Histopathological Correlation Research Articles

An Observational Study to Correlate the Histopathological and Dermoscopic Features in Leprosy Patients in a Tertiary Care Hospital.

Leprosy is a chronic granulomatous infection with varied clinical presentations. Dermoscopy is a noninvasive technique widely used in the diagnosis of various skin diseases. To see the correlation between the clinical and dermoscopic features with the histopathological findings in leprosy. A prospective observational study was conducted on clinically suspected leprosy patients attending the dermatology outpatient department (OPD) for 18 months. Representative lesions were observed by dermoscopy, and a biopsy was performed, followed by histopathology for final diagnosis. Patients were categorized by Ridley-Jopling classification. A total of 70 clinically suspected leprosy patients were included in the study. Amongst 70 cases, 56 cases were diagnosed as leprosy by dermoscopy, and 53 cases were confirmed as leprosy by histopathology (hematoxylin and eosin [H and E] staining and Fite-Faraco staining). The other six cases were diagnosed as other nonspecific dermatitis by histopathological findings. Eleven cases that were dermoscopically negative were also confirmed by histopathology to be truly negative. There are three inconclusive cases of dermoscopic findings, which were diagnosed as mid-borderline leprosy by histopathology. Dermoscopic and histopathological correlation was found above 87% in all types of leprosy except mid-borderline leprosy, which showed only a 25% correlation. Dermoscopy is a useful noninvasive tool to assess lesions of leprosy, requires less time for diagnosis, skin features are magnified several times and may become evident before clinical presentation. It definitely helps to reduce the number of biopsies in case of diagnosis of leprosy. However, in doubtful cases, histopathology is required for definitive diagnosis as it is the gold standard to date.

Arterial spin labeling combined with T1 mapping for assessment of kidney function and histopathology in patients with long-term renal transplant survival after kidney transplantation.

The long-term survival of kidney transplants is often influenced by various factors, among which renal allograft rejection is the most notable factor. A noninvasive and reliable imaging biomarker correlating with kidney function and histopathology would facilitate longitudinal long-term follow-up of renal allografts. The aim of the study is to investigate the value of arterial spin labeling (ASL) combined with T1 mapping for assessing kidney function in patients with long-term renal transplant survival, and to establish radiological and histopathologic correlations between the magnetic resonance imaging (MRI) measurements and kidney allograft biopsy findings. Kidney transplant recipients who were admitted to the Department of Urology in First Affiliated Hospital of Soochow University between January and December 2022 were prospectively consecutively recruited [group A, estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2; group B, 30≤ eGFR <60 mL/min/1.73 m2; group C, eGFR <30 mL/min/1.73 m2], and part of them underwent biopsies. All patients underwent ASL and T1 mapping. MRI parameters were calculated and analyzed. A total of 63 patients (Group A, 30 cases; Group B, 20 cases; and Group C, 13 cases) were included in this cross-sectional study. Cortical T1 increased, whereas renal blood flow (RBF) and ΔT1 [100% × (cortical T1 - medullary T1)/cortical T1] decreased with the decrease of eGFR. The RBF, cortical T1, and ΔT1 values were moderately correlated with eGFR (r=0.569, -0.573, and 0.672, respectively). The MRI parameters were moderately correlated with Banff scores, which determined renal allograft rejection and chronicity. The area under the curve (AUC) for the discrimination of groups A versus B and groups A versus C were 0.740 [95% confidence interval (CI): 0.597-0.854, P=0.004] and 0.923 (95% CI: 0.800-0.982, P<0.001), respectively, using ASL; 0.873 (95% CI: 0.749-0.950, P<0.001) and 0.926 (95% CI: 0.803-0.983, P<0.001), respectively, using T1 mapping; and 0.892 (95% CI: 0.771-0.962, P<0.001) and 0.956 (95% CI: 0.846-0.995, P<0.001), respectively, using multi-parameter MRI. The AUC for discrimination between groups B and C was 0.729 (95% CI: 0.546-0.868, P=0.02) using ASL. The RBF, cortical T1, and ΔT1 can serve as new imaging biomarkers of kidney function and histopathological microstructure.

