed a negative pMAT. Mast cells that were not passively sensitised did not respond to rocuronium. ConclusionsWe show that the pMAT, in many cases, can substitute for BAT in the diagnosis of rocuronium hypersensitivity and advance diagnosis in difficult cases with uncertain ST or sIgE results when BAT is not locally available.

Radiomics, a Promising New Discipline: Example of Hepatocellular Carcinoma

Radiomics is a discipline that involves studying medical images through their digital data. Using "artificial intelligence" algorithms, radiomics utilizes quantitative and high-throughput analysis of an image's textural richness to obtain relevant information for clinicians, from diagnosis assistance to therapeutic guidance. Exploitation of these data could allow for a more detailed characterization of each phenotype, for each patient, making radiomics a new biomarker of interest, highly promising in the era of precision medicine. Moreover, radiomics is non-invasive, cost-effective, and easily reproducible in time. In the field of oncology, it performs an analysis of the entire tumor, which is impossible with a single biopsy but is essential for understanding the tumor's heterogeneity and is known to be closely related to prognosis. However, current results are sometimes less accurate than expected and often require the addition of non-radiomics data to create a performing model. To highlight the strengths and weaknesses of this new technology, we take the example of hepatocellular carcinoma and show how radiomics could facilitate its diagnosis in difficult cases, predict certain histological features, and estimate treatment response, whether medical or surgical.

Second opinions and reference pathology in breast cancer

Second opinion in pathology recruits expert knowledge for the diagnosis in difficult cases and has atradition in Germany with generation of anetwork between primarily diagnostic and academic institutes of pathology, active in research. The term reference pathology does mean alabel for aclass of institutes for pathology but rather specifies afunction within prospective clinical trials with defined endpoints and acentral pathology, which will derive expert knowledge from this function. On either way generated collection of samples and expertise will enable diagnostic support in difficult cases. Furthermore, research based on this tissue material might lead to the establishment of novel biomarkers and methods, which when transferred to decentral application will enhance diagnostic validity of pathological tissue analysis as awhole. Thus, for all institutes participating in the network, pathology as adiagnostic discipline and patients, second opinion and reference pathology provide considerable benefit with regard to quality of histopathological diagnoses.

Second opinions and reference pathology

Second opinions in pathology require expert knowledge for diagnosis in difficult cases and in Germany have atradition that has grown into anetwork between primarily diagnostic care institutions and university-associated institutes of pathology that are active in research. The term reference pathology is not a designation for aclass of institutes for pathology but rather indicates afunction within prospective clinical trials with defined endpoints and acentral pathology, which derives expert knowledge from this function. The thus generated collection of samples and expertise enable diagnostic support in difficult cases. Furthermore, research based on this tissue material might lead to the establishment of novel biomarkers and methods, which when transferred back for local application will enhance the overall diagnostic validity of pathological tissue analysis. Thus, for all institutes participating in the network second opinion and reference pathology provide considerable benefit.

Knee Extensor Mechanism Tendinopathy: Evaluation, Treatment, and Prevention.

Knee extensor mechanism tendinopathy, including patellar and quadriceps tendinopathy, is common among athletes and those involved in jumping sports. It is largely a clinical diagnosis that presents as anterior knee pain and stiffness with associated tenderness over the affected tendon. Imaging modalities, including ultrasound and/or magnetic resonance imaging, may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Focused and structured rehabilitation using eccentric or heavy slow resistance exercise in conjunction with load management is important for recovery. Adjuvant therapies (e.g., injections or surgery) may be necessary in recalcitrant cases or those with insufficient response to rehabilitation efforts. Prevention strategies focus on improving biomechanics, landing mechanism and lower-extremity balance, flexibility, and strength.

