Histopathologic Diagnostic Features Research Articles

Oral Leishmaniasis in HIV-Positive and HIV-Negative Patients: A Comparative Analysis with Two New Case Reports.

This case report examines the clinical presentation, diagnosis, treatment, and outcomes of mucocutaneous leishmaniasis with primary oral involvement in HIV-positive and HIV-negative patients diagnosed in Brazil. We discuss the clinical manifestations, diagnostic methods, and therapeutic strategies, highlighting the clinical and histopathologic diagnostic features and distinct progression patterns based on HIV status. Our findings are compared with patterns observed in other countries, emphasizing the differences between the Americas and Europe, Asia, and Africa. In the Americas, particularly in Brazil, mucocutaneous leishmaniasis often presents with localized oral lesions, even in the presence of systemic immunosuppression, whereas in the Europe, Asia, and Africa, oral involvement is typically associated with visceral leishmaniasis in immunocompromised patients. These differences were due to variations in the parasite species involved. This comparison underscores the importance of regional and immunological factors in diagnosing and managing this neglected infectious disease.

Intraoral Sialadenoma Papilliferum: A Comprehensive Review of the Literature with Emphasis on Clinical and Histopathological Diagnostic Features

Background. Sialadenoma papilliferum (SP) is a rare benign epithelial tumor of salivary gland origin, its diagnosis being potentially challenging. It was first described by Abrams and Finck in 1969 as an analog of the cutaneous syringocystadenoma papilliferum. The aim of this comprehensive review is to highlight the clinical and histopathological diagnostic aspects of intraoral SP, analyzing cases previously described and reporting new cases. Methods. Medline, Scopus, and Web of Science were searched up to February 2022, using as entry term “sialadenoma papilliferum”. No time limits were applied and only studies in English were taken into account. Only cases involving the mouth were included. Conference proceedings, personal communications, and letters to the editor were excluded. Results. In total, 42 out of 234 articles fulfilled the inclusion criteria, with 64 cases reported. Mean age of patients with SP was 57.2 years, with a higher prevalence among males. The most affected site was the palate, particularly the hard palate. Four cases with uncertain malignant features have been reported. While clinical manifestations of SP are rather unspecific (e.g., submucosal swelling with ulceration), histopathological and immunohistochemical features are quite peculiar, SP have a limited growth potential, leading to conservative excision as treatment of choice. Conclusions. SP, though rare, should be taken into consideration in the differential diagnosis of intraoral swellings, particularly those located on the palate.

A Practical Overview on the Molecular Biology of Meningioma

Meningioma is a common intracranial neoplasm currently classified in 15 histologic subtypes across 3 grades of malignancy. First-choice therapy for meningioma is maximum safe resection for grade I tumors, and surgery plus optional and mandatory adjuvant radiotherapy for grade II and III, respectively, given the increased rate of recurrence even in the event of complete resection. The WHO 2016 histopathologic grading of meningioma has been questioned due to subjectivity and its controversial predictive power for recurrence. Novel DNA methylation profiling has simplified classification into six classes that seem to improve prognostic accuracy. We review five main topics of molecular biology research regarding tumorigenesis and natural history of meningioma from the clinician's perspective: the histopathologic diagnostic features and pitfalls of the current tumor classification; the molecular integrated diagnosis supported by identification of genetic alterations and DNA methylation profiling; the general landscape of the various signaling pathways involved in meningioma formation; the pathogenic theories of the peri-tumoral edema present in meningioma and its therapy implications; and a summarized review on the current treatments and plausible targeted therapies directed to meningioma. It seems likely that molecular assessment will be introduced within the next update of the WHO classification of meningiomas, acknowledging the promising value of DNA methylation profiling. This integrated diagnostic protocol will simplify tumor subtype categorization and provide improved accuracy in predicting recurrence and outcome. Although much effort is being done in identifying key gene mutations, and elucidating specific intracellular signaling pathways involved in meningioma tumorigenesis, effective targeted therapies for recurrent meningiomas are still lacking.

