Histopathological Differentiation Research Articles

Histopathological features of subcutaneous and cutaneous mast cell tumors in dogs

BackgroundMast cell tumors (MCTs) are the most common malignant skin neoplasms in dogs. In the past, the distinction between cutaneous MCTs (cMCTs), originating from the dermis, and subcutaneous MCTs (scMCTs), originating from the subcutaneous tissue, was not made. Histopathological differentiation, including grading, is important for prognosis. However, the Patnaik and Kiupel grading systems were proposed for cMCTs only. The objective of our study was to describe and compare the signalment of dogs with scMCTs and cMCTs and histopathological features, anticipating similarities in both groups. Data of dogs histologically diagnosed with scMCTs or cMCTs between September 2020 and July 2023 were analyzed retrospectively. Signalment, tumor location, histopathological features, completeness of removal and lymph node status were recorded.ResultsData on 305 scMCTs and 1291 cMCTs were collected. Breed distribution was different between scMCTs and cMCTs (P < 0.0001). Mitotic count (MC) was not different between scMCTs (1.63) and cMCTs (1.58) (P = 0.8490). Compared to cMCTs, scMCTs more often had anisokaryosis, bizarre nuclei and multinucleation. Kiupel high grade was more often assigned to scMCTs (51/292, 17.5%) than cMCTs (154/1291, 11.9%) (P = 0.009). The odds of MCTs being assigned a high grade in scMCT was 1.578 higher than in cMCTs (95% confidence interval [1.116–2.232]).ConclusionsHistopathological differences between scMCTs and cMCTs were observed. A Kiupel high grade was more often assigned to scMCTs than cMCTs. Whether these histopathological findings correlate with clinical outcome has to be established in additional studies.

Surgical management and histopathological patterns of periampullary cancers in Sudanese patients: A single‐center prospective study

AbstractBackgroundHistopathological patterns of periampullary cancers (PAC) provide valuable information for clinicians in the selection of effective postoperative therapies and serve as a prognostic marker for patients. Therefore, this study was conducted to determine the surgical management and histopathological patterns of PAC necessary to achieve excellent surgical outcomes.MethodsThis prospective study was conducted from October 2021 to September 2023 at Ibn Sina Specialized Hospital, Khartoum, Sudan. Eighty patients diagnosed with resectable PAC were enrolled.ResultsPAC was more prevalent in male patients (52.5%), with a male: female ratio of 1.1:1.0. The peak incidence occurred between 46 and 60 years, representing 38.75% of patients. The most significant reported comorbidity was cigarette smoking (36.25% of patients). Scleral icterus was found in 47.5% of patients. Pancreatic head cancer was found in 55% of patients. Histopathological analysis revealed adenocarcinoma in 82.5% of patients. R0 resection (tumor‐free margins) was the most common resection category (87.5% of patients). Lymphovascular invasion was detected in 37.5% of patients. Malignant lymph node involvement (1–3 nodes) was found 47.5% of patients. Perineural invasion was found in 55%. Finally, the most common histopathological differentiation of PAC was well‐differentiated (Grade I) in 67.5% of patients. The mortality rate was 0%.ConclusionsUpdated knowledge regarding the management modalities of PAC is a prerequisite for accurate histopathological assessment and good surgical outcomes. Furthermore, histopathological analysis helps clinicians to select effective postoperative therapies for greater improvement in survival outcomes.

Uterine Angioleiomyoma: Clinical and Histopathologic Differentiation of an Underrecognized Mimicker of Uterine Leiomyoma.

Angioleiomyoma is an uncommon benign neoplasm of mesenchymal origin that arises from perivascular smooth muscle cells. This soft tissue neoplasm usually occurs in the dermal or subcutaneous tissues of the extremities, head and neck, or trunk with fewer than 40 reported angioleiomyomas arising in the uterine corpus. Herein we report a uterine angioleiomyoma in a 44-year-old G5P4 Hispanic woman with a longstanding history of recurrent abdominal pain, pelvic organ prolapse, abnormal uterine bleeding, anemia, and hypertension. The patient underwent surgical treatment with total laparoscopic hysterectomy with bilateral salpingectomy and a uterosacral ligament suspension. Uterine angioleiomyoma was diagnosed post-operatively based on gross and microscopic features. The location of the uterine angioleiomyoma within the myometrium corresponded with contrast enhancement apparent on preoperative imaging. This and other uterine angioleiomyomas have characteristic imaging, macroscopic, and microscopic features which distinguish it from leiomyoma. Enhancing awareness of this underrecognized entity will facilitate precise diagnosis and thereby enable improved understanding of the clinicopathological characteristics of uterine angioleiomyoma.

