Gross Examination Of Specimen Research Articles

Demographic and Clinicopathological Spectrum of Gallbladder Carcinoma in a Tertiary Care Centre in Jharkhand: A Retrospective Study.

Introduction Gallbladder carcinoma is a rare but aggressive cancer of adults that affects females more than males. Its occurrence is more common in the regions of South America and Asia. Chronic inflammation and cholelithiasis are frequently associated risk factors of gallbladder carcinoma. The incidental discovery of a gallbladder carcinoma during cholecystectomy, gross or microscopic examination of the unsuspected gallbladder specimens is termed incidental gallbladder carcinoma (IGBC). Considering the lack of extensive studies on gallbladder carcinoma in the Eastern region of India, especially in Jharkhand, this study has been done to present the demographic and clinicopathological characteristics of gallbladder carcinoma in this region. Methods A retrospective and descriptive study was done at Rajendra Institute of Medical Sciences (RIMS), Ranchi, a tertiary care center in Jharkhand. The study sample comprised 2386 gall bladder casesreceived in the Department of Pathology over five years, from December 2018 to December 2023. Results Of 2368 specimens, 25 cases (n=25) were reported as primary gallbladder carcinoma. The female-to-male ratio was 4:1. Pain was the most common complaint by the patients. Of the 25 cases, 12 were suspected intra-operatively or diagnosed microscopically (IGBC). Most showed a mass at the neck. In six cases, no gross mass/lesion was seen. Cholelithiasis is present in 19/25 cases.Most cases showed adenocarcinoma (not otherwise specified). Out of the adenocarcinoma cases, most were well differentiated. At the time of diagnosis, most were at the pT2 stage. Twelve cases of IGBC were found. Eight out of 12 IGBC were early-stage carcinoma when diagnosed. Conclusion Twenty-five cases of gallbladder carcinoma were diagnosed in the last five years in our center, with 19 (76%) of them associated with cholelithiasis. Twelve (48%) of the cases were incidentally diagnosed either preoperatively or during gross/microscopic examination, and eight (66%) of those were discovered early, out of which five (62.5%) were observed to be in the T1b stage. At this stage, there is a diversion from the general surgical management of gallbladder carcinoma for a better prognosis. This underscores the significance of routine histopathological examination of gallbladder specimens, even if there is no preoperative suspicion of gallbladder carcinoma.

Primary mucinous adenocarcinoma of the ureter and renal pelvis: A case report.

Primary adenocarcinoma rarely occurs in the upper urinary tract and accounts for less than 1% of the urothelial tumors. Here we present a case report of a 45-year-old female patient who presented with a lump in the abdomen and pain in the right lumbar region for 2 months. Various radiological investigations revealed right-sided hydronephrosis with enhancing masses in the right proximal ureter and renal pelvis associated with multiple calculi. A gross examination of the right nephrectomy specimen revealed multiple cystic areas filled with mucinous material and papillary projections in the renal pelvis. A necrotic growth was observed in the right proximal ureter in association with the staghorn calculus in the renal pelvis. Histological examination of the ureteric mass and solid areas from the renal pelvis showed acini and papillary projections lined by pseudostratified columnar epithelium showing malignant changes. Surrounding areas also revealed intestinal metaplasia with moderate to marked dysplasia in some places. The ureteric malignancy was observed to infiltrate the inner two-thirds of the wall of the ureteric muscular layer and extend until the margin of excision. Thus, a diagnosis of mucinous adenocarcinoma of the ureter and renal pelvis with intestinal metaplasia and dysplasia that occurred in association with a large staghorn calculus was made.

HISTOPATHOLOGICAL STUDY OF NEOPLASTIC BREAST LESIONS IN A TERTIARY CARE CENTRE.