Retrospective application of WHO reporting system for lung cytopathology with assessment of risk of malignancy

INTRODUCTIONThe recently introduced World Health Organization (WHO) reporting system for lung cytopathology presents five diagnostic categories with corresponding risk of malignancy (ROM) and management protocols. This study employs the system to categorize our institutional respiratory tract cytology specimens, evaluating ROM and diagnostic accuracy for each category. METHODSIn a retrospective analysis (May 2020 to August 2021), following respiratory cytology specimens were classified based on the WHO categories: bronchoalveolar lavage (BAL), bronchial wash/bronchial brushings (BB/BW), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), fine needle aspiration cytology (FNAC), sputum, biopsy imprint (BI), and endotracheal wash. Exclusions comprised Pleural effusions and EBUS-TBNA from mediastinal and hilar lymph nodes. Correlation of cytological and histopathological diagnoses was done to assess ROM collectively and individually. RESULTSA total of 1518 respiratory samples (BAL(968), BW/BB(380), EBUS-TBNA(42), FNAC(32), Sputum(80), BI(11) and endotracheal wash(5) of 1410 patients were screened, of which 522 cases (34.3%) had histopathological correlation. One forty-one cases (9.3%) were ‘Insufficient/Inadequate/Non-Diagnostic’(ND), 1221(80.4%) were ‘Benign’ (B), 3(0.2%) were ‘Atypical’ (A), 32(2.1%) were ‘Suspicious for malignancy’ (SM) and 121(8.0%) were ‘Malignant’ (M). The estimated ROM for each category was 49.2% for ND, 13.3% for B, 66.6% for A, 81.5% for SM and 92.7% for M. FNAC and EBUS-TBNA exhibited the highest sensitivity (100%) compared to BW/BB (66.3%). Specificity ranged from 96.8% to 100% across the samples, while diagnostic accuracy varied from 58.8% to 100%. CONCLUSIONApplication of the WHO reporting system enhances standardized terminology, aiding clinicians in informed decision-making and improving patient care through accurate risk assessment of malignancy.

Intratumoral Heterogeneity, Chemoresistance and Lymph Node Landing Zone Prognosis in Testicular Tumors Based on Histopathological Characteristics.

Existing data on the histopathological correlation of testicular tumors with lymph node prognosis have been poorly explored. We aimed to investigate the relationship of the histopathological properties of testicular tumors with lymph nodes and their involvement with chemoresistance and heterogeneity of testicular tumors. Patients with non-seminomatous germ cell tumor (NSGCT) were selected for histopathological correlation of testicular tumor with lymph nodes and its relationship with chemoresistance and heterogeneity. Histopathological and radiological parameters associated with the risk of chemoresistance and tumor progression were measured pre- and post-chemotherapy. Binomial logistic regression and Kaplan-Meier analysis were implemented to determine the predictors of progression and adverse overall patient survival. All categorical variables were analyzed using the Chi-square test, while Pearson's R coefficient determined the correlation. Male patients who were diagnosed with NSGCT from March 2017 to December 2018 at Guwahati Medical College, Guwahati, India, were included in this study. Lymph node groups were predominantly incriminated with the EYST or EYS groups and minimally linked with the pure E and YCS groups. Furthermore, the highest number of lymph node stations was associated with pre-chemotherapy. In salvage chemotherapy in the form of VIP, we found exciting outcomes, as approximately 41% of cases responded positively, especially in the EYS group. Our study classifies NSGCT according to the most favorable histopathological grouping and explores the tumoral response in different intrinsic and extrinsic variables. Our analysis can serve as a triumphant histopathological nomogram for a sublime management protocol to deal with the onerous histological pairing in NSGCT.

Fluorescence-guided minimally-invasive resection of abdominal paragangliomas using indocyanine green

This retrospective study explores the utility of near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) in enhancing the intraoperative identification and guidance for the resection of abdominal paragangliomas. They can be challenging to detect during minimally invasive surgery, due to their anatomical location, varying size and similar appearance in regard to their surrounding tissue. Patients with suspected abdominal paragangliomas planned for a minimally-invasive resection were included. As part of standard of care they received single intravenous dose of 5 mg ICG after abdominal exploration. NIR fluorescence imaging of the anatomical region of the suspected lesion was performed immediately following intravenous administration, to assess fluorescence signals, intraoperative identification, and histopathological correlation. Out of five resected suspicious lesions, four were imaged with NIR fluorescence, pathology confirming four as paragangliomas, the latter turned out to be an adrenal adenoma. NIR fluorescence identified all four lesions, surpassing the limitations of white-light visualization. Homogeneous fluorescence signals appeared 30–60 s post-ICG administration, which lasted up to 30 min. The study demonstrates the feasibility and potential clinical value of fluorescence-guided minimally-invasive resections of abdominal paragangliomas using a single intravenous ICG dose. These findings support the scientific basis for routine use of ICG-fluorescence-guided surgery in challenging anatomical cases, providing valuable assistance in lesion detection and resection.

