Grading Of Tumors Research Articles

Non-invasive grading and prognosis of Brain Tumours using fuzzy inferencing for rural India

A Brain tumour is an abnormal tissue that grows by uncontrolled cell division. CT and MRI scans are the two most important and commonly used imaging modalities to identify the presence of a brain tumour. The severity of the tumour is graded and prognosis can be predicted only after a biopsy procedure. We have developed a Non-invasive grading and prognosis prediction methodology using CT and MRI images that obviates the need of biopsy to confirm the presence of tumour and thereby helps the clinician in accurate diagnosis.

Immunohistochemical Detection of Proliferative Marker Ki-67 in Benign and Malignant Salivary Gland Tumors

Introduction: Salivary gland tumors are the most histologically heterogeneous group of tumors with the greatest diversity of morphologic features among their cells and tissues. The present study was aimed at assessing the validity of Ki-67, a cell proliferation marker, as a prognostic factor in benign and malignant salivary gland tumors and to study whether it is related to age, sex, anatomical site, and size of the lesion in salivary gland tumors. Materials and methods: A retrospective study consisted of benign salivary gland tumors (BSGTs) (n = 15), malignant salivary gland tumors (n = 18), and normal salivary gland parenchyma (n = 15). Results: There was a significant difference of Ki-67 labeling index (LI, %) in normal salivary gland parenchyma, BSGTs, and malignant salivary gland tumors. The Ki-67 LI (%) in normal salivary gland parenchyma is negligible (0.27 ± 0.31%), whereas malignant salivary gland tumors showed very high Ki-67 LI (%) of 18.79 ± 18.06% compared with BSGTs being 0.76 ± 2.02%. There was a significant correlation statistically of mean ± standard deviation (SD) of Ki-67 LI (%) with the age of the patients being the maximum (32.68 ± 15.87%) in the 50 to 59 years age group, whereas sex, site of the lesion, and size of the lesion in salivary gland tumors had no significant correlation. Conclusion: The Ki-67 is a useful marker for assessing prolif-erative potential of tumors. Clinical significance: The Ki-67 LI% can be used as a reliable adjuvant diagnostic tool to differentiate between the subtypes and grading of certain malignant tumors, such as mucoepi-dermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), and acinic cell carcinoma (AcCC), which are usually difficult to diagnose on histopathological criteria alone. Keywords: Immunohistochemistry, Ki-67, Salivary gland neoplasms.

Abstract B66: P53 expression and survivin subcellular localization contribute to the diagnosis and prognosis of patients with astrocytomas

Abstract Astrocytomas are the most frequent subtype of primary central nervous system (CNS) tumors. Diffuse astrocytoma (grade II), anaplastic astrocytoma (grade III) and glioblastoma (GB–grade IV) are diffuse infiltrating astrocytomas derived from glial cells or precursors. Despite continuous efforts from the scientific community, these tumors still have a poor prognosis. Histologic grading is still challenging, and prognostic factors are still limited to age and tumor grade. Biomarkers that could improve histologic grading, especially that could help differentiate grade III from the other subtypes, and/or serve as prognostic factors are much needed. Furthermore, the relationship between survivin and p53 in astrocytoma progression and survival is still controversial. The present study aims to investigate the role of these proteins in the accuracy of histologic grading of diffuse astrocytic tumors and treatment response. One hundred thirty-five formalin-fixed, paraffin-embedded astrocytoma samples were obtained from patients. Tumor samples were reviewed and stained for survivin and p53 by immunohistochemistry, and the staining levels and survivin subcellular localization were correlated with histologic grading and patient outcomes. Age and histologic grade were the only clinical features that had a prognostic impact. High nuclear survivin and p53 correlated with grade III astrocytomas. High cytoplasmic survivin correlated with GB. Furthermore, patients whose tumors expressed high cytoplasmic survivin, high nuclear surviving, or high p53 and did not receive radiotherapy had worse short-term and long-term survival. Our results suggest that survivin subcellular localization and p53 expression improve the accuracy of histologic grading. Patients whose tumors overexpress these proteins benefit from radiotherapy regardless of age and histologic grade. Furthermore, patients whose tumors overexpress survivin may benefit from novel targeted antisurvivin treatment. Citation Format: Roberta Soares Faccion*, Paula Sabbo Bernardo*, Giselle Pinto de Faria Lopes*, Leonardo Soares Bastos, Cristina Lordello Teixeira, José Antonio de Oliveira, Priscila Valverde Fernades, Luiz Gustavo Dubois, Leila Maria Chimelli, Raquel Ciuvalschi Maia. P53 expression and survivin subcellular localization contribute to the diagnosis and prognosis of patients with astrocytomas [abstract]. In: Proceedings of the AACR International Conference held in cooperation with the Latin American Cooperative Oncology Group (LACOG) on Translational Cancer Medicine; May 4-6, 2017; São Paulo, Brazil. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(1_Suppl):Abstract nr B66.