We have studied 194 cases of neoplastic breast lesions over a period of 2 years (1 Jan 2020 to 31 December 2021) in MGM Medical college and Hospital, Aurangabad. The specimens were received in histopathology section of pathology department. Specimens were received in different forms such as Lumpectomy, trucut biopsy, simple mastectomy and MRM. Detailed gross examination of specimens (grossing of MRM: - according to AJCC protocol) followed by xation, thorough sampling and tissue processing. The different lesions were studied by histopathological examination and analysed. Neoplastic lesions were classied according to WHO classication (2017).Out of 194 cases, 75 cases had benign breast tumours and 119 had malignant tumours. Fibroadenoma (68 cases) was most common benign tumour followed by benign phyllodes (4cases), lactating adenoma (2 cases) and multiple ductal papilloma(1 case). Invasive carcinoma with no special type (104 cases) was most common malignant tumour. Special subtypes of invasive carcinoma found in our study were:- Invasive metaplastic carcinoma (1 case) Invasive lobular carcinomas (2cases), Invasive papillary carcinoma (1 case), Invasive mucinous adenocarcinoma (1 case), Solid papillary carcinoma (1 case), Invasive carcinoma with mucinous component (1 case) , Invasive carcinoma with neuroendocrine features (1 case) and Intracystic papillary carcinoma (2cases). Other malignant tumours included malignant phyllodes (2 cases) and malignant spindle cell neoplasm (3 cases). In our study, we found that malignant neoplasms were more common than benign neoplasms with Invasive breast carcinoma with no special type being the commonest malignant tumour. Histopathological study plays an important role in diagnosis of breast neoplasms and hence in treatment and prognosis.

Studying the use of a proposed three-level grossing protocol in the histopathological diagnosis of COVID-19-associated rhinomaxillary mucormycosis.

Mucormycosis is an acute and rapidly progressing opportunistic fungal infection. COVID-19-associated mucormycosis (CAM) had re-emerged as a complication of COVID-19 infection during the second wave of the pandemic in 2021. The rhinomaxillary form is a variant of the rhino-cerebral mucormycosis that presents a diagnostic challenge to the dentist and the oral and maxillofacial pathologist. Gross examination of pathological specimens is the most undermined step even though it plays a vital role in the final diagnosis. No studies have described this post-clinical step for the maxillofacial soft and hard tissue submitted for examination. A prospective comparative study was carried out on 52 COVID-19-associated rhinomaxillary mucormycosis (CARM) cases to achieve complete, representative, and informative sampling of the submitted tissue and establish a three-level gross macroscopic examination protocol. Complete clinical and radiological histories were recorded after informed, written consent from every patient was received. Details of the number and type of samples received were recorded, grossing procedure was done as per the proposed three-level grossing protocol and were then compared to the presence of fungal hyphae in the soft tissue or decalcified hard tissue. All 100% of the samples consisted of soft tissue (maxillary sinus lining), while 90.4% of the samples contained different hard tissue specimens. Seventy percent of the grossing workload was carried out by first-year oral pathology residents. Sixty-seven point three percent of the total soft tissue samples submitted showed no presence of fungal hyphae, while 69.2% of total decalcified sections of hard tissue were positive for fungal hyphae with a positive correlation. Out of the 29 cases grossed via the three-level grossing protocol, 89.6% of the cases were histopathologically positive for fungal hyphae. Thus a positive association (P < 0.05) between histopathological diagnosis and the proposed three-level grossing protocol was found. It is imperative to recognise that no mucormycosis report is to be signed out without multi-site (three-level grossed) bone decalcified reports. There is an immediate need to realise how vital documentation, correct laboratory practices, and grossing are for accurate histopathological diagnosis.

A rare case of pancreatic acinar cell carcinoma presenting a submucosal tumor.