Magnetic Resonance Spectroscopy of Intra-axial Gliomas With Histopathological Correlation in a Tertiary Care Center of Eastern Nepal.

Background and objective Magnetic resonance spectroscopy (MRS) is a magnetic resonance imaging technique used to identify in vivo metabolites non-invasively within the tissue of interest. It plays an important role in diagnosing brain lesions, particularly tumors and infections. There are certain metabolites whose levels are increased or decreased in brain tumors, the ratios of which can also be used to grade the tumors as high- or low-grade. This study aimed to assess the spectrum of different metabolites in intraaxial gliomas using magnetic resonance spectroscopy and to assess the usefulness of their ratios for grading gliomas into high-grade and low-grade. Methods This descriptive cross-sectional study was performed in the radiology department of Nobel Medical College and Teaching Hospital, Biratnagar, Nepal over one year (September 2019 to September 2020). Thirty-five patients diagnosed as having intra-axial tumors were enrolled. After taking informed consent the examination findings were recorded in structured proforma. Siemens' 3 Tesla open magnet MAGNETOM Skyra (Siemens Healthineers AG, Munich, Germany) MR scanner was used to evaluate each patient. Data was analyzed using the software Statistical Package for Social Sciences (SPSS), version 26.0 (IBM Corp., Armonk, NY). Results Out of 35 patients scanned, 18 had high-grade glioma and 17 had low-grade glioma. High-grade glioma had a choline/creatine (Cho/Cr) ratio of 2.44 ± 0.78 and a choline/N-acetyl-aspartate (Cho/NAA) ratio of 2.05 ± 0.84. Low-grade glioma had a Cho/Cr ratio of 1.48 ± 0.50 and a Cho/NAA ratio of 1.41 ± 0.19. Fourteen out of eighteen high-grade gliomas had raised lipid/lactate peaks. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and accuracy for diagnosing high-grade glioma with a Cho/Cr ratio cut-off of 1.5 was 83.3 %, 82.4%, 83.3%,82.4 %, and 82.85% respectively. Conclusion MRS metabolite ratios can be used to diagnose and grade gliomas. Cho/Cr, Cho/NAA, and the presence or absence of lipid/lactate peak can significantly improve the sensitivity, specificity, predictive values, and accuracy of preoperative glioma grading when used in conjunction with conventional MRI.

Should Liquid-Based Cytology (LBC) be Preferred than Conventional Pap Smear (CPS): A Comparative Analysis.

To study the cytomorphological differences of both techniques and to study the relative advantages and limitations of both techniques. A total of five hundred cases were collected. The conventional Pap smears (CPS) were prepared with cytobrush, and the same brush head was suspended in LBC vial and processed by SurePath. Of the 500 cases studied, the age ranged from 21 to 80years with a mean of 40.02. The number of satisfactory smears in CPS and LBC was 490 and 496 cases, respectively. In conventional method, 417 cases (83.4%) and LBC 430 cases (86.0%) were inflammatory smears. The number of LSIL was 18 in conventional method and 15 in LBC. HSIL was 11 in CPS and 10 in LBC, and 8 squamous cell carcinoma cases were seen in LBC. Histopathological correlation was observed in 19 cases of which LBC showed sensitivity and specificity of 100%. LBC may be considered better than conventional Pap smear due to better adequacy, clarity of background, detection of infections and increased sensitivity and specificity in detecting LSIL and HSIL.