Hydatidiform mole in Duhok, Iraq: Frequency, types and histopathological diagnostic features

Aim: There is a worldwide variation in the distribution of molar pregnancy with respect to its type. Difficulties in obtaining accurate data about miscarriage make the precise incidence uncertain. The aim of this study was to estimate the frequency of Hydatidiform mole among the miscarriages and deliveries in Duhok province, estimate their main types, partial or complete, and correlate them with histopathological diagnostic features. Methods: This cross-sectional study was conducted between June 1, 2016 and September 1, 2019 and included Hydatidiform mole cases from the main histopathological centers in Duhok and Zakho. All childbirths and miscarriages were evaluated within the same areas and during the same period. Samples were examined histologically and divided into three groups as partial, complete, and indeterminate molar types, after which their correlation with the main histopathological features were examined. Additional efforts were made to identify the indeterminate cases, like the use of P57 marker. Results: The frequency of Hydatidiform mole was less than 1%. Complete type represented 43% of the cases with a relatively high percentage of indeterminate molar pregnancies (26%). The highest percentage of women belonged to the 20-30 years-old group. The most common histological feature was circumferential trophoblastic proliferation. Conclusion: The frequency of Hydatidiform mole in Duhok was within the world range, with a relatively high percentage of indeterminate types. More efforts should be made to establish an accurate diagnosis depending on histopathological features and additional markers like P57 should be used.

Plucked hair follicles from patients with chronic discoid lupus erythematosus show a disease-specific molecular signature

ObjectiveWhen faced with clinical symptoms of scarring alopecia—the standard diagnostic pathway involves a scalp biopsy which is an invasive and expensive procedure. This project aimed to assess if plucked hair...

Female Adnexal Tumour of Probable Wolffian Origin (FATWO): Review of the Literature.

FATWO (female adnexal tumour of probable Wolffian origin) denotes a rare tumour of the female adnexa which has been described in nearly 80 cases worldwide and which presumably originates in the remains of the Wolffian ducts. In 10 to 20 percent of patients, a metastasis or recurrence was seen subsequently and for this reason, a malignant potential is attributed to the FATWO. Because of the small number of cases, there is no clear therapeutic recommendation. The method of choice currently is surgical treatment with hysterectomy and adnexectomy. The benefit of radio- and chemotherapies is not clear and a small number of treatment attempts with imatinib have been made in cases of CD117 positivity or treatment attempts on an endocrine basis. This work provides an overview of the literature on epidemiology, imaging and histopathological diagnostic features as well as therapeutic options of this same tumour form.

Are quantitative histopathologic criteria capable of differentiating psoriasis from chronic dermatitis?

BackgroundThere are overlapping features in histopathologic characteristics of psoriasis and chronic dermatitis, which sometimes make the correct diagnosis difficult.ObjectiveThe aim of this study was to compare the histopathologic diagnostic features of psoriasis with chronic dermatitis quantitatively.Patients and methodsIn this study, 30 patients with psoriasis and 30 patients with chronic dermatitis were included. Diagnosis of psoriasis or chronic dermatitis was based on clinicopathologic correlation. Photos of histopathologic slides were provided by LABOMED Digital Camera and LABOMED Microscope. Width and length of rete ridges, minimal thickness of suprapapillary plates, thickness of epidermis, thickness of hyperkeratotic layer, and minimal thickness of granular layer were determined using Pixel Pro software on micrometer scale.ResultsSuprapapillary plates and granular layer were significantly thicker in patients with chronic dermatitis compared with patients with psoriasis. The rete ridges were longer and wider, the epidermis was thicker, and the parakeratotic layer was also thicker in patients with psoriasis compared with patients with chronic dermatitis, and the difference between these corresponding parameters in the two groups was statistically significant except for thickness of parakeratotic layer. Moreover, the mean ratio of minimal suprapapillary plate’s thickness to epidermal thickness and the mean ratio of minimal granular layer’s thickness to parakeratotic layer’s thickness were significantly higher in patients with chronic dermatitis compared with those with psoriasis.ConclusionDespite overlapping histopathologic features in psoriasis and chronic dermatitis, quantitative histopathologic criteria might be valuable for differentiation of these two conditions. Ratios of minimal suprapapillary plate’s thickness to epidermal thickness and minimal granular layer’s thickness to parakeratotic layer’s thickness can be particularly helpful in this regard.

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update

Pancreatic neuroendocrine tumors (PNETs) are rare, reported to account for less than 1% - 2% of all pancreatic tumors. This, however, is likely an underestimation, as improved radiologic techniques and heightened awareness have resulted in an increase in the detection of incidentalomas, with estimations of true prevalence as high as 10%. The term “PNET” is an umbrella name that encompasses a heterogeneous group of neoplasms each with distinct clinical presentations, diagnostic radiographic features, management principles, and tumor/patient outcomes. In this context, accurate diagnosis is challenging, and management guidelines remain unclear. A high degree of clinical suspicion is required for best patient management. This manuscript provides an update on PNETs in the 21st century, in which we re-examine the terminology, epidemiology, classification, etiopathogenesis, radiographic and histopathologic diagnostic features, management for localized and metastatic disease, as well as a review of features defining functional and non-functional PNETS, and finally deliberates on the prognosis and predictive features of this unpredictable and largely unfathomable neoplasm.