A 66-year-old man, who underwent distal gastrectomy with Billroth I reconstruction for gastric cancer, regularly underwent upper endoscopy as a routine examination. Unlike 1 year earlier [Figure 1a], a submucosal tumor-like lesion was identified near the minor papilla [Figure 1b], but the opening of the minor papilla could not be confirmed. Computed tomography revealed a mass (26 mm × 10 mm) protruding from the duodenal wall into the duodenal lumen [Figure 2] without pancreatic duct dilation. EUS using a linear array echoendoscope showed that the hypoechoic and smooth-marginal mass adjacent to the pancreatic head [Figure 3a] and the accessory pancreatic duct could not be recognized. EUS using a miniature probe showed that the mass was mainly located in the muscularis propria of the duodenal wall [Figure 3b]. The initial diagnosis was a duodenal gastrointestinal stromal tumor; however, EUS-guided fine-needle biopsy of the mass revealed suspicious pancreatic acinar cell carcinoma (PACC). A pancreaticoduodenectomy was performed. Macroscopically, a gray-white mass with a 25-mm maximum diameter was found in the duodenal submucosa on the cut surface [Figure 4a]. The boundary between the mass and the pancreatic parenchyma was unclear. Predominant growth of the tumor was observed within the accessory pancreatic duct by loupe image [Figure 4b]. No invasive growth or cystic formation was found. The tumor cells having irregular, hyperchromatic nuclei and eosinophilic cytoplasm proliferated mainly in an acinar or tubular pattern [Figure 4c]. The neoplastic cells were diffusely positive for anti-trypsin [Figure 4d] and bcl-10, whereas they were negative for a neuroendocrine marker, chromogranin or synaptophysin. Finally, the pathological diagnosis was a PACC at stage TisN0M0.Figure 1: (a) Endoscopic image showing no abnormality of the duodenal wall and minor papilla 1 year ago. (b) Endoscopic image showing a submucosal tumor-like lesion near the original minor papillaFigure 2: Contrast-enhanced computed tomography showing a mass (arrow) protruding from the duodenal wall into the duodenal lumen located in contact with the pancreatic headFigure 3: (a) EUS using a linear array echoendoscope showing a hypoechoic and smooth-marginated mass outside the pancreatic head. (b) EUS using a miniature probe showing the mass mainly located in the muscularis propria of the duodenal wallFigure 4: (a) Gross examination of resected specimen revealed a gray-white, solid lesion mainly occupying the duodenal submucosa on the cut surface. (b) A tumor with intraductal growth was observed by loupe image of histologic specimen (H and E). Normal pancreatic parenchyma (arrow). (c) Tumor cells having irregular, hyperchromatic nuclei and eosinophilic cytoplasm proliferated resembling acini of the pancreas (H and E, × 200). (d) Immunohistochemically, the neoplastic cells were positive for anti-trypsin (×40)PACC is a rare pancreatic tumor,[1] which is typically a solid tumor with expansive growth.[2] A PACC that predominantly grows within the main pancreatic ducts is extremely rare.[3] There has not been any reported case of PACC growing in the accessory pancreatic duct and presenting a submucosal tumor. In this case, there are some hypotheses regarding the specific tumor appearance: PACC originating from (1) pancreatic parenchyma near the accessory pancreatic duct and (2) ectopic pancreas[4] or submucosal pancreatic parenchyma.[5] However, it is a limitation that it was difficult to prove the hypotheses. Authors’ contributions R.S. treated the patient and wrote the manuscript; H.K., H.N., S.H., T.M., K.S., T.Y., H.A., M.K., M.F., T.M., M.F., K.O., E.T., T.U., A.T., and A.I. treated the patient and contributed writing the manuscript; T.T. performed pathological diagnosis and contributed writing the manuscript; all authors approved the final manuscript. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest Masaki Kuwatani is an Editorial Board Member of the journal. This article was subject to the journal’s standard procedures, with peer review handled independently of the editor and his research group.

Histopathological Spectrum of Findings in Liver in Autopsy Cases: A Case Study in Tertiary Centre

Background: Liver is the most vulnerable and major organ in our body which undergoes variety of insultslike metabolic, toxic, microbial and circulatory disturbances. Liver is the site of many diseases which becomesymptomatic while some are diagnosed only on autopsy.It is beneficial for clinician and pathologist to reachaccurate diagnosis through histopathological examination of liver and determine the involvement of liver inautopsy cases.Methods: A prospective study was conducted in the Department of Pathology, Government Medical College,Amritsar from January 2021 to December 2022. One hundred liver specimens were studied in autopsy cases ofdifferent age groups received in department of Pathology. Gross examination of liver specimen was done and.Hand E stained slides were subjected to microscopic examination. The aim of the study was to see the prevalenceof liver diseases in medicolegal autopsies and their histopathological examination.Conclusion: In our study number of males was more than females. Liver congestion was the most common findingin our study followed by fatty liver. Alcohol intake was the common findings in large number of autopsy cases.