Intraoperative Cytology of Ovarian Neoplasms with an Attempt to Grade Epithelial Tumors.

Background:Intraoperative cytology (IOC) is a simple and quick technique with excellent preservation of cellular details. In the present study, we have evaluated the role of IOC by various methods of smear preparation and compared it with frozen section diagnosis. A scoring system was followed for epithelial tumors for characterization and grading on the basis of cellularity, pattern, nuclear, cytoplasmic features, and background details.Materials and Methods:The study was conducted during a time span of 2 years in total 48 cases of ovarian tumors. Fine-needle aspiration cytology, touch/imprint, scrape, and crush techniques were used. The smears so prepared were processed for toluidine blue and Giemsa and Papanicolaou staining. Cases were cytomorphologically categorized into four groups: Indeterminate; unequivocally benign; borderline tumor with equivocal morphology; and unequivocally malignant (graded into well, moderately, and poorly differentiated).Results:In our study, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 88.88, 96, 96, 88.88, and 92.31%, respectively, were recorded. This was comparable to frozen section diagnosis with a sensitivity, specificity, PPV, NPV, and accuracy of 85.18, 96.15, 95.83, 86.21, and 90.56%, respectively. In epithelial tumors, cytological grading correlated with histopathological grading in 85.29% cases of epithelial tumors.Conclusion:IOC gives comparable results to frozen section and can be used for intraoperative assessment of ovarian tumors. Grading of epithelial tumors on IOC can be performed and may become an important step in intraoperative decision-making for better management and outcome of the patient.

Trucut Biopsy vs FNAC of Pelvic Tumors-Who Wins the Match?

Preoperative pathologic diagnosis of pelvic tumors is mandatory for proper management of patients like neoadjuvant chemotherapy and interval debulking. Currently there are many minimally invasive methods available which include fine-needle aspiration cytology (FNAC) and trucut biopsy, mostly complimentary to each other. FNAC is a cheap, rapid and sensitive method for diagnosis of pelvic tumors. It can be done as an outpatient procedure without complications. But with it, the tissue architecture cannot be seen. Trucut biopsy on the other hand reveals tissue architecture and can help in grading and subtyping of malignant tumors. Trucut biopsy has to be done under image guidance like ultrasound and computed tomography. Patient is administered local anaesthetic and can be discharged safely after 2 hours. Pathologists familiar with histomorphology can give a correct diagnosis easily. But many times sampling errors may occur; especially in large tumors, resulting only in necrosis, hemorrhage and degenerated tissue bits. Also differentiation of borderline from malignant ovarian tumors is very difficult. In case of mixed tumors one component may be missed. Hard tumors like fibromas and leiomyomas yield scanty material and result in inadequate reporting. With FNAC, the overall accuracy rate is estimated to be around 96.3%. With trucut biopsy, adequacy is from 91 to 95% and accuracy is approximately 98% in different studies. When both methods are combined, the adequacy is 100%, diagnostic accuracy 95.5%, sensitivity 94.9% and specificity 100%. Therefore depending on the clinical diagnosis and the location of tumors, either FNAC and/or trucut biopsy can be chosen.