Abstract 1122‐000235: Artificial Intelligence Algorithms for Hemorrhage Detection in CTs and MRI Scans: A Systematic Review

Introduction : Stroke is a leading cause of morbidity and mortality worldwide, with hemorrhagic strokes accounting for 10–20% of all strokes. Patients presenting with intracerebral hemorrhage (ICH) often face higher rates of mortality and poorer prognosis than those with other stroke types. As ICH treatment relies on in‐hospital neuroimaging findings, one potential barrier in the effective management of ICH includes increased time to ICH detection and treatment, particularly due to delays in imaging interpretation in busy hospitals and emergency departments. Artificial Intelligence (AI) driven software has recently been developed and become commercially available for the detection of Intracranial Hemorrhage (ICH) and Chronic Cerebral Microbleeds (CMBs). Such adjunct tools may enhance patient care by decreasing time to treatment and diagnosis by helping to adjudicate diagnoses in difficult cases. This systematic review aims to describe the current literature surrounding all currently existing AI algorithms for ICH detection with either non‐contrast computed tomography (CT) scans or CMBs detection with magnetic resonance imaging (MRI). Methods : Following PRISMA guidelines, MEDLINE and EMBASE were searched for studies published through March 1st, 2021, and all studies investigating AI algorithms for hemorrhage detection in non‐contrast CT scans or CMBs detection on MRI scans were eligible for inclusion. Any studies focusing on AI for hemorrhage segmentation only, including studies that enrolled patients with hemorrhages only as their study group, were excluded. Extracted data included development methods, training, validation and testing datasets, and accuracy metrics for each algorithm, when available. Meta‐analysis was not conducted due to heterogeneity in reported accuracy metrics and highly variant algorithmic development. The completed protocol is available for review in the PROSPERO registry. Results : After the removal of duplicates, a total of 609 studies were identified and screened. After an initial screening and full text review, 40 studies were included in this review. Of these, 18 tested a 2‐Dimensional (2D) convolutional neural network (CNN) AI algorithm, 3 used a purley 3‐Dimension (3D) CNN, and 2 utilized a hybrid 2D‐3D CNN. Of note, one software was able to identify ICH in the setting of ischemic stroke using MRI scans. Included papers noted the following challenges when developing these AI algorithms: extensive time required to create suitable datasets, the volumetric nature of the imaging exams, fine tuning the system, and focusing on the reduction of false positives. Diagnostic accuracy data was available for 21 of these studies, which reported a mean accuracy of 94.37% and a mean AUC of 0.958. Conclusions : As reported in this study, many AI‐driven software tools have been developed over the last 5 years. These tools have high diagnostic accuracy on average and have the potential to contribute to the diagnosis of ICH or CMBs with expert‐level accuracy. With time to treatment often dependent on time to diagnosis, this AI software may increase both the speed and accuracy of adjudicating diagnoses. Although there have been several obstacles faced by the developers of these algorithms, AI‐driven software is an important frontier for the future of clinical medicine.

Rolf Zetterström: Discovered how bilirubin harms the brain in newborns with jaundice.

From the time I started school, I heard how brilliant Rolf Zetterström was from my father, who was also a paediatrician. Rolf had applied for a professorship in paediatrics at the Karolinska Hospital Children’s Clinic and was the favourite among the experts. He had among other things discovered how bilirubin harms the brains of newborns with jaundice. But the faculty likely considered him to be too young, which is why he was bypassed by the somewhat older Johnny Lind. As young as 38, Rolf was instead granted professorship at Gothenburg, where he quickly established distinguished research projects with adeptes such as Jan Winberg, Olov Celander and Johan Gentz. Four years later, he was called to the paediatric professorship at the Crown Princess Lovisa—later Saint Göran—Hospital. He had a fantastic ability to recruit research paediatricians, whereof several were from preclinical institutions. Several of them later became professors, such as Ove Broberger, Anita Aperia, Birgitta Strandvik, Ulla Berg, Agne Larsson and Gisela Dahlquist. Rolf was not just an influential researcher with over 400 publications but also a skilful clinician, who quickly could make the correct diagnosis in difficult cases. He was active for many years in the Nobel committee for physiology or medicine and the Royal Swedish Academy of Sciences. He was known in academic contexts for almost always asking relevant questions, if only after first giving a historical summary, before—in a somewhat crumpled way—reaching the point. For 40 years—between 1965 and 2005—he was editor-in-chief for Acta Paediatrica (Figure 1) and then continued as literature editor almost until his death in 2011. Owing to his encyclopaedic knowledge, he was competent to review articles within almost all paediatric subspecialties, even if he had associate editors to assist. I believe he read most of the articles himself and was very particular with the scientific quality. Manuscripts could be sent back and forth between the editorial office and the authors before they were accepted. Rolf was also recognised and respected internationally. It was therefore a challenge for me to succeed him in 2005, and he was not exactly happy to retire as editor-in-chief at 85 years of age. But we became very good friends. He came almost daily to the editorial office in an old villa between Karolinska Hospital’s main building and the Northern Cemetery. His office was cluttered with books and manuscripts. He continued to write, and engaged himself in all sorts of projects, on topics such as the environmental disasters around the polluted Aral Sea. I could always visit his office and discuss everything from Vitamin D, to BCG vaccination, to social paediatrics. He told me about several Nobel prize winners in physiology or medicine, which he had helped to judge. To a great extent, the conversations also surrounded the incompetence of most hospital directors. I was myself critical, but not nearly to Rolf’s degree. But when I met him in his later days, Rolf was not some hard authoritarian type of boss as the rumours went. He was then relatively humble and warm-hearted, and it was always rewarding to converse with him. The author has no conflicts of interest to declare.