IMPS-10BRAFV600E-MUTANT IMMUNOCOMPETENT GLIOMA MODEL EXHIBITS TYPICAL HISTOPATHOLOGICAL FEATURES OF HUMAN GLIOBLASTOMA MULTIFORME

INTRODUCTION: Targeted monotherapy against BRAFV600E displays efficacy in preclinical models of BRAFV600E-mutant gliomas, however xenograft tumors adapt rapidly and escape from the growth-inhibitory effects. The question emerges whether a more durable anti-tumor effect will be achieved by combining BRAF inhibitors with immune-modulatory agents such as anti-CTLA-4 and anti-PD-L1. The lack of an immunocompetent preclinical model of BRAFV600E-mutant astrocytoma however has been prohibitive to addressing this question. METHODS: A BRAFV600E-mutant murine tumor cell line (2341) was isolated from tumors developed in transgenic mice with Cre-conditional alleles of BRAFV600E and CDKN2A. Multiple cohorts of syngeneic FVBN mice, as well as athymic mice were injected orthotopically with the BRAFV600E-mutant tumor cell line and evaluated for the occurrence of neurological symptoms. Symptomatic animals were sacrificed and brains were harvested and subjected to a detailed immunohistopathological characterization. Tumor growth was studied employing bioluminescence (BLI). The presence of tumor fluorescence following in vivo injection of 5-aminolevulinic acid (5-ALA) was investigated as well. RESULTS: Injected animals developed tumors in the right striatum exhibiting all histopathological diagnostic features of human glioblastomas. Neurological free survival was significantly longer in immunocompetent FVBN mice (mean 56 days) compared to similarly treated athymic mice (mean 15 days). Additionally, 5-ALA injected mice exhibited strong fluorescence of tumor cells, when exposed to ultraviolet light compared to normal brain tissue. Results from ongoing work regarding T-cell regulation in the immunocompetent glioma model will be presented and discussed at the meeting. CONCLUSIONS: A BRAFV600E-mutant glioma model that recapitulates the typical genetical, histopathological and behavioral features of human glioblastoma multiforme can be established in fully immunocompetent FVBN mice. These tumors also exhibit 5-ALA induced tumor fluorescence, a typical feature of human malignant astrocytomas. Further studies will reveal this modelś ability to reliably test the anti-glioma efficacy of immune-modulatory drugs in combination with BRAFV600E inhibition.

How I treat HHV8/KSHV-related diseases in posttransplant patients

AbstractPosttransplantation human herpesvirus-8 (HHV8)/Kaposi sarcoma herpesvirus (KSHV) primary infection and/or reactivations are associated with uncommon and sometimes fatal, neoplastic, and non-neoplastic diseases. HHV8-related clinical manifestations notably range from Kaposi sarcoma (KS) to either primary effusion lymphoma or multicentric Castleman disease B-cell malignancies, and from polyclonal HHV8-positive plasmacytic lymphoproliferative disorders to bone marrow failure and peripheral cytopenias, associated or not with hemophagocytic syndromes, and to acute hepatitis syndromes. We reviewed the patient series reported in the literature and summarized clinical management aspects, in terms of diagnosis, follow-up, and treatment. We described typical clinical presentations and histopathologic diagnostic features of these diseases, and we discussed the role of HHV8-specific serologic, molecular, and immunologic assays, particularly focusing on recent data from HHV8-specific T-cell monitoring in posttransplantation KS patients. We finally discussed actual therapeutic options, namely, the reduction or discontinuation of immunosuppressive therapy or the switch from calcineurin inhibitors to mTOR inhibitors, as alternatives to antineoplastic chemotherapy, along with the use of antiherpesvirus agents as prophylactic or therapeutic measures, and treatment with rituximab in posttrans-plantation multicentric Castleman disease patients and non-neoplastic HHV8-associated syndromes.