Retrospective analysis of intracranial and intraspinal space-occupying lesions at a tertiary care center: A 5-Year study

Background: Incidence of central nervous system (CNS) tumors is 2% of all malignancies. Low-grade tumors progress to high-grade tumors. CNS is a common site for metastasis from other organs. Aims: The aim is to study the incidence of various lesions in light of the World Health Organization (WHO) classification of tumors of the CNS, 2016, and to study relevant statistics. Objectives: The objective of this study is to provide an overview of intracranial and intraspinal space-occupying lesions at a single tertiary care referral center. Materials and Methods: A total of 124 cases were studied. Intraoperative diagnosis was desired in 70 cases. The final diagnoses in all the cases were made by routine histopathology. Results: Neoplastic lesions comprised 83.88%, including metastatic tumors, while 16.12% were nonneoplastic. Classification and grading of CNS tumors was done according to the WHO, 2016. Astrocytic tumors constituted the largest category. Incidence was more in females than males and in the fifth and sixth decades of life. Conclusion: This study highlights histological diversity of CNS tumors in adults and children. The most common destructive but nonneoplastic lesions such as infections/abscesses, infarcts, and cysts can be diagnosed, by crush cytology and frozen section for the definitive management.

Prognostic significance of prostate specific antigen in comparison with histological grade of prostatic adenocarcinoma: A Hospital based study.

Background : Prostate gland disease causes significant morbidity in elderly males. Our objective of the study was to evaluate the histopathological spectrum of prostatic lesions in correlation with prostate specific antigen and compare the prostate specific antigen with histological grade of prostatic adenocarcinoma. Methods: The present retrospective study was carried in the department of pathology, Narayana Medical College & Hospital, Nellore, and Andhra Pradesh, India from January 2015 to December 2015. 119 Prostatic biopsy specimens were analyzed histopathologically for diagnosis of types of prostatic lesion and correlated with serum PSA level. Prostatic adeno carcinomas were graded according to Gleason histological grading. Gleason’s grading of tumors was correlated with serum PSA levels Result: Out of 119 patients, 95 cases had benign prostatic hyperplasia, 17 cases had prostatic adenocarcinoma, 7 cases had prostatitis. In our study, the maximum number of BPH cases (51.58%) showed PSA levels 10ng/ml. 5 cases (71.43%) of prostatitis showed PSA levels of 4-10ng/ml.Maximum cases of grade 2 and grade 3 prostatic adenocarcinoma had PSA range of 20-49 .99ng/ml. Conclusion : Benign prostatic hyperplasia is the most commonly diagnosed prostatic lesions. Investigation like serum PSA level detection can aid in the diagnosis, but accurate diagnosis of non-neoplastic and neoplastic lesions of prostate can be made by histopathological study of prostate biopsy. There is a positive relation was seen between higher levels of PSA and Gleason histopathological grade.

Correlation between dual-energy spectral CT imaging parameters and pathological grades of non-small cell lung cancer

To investigate the correlation between pathological grades of non-small cell lung cancers (NSCLCs) and quantitative parameters generated in dual-energy spectral computed tomography (CT). Fifty-three patients with NSCLCs who underwent preoperative dual-energy spectral CT imaging and surgical resection were evaluated retrospectively. These patients were divided into a low-grade group and a high-grade group based on their histopathological differentiation. In the arterial phase (AP) and venous phase (VP), iodine concentration (IC) in cancers was measured in iodine-based material decomposition images, and normalised to the IC in the aorta to calculate the normalised iodine concentration (NIC), the spectral CT curve was generated from the monochromatic images to calculate the slope of the spectral curve (λHU). Differences in quantitative parameters (NIC and λHU) were compared using the two-sample t-test. The correlations between spectral CT parameters and tumour grades were evaluated using the Spearman rank correlation analysis. Receiver operating characteristic (ROC) curves were generated to calculate their diagnostic efficacies. The NIC and λHU in the low-grade NSCLC group were significantly higher than those in the high-grade NSCLC group both in AP and VP (all p<0.001). There was a significant negative correlation between spectral CT parameters and pathological grades by the Spearman rank correlation (all p<0.001). ROC analysis indicated that λHU in VP provided the best diagnostic performance in distinguishing high-grade cancers from low-grade cancers (area under the ROC curve [AUC], 0.914; sensitivity, 85.7%; specificity, 84.4%). The quantitative parameters in dual-energy spectral CT imaging provide useful information to differentiate the pathological grades of NSCLCs.