Achilles Tendinopathy: Evaluation, Rehabilitation, and Prevention.

Achilles tendinopathy is a common overuse condition that is characterized by degenerative, cumulative tissue microtrauma. It is largely a clinical diagnosis in which the patient typically presents with localized pain that is worse with tendon-loading activities. Imaging modalities may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Midportion (noninsertional) and insertional tendinopathy have distinct features and differences for therapeutic paradigms. Overall, Achilles tendinopathy has a good clinical prognosis with most patients improving with activity modification and rehabilitation, with a focus on progressive tendon-loading. Recalcitrant cases may require adjuvant treatment with procedures (e.g., injections, shockwave therapy) and rarely surgical intervention.

Description of rare alleles of the CFTR gene in cystic fibrosis using functional tests and forskolin-induced swelling assay in rectal organoids

Cystic fibrosis (CF) is a systemic hereditary disease caused by a mutation of the CFTR gene and characterized by damage to the glands of external secretion and severe dysfunctions of the respiratory system. The “severe” genotypes are associated with more pronounced and early clinical manifestations. The “mild” genotypes are associated with a delayed onset of clinical manifestations.Methods. An analysis of the medical history of patients with asymptomatic CF from the Russian CF centers was carried out. Rectal biopsy specimens were used for intestinal current measurement (ICM) and forskolin-induced swelling assay in intestinal organoids. DNA for sequencing was isolated from the venous blood leukocytes.Results. 2 CF patients with genotypes F508del/c.1584+18672A>G (patient 1, 12 years old) and F508del/G509D-E217G (patient 2, 3 years old) were examined. The diagnosis was based on neonatal screening. The ICM assay showed a reduced function of the CFTR channel: ΔISC for forskolin was 12.33 ± 2.35 μA/cm2 in patient 1 and 25 ± 3.37 μA/cm2 in patient 2. The negative response to carbachol and histamine reflects the entry of potassium ions into the cells, which is typical for CF. The assay in intestinal organoids showed that the amount of functional protein on the apical membrane of the intestinal epithelium increases both under the action of the potentiator and the corrector in both patients. The greatest effect is observed when the VX-770 and VX-809 are used together.Conclusion. The ICM functional assay and the forskolin-induced swelling assay in intestinal organoids are sensitive enough to determine the residual functional activity of the CFTR channel and clarify the diagnosis in difficult cases. The studied genetic variants c.1584+18672A>G and G509D-E217G belong to class IV – VI mutations. The clinical picture corresponds to the manifestations of “mild” mutations. The studied patients still attend the Russian cystic fibrosis centers.

Prostate carcinomas mimicking a digestive malignancy.