A124 A SYSTEMATIC REVIEW OF THE EFFICACY OF ARTIFICIAL INTELLIGENCE IN IDENTIFYING BARRETT'S ESOPHAGUS NEOPLASIA

Abstract Background Barrett’s Esophagus (BE) is a known precursor for esophageal adenocarcinoma and requires frequent surveillance with esophagogastroduodenoscopy. Due to tumour heterogeneity and logistical demands on endoscopists, identification of BE dysplasia is difficult and random biopsies are riddled with sampling error. Artificial Intelligence (AI), in the form of computer-aided detection, has entered the endoscopic realm to improve BE dysplasia detection. This systematic review aims to evaluate its efficacy in BE screening. Aims To survey the literature regarding the efficacy of machine learning tools in identifying BE dysplasia. The primary outcome was recognition of BE from a database of endoscopic images with histopathologic correlation utilizing a machine learning algorithm, with sensitivity and specificity reported. Methods Using the PRISMA framework, MEDLINE, EMBASE and Compendex databases were searched from inception to Sept 1, 2023. Of 1915 articles identified, 35 were selected for full-text review. Two reviewers, JB and JK, independently completed the literature review and discrepancies were reviewed by the PI. After applying inclusion and exclusion criteria, 20 studies were included in the systematic review. The quality of studies was assessed using the Newcastle-Ottawa Scale. Inclusion Criteria: -Must include Barrett's esophagus and / or EAC (esophageal adenocarcinoma) -Must include novel research (not a systematic review or MA) -Requires use of endoscopic images -English only, full text manuscripts Exclusion Criteria: -No prior surgery (esophagectomy) -Does not include esophageal squamous cell carcinoma Results Of the 20 articles selected, seven were published after 2021. All studies utilized a machine learning algorithm to aid in identification of BE dysplasia. Various imaging modalities were used, including white light imaging, narrow-band imaging, or volumetric laser endomicroscopy. A total of 3,886 patients were included with 5,605 images. Sensitivity ranged from 72 – 100%, specificity ranged from 64 – 94%. The overall quality of studies included was low. Conclusions Surveillance of BE dysplasia remains a difficult and time-intensive task. Computer-aided detection of BE dysplasia demonstrates strong performance independent of the machine learning algorithm or imaging modality. Meta-analyses are required to illustrate heterogeneity and power to bolster these preliminary findings. Funding Agencies None

Primary pulmonary osteosarcoma: A rare malignancy of the lung with histopathologic correlation

Primary pulmonary osteosarcoma (PPO) is an uncommon aggressive mesenchymal neoplasm of the lung characterized by the production of osteoid matrix. Calcified metastases from osteosarcoma of bone are more common in the lung rather than PPOs, and the differentiation between these two entities is important for the management. The diagnosis of PPO requires exclusion of primary osteosarcoma elsewhere in the body and also histopathological confirmation. We report a case of primary osteosarcoma of the lung with a brief review of literature.

Unveiling Variations: A Comprehensive Comparison of Five Globally Used Thyroid Cytology Reporting Systems With Histopathological Correlation.

Introduction Accurate cytological assessment is pivotal for managing thyroid lesions and various global reporting systems are in use, such as the globally acclaimed The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), alongside other reporting systems namely, the Japanese Reporting System for Thyroid Aspiration Cytology (JRSTAC), Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC), the UK Royal College of Pathologists System for Reporting Thyroid Cytopathology (UK RCPath), the Royal College of Pathologists of Australasia and Australian Society of Cytology Classification System (RCPA/ASC). Notably, variations exist among these systems which are influenced by country-specific statistics. Given the lack of large-scale data in India and the difference in prevalence of diagnostic entities compared to the western population, this study aimed to identify reporting systems suitable for the Indian population focusing on distinguishing neoplastic from non-neoplastic lesions. Materials and methods A cross-sectional analysis of 40 thyroid cytology cases with histopathological correlation was conducted. Pathologists independently assessed cytology slides using JRSTAC, ICCRTC, RCPA/ASC, UK RCPath and TBSRTC. Five performance indicators, sensitivity, specificity, positive predictive value (PPV) of neoplastic conditions, negative predictive value (NPV) of non-neoplastic conditions, diagnostic accuracy and two quality indicators, percentage of Atypia of undetermined significance (AUS) and AUS/Malignant ratio were analyzed and compared. Results Among 40 cases, 22 cases were neoplastic (16 papillary thyroid carcinoma, six follicular adenoma) and 18 non-neoplastic (14 multinodular goiter, four lymphocytic thyroiditis). Specific patterns emerged in cases labeled "Non-diagnostic", prompted questions about categorizing inadequately cellular cases as "benign" in light of the presence of specific findings. All reporting systems showed 100% specificity in detecting non-neoplastic and neoplastic conditions in Category 1 and Category 6 respectively. Performance and quality indicators varied among reporting systems with TBSRTC (PPV of neoplastic cases 85.71%, NPV of non-neoplastic cases 70.58%, specificity 85.7%, sensitivity 70.58%, diagnostic accuracy 60%, AUS percentage 22.5% and AUS/Malignant ratio 3%) and RCPA/ASC (PPV of neoplastic cases 76.47%, NPV of non-neoplastic cases 70.58%, specificity 75%, sensitivity 72.2%, diagnostic accuracy 62.5%, AUS percentage 15% and AUS/Malignant ratio 3%) showing better results. Conclusion Among the five thyroid cytology reporting systems studied, TBSRTC and RCPA/ASC showed better overall performance results and quality indicators were close to benchmark. Better performance by TBSRTC 2023 could be due to the detailed criterion mentioned per category with subcategorization of AUS and suspicious for malignancy by features of cytological and architectural atypia. Similarly, RCPA/ASC has subcategorized AUS with defined criteria and certain background features were included as an isolated criterion for the suspicious for malignancy category. These defined criteriaoutlined in TBSRTC and RCPA/ASC played a crucial role in minimizing and reclassifying cases from the indeterminate categories (AUS and suspicious for malignancy) into well-defined categories with established management protocols.