Evolving Management of Breast Cancer in the Era of Predictive Biomarkers and Precision Medicine.

Breast cancer is the most common cancer among women in the world as well as in the United States. Molecular and histological differentiation have helped clinicians optimize treatments with various therapeutics, including hormonal therapy, chemotherapy, immunotherapy, and radiation therapy. Recently, immunotherapy has become the standard of care in locally advanced triple-negative breast cancer and an option across molecular subtypes for tumors with a high tumor mutation burden. Despite the advancements in personalized medicine directing the management of localized and advanced breast cancers, the emergence of resistance to these therapies is the leading cause of death among breast cancer patients. Therefore, there is a critical need to identify and validate predictive biomarkers to direct treatment selection, identify potential responders, and detect emerging resistance to standard therapies. Areas of active scientific and clinical research include novel personalized and predictive biomarkers incorporating tumor microenvironment, tumor immune profiling, molecular characterization, and histopathological differentiation to predict response and the potential emergence of resistance.

Dual concentric echo sign of ultrasound in primary hyperparathyroidism: The clinical and histopathologic features and differentiation from lymph nodes

ContextUltrasound (US) is the most economical and widely used method for detecting lesions in parathyroid regions. Identifying typically parathyroid adenomas as hypoechoic nodules with clear margins. However, 10 % of lesions exhibit atypical features, such as the dual concentric sign, and the cognition of them still needs to be improved. ObjectiveTo promote understanding of clinical and histopathological features for parathyroid lesions with the dual concentric echo sign and to investigate its pathogenesis and methods for distinguishing from cervical lymph nodes to improve US diagnostic accuracy. MethodsRetrospectively, patients were categorized into three groups: Group 1, with 36 patients showing parathyroid lesions with dual concentric echo signs; Group 2, with 40 patients displaying classic hypoechoic parathyroid lesions; and Group 3, comprising 36 patients with identified lymph nodes, which were all examined from January 2018 to December 2019. The clinical data on demographics, clinical symptoms, serum levels, histopathologic findings, and US image characteristics were thoroughly reviewed. ResultsAccording to the clinical data, no significant differences in demographics or lesion sizes were observed in Group 1 and Group 2 (p > 0.05). No significant variances were noted in biochemical markers, including PTH, T-25OHD, and ALP. However, a notable difference was identified in adjusted serum calcium levels, which were significantly lower in Group 1 compared to Group 2 (p < 0.05). Additionally, the proportion of asymptomatic patients was significantly higher in Group 1 compared to Group 2 (p < 0.05). Pathological examination revealed that all lesions with dual concentric echo signs were parathyroid adenomas. The isoechoic central region predominantly corresponded to areas of loose edema, while the hypoechoic peripheral layer was primarily associated with chief and/or oncocytic cells. By comparing the ultrasonography of Groups 1 and 3, the parathyroid lesions with dual concentric echo signs exhibited significant distinctions from lymph nodes in size, blood flow classification, vascular distribution, and anatomical location (p < 0.05). ConclusionThe parathyroid lesions with dual concentric echo signs in US corresponded to specific histopathological manifestations and relatively mild clinical features in the patients, this finding may increase the likelihood of incidental detection of parathyroid lesions by US. Attention to the details of size, location, and blood flow, especially, may aid US physicians in differentiating parathyroid adenomas from cervical lymph nodes.