Aim: To report our experience with specific cases of prostate cancer (PC) in which patients presented digestive symptoms, cases that represent a challenge and a source of error regarding the clinical and morphological diagnosis. Methods: The most important clinical and pathological data were collected from three patients with PC which presented symptoms and/or investigations that initially suggested a digestive malignant tumor. Results: We identified three patients with PC where the prostate tumor was not suspected based on the clinical-imagistic data, the correct diagnosis being the prerogative of the morphological investigation: in the first case, PC was detected during the microscopic examination of the lymph nodes (LN) in the intestinal resection specimen performed for suspected rectal cancer (RC), in the second case, in which the PC was synchronous with a RC, the dominant symptomatology was gastrointestinal, and in the third case, initially, the patient presented a widely disseminated PC, with pleural and bone metastases, as well as LN metastases, and apparent peritoneal involvement. Conclusions: Unusual forms of PC presentation are not as rare as expected and should be acknowledged by all those involved in diagnosing this neoplasm. PC should always be considered in the differential diagnosis of a rectal tumor. The immunohistochemical (IHC) investigation is essential for establishing the diagnosis in difficult cases. An integrated approach of the interpretation of clinical manifestations, imagistic and serological changes would shorten the diagnostic time and help reduce diagnostic errors.

DOG 1 EXPRESSION IN DIFFERENTIAL DIAGNOSIS OF CHONDROBLASTOMAS AND ITS HISTOLOGICAL MIMICKERS

Objective: Chondroblastoma is rare benign cartilage forming tumor of bone predominantly in individuals less than 20 years of age. Recently immunohistochemical marker DOG 1 has been reported to help in the diagnosis in difficult cases where histological features overlap with other similar entities. Current study aims to assess the sensitivity and specificity of DOG 1 in the diagnosis of chondroblastomas.
 Study design: descriptive cross-sectional study
 Place and duration of study: The study was conducted from June 2015 to July 2017 in Department of Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
 Patients and methods: Total fifty-two patients were included in this study including 19 chondroblastomas, 21 giant cell tumors and 12 chondromyxoid fibromas. DOG 1 antibody was applied on all the cases
 Results: DOG 1 was positive in 100 % of cases of chondroblastomas. However, intensity and proportion of staining pattern was variable among them. 78% (n=15) cases showed diffuse moderate to strong expression while 22% (n=4) cases showed focal weak expression. Only 10% (n=2) cases of giant cell tumors and 33% (n=4) of chondromyxoid fibromas expressed focal weak expression for DOG 1.
 Conclusions: This study confirms 100 % expression of DOG 1 in cases of chondroblastomas but intensity and proportion of staining pattern was variable. Therefore DOG 1 may prove to be a useful immunohistochemical marker for diagnosis of chondroblastomas in the future in difficult cases in correlation with histological and radiological features.

Application of Cardiovascular Angiography in Diagnosis of Heart Disease Based on Adaptive Tracking Circular Template Technique

Objective: To explore the application value of cardiovascular extraction technique in the complex and/or complex malformation of congenital heart disease (CHD) and the application of deep learning to the diagnosis of medical imaging. Methods: Quantitative description of cardiovascular lesions and reconstruction of three-dimensional cardiovascular using angiographic images, the cardiovascular representation of the contrast image as a single pixel wide cardiovascular skeleton, using a rotating Gaussian function to enhance the image, using adaptive tracking circular template pair Enhanced cardiovascular images for cardiovascular extraction. The 360 cases of complex and/or complex malformation were analyzed and their association with clinical examinations such as echocardiography. Results: This group of 360 patients (including 75 cases of pulmonary atresia with ventricular septal defect, 62 cases of right ventricular double exit, 60 cases of tetralogy of Fallot, 52 cases of single ventricle, 42 cases of aortic dislocation, 15 cases of tricuspid atresia, 6 cases of coronary artery Abnormalities, 5 cases of complete pulmonary venous malformation, 5 cases of complete endocardial pad defect, 4 cases of common arterial trunk, 3 cases of interventricular complete pulmonary atresia, 7 cases of other cases and 24 cases of postoperative examination) angiography. Compared with ultrasound, the latter was corrected in 34 cases, missed diagnosis in 30 cases, and misdiagnosis in 16 cases of combined malformation. The detection and diagnosis of collateral vessels, coronary artery malformations and branches of pulmonary arteries and their abnormalities in complex and/or complex malformations are superior to echocardiography, and can measure pulmonary arterial and venous pressures and collateral vessel pressure It is superior to other imaging methods. Conclusions: Cardiac angiography (DSA) is still important for the diagnosis and differential diagnosis of difficult cases of congenital heart disease complex and/or complex malformation, especially showing the whole appearance and related lesions of the body, lung and coronary branches, as well as measuring pulmonary artery and ventricular pressure.