A Clinico-Epidemiological Study on Porokeratosis.

Porokeratosis (PK) is a chronic progressive disorder of keratinization characterized clinically by hyperkeratotic papules or plaques surrounded by a threadlike, elevated border that expands centrifugally. Pathogenesis involves heterozygous mutations in mevalonate kinase enzyme. The most common variants are disseminated superficial actinic porokeratosis (DSAP) and PK of Mibelli. All forms show a thin column of parakeratosis, the cornoid lamella, representing the active border. Dermoscopy reveals central brownish discoloration surrounded by a single hypopigmented band and a peripheral 'white track'. Long-standing cases of PK may undergo malignant transformation. UV-protection and topical agents, such as 5-fluorouracil, imiquimod, calcipotriol, tretinoin and oral retinoids are helpful. To study the clinical and epidemiological pattern of PK and the clinico-dermoscopic and histopathological correlation of PK. A prospective cross-sectional study was conducted on the patients attending the dermatology outpatient department (OPD) over 9 months with suspected features of PK. These patients were evaluated clinically and subjected to dermoscopy and histopathology. Statistical Package for the Social Sciences (SPSS) Of 11 patients, there were four (36.36%) males and seven (63.66%) females. The youngest was 18-year-old boy, and the eldest was 63-year-old man. The clinically most common type was PK of Mibelli with five (45.45%) cases. The most common dermoscopic feature observed was double-marginated, white peripheral border. The most common histopathological feature noted was cornoid lamella. PK is a rare skin disorder with a wide spectrum of clinical variants. Dermoscopy and histopathology aid in diagnosis, whereas dermoscopy plays a pivotal role in early and non-invasive diagnosis. Regular follow-up is mandatory to watch for the development of malignancies in a few variants.

Dermatoscopic Characteristics, Lesional Capillaroscopic Features, and Histopathological Correlation of Small Plaque Parapsoriasis and Mycosis Fungoides.

Dermatoscopy is a frequently used non-invasive diagnostic procedure. Considering that mycosis fungoides (MF) mimics parapsoriasis clinically in early stages, we aim to determine the dermatoscopic criteria and the histopathological correlations in patients with MF and small plaque parapsoriasis (SPP). This prospective study involved 28 patients with clinical and histopathological diagnoses of MF and 31 patients with SPP. Videodermoscopy and USB capillaroscope were used to evaluate the patients vessels at ×200 magnification. Vascularity was evaluated through microvascular density (MVD) scoring involving CD34 antibody staining. Fifty-nine patients were included in this study. The scores corresponding to the presence of short linear vessels, linear-curved vessels, branching linear vessels, and non- structured orange-colored areas were significantly higher in the MF patients than in the SPP patients (P < 0.05). The highest MVD (P = 0.01) scores were also higher in the MF patients than in the SPP patients. The SPP and early-stage MF patients differed in their MVD scores, and the findings correlated with the dermatoscopy and lesional capillaroscopy findings. Differentiating features between SPP and MF were thus identified.