LANGERHANS CELL HYPERPLASIA OF THE SKIN MIMICKING LANGERHANS CELL HISTIOCYTOSIS: A Report of Two Cases in Children Not Associated with Scabies

Langerhans cells histiocytosis (LCH) affecting the skin most commonly has clinical and histopathologic diagnostic features. We are reporting two examples of Langerhans cell (LC) hyperplasia recognized in the skin biopsies of two children initially interpreted as LCH. The first was an 8-year-old boy finally interpreted as having an atypical type of contact dermatitis, while the second, an 8-year-old girl, was assumed to have Pytiriasis lichenoides et varioliformis acuta. None showed evidences of scabies. Both presented spongiotic dermatitis with numerous CD1a+ cells. As more cases of LC hyperplasia are recognized, new details emerge helping in the differential diagnosis. Strict clinical-pathologic correlation is suggested in order to avoid misdiagnosis.

Placental Pathology, a Survival Guide

Placental pathology continues to be an underutilized, undertaught, and inadequately handled surgical subspecialty. The requests for placental pathology are soaring, due partly to demands from obstetricians and to the litigious environment in which they practice, and to improved obstetrical care leading to pregnancies in medically challenging situations. Evaluation of the placenta requires a good understanding of the questions and issues concerning both the fetus/infant and the mother. Information from placental pathology can be critical in early neonatal care and in reproductive planning for the family, and it can provide risk assessment for neurologic outcome of the infant. A comfortable interaction among the obstetric staff, mothers, and pathologists often obviates need for legal intervention in unexpected pregnancy outcomes. Some critical pathologic features that involve maternal and fetal management are illustrated herein. A template for gross examination and a few critical histopathologic diagnostic features with clincopathologic correlation are included.

Placental Pathology, a Survival Guide

Placental pathology continues to be an underutilized, undertaught, and inadequately handled surgical subspecialty. The requests for placental pathology are soaring, due partly to demands from obstetricians and to the litigious environment in which they practice, and to improved obstetrical care leading to pregnancies in medically challenging situations. Evaluation of the placenta requires a good understanding of the questions and issues concerning both the fetus/infant and the mother. Information from placental pathology can be critical in early neonatal care and in reproductive planning for the family, and it can provide risk assessment for neurologic outcome of the infant. A comfortable interaction among the obstetric staff, mothers, and pathologists often obviates need for legal intervention in unexpected pregnancy outcomes. Some critical pathologic features that involve maternal and fetal management are illustrated herein. A template for gross examination and a few critical histopathologic diagnostic features with clincopathologic correlation are included.

Cuterebra cutaneous myiasis: case report and world literature review

Most cases of myiasis in North America are caused by fly larvae from South America or Africa, as these cases represent travelers returning from endemic regions. The etiology of creeping eruptions and furuncular lesions in North American patients who have no history of recent travel can therefore be a diagnostic problem. Among cases acquired in North America, Cuterebra species are the usual cause. Dermatologists and dermatopathologists should be aware that this unusual infestation may occur without a travel history. Here we report a case of Cuterebra cutaneous myiasis acquired in New Jersey. A world literature review of articles on Cuterebra myiasis in humans, without age or year restriction, was performed. The pertinent references of those articles were also searched. Most cases occur in the skin, as a furuncle. Sometimes a cutaneous creeping eruption is present. Children account for at least half of the reported cases. The infestations tend to occur in the late summer, and most frequently in the north-eastern and southern states of the United States. An overview of the clinical and histopathologic diagnostic features are presented. Though rare, myiasis can occur in North America without a travel history. Awareness of this entity, its epidemiologic patterns and diagnostic characteristics, can prevent lengthy delays in diagnosis and unnecessary treatments.

Desmoplastic ameloblastoma of anterior mandible: Case report of a rarity

Ameloblastoma, one of the most common odontogenic tumors of the jaws, presents classical clinical, radiographic and histopathological diagnostic features exhibiting a benign but locally aggressive and destructive clinical course with a high rate of recurrence. A case of desmoplastic ameloblastoma of mandible is discussed in this article, which presents itself as a rare variant of ameloblastoma with unusual inconclusive clinico-radiographic features to be diagnosed as classical ameloblastoma and difficult to differentiate from other suspected multilocular benign odontogenic or reactive lesions of the jaws. It is the typical histopathological picture of the lesion exhibiting a blend of desmoplasia (collagenization) and ameloblastoma that leads to its final diagnosis and determines its management.