Octreotide long-acting repeatable in the treatment of neuroendocrine tumors: patient selection and perspectives.

Over the past three decades, the incidence and prevalence of neuroendocrine tumors have gradually increased. Due to the slow-growing nature of these tumors, most cases are diagnosed at advanced stages. Prognosis and survival are associated with location of primary lesion, biochemical functional status, differentiation, initial staging, and response to therapy. Octreotide, the first synthetic somatostatin analog, was initially used for the management of gastrointestinal symptoms associated with functional carcinoid tumors. Its commercial development over time led to long-acting repeatable octreotide acetate, a long-acting version that provided greater administration convenience. Recent research demonstrates that octreotide’s efficacy has evolved beyond symptomatic management to targeted therapy with antitumoral effects. This review examines the history and development of octreotide, provides a synopsis on the classification, grading, and staging of neuroendocrine tumors, and reviews the evidence of long-acting repeatable octreotide acetate as monotherapy and in combination with other treatment modalities in the management of non-pituitary neuroendocrine tumors with special attention to recent high-quality Phase III trials.

2016 World Health Organization Classification of Central Nervous System Tumors.

Since 1979, the World Health Organization (WHO) has periodically published a consensus classification and grading of tumors of the central nervous system (CNS) to ensure uniform histopathologic diagnostic criteria worldwide. In 2016, the WHO published an update of the fourth edition of the classification of CNS tumors. This article summarizes the major changes in the update and discusses their impact on clinical practice. For the first time, the 2016 revision of the WHO classification uses molecular parameters in addition to traditional histology to diagnose many CNS tumors, resulting in major restructuring of the classification of many tumors, especially gliomas, ependymomas, and medulloblastomas. Accordingly, nomenclature for selected entities now includes both a histopathologic diagnosis and defining molecular features. The use of integrated phenotypic and genotypic parameters for the classification of CNS tumors introduces greater objectivity to the diagnosis but also requires more widespread availability of molecular testing. It is hoped that these changes will lead to greater diagnostic accuracy with more biologically homogeneous diagnostic entities and improved patient management and determination of prognosis.

Pre-operative neutrophil count and neutrophil-lymphocyte count ratio (NLCR) in predicting the histological grade of paediatric brain tumours: a preliminary study

IntroductionThe neutrophil-lymphocyte count ratio (NLCR) is an established prognostic marker for renal, lung and colorectal carcinomas and has been suggested to be predictive of histological grade and outcome in adult intracranial tumours. The purpose of this study was to determine whether a correlation of the pre-operative neutrophil count (NC) and NLCR with the final histological grade exists in paediatric intracranial tumours.MethodsA retrospective analysis was undertaken at a single centre. Patients less than 18 years old at the time of surgery who underwent tumour-related procedures from 2006 to 2015 were included. Patients with recurrent tumours, previous bone marrow transplant and metastases were excluded. Pre-operative full blood counts (FBC), collected before the diagnosis of intracranial pathology and before administration of steroids, were matched with histological diagnosis for each patient. Post-operative FBC was also recorded, together with survival data where applicable.ResultsA total of 116 patients (74 male, 42 female; mean age, 8 ± 0.9 years) with a diagnosis of primary intracranial tumours had pre-operative FBC that could be matched to final histological grade. Pre-operative NC and NLCR were higher with increasing grade of tumour: grade 1 (NC 4.29 109/l, NLCR 2.26), grade 2 (NC 4.59 109/l, NLCR 2.38), grade 3 (NC 5.67 109/l, NLCR 2.72) and grade 4 (NC 6.59 109/l, NLCR 3.31). Patients with WHO grade 1 and 2 tumours pooled together had a lower NC (4.37 95% CI ± 0.67 109/l) compared to WHO grade 3 and 4 patients (6.41 95% CI ± 0.99 109/l, p = 0.0013). The NLCR was lower in grade 1 and 2 tumours (2.29 ± 0.59) (compared to grade 3 and 4 tumours; 3.20 ± 0.76) but this did not reach significance (p = 0.069). The subgroup of patients with pilocytic astrocytoma had a significantly lower NC when compared to patients with high-grade tumours (p = 0.005). Medulloblastoma and supratentorial PNET subgroups had significantly higher NC compared to the low-grade group (p = 0.033, p = 0.002). Post-operative NC was significantly higher in the high-grade tumours (p = 0.034), but no difference was observed for NLCR (p = 0.28).ConclusionsNo evidence exists to support the correlation of pre-operative NC or NLCR to histological diagnosis in paediatric intracranial tumours. Our results indicate that a higher pre-operative NC/NLCR correlates with a higher histological grade of tumour. This suggests that immunological mechanisms may be involved in the pathogenesis of paediatric brain tumours, and a further prospective study is required to substantiate and expand these findings.