Role of Computed Tomography in Differentiating between Benign and Malignant Gallbladder Masses with Histopathological Correlation

A cross-sectional study was done to evaluate computed tomography (CT) scans as a diagnostic tool for distinguishing between benign and malignant gallbladder masses corroborated by histopathological findings. The study was conducted in the Department of Radiology &amp; Imaging of Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, between January and December of 2013. The study included a total of 45 patients who were ultrasonographically diagnosed with gallbladder masses. Later, those patients underwent CT scans using a 16-slice helical CT scan machine. All CT scan findings were interpreted by the specialist radiologists, focusing on lesion involvement, contrast enhancement characteristics, and invasion into adjacent structures. Postoperative tissues were examined histopathologically, and these findings were correlated with the CT scan results. The study revealed a higher prevalence of GBC in females (73.33%) and in the age group of 40-60 years. CT scans indicated malignancy in 84.44% of cases, which was confirmed as adenocarcinoma in 88.89% of cases through histopathology. The sensitivity, specificity, and accuracy of CT scans for detecting malignant gallbladder masses were 90.24%, 75.00%, and 88.89%, respectively. For benign masses, the corresponding values were 75.00%, 90.24%, and 88.89%. The positive predictive value was notably high at 97.37% for malignant masses but lower at 42.86% for benign masses. CT scans demonstrated high sensitivity and specificity in the diagnosis of malignant gallbladder masses, corroborated by histopathological findings. The study underscores the utility of CT scans as an effective, non-invasive diagnostic tool for early detection and management of gallbladder masses, although caution is advised in interpreting benign results due to a lower positive predictive value. CBMJ 2024 January: vol. 13 no. 01 P: 22-27

Near-infrared spectroscopy as a novel method of exvivo bladder cancer tissue characterisation.

To evaluate near-infrared (NIR) spectroscopy in differentiating between benign and malignant bladder pathologies ex vivo immediately after resection, including the grade and stage of malignancy. A total of 355 spectra were measured on 71 bladder specimens from patients undergoing transurethral resection of bladder tumour (TURBT) between April and August 2022. Scan time was 5 s, undertaken using a portable NIR spectrometer within 10 min from excision. Specimens were then sent for routine histopathological correlation. Machine learning models were applied to the spectral dataset to construct diagnostic algorithms; these were then tested for their ability to predict the histological diagnosis of each sample using its NIR spectrum. A two-group algorithm comparing low- vs high-grade urothelial cancer demonstrated 97% sensitivity, 99% specificity, and the area under the receiver operating characteristic curve (AUC) was 0.997. A three-group algorithm predicting stages Ta vs T1 vs T2 achieved 97% sensitivity, 92% specificity, and the AUC was 0.996. This first study evaluating the diagnostic potential of NIR spectroscopy in urothelial cancer shows that it can be accurately used to assess tissue in an ex vivo setting immediately after TURBT. This offers point-of-care assessment of bladder pathology, with potential to influence the extent of resection, reducing both the need for re-resection where invasive disease may be suspected, and also the potential for complications where extent of diagnostic resection can be limited. Further studies utilising fibre-optic probes offer the potential for in vivo assessment.

Radiologic Features of Well-circumscribed Orbital Tumors With Histopathologic Correlation: A Multi-center Study.

To delineate specific imaging characteristics of solitary fibrous tumors, schwannomas, cavernous venous malformations, and well-circumscribed orbital lymphoma. Patients undergoing excisional biopsy of solitary fibrous tumor, schwannomas, cavernous venous malformations, or well-circumscribed orbital lymphoma with preoperative MRIs available for review were identified at 3 academic centers in the United States and Australia. An exploratory statistical analysis was performed to identify important radiologic features, which were subsequently included in a random forest model. Histopathologic correlates were evaluated in representative cases. A total of 91 cases were included with a mean age of 52.9 ± 17.2 years. Nearly all solitary fibrous tumors were located in the anterior or mid orbit (87.5%) and they more commonly demonstrated intralesional heterogeneity on T2-weighted imaging (45.5%) ( p < 0.01). Compared with the other tumors, schwannomas tended to be intraconal (66.7%) and were often in the mid or posterior orbit (83.4%) ( p < 0.01). Cavernous venous malformations characteristically demonstrated progressive contrast enhancement (93.9%; p < 0.01). Most lesions in all 4 groups were hypointense on T1-weighted imaging (80%-100%; p = 0.14) and only well-circumscribed orbital lymphoma tended to also be hypointense on T2 (81.8%) ( p < 0.01). Finally, cases of lymphoma had significantly lower apparent diffusion coefficient ratios (0.9 ± 0.2) ( p < 0.001), while the other 3 groups were not significantly different from one another (cavernous venous malformations: 1.8 ± 0.4; schwannomas: 1.8 ± 0.5; and solitary fibrous tumor: 1.6 ± 0.6) ( p = 0.739). Key features that aid in the differentiation of these 4 tumors from one another include T2 intensity and homogeneity, early contrast-enhancement pattern, and ADC ratio.