Lupus erythematosus tumidus: a series of 26 cases

To study 26 cases of lupus erythematosus tumidus (LET), a subset of chronic cutaneous lupus erythematosus (CCLE), referred to in the literature as a rare entity. A retrospective study was conducted of 26 patients diagnosed with LET between 1996 and 2002. The clinical characteristics, histopathologic and laboratory findings, response to treatment, association with other subsets of lupus, course, and diagnostic criteria were analyzed. The incidence by sex was similar. The mean age of presentation was 49.19 years. The clinical presentation usually involved erythematous, edematous plaques located on the face, chest, back, or extremities, related to sun exposure. A dermal lymphocytic infiltrate with a perivascular disposition and differing degrees of mucin deposition was observed in all cases. Minimal epidermal changes were present in 18 cases, and 11 of these also showed minimal dermal-epidermal changes. Only one case showed dermal-epidermal changes without any epidermal alteration. Direct immunofluorescence test was performed in 15 patients, and 11 were negative. All cases showed a benign course without systemic manifestations. The response to topical steroids or antimalarial treatment was excellent, but a seasonal recurrence was usually observed. Discussion No defined criteria for LET are universally accepted. The main controversies are the acceptance of LET as a separate subset of CCLE, and the histopathologic diagnostic features, mainly the presence or absence of epidermal and dermal-epidermal changes in these lesions. No inflexible histologic criteria should be employed for the diagnosis of LET. This subset of lupus erythematosus is characterized by intense photosensitivity, definite clinical lesions, a benign course, the absence of systemic disease, good response to antimalarial treatment, and a tendency to recur. More studies should be performed in order to establish the true incidence of LET because this subset of CCLE is probably underestimated.

The potential for sampling error in incisional biopsies of odontogenic keratocysts

Incisional biopsies of large lytic jaw lesions are commonly performed in order to obtain a pretreatment diagnosis. Odontogenic keratocyst (OKC) is a frequent entity in the differential diagnosis of such lesions and mandates a relatively more aggressive surgical approach. Preliminary analysis of incisional biopsies of OKCs revealed that often, in areas of inflammation, samples did not show the classic histopathologic diagnostic features. Instead, the epithelial lining displayed a squamous-type metaplasia that precluded such diagnosis if that was the only area of epithelium sampled. The purpose of this study, therefore, was to determine the likelihood of sampling error resulting in a nondiagnosis of OKC in cases which truly were OKCs. Fifteen cases of totally excised inflamed OKCs were histomorphometrically analyzed to determine the total area of epithelium in each cyst that was diagnostic or nondiagnostic, respectively, utilizing classic histopathologic criteria. The mean for the total area of lining epithelium was 0.098 mm², with nondiagnostic and diagnostic epithelium comprising 0.033 mm² and 0.063 mm² respectively. Standard deviations were 0.025 for the total areas, 0.026 for nondiagnostic areas, and 0.016 for diagnostic areas. Standard errors of the mean were 0.007, 0.007, and 0.004, respectively. Results show that 33.6% of the area sampled when incisionally biopsying an inflamed OKC is likely to be nondiagnostic. We conclude that in order to minimize the risk of sampling cystic lining nondiagnostic for OKC, large lytic lesions should be sampled away from sites associated with inflammation, such as those in proximity to sulcular regions or partially impacted teeth or in areas exposed to the oral cavity. The caveat is also given that the smaller the incisional biopsy, the greater the chance for sampling error.

Long-term results of organ preservation in chondrosarcoma of the cricoid.

Chondrosarcoma of the larynx is rare. The posterolateral lamina of the cricoid cartilage is the site most commonly involved. Although the symptomology, radiological and histopathological diagnostic features are well known, the condition continues to be diagnosed late and recurrences after excision are common. In general, radical surgical excision can result in long-term remission, although prognosis is related to the histopathological grade of the tumor. While a conservative surgical approach in low-grade tumors is justified, unexplained hoarseness, unilateral vocal cord paralysis and dyspnea requires CT scan examination.

Eosinophilic Globules in Pigmented Spindle Cell Nevus

Reed's pigmented spindle cell nevus is often misdiagnosed as malignant melanoma despite reliable clinical and histopathologic diagnostic features. In the present report, 10 cases of pigmented spindle cell nevus were studied with step sections to identify Kamino's eosinophilic globules. Eighty percent of the cases disclosed numerous eosinophilic globules, supporting the hypothesis that this nevus is a variant of Spitz's nevus. Kamino's eosinophilic globules could be considered another important sign for the differential diagnosis between pigmented spindle cell nevus and malignant melanoma.