Differences in Carcinoembryonic Antigen (CEA) Levels Based on the Degree of Histopathological Differentiation of Colorectal Cancer: Single Center Observational Study at Dr. M. Djamil General Hospital, Padang, Indonesia

Background: Colorectal cancer is the third malignancy and second leading cause of death in the world. CEA levels before surgery can be used as a cancer marker to help staging, planning, monitoring therapy and disease recurrence. One factor that influences CEA levels is the degree of differentiation of cancer cells. This study aims to determine differences in CEA levels based on the degree of histopathological differentiation in colorectal cancer patients at Dr. M. Djamil General Hospital Padang. Methods: This study was a cross-sectional analytical observational study using medical record data from colorectal cancer patients from January 2021 – August 2023. The sample was 65 patients who met the inclusion and exclusion criteria. CEA examination uses the ELFA method. The Mann Whitney test was used to see differences in CEA levels based on the degree of differentiation, statistically significant if p &lt; 0.05. Results: A total of 65 patients with an average age of 56.89 years, 58.5% men, 41.5% women. A total of 10 patients were stage I, 29 stage II, and 26 stage III. Based on histopathology, 50 patients were classified as low grade and 15 as high grade. Low-grade CEA levels were 67.72 (3.14-200) ng/mL, while high grade were 3.2 (0.57-11.42) ng/mL. There was a significant difference in CEA levels based on histopathological differentiation (p &lt; 0.001). Conclusion: CEA levels are higher in low-grade than high-grade colorectal cancer.

Primary Cutaneous NUT Carcinoma: Clinicopathologic and Genetic Study of 4 Cases.

WHO Classification of Skin Tumors, fifth edition (2023) has newly described primary cutaneous NUT carcinoma; however, information on this cancer type remains scarce. Herein, we performed clinicopathologic and genetic analyses of 4 cases. Four elderly women (median age 77y, range: 68 to 82y) were included. The median tumor size was 12.5 (10 to 40mm). Tumors were located on the scalp, temple, thigh, and palm. Two (50%) patients presented with regional lymph node metastases. Neither distant metastasis nor mortality was observed during patient follow-up of 10.5 (3 to 15) months. Sanger, panel DNA and whole-exome RNA sequencing revealed BRD3::NUTM1 (n=2) and BRD4::NUTM1 (n=2) fusions. Histology of BRD3 -rearranged tumors revealed an epidermal connection, relatively small tumor nests, and ductal or intracytoplasmic luminal formation, whereas that of BRD4 -rearranged tumors revealed large solid nests comprising discohesive tumor cells. NUT, cytokeratins, p63, EMA, TRPS1, c-MYB, CD56, and INSM1 were immunoexpressed to varying degrees in all (100%) tumors. Furthermore, diffuse SOX10 expression was common (3/4, 75%). The literature review of five previously described cases revealed women predominance, no recurrence, frequent BRD3::NUTM1 fusions, and histology of ductoglandular structures. Our study findings and literature suggest elderly women predominance, relatively frequent BRD3::NUTM1 fusions, histopathologic ductoglandular differentiation, absence of abrupt keratinisation, and a characteristic immunoprofile in primary cutaneous NUT carcinoma, unlike in that of other organ. No distant metastasis or disease-associated mortality was seen in all cases with limited follow-up.

Long-term results of liver thermal ablation in patients with hepatocellular carcinoma and colorectal cancer liver metastasis regarding spatial features and tumor-specific variables

Colorectal cancer liver metastasis (CRLM) and hepatocellular carcinoma (HCC) are widely treated using microwave and radiofrequency ablation. Local tumor progression (LTP) may develop depending on the shortest vascular distance and large lesion diameter. This study aims to explore the effect of these spatial features and to investigate the correlation between tumor-specific variables and LTP. This is a retrospective study covering the period between January 2007 and January 2019. One hundred twenty-five patients (CRLM: HCC: 64:61) with 262 lesions (CRLM: HCC: 142:120) were enrolled. The correlation between LTP and the variables was analyzed using the chi-square test, Fischer's exact test, or the Fisher-Freeman-Halton test where applicable. The local progression-free survival (Loc-PFS) was analyzed using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors. Significant correlations were observed for LTP in both CRLM and HCC at a lesion diameter of 30-50 mm (P = 0.019 and P < 0.001, respectively) and SVD of ≤3 mm (P < 0.001 for both). No correlation was found between the ablation type and LTP (CRLM: P = 0.141; HCC: P = 0.771). There was no relationship between residue and the ablation type, but a strong correlation with tumor size was observed (P = 0.127 and P < 0.001, respectively). In CRLM, LTP was associated with mutant K-ras and concomitant lung metastasis (P < 0.001 and P = 0.003, respectively). In HCC, a similar correlation was found for Child-Pugh B, serum alpha-fetoprotein (AFP) level of >10 ng/mL, predisposing factors, and moderate histopathological differentiation (P < 0.001, P = 0.008, P = 0.027, and P < 0.001, respectively). In CRLM, SVD of ≤3 mm proved to be the variable with the greatest negative effect on Loc-PFS (P = 0.007), followed by concomitant lung metastasis (P = 0.027). In HCC, a serum AFP level of >10 ng/mL proved to be the variable with the greatest negative effect on Loc-PFS (P = 0.045). In addition to the lesions' spatial features, tumor-specific variables may also have an impact on LTP.