SARIFA as a new histopathological biomarker is associated with adverse clinicopathological characteristics, tumor-promoting fatty-acid metabolism, and might predict a metastatic pattern in pT3a prostate cancer

BackgroundRecently, we introduced Stroma-AReactive-Invasion-Front-Areas (SARIFA) as a novel hematoxylin–eosin (H&E)-based histopathologic prognostic biomarker for various gastrointestinal cancers, closely related to lipid metabolism. To date, no studies on SARIFA, which is defined as direct tumor-adipocyte-interaction, beyond the alimentary tract exist. Hence, the objective of our current investigation was to study the significance of SARIFA in pT3a prostate cancer (PCa) and explore its association with lipid metabolism in PCa as lipid metabolism plays a key role in PCa development and progression.MethodsTo this end, we evaluated SARIFA-status in 301 radical prostatectomy specimens and examined the relationship between SARIFA-status, clinicopathological characteristics, overall survival, and immunohistochemical expression of FABP4 and CD36 (proteins closely involved in fatty-acid metabolism). Additionally, we investigated the correlation between SARIFA and biochemical recurrence-free survival (BRFS) and PSMA-positive recurrences in PET/CT imaging in a patient subgroup. Moreover, a quantitative SARIFA cut-off was established to further understand the underlying tumor biology.ResultsSARIFA positivity occurred in 59.1% (n = 178) of pT3a PCas. Our analysis demonstrated that SARIFA positivity is strongly associated with established high-risk features, such as R1 status, extraprostatic extension, and higher initial PSA values. Additionally, we observed an upregulation of immunohistochemical CD36 expression specifically at SARIFAs (p = 0.00014). Kaplan–Meier analyses revealed a trend toward poorer outcomes, particularly in terms of BRFS (p = 0.1). More extensive tumor-adipocyte interaction, assessed as quantity-dependent SARIFA-status on H&E slides, is also significantly associated with high-risk features, such as lymph node metastasis, and seems to be associated with worse survival outcomes (p = 0.16). Moreover, SARIFA positivity appeared to be linked to more distant lymph node and bone metastasis, although statistical significance was slightly not achieved (both p > 0.05).ConclusionsThis is the first study to introduce SARIFA as easy-and-fast-to-assess H&E-based biomarker in locally advanced PCa. SARIFA as the histopathologic correlate of a distinct tumor biology, closely related to lipid metabolism, could pave the way to a more detailed patient stratification and to the development of novel drugs targeting lipid metabolism in pT3a PCa. On the basis of this biomarker discovery study, further research efforts on the prognostic and predictive role of SARIFA in PCa can be designed.

Correlation of Histopathology and Radiological Findings Among the Diverse Breast Lesions in a Tertiary Care Centre.