The Significance of Unsampled Microscopic Thyroid Carcinomas in Multinodular Goiter.

Thorough gross examination and appropriate sampling of the thyroidectomy specimens are fundamental to the diagnosis and clinical risk management of patients. This study aims to investigate the frequency and clinical significance of initially unsampled microscopic thyroid carcinomas in total thyroidectomy specimens with presumed benign multinodular thyroid disease. Seventy-two total thyroidectomy specimens belonging to multinodular goiter patients were randomly selected and included in this prospectively designed study. Inclusion criteria were set as no suspicion of malignancy before surgery as well as lack of intra-parenchymal primary thyroid carcinoma after histopathological evaluation of slides generated from initial sampling. Subsequently, the remaining thyroidectomy specimens were submitted for microscopic examination and sign-outs were finalized following the microscopic examination of the entire thyroid tissue. Microcarcinomas, with a maximum diameter of 3.5mm, were detected in 29 cases (40.2%) after the whole gland sampling. Although most of these tumors were low-risk papillary microcarcinomas confined to the thyroid, one specimen also showed a medullary microcarcinoma measuring 1.5mm. Three had micrometastatic nodal disease. There was no local recurrence or distant metastatic disease during the follow-up (mean 51.4months). This study further supports microscopic carcinomas, including papillary microcarcinoma, and medullary microcarcinoma might stay hidden in thyroidectomy specimens. Increased glandular weight, male gender, and advanced age were significant risk factors in the detection of microcarcinomas in this series. While each multinodular thyroidectomy specimen is unique, we recommend dynamic extensive sampling (rather than bare-minimum approach) strategy based on careful gross and initial histologic examination findings as well as by taking into consideration risk factors.

The Use of Optical Coherence Tomography for Gross Examination and Sampling of Fixed Breast Specimens: A Pilot Study.

Thorough gross examination of breast cancer specimens is critical in order to sample relevant portions for subsequent microscopic examination. This task would benefit from an imaging tool which permits targeted and accurate block selection. Optical coherence tomography (OCT) is a non-destructive imaging technique that visualizes tissue architecture and has the potential to be an adjunct at the gross bench. Our objectives were: (1) to familiarize pathologists with the appearance of breast tissue entities on OCT; and (2) to evaluate the yield and quality of OCT images of unprocessed, formalin-fixed breast specimens for the purpose of learning and establishment of an OCT–histopathology library. Methods: Firstly, 175 samples from 40 formalin-fixed, unprocessed breast specimens with residual tissue after final diagnosis were imaged with OCT and then processed into histology slides. Histology findings were correlated with features on OCT. Results: Residual malignancy was seen in 30% of tissue samples. Corresponding OCT images demonstrated that tumor can be differentiated from fibrous stroma, based on features such as irregular boundary, heterogeneous texture and reduced penetration depth. Ductal carcinoma in situ can be subtle, and it is made more recognizable by the presence of comedo necrosis and calcifications. OCT features of benign and malignant breast entities were compiled in a granular but user-friendly reference tool. Conclusion: OCT images of fixed breast tissue were of sufficient quality to reproduce features of breast entities previously described in fresh tissue specimens. Our findings support the use of readily available unprocessed, fixed breast specimens for the establishment of an OCT–histopathology library.

Harnessing stereomicroscopy in pathological diagnosis: A case report on oral mucocele

The pre-analytic phase of a histopathology laboratory begins with the gross examination of biopsy specimens for orientation and dissecting the area of suspicion in histological diagnosis. This step is routinely performed by junior residents or laboratory technicians and very rarely by the diagnosing pathologists. Following conventional method of grossing, the macroscopic features recorded are subjective and limited and the photographs taken of the surgical specimens are often pixilated when magnified. The present case report describes the application of stereomicroscopy in gross examination of a case of oral mucocele and its function in histologic diagnosis.