MiR-19 regulates the proliferation and invasion of glioma by RUNX3 via β-catenin/Tcf-4 signaling.

Accumulating data demonstrates that the network dysregulation of microRNA-medicated target genes is involved in glioma. We have previously found miR-19a/b overexpression in glioma cell lines and specimens with various tumour grades. However, there was no report on the function and regulatory mechanism of miR-19a/b in glioma. In this study, based on our previous research data, we first determine the inverse relationship between miR-19 (miR-19a and miR-19b) and RUNX3 which is also identified the reduced expression in tumour tissues by real-time PCR and IHC. Luciferase reporter assay and western blot analysis revealed that RUNX3 was a direct target of miR-19. Down-regulation of miR-19 dramatically inhibited proliferation, invasion and induced the cell cycle G1 arrest and apoptosis, at least partly via the up-regulation of RUNX3. Furthermore, Mechanistic investigation indicated that knockdown of miR-19 repressed the β-catenin/TCF4 transcription activity. In conclusion, our study validates a pathogenetic role of miR-19 in glioma and establishes a potentially regulatory and signaling involving miR-19 /RUNX3/β-catenin, also suggesting miR-19 may be a candidate therapeutic target in glioma.

Autophagy regulates cisplatin-induced stemness and chemoresistance via the upregulation of CD44, ABCB1 and ADAM17 in oral squamous cell carcinoma.

We inspected the relevance of CD44, ABCB1 and ADAM17 in OSCC stemness and deciphered the role of autophagy/mitophagy in regulating stemness and chemoresistance. A retrospective analysis of CD44, ABCB1 and ADAM17 with respect to the various clinico-pathological factors and their correlation was analysed in sixty OSCC samples. Furthermore, the stemness and chemoresistance were studied in resistant oral cancer cells using sphere formation assay, flow cytometry and florescence microscopy. The role of autophagy/mitophagy was investigated by transient transfection of siATG14, GFP-LC3, tF-LC3, mKeima-Red-Mito7 and Western blot analysis of autophagic and mitochondrial proteins. In OSCC, high CD44, ABCB1 and ADAM17 expressions were correlated with higher tumour grades and poor differentiation and show significant correlation in their co-expression. In vitro and OSCC tissue double labelling confirmed that CD44+ cells co-expresses ABCB1 and ADAM17. Further, cisplatin (CDDP)-resistant FaDu cells displayed stem-like features and higher CD44, ABCB1 and ADAM17 expression. Higher autophagic flux and mitophagy were observed in resistant FaDu cells as compared to parental cells, and inhibition of autophagy led to the decrease in stemness, restoration of mitochondrial proteins and reduced expression of CD44, ABCB1 and ADAM17. The CD44+ /ABCB1+ /ADAM17+ expression in OSCC is associated with stemness and chemoresistance. Further, this study highlights the involvement of mitophagy in chemoresistance and autophagic regulation of stemness in OSCC.

Characterization of brain tumours with spin-spin relaxation: pilot case study reveals unique T 2 distribution profiles of glioblastoma, oligodendroglioma and meningioma.