Introduction Breast lumps in any age group are addressed cautiously to exclude the possibility of breast cancer. The clinical approach to breast lumps involves the "triple test" for cancer screening. The triple test includes clinical examination, imaging (mammogram or ultrasonogram), and tissue sampling (fine needle aspiration cytology(FNAC) and core needle biopsy). These tests happen in a sequential process, and it is important that their findings support the final diagnosis for accurate management of the patient. Aims and objectives This study aims to determine the correlation between the histopathological and radiological findings among the various breast lesions and describe the spectrum of breast lesions received in our center. Methods This is a retrospective observational study for a period of three years, from January 2020 toDecember 2022. The study included 400 patients who had undergone ultrasonography or mammograms for breast lumps, FNAC, core needle biopsy, or surgical resection. The datacollected was analyzed for concordance and discordance status. Results A total of 400 cases were reviewed. There were 238 (59.5%) histologically confirmed benign breast lesions and 162 (40.5%) malignant lesions with their corresponding BI-RADS (Breast Imaging Reporting and Data System) scores. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the imaging modalities (ultrasonogram and mammogram) in diagnosing breast lesions were 95.06%, 94.96%, 92.77%, 96.58%, and 95%, respectively, which were comparable with other similar studies. The biological and immunohistochemical factors of all the invasive carcinomas were studied in detail. Conclusions Imaging modalities (ultrasonogram or mammogram) have good sensitivity and specificity in diagnosing breast lesions and can be reliably used as a preliminary test in breast lump evaluation. The BI-RADS score is a reliable indicator and can be considered for the effective follow-up or intervention of the breast lesion. In discordant cases, a repeated core needle biopsy or excision has to be recommended, as pathological diagnosis is the cornerstone of effective management. A good rapport between the surgeon, radiologist, and pathologist aids in effective feedback and learning for achieving diagnostic accuracy.

A RETROSPECTIVE COHORT STUDY IN AN INDIAN TERTIARY CARE HOSPITAL ON BREAST LESION CLASSIFICATION BY THE IAC YOKOHAMA SYSTEM USING FNAC

Objective: The International Academy of Cytology (IAC) Yokohama system was used to categorize breast lesions as the major goal of this investigation. Methods: Between January 2022 and March 2023, this study on breast fine needle aspiration cytology (FNAC) was carried out at a tertiary care facility in north India. This System of reporting breast cytopathology was used to classify a total of 100 patients. Histopathology correlation was available in 40 cases; Malignancy risk, sensitivity, specificity, and diagnostic precision were assessed. Results: Breast FNAC cytology was divided into five groups using the new IAC Yokohama system and discovered C1: Insufficient material (6%), C2: Benign type (72%), C3: Atypical type (05%), C4: Suspicious type of malignancy (06%), C5: Malignancy (11%). When histopathological reports were available, FNACs were connected with them. The likelihood of cancer, the precision, sensitivity, and specificity of the diagnosis were all calculated. Conclusion: The IAC Yokohama System for reporting breast cytopathology governs how breast FNAC are categorized, which offers an excellent method for reporting breast cytopathology with a uniform method of reporting and clear definition of each category as well as clear communication between pathologists and clinicians regarding the risk of malignancy and subsequent management.

CT Imaging Findings of Extra-adrenal Abdominal Paragangliomas: A Case Series

Extra-adrenal paragangliomas are rare neuroendocrine tumours originating from paraganglia outside the adrenal glands. The present case series illustrates the Computed Tomography (CT) imaging features of three instances of extra-adrenal abdominal paragangliomas. The discussed cases include Retroperitoneal paraganglioma with Inferior Vena Cava (IVC) infiltration and associated hepatic, pancreatic, and skeletal metastasis; Inter-aortocaval paraganglioma; and Organ of Zuckerkandl Paraganglioma. The CT imaging features of the lesions and their relation with the adjacent vascular structures are described. The differential diagnosis and histopathological correlations are discussed. These cases underscore the importance of considering paragangliomas in the differential diagnosis of soft-tissue masses in the abdomen and highlight the role of Contrast-enhanced CT (CECT) imaging in their evaluation. Understanding the diverse imaging characteristics of extra-adrenal paragangliomas aids in accurate diagnosis and appropriate management. Further studies are needed to expand the authors knowledge of these rare tumours and optimise their imaging evaluation.

Liquid-based Cytology as a Superior Tool Compared to Conventional Pap Smear in Detecting Cervical Cancer in Suspected Cases: A Comparative Study

Abstract Introduction: Screening programs has conventional cytology such as Conventional Pap Smear (CPS) have successfully reduced cervical cancer, but newer tests like Manual Liquid-based cytology (MLBC) and Human Papillomavirus testing might enhance screening. Materials and Methods: This was a cross sectional study conducted on 175 samples was processed for CPS and MLBC. Cytobrush was used for LBC which was suspended and detached in the preservative fluid and processed by manual method. Histopathological correlation and HPV DNA testing was also done. Results: MLBC showed higher specimen adequately, cellularity, clean background and uniform distribution of cells than CPS. Conclusion: MLBC showed improved specimen adequately, better cytomorphological features and higher detection of epithelial cell abnormality.