Monophasic Synovial Sarcoma of Foot Masquerading Squamous Cell Carcinoma

Synovial sarcoma being a rare sarcoma typically arises near articular surface most commonly around knee joint. Hereby, a case report of a 38-year-old male with complaint of cauliflower-like proliferative growth on the plantar aspect of left foot. It rapidly progressed in size over a period of one month. Wedge biopsy was done and diagnosis of malignant mesenchymal tumour was suggested. Further clinical workup of the case was carried out and the surgeons proceeded with amputation of the foot. Gross examination of specimen showed a large, ulcerated, nodular, exophytic, cauliflower-like growth over the plantar aspect of left foot along with areas of haemorrhage and necrosis masquerading more common squamous cell carcinoma. Histopathology revealed characteristic hypocellular and hypercellular areas showing pleomorphic spindle cells in fascicles and whorls suggesting monophasic synovial sarcoma. Immunohistochemistry stains further confirmed the diagnosis. The current case report highlights the rare presentation of synovial sarcoma as a cauliflower type of growth at a rare location.

Failure of placental detachment in accreta placentation is associated with excessive fibrinoid deposition at the utero-placental interface

The main histopathologic diagnostic criteria for the diagnosis of placenta accreta for more than 80 years has been the finding of a direct attachment of the villous tissue to the superficial myometrium or adjacent to myometrial fibers without interposing decidua. There have been very few detailed histopathologic studies in pregnancies complicated by placenta accreta spectrum disorders and our understanding of the pathophysiology of the condition remains limited. To prospectively evaluate the microscopic changes used in grading and to identify changes that might explain the abnormal placental tissue attachment. A total of 40 consecutive cesarean delivery hysterectomy specimens for placenta previa accreta at 32 to 37 weeks of gestation with at least 1 histologic slide showing deeply implanted villi were analyzed. Prenatal ultrasound examination included placental location, myometrial thickness, subplacental vascularity and lacunae. Macroscopic changes of the lower segment were recorded during surgery and areas of abnormal placental adherence were sampled for histology. In addition, 7 hysterectomy specimens with placenta in-situ from the Boyd Collection at 20.5 to 32.5 weeks were used as controls. All 40 patients had a history of at least 2 previous cesarean deliveries and presented with a mainly anterior placenta previa. Of note, 37 (92.5%) cases presented with increased subplacental vascularity, 31 (77.5%) cases with myometrial thinning and all with lacunae. Furthermore, 20 (50%) cases presented with subplacental hypervascularity, lacunae score of >3, and lacunae feeder vessels. Intraoperative findings included anterior lower segment wall increased vascularization in 36 (90.0%) cases and extended area of dehiscence in 18 (45.0%) cases. Immediate gross examination of hysterectomy specimens showed an abnormally attached areas involving up to 30% of the basal plate, starting at <2 cm from the dehiscence area in all cases. Histologic examination found deeply implanted villi in 86 (53.8%) samples with only 17 (10.6%) samples presenting with villous tissue reaching at least half the uterine wall thickness. There were no villi crossing the entire thickness of the uterine wall. There was microscopic evidence of myometrial scarification in all cases. Dense fibrinoid deposits, 0.5 to 2 mm thick, were found at the utero-placental interface in 119 (74.4%) of the 160 samples between the anchoring villi and the underlying uterine wall at the accreta areas and around all deeply implanted villi. In the control group, the Nitabuch stria and basal plate became discontinuous with advancing gestation and there was no evidence of fibrinoid deposition at these sites. Samples from accreta areas at delivery present with a thick fibrinoid deposition at the utero-placental interface on microscopic examination independently of deeply implanted villous tissue in the sample. These changes are associated with distortion of the Nitabuch membrane and might explain the loss of parts of the physiological site of detachment of the placenta from the uterine wall in placenta accreta spectrum. These findings indicate that accreta placentation is more than direct attachment of the villous tissue to the superficial myometrium and support the concept that accreta villous tissue is not truly invasive.