Prolonged spin-spin relaxation times in tumour tissue have been observed since some of the earliest nuclear magnetic resonance investigations of the brain. Over the last three decades, numerous studies have sought to characterize tumour morphology and malignancy using quantitative assessment of T 2 relaxation times, although attempts to categorize and differentiate tumours have had limited success. However, previous work must be interpreted with caution as relaxation data were typically acquired using a variety of multiple echo sequences with a range of echoes and T 2 decay curves and were frequently fit with monoexponential analysis. We defined the distribution of T 2 components in three different human brain tumours (glioblastoma, oligodendroglioma, meningioma) using a multi-echo sequence with a greater number of echoes and a longer acquisition window than previously used (48 echoes, data collection out to 1120ms) with no a priori assumptions about the number of exponential components contributing to the T 2 decay. T 2 relaxation times were increased in tumour tissue and each tumour showed a distinct T 2 distribution profile. Tumours have complex and unique compartmentalization characteristics. Quantitative assessment of T 2 relaxation in brain cancer may be useful in evaluating different grades of brain tumours on the basis of their T 2 distribution profile, and has the potential to be a non-invasive diagnostic tool which may also be useful in monitoring therapy. Further study with a larger sample size and varying grades of tumours is warranted.

Concordance of Grading of Pancreatic Neuroendocrine Tumors Using Ki-67 on Cytology with Histologic Grade

Concordance of Grading of Pancreatic Neuroendocrine Tumors Using Ki-67 on Cytology with Histologic Grade

Role of Dynamic Contrast-Enhanced Perfusion Magnetic Resonance Imaging in Grading of Pediatric Brain Tumors on 3T

Background/Aims: Perfusion magnetic resonance imaging (MRI) is useful for preoperative assessment of brain tumors. Dynamic susceptibility contrast perfusion MRI is commonly used for evaluation of brain tumors. Dynamic contrast-enhanced (DCE) MRI is an alternative method that has mainly been used in adult brain tumors. In this preliminary study, we report our initial experience with the DCE perfusion MRI in pediatric brain tumors. Methods: Sixty-four newly diagnosed pediatric brain tumor patients underwent DCE perfusion MRI on a 3-T scanner. Hemodynamic and kinetic parametric maps were generated and the regions with the highest values were measured on each map. Statistical differences were sought to differentiate between low-grade tumors, high-grade tumors, and medulloblastomas. The perfusion metrics of common posterior fossa tumors were also compared. Results: Relative corrected cerebral blood volume (rCBV) and fractional plasma volume measures differed significantly between high- and low-grade tumors (p < 0.05). High-grade tumors could be differentiated from low-grade tumors, with an rCBV cutoff value of 2.41 and 88.6% sensitivity and 65% specificity. There was no significant difference in K^trans, K_ep, V_e, or λ^tr between these 2 groups of tumors. rCBV, relative quantification of the cerebral blood flow, and permeability indices were found to be significantly different in various posterior fossa tumors, i.e., pilocytic astrocytoma, ependymoma, and medulloblastoma (p < 0.05). Conclusion: DCE-derived perfusion metrics are useful in differentiating high-grade tumors from low-grade ones and discriminating among various posterior fossa tumors in the pediatric age group.

A rare case report of bilateral synchronous carcinoma breast

Bilateral Breast Carcinoma (BBC) is a rare entity with incidence of synchronous carcinoma being 2-5% of all breast malignancies, which is much less than metachronous carcinoma. Synchronicity/metachronicity are usually associated with local and lymphatic spread and with blood-borne spread to lungs, bones and liver. Moreover, BBC are mostly lobular carcinomas but we report a rare case of Infiltrating Ductal Carcinoma (IDC), medullary type as the primary carcinoma. 56-year-old female who presented with a lump in her right breast for 6 months and lump in her left axilla. There was no e/o palpable lump in her left breast. Trucut biopsy was taken from both the lumps and was s/o infiltrating ductal carcinoma. Different histological subtypes with different grades of tumour in both breasts suggested synchronous primary tumours. Early detection of the contralateral tumour is of utmost importance emphasizing the significance of breast self-examination. Screening tools like MRI have a greater sensitivity compared to Mammography. There are no clear treatment guidelines for bilateral breast cancer. Patients are often treated with bilateral mastectomy, with breast conservative surgery having unclear importance. Meticulous diagnosis and appropriate management help to improve the longevity with an improved quality of life.

The 2017 World Health Organization classification of tumors of the pituitary gland: a summary.