Artificial Intelligence-Based Non-invasive Differentiation of Distinct Histologic Subtypes of Renal Tumors With Multiphasic Multidetector Computed Tomography.

With rising cases of renal cell carcinoma (RCC), precise identification of tumor subtypes is essential, particularly for detecting small, heterogenous lesions often overlooked in traditional histopathological examinations. This study demonstrates the non-invasive use of deep learning for Histopathological differentiation of renal tumors through quadriphasic multidetector computed tomography (MDCT). This prospective longitudinal study includes 50 subjects (32 males, 18 females) with suspected renal tumors. A deep neural network (DNN) is developed to predict RCC subtypes using peak attenuation values measured in Hounsfield Units (HUs) obtained from quadriphasic MDCT scans. The network then generates confidence scores for each of the four primary subtypes of renal tumors, effectively distinguishing between benign oncocytoma and various malignant subtypes. Our neural network accurately distinguishes Renal tumor subtypes, including clear cell, papillary, chromophobe, and benign oncocytoma, with a confidence score of 68% with the network's diagnosis aligning with Histopathological examinations. Our network was also able to accurately classify RCC subtypes on a synthetically generated dataset with 20,000 samples. We developed an artificial intelligence-based RCC subtype classification technique. Our approach is non-invasive and has the potential to transform the methodology in Renal oncology by providing accurate and timely diagnostic information and enhancing clinical decisions.

TGF-β3 from fibroblasts promotes necrotising sialometaplasia by suppressing salivary gland cell proliferation and inducing squamous metaplasia.

Necrotising sialometaplasia (NSM) is a non-neoplastic lesion mainly arising in the minor salivary glands of the oral cavity. In the clinical features, NSM shows swelling with or without ulceration, and can mimic a malignant disease such as squamous cell carcinoma. Histopathologically, NSM usually shows the lobular architecture that is observed in the salivary glands. Additionally, acinar infarction and squamous metaplasia of salivary ducts and acini are observable. The aetiology of this lesion remains unknown, although it has a characteristic feature that sometimes requires clinical and histopathological differentiation from malignancy. In this study, we investigated upregulated genes in NSM compared with normal salivary glands, and focused on the TGF-β3 (TGFB3) gene. The results of the histopathological studies clarified that fibroblasts surrounding the lesion express TGF-β3. Moreover, in vitro studies using mouse salivary gland organoids revealed that TGF-β3 suppressed salivary gland cell proliferation and induced squamous metaplasia. We demonstrated a possible aetiology of NSM by concluding that increased TGF-β3 expression during wound healing or tissue regeneration played a critical role in cell proliferation and metaplasia. © 2024 The Pathological Society of Great Britain and Ireland.