A retrospective analysis of spectrum of presentation of adenomyosis in tertiary centre

Benign invasion of endometrial tissue into the myometrium of uterus is known as adenomyosis. It is found typically between the age of 35-50 years. Prevalence is 6- 39%. Modern imaging techniques, both ultrasound (TAS, TVS) and MRI have made possible, for the first time, a non-invasive identification of adenomyosis. To analyse the spectrum of presentation of adenomyosis and to determine the accuracy of clinical examination and imaging modalities in the diagnosis. It is a retrospective study done at hospitals attached to Bangalore Medical College &amp; Research Institute during august 2016-august 2017. The HPE reports and case records of all the hysterectomy specimens were reviewed. Data regarding age, parity, symptoms, obstetric history, examination, co morbidities, investigation findings, associated pathology and treatment modality were noted. They were tabulated and analysed. Out of the 50 patients, 56% were in the age group of 41-50 years. The prevalence of adenomyosis in our study was only 10% in post-menopausal women when compared to the age group 41-50yrs (56%). Multiparous women had 94% incidence of adenomyosis. 26% of women had prior uterine surgeries. 22% of cases had history of infertility in this study. 56% had menstrual disturbances. Dysmenorrhea &amp; Dyspareunia were the next common symptoms. Fibroid was the commonest associated pathology (38%). 34% had hyperplasia of endometrium whereas 66% had no pathology. Imaging picked up only 40% of cases contrary to 36% of clinical diagnosis and was raised to 66% with gross examination of specimen and 100% with HPE. Adenomyosis has a varied presentation. Ultrasound fails to diagnose all the cases. Clinical examination is a better modality. Associated pathology may mask the clinical features of adenomyosis, and diagnosis may be missed. Presently HPE is probably the gold standard for diagnosing adenomyosis.

Mimicker of Renal Cell Carcinoma- A Case Report

Oncocytoma is a rare epithelial tumour composed of oncocytes which are epithelial cells with excessive amount of mitochondria. The tumour is most often benign, and diagnosis can be made on the basis of histopathological examination. Here, the authors present a 64-year-old female patient, with complaints of abdominal discomfort and flank pain, along with history of loss of weight and appetite for one month. Radiology showed a left renal mass of measuring 9×7×4.5 cm involving the upper and middle pole suggestive of malignancy. Following which radical nephrectomy was done. Examination of gross specimen showed a fairly circumscribed brownish lesion in the upper and middle pole of left kidney measuring 8.8×7×4.5 cm with a central scar. There was no evidence of hilar and perirenal fat invasion. Histology showed sheets of large polygonal eosinophilic cells with centrally placed nucleus. The differentials were eosinophilic variant of clear cell renal cell carcinoma, chromophobe renal cell carcinoma and oncocytoma. A panel of Immunohistochemical (IHC) markers was performed for further categorisation and the lesional cells were positive for CD 117 and negative for CD 7 and CD 10. This ruled out the differentials and confirmed oncocytoma, thus ruling out the necessity for chemotherapy.

Intrathoracic Liver Heterotopia: An Incidental Finding at Autopsy

AbstractHeterotopia is the presence of a particular tissue at a nonphysiological site. The most common sites are gastric, pancreatic, and splenic heterotopias. While liver heterotopias are rare, intrathoracic heterotopias are much more limited. It is usually reported incidentally on imaging investigations or at autopsy. There is a high incidence of malignant transformation of heterotopic livers, and hence resection is always recommended. Here we report a case of heterotopic liver tissue in the right lung in a 42-year-old male, incidentally found at the gross examination of autopsy specimen of the lung.

A new methodologic approach for clinico-pathologic correlations in invasive placenta previa accreta