Usefulness of intravenous contrast-enhanced MRI for diagnosis of adhesive capsulitis

We aimed to compare the reliability and performance of MRI measures enhanced with intravenous (IV) injection of gadolinium contrast versus non-enhanced MRI measures for the diagnosis of adhesive capsulitis (AC). We also aimed to examine the association between MRI findings and clinical features in patients with AC. MRI of 42 patients with a clinical diagnosis of AC confirmed by arthrography and that of 42 patients in a control group were retrospectively studied by 2 blinded readers. Reliability and performance of MRI findings were compared between IV contrast-enhanced measures and non-enhanced MRI measures in T2-weighted fat-saturated and T1-weighted images. MRI findings were correlated with clinical stage, etiology, and pain. Sensitivity (97.6%) and specificity (97.6%) of axillary-recess capsule signal enhancement for AC diagnosis were significantly superior (p= 0.02) to hyperintense signals on T2-weighted fat-suppressed images (sensitivity 90.5%, specificity 92.7%). Measures of the intensity signal in the area of the rotator interval were less performant for AC diagnosis but could be improved with joint capsule enhancement. Moreover, we found very high specificity (100%) of enhancement of the coracohumeral ligament signal for AC diagnosis. The early stage of adhesive capsulitis was positively correlated with joint capsule enhancement in the rotator interval. Secondary etiology of capsulitis was correlated with joint capsule hyperintensity signals of the rotator interval on T2-weighted fat-suppressed images. IV contrast injection with MRI can be helpful for AC diagnosis in difficult cases. The stage of AC seems related to joint capsule enhancement in the rotator interval. • IV gadolinium-enhanced MRI can improve the analysis of signal changes in the shoulder synovium and capsule of the shoulder that are related to adhesive capsulitis. • As an original finding, we observed that coracohumeral ligament enhancement had a 100% specificity for the diagnosis of adhesive capsulitis. • The intensity of enhanced signals in the rotator interval seems to be related to the early stage of frozen shoulder.

Application of intraoperative rapid immunohistochemistry in diagnosis of difficult cases

术中快速疑难病例包括乳腺导管原位癌是否伴微浸润、乳腺硬化性腺病与浸润性癌鉴别、不同系统来源低分化癌与炎性病变的鉴别等，利用术中快速免疫组织化学染色技术，标记特异性肌上皮细胞指标p63、Calponin以及广谱细胞角蛋白，可以在15 min内完成染色，快速、准确地辅助术中快速诊断，显著降低误诊、漏诊率。.

Hevea latex-associated allergies: piecing together the puzzle of the latex IgE reactivity profile

ABSTRACTIntroduction: IgE-mediated Hevea latex allergy and associated food-allergies constitute a significant health issue with serious consequences of diagnostic error. Hence, there is a need for more reliable confirmatory diagnostics.Areas covered: Here, we summarize the major limitations of conventional tests using native extracts and describe how piecing together the IgE reactivity profile can benefit correct diagnosis in difficult cases in whom conventional tests yield equivocal or negative results. A diagnostic algorithm integrating traditional sIgE and component-resolved diagnosis (CRD) is presented.Expert opinion: Moreover, it is clear that the discoveries in the field of the Hevea latex proteome will contribute to our understandings and accurate approach of sometimes complex cross-reactivity phenomena that extend beyond the ‘latex-fruit syndrome.’