The clinical, dermoscopic, and histopathologic differentiation of cutaneous leishmaniasis from cutaneous sarcoidosis and tuberculosis: A review article

Leishmaniasis is a neglected tropical disease caused by infected female sandflies (Phlebotomus and Lutzomyia), which are vector-borne protozoan parasites belonging to the genus Leishmania. The diagnosis of cutaneous leishmaniasis (CL) can be challenging and delayed, particularly in areas where leishmaniasis is not endemic. CL is known as “the great imitator” because it can mimic many skin disorders due to its various clinical manifestations. Cutaneous sarcoidosis (CS) and cutaneous tuberculosis (CTB), which are also known as “the great imitators,” should be differentiated from CL due to the common clinical, dermoscopic, and histopathologic features. In this article, we aim to help clinicians differentiate CL by listing its clinical manifestations those are similar to CS and CTB and highlighting common and uncommon dermoscopic and histopathologic findings. We have also created a brief approach to diagnose CL, CS, and CTB, which is presented as a diagram. A search was performed on PubMed and Google Scholar using the keywords CL, CTB, CS, and granulomatous disease for all articles, with no restrictions. Updated articles on leishmaniasis, tuberculosis, and sarcoidosis, including some new concepts in clinical presentations, dermoscopy, and histopathology, were reviewed.

Oat β-glucan repairs the epidermal barrier by upregulating the levels of epidermal differentiation, cell-cell junctions and lipids via Dectin-1.

Oat β-glucan could ameliorate epidermal hyperplasia and accelerate epidermal barrier repair. Dectin-1 is one of the receptors of β-glucan and many biological functions of β-glucan are mediated by Dectin-1. Dectin-1 promotes wound healing through regulating the proliferation and migration of skin cells. Thus, this study aimed to investigate the role of oat β-glucan and Dectin-1 in epidermal barrier repair. To investigate the role of Dectin-1 in the epidermal barrier, indicators associated with the recovery of a damaged epidermal barrier, including histopathological changes, keratinization, proliferation, apoptosis, differentiation, cell-cell junctions and lipid content were compared between WT and Dectin-1-/- mice. Further, the effect of oat β-glucan on the disruption of the epidermal barrier was also compared between WT and Dectin-1-/- mice. Dectin-1 deficiency resulted in delayed recovery and marked keratinization, as well as abnormal levels of keratinocyte differentiation, cell-cell junctions and lipid synthesis during the restoration of the epidermal barrier. Oat β-glucan significantly reduces epidermal hyperplasia, promotes epidermal differentiation, increases cell-cell junction expression, promotes lipid synthesis and ultimately accelerates the recovery of damaged epidermal barriers via Dectin-1. Oat β-glucan could promote CaS receptor expression and activate the PPAR-γ signalling pathway via Dectin-1. Oat β-glucan promote the recovery of damaged epidermal barriers through promoting epidermal differentiation, increasing the expression of cell-cell junctions and lipid synthesis through Dectin-1. Dectin-1 deficiency delay the recovery of epidermal barriers, which indicated that Dectin-1 may be a potential target in epidermal barrier repair.

Dual-layer spectral detector CT: A noninvasive preoperative tool for predicting histopathological differentiation in pancreatic ductal adenocarcinoma

PurposeTo predict histopathological differentiation grades in patients with pancreatic ductal adenocarcinoma (PDAC) before surgery with quantitative and qualitative variables obtained from dual-layer spectral detector CT (DLCT). MethodsTotally 128 patients with histopathologically confirmed PDAC and preoperative DLCT were retrospectively enrolled and categorized into the low-grade (LG) (well and moderately differentiated, n = 82) and high-grade (HG) (poorly differentiated, n = 46) subgroups. Both conventional and spectral variables for PDAC were measured. The ratio of iodine concentration (IC) values in arterial phase(AP) and venous phase (VP) was defined as iodine enhancement fraction_AP/VP (IEF_AP/VP). Necrosis was visually assessed on both conventional CT images (necrosis_con) and virtual mono-energetic images (VMIs) at 40 keV (necrosis_40keV). Forward stepwise logistic regression method was conducted to perform univariable and multivariable analysis. Receiver operating characteristic (ROC) curves and the DeLong method were used to evaluate and compare the efficiencies of variables in predicting tumor grade. ResultsNecrosis_con (odds ratio [OR] = 2.84, 95% confidence interval [CI]: 1.13–7.13; p < 0.001) was an independent predictor among conventional variables, and necrosis_40keV (OR = 5.82, 95% CI: 1.98–17.11; p = 0.001) and IEF_AP/VP (OR = 1.12, 95% CI:1.07–1.17; p < 0.001) were independent predictors among spectral variables for distinguishing LG PDAC from HG PDAC. IEF_AP/VP (AUC = 0.754, p = 0.016) and combination model (AUC = 0.812, p < 0.001) had better predictive performances than necrosis_con (AUC = 0.580). The combination model yielded the highest sensitivity (72%) and accuracy (79%), while IEF_AP/VP exhibited the highest specificity (89%). ConclusionVariables derived from DLCT have the potential to preoperatively evaluate PDAC tumor grade. Furthermore, spectral variables and their combination exhibited superior predictive performances than conventional CT variables.