The 4th edition of the World Health Organization (WHO) classification of endocrine tumors has been recently released. In this new edition, major changes are recommended in several areas of the classification of tumors of the anterior pituitary gland (adenophypophysis). The scope of the present manuscript is to summarize these recommended changes, emphasizing a few significant topics. These changes include the following: (1) a novel approach for classifying pituitary neuroendocrine tumors according to pituitary adenohypophyseal cell lineages; (2) changes to the histological grading of pituitary neuroendocrine tumors with the elimination of the term "atypical adenoma;" and (3) introduction of new entities like the pituitary blastoma and re-definition of old entities like the null-cell adenoma. This new classification is very practical and mostly based on immunohistochemistry for pituitary hormones, pituitary-specific transcription factors, and other immunohistochemical markers commonly used in pathology practice, not requiring routine ultrastructural analysis of the tumors. Evaluation of tumor proliferation potential, by mitotic count and Ki-67 labeling index, and tumor invasion is strongly recommended on individual case basis to identify clinically aggressive adenomas. In addition, the classification offers the treating clinical team information on tumor prognosis by identifying specific variants of adenomas associated with an elevated risk for recurrence. Changes in the classification of non-neuroendocrine tumors are also proposed, in particular those tumors arising in the posterior pituitary including pituicytoma, granular cell tumor of the posterior pituitary, and spindle cell oncocytoma. These changes endorse those previously published in the 2016 WHO classification of CNS tumors. Other tumors arising in the sellar region are also reviewed in detail including craniopharyngiomas, mesenchymal and stromal tumors, germ cell tumors, and hematopoietic tumors. It is hoped that the 2017 WHO classification of pituitary tumors will establish more biologically and clinically uniform groups of tumors, make it possible for practicing pathologists to better diagnose these tumors, and contribute to our understanding of clinical outcomes for patients harboring pituitary tumors.

MRI based medical image analysis: Survey on brain tumor grade classification

Abstract A review on the recent segmentation and tumor grade classification techniques of brain Magnetic Resonance (MR) Images is the objective of this paper. The requisite for early detection of a brain tumor and its grade is the motivation for this study. In Magnetic Resonance Imaging (MRI), the tumor might appear clear but physicians need quantification of the tumor area for further treatment. This is where the digital image processing methodologies along with machine learning aid further diagnosis, treatment, prior and post-surgical procedures, synergizing between the radiologist and computer. These hybrid techniques provide a second opinion and assistance to radiologists in understanding medical images hence improving diagnostic accuracy. This article aims to retrospect the current trends in segmentation and classification relevant to tumor infected human brain MR images with a target on gliomas which include astrocytoma. The methodologies used for extraction and grading of tumors which can be integrated into the standard clinical imaging protocols are elucidated. Lastly, a crucial assessment of the state of the art, future developments and trends are dissertated.

Quantitative evaluation of diffusion-kurtosis imaging for grading endometrial carcinoma: a comparative study with diffusion-weighted imaging

To evaluate the diagnostic performance of histogram analysis of diffusion kurtosis magnetic resonance imaging (DKI) and standard diffusion-weighted imaging (DWI) in discriminating tumour grades of endometrial carcinoma (EC). Seventy-three patients with EC were included in this study. The apparent diffusion coefficient (ADC) value from standard DWI, apparent diffusion for Gaussian distribution (Dapp), and apparent kurtosis coefficient (Kapp) from DKI were acquired using a 3 T magnetic resonance imaging (MRI) system. The measurement was based on an entire-tumour analysis. Histogram parameters (Dapp, Kapp, and ADC) were compared between high-grade (grade 3) and low-grade (grade 1 and 2) tumours. The diagnostic performance of imaging parameters for discriminating high- from low-grade tumours was analysed using a receiver operating characteristic curve (ROC). The area under the ROC curve (AUC) of the 10th percentile of Dapp, 90th percentile of Kapp and 10th percentile of ADC were higher than other parameters in distinguishing high-grade tumours from low-grade tumours (AUC=0.821, 0.891 and 0.801, respectively). The combination of 10th percentile of Dapp and 90th percentile of Kapp improved the AUC to 0.901, which was significantly higher than that of the 10th percentile of ADC (0.810, p=0.0314) in differentiating high- from low-grade EC. Entire-tumour volume histogram analysis of DKI and standard DWI were feasible for discriminating histological tumour grades of EC. DKI was relatively better than DWI in distinguishing high-grade from low-grade tumour in EC.