Dermatose bulleuse avec kératinocytes multinucléés révélant une dermatose factice : à propos d’un cas et revue de la littérature

We report the case of a 13-year-old young lady with a one year reccuring bullous dermatitis history for which the diagnostic hypothesis of dermatitis arterfacta was made. This hypothesis was made by the pathologist, without it being suggested by the dermatologist, after observing singular histological lesions coresponding to a cutaneous blister associated with epidermic necrosis with multinucleated keratinocytes. When dermatitis artefacta is suspected, a biopsy is usually conducted to rule out differential diagnosis such as auto-immmune dermatitis when there is a blister. Confession from patients is rarely obtained. Therefore, having positive histogical clues for dermatitis artefacta would be of a great use to help making the diagnosis in difficult cases.

E-Diagnosis in Medical Parasitology

Over the past decade or two, the teaching of laboratory diagnostic parasitology has been neglected in Australasia, as parasitic infections are relatively uncommon. As a consequence, expertise in medical parasitology is dwindling. A team of international experts (including Professor John Goldsmid) has been formed to help in the diagnosis of human parasitic infections. The team includes experts from Australia, Europe, South Africa and the USA. Some senior members of the team are excellent morphologists, and we have both human and veterinary parasitologists who help with molecular diagnosis in difficult cases.

Кольцевидная форма красного плоского лишая. Редкое клиническое наблюдение

The paper reviews current data on lichen ruber planus, a disease characterized by multifactorial pathogenesis, polymorphic clinical symptoms, severe long recurrent course, and a significant resistance to treatment. In the last decades, a substantial growth in the prevalence of this dermatosis is observed. Moreover, the rate of atypical cases also increases. The most common symptoms at disease onset are a generalized rash, severe itching, and malaise. Many patients present with acute clinical signs. Patients with the different forms of the disease (in particular, those with oral lichen planus) report on the significant reduction in the quality of life. The authors describe the specificity of clinical polymorphism, the variability of clinical manifestations and HLA system in annular lichen planus. The aim of this paper is to summarize currently available data considering the diversity of clinical variants which are required for the understanding of the pathogenesis to improve the diagnosis in difficult cases and to control its course. The authors also address a case study of annular lichen planus in a 63-year-old woman. KEYWORDS: lichen ruber planus, dermatosis, histopathology, HLA system. FOR CITATION: Zakhur I.I., Koshkin S.V., Bobro V.A. Annular lichen planus, a rare variant of lichen planus. Russian Medical Inquiry. 2020;4(10):642–646. DOI: 10.32364/2587-6821-2020-4-10-642-646.

The Frequency and Prognostic Significance of the Histologic Type in Early-stage Ovarian Carcinoma

The frequency and prognostic significance of the histologic type in early-stage ovarian cancer (OC) is not as well established as in advanced stages. In addition, histologic typing based only on morphologic features may be difficult, especially in high-grade tumors. In this study, we have analyzed a prospective cohort of 502 early-stage OCs to investigate their frequency, immunohistochemical characteristics, and survival of the 5 main histologic types. Histotype was assigned according to not only the morphologic features but also according to the expression pattern of WT1, p53, Napsin A, and progesterone receptors. In addition, an extended panel including p16, β-catenin, HER2, Arid1A, HINF1B, CK7, CDX2, and CK20 was used to refine the diagnosis in difficult cases. In this series, the frequency of the 5 major histologic types was as follows: endometrioid carcinoma, 32.7%; clear cell carcinoma, 25.1%; high-grade serous carcinoma (HGSC), 24.7%; mucinous carcinoma, 10.2%; low-grade serous carcinoma, 4.6%; and others, 2.8%. The combination of morphology and immunohistochemistry allowed the reclassification of 23% of OCs. The lowest concordance was found between samples initially diagnosed as endometrioid, but finally classified as high-grade serous tumors (22% error rate). Endometrioid carcinoma was the most favorable histologic type, whereas HGSC and low-grade serous carcinoma had the worst prognosis. Clear cell carcinoma with abnormal p53 immunostaining pattern also had poor prognosis. Although histologic grade was not a prognostic factor among early-stage endometrioid OCs, distinction between grade 3 endometrioid OC and HGSC is recommended, taking into account differences in prognosis and molecular alterations that can guide different treatments.