Clinicopathological features and clinical outcomes in individuals with Krukenberg tumors of colorectal origin.

191 Background: Krukenberg tumors (KT) are metastases to the ovary generally originating from a gastrointestinal primary such as colorectal carcinoma. The prognosis is poor with KT, and clinicopathological features associated with clinical outcomes have not been extensively studied. The study aimed to investigate the associations of clinicopathological features with outcomes in patients with KT of colorectal carcinoma (CRC) origin. Methods: This retrospective study utilized medical records and patient registries to identify 160 patients with a confirmed histopathological diagnosis of KT at Stanford University Medical Center between 2000 and 2020. Data collection included demographics, historical, clinicopathological, treatment and outcome variables. The primary tumor type was (N, %): CRC (101, 63.1%); gastric (24, 15%), breast (13, 8.1%); small bowel (10, 6.2%), other (12, 7.5%). Statistical analysis was performed using Chi-squared, Mann-Whitney U, and log-rank Kaplan-Meier analysis. Results: Analysis of the CRC cohort subdivided by location of the primary, N: 45 vs. 56, right colon (R) vs. left colon (L) revealed no significant difference in median age at diagnosis of KT, race/ethnicity, oligometastatic disease, histopathological differentiation or ovarian tumor volume. Patients with R vs L sided CRC primaries had a higher proportion of synchronous presentation at the time of KT diagnosis (75.6% vs 41.1%, R vs L, p&lt;0.001). Time to progression was not different, but overall survival (OS) was shorter in R CRC (767 vs. 1246 days, R vs. L, p &lt;0.01). By Kaplan-Meier analysis, patients with R CRC had a shorter OS (log-rank p=0.016). In the subgroup with unilateral KT, R sided CRC primaries involved the R ovary (85%) whereas L-sided CRC primaries involved the L ovary (70%) ( χ2, p&lt;0.002). Patient with bilateral (B) versus unilateral (U) had a larger ovarian tumor volume (2,073cm3 vs. 307 cm3, p&lt;0.01) but no difference in oligometastatic disease, chronicity, time to progression or overall survival. There was no statistical difference (p=0.93) between the association of bilateral KT inter-ovarian tumor size and CRC Laterality within individual patients. Conclusions: In this study, KT tumors predominantly originate from CRC. The clinical features of R versus L CRC, such as chronicity and OS are conveyed prognostically in patients with KT. Individuals with L CRC exhibited a better overall prognosis compared to those with R CRC. In patients with unilateral KT metastasis to ipsilateral ovary is significantly associated with location of CRC and is suggestive of a retrograde lymphatic or transcoelomic route of metastatic spread. Further studies are needed to confirm these findings and to elucidate ovarian organ tropism mediators that facilitate development and growth in metastatic ovarian cancer.

Prognostic significance of grade of malignancy based on histopathological differentiation and Ki-67 in pancreatic ductal adenocarcinoma.

Tumor cell malignancy is indicated by histopathological differentiation and cell proliferation. Ki-67, an indicator of cellular proliferation, has been used for tumor grading and classification in breast cancer and neuroendocrine tumors. However, its prognostic significance in pancreatic ductal adenocarcinoma (PDAC) remains uncertain. Patients who underwent radical pancreatectomy for PDAC were retrospectively enrolled, and relevant prognostic factors were examined. Grade of malignancy (GOM), a novel index based on histopathological differentiation and Ki-67, is proposed, and its clinical significance was evaluated. The optimal threshold for Ki-67 was determined to be 30%. Patients with a Ki-67 expression level > 30% rather than ≤ 30% had significantly shorter 5-year overall survival (OS) and recurrence-free survival (RFS). In multivariate analysis, both histopathological differentiation and Ki-67 were identified as independent prognostic factors for OS and RFS. The GOM was used to independently stratify OS and RFS into 3 tiers, regardless of TNM stage and other established prognostic factors. The tumor-node-metastasis-GOM stage was used to stratify survival into 5 distinct tiers, and surpassed the predictive performance of TNM stage for OS and RFS. Ki-67 is a valuable prognostic indicator for PDAC. Inclusion of the GOM in the TNM staging system may potentially enhance prognostic accuracy for PDAC.