The development of new management strategies for women presenting with placenta accreta spectrum requires quality epidemiology data, which have so far been limited by the high variability in clinical and histopathologic data confirming the diagnosis at birth. To evaluate the role of a new methodologic approach for the correlation of clinical and pathological data for women with a history of prior cesarean delivery diagnosed prenatally with placenta previa accreta. A modified pathologic technique for gross examination of hysterectomy specimens with placenta in situ consisting of intraoperative examination, immediate postoperative examination, and guided histologic sampling was used prospectively in a cohort of 24 patients with singleton pregnancies complicated by placenta low-lying/placenta previa accreta. Maternal characteristics, detailed ultrasound findings, surgical outcomes, and histopathologic examination were compared with those of a group of 24 patients with similar clinical characteristics and in whom a standard pathologic examination method was used. The median reporting time for obtaining the complete histopathology results including the microscopic examination was significantly shorter (7 versus 15 days; P < .001) and the median number of samples taken for histologic examination significantly lower (4 versus 14 samples; P < .001) in the study group than in the controls. The number of histologic slides showing villous invasion was significantly higher (2 versus 1 slide; P= .002), and the ratio of the number of samples taken to the numbers of slides confirming villous invasion was significantly lower (2 versus 9; P < .001) in the study group than in the controls. In all cases in the study group, intraoperative examination identified a dense tangled bed of vessels or multiple vessels running laterally and cranio-caudally in the uterine serosa above the placental insertion that were no longer visible during immediate gross postoperative examination of the hysterectomy specimens. Immediate postoperative dissection enables the differential diagnosis between focal and large increta areas, and between abnormally adherent placenta and invasive placenta accreta. Valuable clinical information on the serosal vascularity, uterine dehiscence, and extension of the accreta area is added with the description of the macroscopic examination during the surgical procedure and immediate dissection of the specimen. This methodological approach is cost-effective and increases the quality of the histologic sampling. It thus provides more accurate correlations with the clinical data and more accurate epidemiologic data collection. Perinatal pathologists should be part of multidisciplinary teams involved the management placenta accreta spectrum disorders.

Pathology of pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy and estimated to become the second leading cause of cancer-related deaths by 2030. Although overall 5-year survival rates have constantly remained below 10% for the last decades, several key points important for accurate patient stratification have emerged during recent years. These key points include a highly standardized gross examination of PDAC resection specimens, using an axial slicing technique and inking of the circumferential resection margin (CRM), as well as a meticulous microscopic examination, taking into account the prognostic relevance of factors such as the exact resection status (R0 vs. R1 1-mm vs. R1 resection), histopathological tumor grading and the so-called lymph node ratio (LNR). With increasing use of neoadjuvant therapy in PDAC, tumor regression grading (TRG) for PDAC is currently rising in relevance in order to stratify and manage pre-operatively treated PDAC patients. As all current TRG systems for PDAC are unsatisfactory, new standardized international protocols are urgently needed. Several morphological subtypes of PDAC exist, some of which share the same molecular background with classical PDAC, while others are characterized by a distinct molecular pathogenesis. While some show a prognosis similar to classical PDAC, other subtypes stand out due to a better or even worse prognosis than classical PDAC. Prognostic relevant molecular subtypes of PDAC have been proposed as well, however, limitations of used cohorts and the lacking correlation of molecular subtypes with histomorphological subtypes limit the translation of these findings into valuable clinical applications. Lastly, several macroscopic and microscopic precursor lesions of PDAC have been described in genetically engineered mouse models (GEMM) and humans in recent times, providing further insight into PDAC carcinogenesis. In addition, improved diagnosis of PDAC precursors represents a chance to select patients for resection before invasive PDAC is present.

Prenatal ultrasound observation of duplication of the large intestine wall with the formation of cysts

The article presents the results of prenatal ultrasound monitoring of a rare colon anomaly — duplication of a blind gut wall with cyst formation. This abnormality was difficult to accurately in during prenatal and postnatal periods using sonography, computer tomography and magnetic resonance imaging. The final diagnosis made only after histopathological examination of gross specimen obtained in operation.