Investigation of human epidermal growth factor receptor 2 expression and its correlation with age, gender, disease stage and degree of tumor differentiation of gastric cancer patients

We performed a comparative observational study to evaluate HER2 protein expression in gastric cancer patients, and explored its correlations with clinicopathological characteristics. HER2 protein expression were assessed in formalin-fixed, paraffin-embedded stomach tissue by immunohistochemistry. Patient information was collected, and associations between clinicopathological factors and HER2 positivity (IHC score 3+ or 2 +) and HER2 negative expression (IHC score 1+or 0) were examined. A total of 109 patients with stomach cancer were included in the study. The level of positivity of Her2 expression, according to the recommendations of the National Comprehensive Cancer Network, in 57 cases (52.3%) showed “no membrane reactivity, in 19 (17.4%) “+” weak membrane reactivity, in 21 (19.3%) “++” cases the reaction was “moderate or lateral membrane and only in 12 cases (11.0%) expression was “+++”, which means “complete basolateral and correlated with various clinical and pathological parameters in patients with gastric cancer: older age, male gender, low-grade tumor. However, we did not find any significant correlation between overexpression of HER2 and tumor localization, histopathological differentiation of the tumor, as well as with the stage of the disease according to TNM.

Local management of unresectable lung atypical carcinoid tumor: a case report and review of literature

Neuroendocrine tumors comprise a rare but increasing heterogeneous group of malignancies arising from neuroendocrine cells, most commonly from the lung and gastrointestinal tract. Due to the vast histopathological differentiation of each subtype and the scarce clinical data published, choosing the most effective therapy can be challenging. Radiotherapy can play a significant role in the treatment of locally advanced metastatic tumors, however there is a lack of randomized clinical trials in this setting. This article reviews the current knowledge on the classification and treatment of unresectable lung atypical carcinoids. We present a clinical case of a ULAC treated with systemic therapy and RT in different settings of the disease. The subject is a 48 years old male, diagnosed with a well differentiated pulmonary NET, classified as cT4N3M1b (supraclavicular and mediastinal adenopathies and an adrenal metastatic lesion) with disease progression after systemic treatment, and with superior vena cava compression. The primary tumor and involved nodal areas were treated to 54Gy/30 fractions using VMAT. SBRT was given to the metastatic left adrenal gland. Five months after RT, CT showed a volumetric reduction of &lt;25% of the thoracic disease and adrenal gland’s lesion stability. The disease remained stable for the next year and a half, when local and distant progression occurred, starting systemic treatment. A year and a half later, the patient presented with brain metastasis and underwent radiosurgery. At last follow-up, 5 years after diagnosis, the patient maintains treatment with capecitabine and temozolomide and is clinically stable. Definitive RT should be considered in the management of ULAC to improve local control.

Conjoint analysis of clinical, imaging, and pathological features of schistosomiasis and colorectal cancer

This study aims to examine and compare clinical, radiological, and pathological data between colorectal cancer (CRC) patients with and without schistosomiasis and uncover distinctive CRC characteristics when accompanied by schistosomiasis. This retrospective study is based on data collected from 341 patients diagnosed with CRC post-surgery and pathology. Of these patients, 101 (Group A) were diagnosed with colorectal cancer co-occurring with schistosomiasis (CRC-S), while 240 patients (Group B) were diagnosed with colorectal cancer without concurrent schistosomiasis (CRC-NS). Both groups were compared and analyzed based on their clinical data, imaging-based TNM staging, lymph node metastasis, nerve invasion, vascular cancer thrombus, and histopathological differentiation. A Chi-squared test revealed a significant difference in gender distribution between the patients with CRC-S (Group A) and CRC-NS (Group B), with a p -value of 0.043 and χ2 = 4.115. Specifically, a higher incidence rate was observed among males in Group A. There was a difference in the overall distribution of TNM staging between the two groups (p = 0.034, χ2 = 6.764). After pairwise comparison, a statistically significant difference was observed in the T3 stage (p &amp;lt;0.05). The proportion of the T3 stage in Group A was significantly higher than that in Group B, indicating certain advantages. There was a difference in postoperative histopathological grading between the two groups (p = 0.005, χ2 = 10.626). After pairwise comparison, a statistically significant difference was observed between the well-differentiated adenocarcinoma and the moderately and poorly differentiated adenocarcinoma (p &amp;lt;0.05), with a higher proportion of welldifferentiated patients in Group A compared to Group B. There was no significant difference in age, lymph node metastasis, nerve invasion, and vascular invasion between the two groups of patients (p &amp;gt; 0.05). Among the 101 patients with CRC-S, 87 (86%) showed linear calcification on CT imaging. Patients with CRC-S are mainly male, with tumor staging mostly in the middle stage, high tumor differentiation, and low malignancy. CT imaging can help identify the presence of lumps and linear calcification indicative of schistosome deposits. MRI can early clarify TNM staging and determine the presence of lymph node metastasis and nerve and vascular invasion.

Histology-based classifier to distinguish early mycosis fungoides from atopic dermatitis.

Histopathological differentiation of early mycosis fungoides (MF) from benign chronic inflammatory dermatoses remains difficult and often impossible, despite the inclusion of all available diagnostic parameters. To identify the most impactful histological criteria for a predictive diagnostic model to discriminate MF from atopic dermatitis (AD). In this multicentre study, two cohorts of patients with either unequivocal AD or MF were evaluated by two independent dermatopathologists. Based on 32 histological attributes, a hypothesis-free prediction model was developed and validated on an independent patient's cohort. A reduced set of two histological features (presence of atypical lymphocytes in either epidermis or dermis) was trained. In an independent validation cohort, this model showed high predictive power (95% sensitivity and 100% specificity) to differentiate MF from AD and robustness against inter-individual investigator differences. The study investigated a limited number of cases and the classifier is based on subjectively evaluated histological criteria. Aiming at distinguishing early MF from AD, the proposed binary classifier performed well in an independent cohort and across observers. Combining this histological classifier with immunohistochemical and/or molecular techniques (such as clonality analysis or molecular classifiers) could further promote differentiation of early MF and AD.

EXPRESSION OF CYCLIN D1 IN ORAL SQUAMOUS CELL CARCINOMA AND ITS CORRELATION WITH HISTOPATHOLOGICAL DIFFERENTIATION.

BACKGROUND: Cyclin D1 is an important protein that has a widespread role in governing cell proliferation rates, and cell cycle regulations. In variety of tumors overexpression of Cyclin D1 has been reported. Present study was carried out to study the expression of cyclin D1 in oral squamous cell carcinoma and its association with histopathological differentiation and staging. To correlate expression AIM &amp; OBJECTIVES: of cyclin D1 with histological grading and staging in oral squamous cell carcinoma. 98 biopsy specimens of oral MATERIALS &amp; METHODS: squamous cell carcinoma were included in this study and were immunohistochemically evaluated for expression of cyclin D1. Samples were received and reported in Department of Pathology Gandhi Medical College, Bhopal, Madhya Pradesh A total of 98 cases of oral RESULT: squamous cell carcinoma were studied. Cyclin D1 reactivity was seen in 76% cases of oral squamous cell carcinoma. Cyclin D1 reactivity did not correlate with site, tumor grade, and stage, whereas Cyclin D1 expression score which was obtained by multiplication of labeling index score and intensity showed signicant correlation with tumor grade and stage. Higher Cycli CONCLUSION: n D1 expression observed in patients with less differentiated tumours and with higher stage. Therefore, there is value of analysing cyclin D1 amplication and expression, for prognostic evaluation. This may also be further used for targeted therapy in oral squamous cell carcinoma