Colloid Carcinoma of Gallbladder - Incidental Finding of a Rare Entity

Majority gall bladder carcinomas are conventional adenocarcinomas of pancreatobiliary type. Mucinous carcinomas in gall bladder constitutes 2.5% of all gallbladder carcinomas. Pure mucinous (colloid carcinomas) are even rarer. Its rarity deserves this case being highlighted. Less than twenty-five cases of mucinous carcinomas of the gallbladder have been reported so far. A 46-year-old female presented with recurrent right upper quadrant pain along with nausea and vomiting for last one year. Liver function tests &amp; kidney function tests were within range. USG Abdomen revealed an enlarged gallbladder measuring 8x5 cm with no stones. No other abnormalities were found on USG. A simple cholecystectomy was performed for chronic cholecystitis. Gross examination of specimen showed glistening, globular, soft and cystic gall bladder filled with mucoid tenacious yellowish material. There was no discernible mass lesion. Microscopic examination revealed pools of extracellular mucinous material dissecting muscular wall containing few signet ring cells. A diagnosis of colloid or pure mucinous adenocarcinoma of the gallbladder was made. Pure mucinous carcinomas as seen in exocrine glands like breast, pancreas and skin are very uncommon in gall bladder. Mucinous variant (&gt;50% stromal mucin) are most of the time admixed with conventional type. Mucinous carcinomas most of the time are large and advanced at the time of diagnosis and are aggressive in nature than conventional type. This case is presented owing to its extreme rarity.

Clinicopathological Spectrum of Chronic Filarial Epididymo-Orchitis

Background: Filariasis is a vector-borne neglected tropical disease, most commonly caused by Wuchereria bancrofti. Chronic lymphatic filariasis in males usually presents as scrotal swelling with hydrocoele, although, a variety of other genital manifestations can also be seen. This study was undertaken to establish the clinicopathological spectrum of chronic filarial epididymo-orchitis (FEO) in a tertiary care institution in India. Methods: Cross-sectional observational study spanning a retrospective period of 17 years from 2000-2017. Results: Nineteen cases of chronic FEO were diagnosed, comprising 1.8% of all testicular and paratesticular biopsies (n=1055). Median age was 40 years. All patients presented with scrotal swelling. Examination revealed hydrocoele (12/19), lymph scrotum (5/19), epididymal nodules (4/19) or scrotal elephantiasis mimicking testicular tumour (3/19). Gross examination of orchidectomy specimens revealed cystic hydrocoele sacs with markedly thickened tunica, while four cases showed extensive parenchymal necrosis. Histopathology revealed adult filarial worms either within the epididymal/paratesticular tissues (9/19) or in the tunica vaginalis (7/19). Two cases, in addition, showed microfilarial larvae within the tissues. Six cases showed characteristic Meyers-Kouvenaar bodies surrounding adult worms. Conclusion: This single institution study from India identifies chronic FEO as a rare but important cause of scrotal swelling. Since chronic FEO may be clinically mistaken for testicular tumour, awareness of the clinicopathological spectrum is essential. Biopsies with intense infiltrate of eosinophils and lymphangiectasia need high index of suspicion for filariasis and warrant careful search for adult filarial worm as well as microfilaria in tissue sections.

Short-Duration Rapid Chilling of Mastectomy Specimens Does Not Interfere With Breast Cancer Biomarker and Molecular Testing.

A thorough gross examination of specimens for breast cancer requires the tissue to be very thinly sectioned, which is often difficult in large mastectomy samples. We have implemented rapid chilling of mastectomy specimens before formalin fixation. To evaluate the effects of rapid chilling of breast tissue on subsequent biomarker and molecular testing. Mastectomy specimens were chilled at -80°C for 20 minutes to facilitate uniform sectioning of tissue at 4-mm intervals and enhance proper fixation and identification of small lesions. The integrity of chilled tissue for ancillary and molecular testing was assessed. We identified patients who were diagnosed with breast cancer on biopsy at outside institutions and subsequently underwent mastectomy at our institution during 2010-2014. We compared the results of biomarker testing performed on biopsy tissue with those performed on mastectomy tissue. The quantity and quality of DNA extracted from formalin-fixed, paraffin-embedded (FFPE) mastectomy tissue with invasive carcinoma were assessed by using spectrophotometry and polymerase chain reaction. All Oncotype DX reports from 2011-2014 were reviewed to identify any documented evidence of assay interference caused by rapid chilling of tissue. We found essentially 100% concordances in estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 gene ERBB2 (HER2/neu) studies. Extracted tumor DNA showed suitable purity and concentration that produced amplified fragments of 300 to 400 base pair lengths by polymerase chain reaction of FFPE tissue. No documented assay interferences were found in the Oncotype DX reports. Short-duration rapid chilling of mastectomy tissue improves gross examination, optimally preserves DNA, allows for molecular testing, and does not interfere with biomarker assessment.