Histopathological Specimens Research Articles

The Imaging Database for Epilepsy And Surgery (IDEAS).

Magnetic resonance imaging (MRI) is a crucial tool for identifying brain abnormalities in a wide range of neurological disorders. In focal epilepsy, MRI is used to identify structural cerebral abnormalities. For covert lesions, machine learning and artificial intelligence (AI) algorithms may improve lesion detection if abnormalities are not evident on visual inspection. The success of this approach depends on the volume and quality of training data. Herein, we release an open-source data set of pre-processed MRI scans from 442 individuals with drug-refractory focal epilepsy who had neurosurgical resections and detailed demographic information. We also share scans from 100 healthy controls acquired on the same scanners. The MRI scan data include the preoperative three-dimensional (3D) T1 and, where available, 3D fluid-attenuated inversion recovery (FLAIR), as well as a manually inspected complete surface reconstruction and volumetric parcellations. Demographic information includes age, sex, age a onset of epilepsy, location of surgery, histopathology of resected specimen, occurrence and frequency of focal seizures with and without impairment of awareness, focal to bilateral tonic-clonic seizures, number of anti-seizure medications (ASMs) at time of surgery, and a total of 1764 patient years of post-surgical followup. Crucially, we also include resection masks delineated from post-surgical imaging. To demonstrate the veracity of our data, we successfully replicated previous studies showing long-term outcomes of seizure freedom in the range of ~50%. Our imaging data replicate findings of group-level atrophy in patients compared to controls. Resection locations in the cohort were predominantly in the temporal and frontal lobes. We envisage that our data set, shared openly with the community, will catalyze the development and application of computational methods in clinical neurology.

Adequacy of histopathology request forms and specimens sent to two histopathology centers in Khartoum, Sudan

Abstract Background Every branch of surgery relies in some way on histology to obtain a conclusive diagnosis. Since precise and comprehensive information on the request form is crucial to the correct analysis and interpretation of test results, it is anticipated that all patient data and information for any requested test be provided. One of the most significant duties of the peri-operative team is the care and handling of intraoperative surgical specimens. Poor labeling and handling of surgical specimens can lead to unfavorable consequences such as misdiagnosis, incorrect or delayed therapy, and even the need for repeat surgery. The study’s. objective is to highlight the primary mistakes that occur in the pre analytical stage of histopathology request forms and specimens at two Khartoum-based histopathological institutions. Methods A prospective descriptive laboratory based cross-sectional study was carried out on 528 request forms and specimens sent to two histopathology centers between the period of May to August 2019 having gotten Ethical clearance from SMSB. Results A total of 528 laboratory request forms and specimens, Age was written in 75.6% (n 399), while the gender only was written only in 46.2% (n 244). No clinical history in 48.3% (n 255). The differential diagnosis found only in 29.5% (n156) of request forms. Regarding specimen 15.7% (83) were inadequate relative to the size of the container and only 5.3% (28) were not labeled with any information. 17.4% (92) were not sent in formalin but in normal saline. Marking of the specimen was not needed in 60% (317) and among the rest cases; 34.2% was not marked. Conclusion The study shows that laboratory request forms were not properly and thoroughly completed. Most of the specimens sent for histology had inadequate fixative and unsuitable containers, or they were mislabeled and not properly tagged. This for sure will have a detrimental effect on the quality of care.

In vivo biodegradation rates of domestic membranes for guided tissue regeneration

Background: Experimental research is required to provide guidelines for the use of domestic biodegradable membranes. Aim: To assess the swelling index and biodegradation rate of barrier membranes (non-collagen and collagen) for guided tissue regeneration in vitro, as well as their biocompatibility in vivo. Materials and Methods: The swelling index of two types of membranes was assessed after 24 h of exposure to phosphate-buffered saline (PBS) at different pH levels (6.50 and 7.37). The spontaneous degradation rate of the two types of membranes was assessed; changes in their weight following exposure to PBS at different pH levels (6.50 and 7.37) were measured at predetermined time points. Moreover, the biocompatibility of two membrane samples following subcutaneous implantation in B/D male mice was assessed. Results: The swelling index of non-collagen membranes was higher at neutral pH compared to acidic pH: 7.7 for pH 7.37 vs 7.2 for pH 6.50. For collagen membranes, the swelling index was pH-independent. There were no differences in membrane weight loss following exposure to PBS at pH 6.5 during 8 weeks. During the first two weeks, collagen membranes had a higher resorption rate at pH 7.37 than non-collagen membranes. Following subcutaneous implantation of both membranes, histopathological specimens collected two weeks after surgery revealed the formation of foreign body granulomas with well-defined boundaries around the implants. Macrophages, monocytes, single giant cells of foreign bodies, and Pirogov–Langhans giant cells were detected, with the number gradually increasing over time. Conclusion: Non-collagen membranes had a larger swelling index than collagen membranes, which depended on pH. At pH 7.37, collagen membranes had a higher resorption rate during the first two weeks compared to non-collagen membranes. In vitro weight loss after 8 weeks was 20–30% for both membranes, regardless of pH. Subcutaneous implantation in mice confirmed the biocompatibility of the membranes. The biodegradation rate of non-collagen membranes was higher than that of collagen membranes.

Is histopathological analysis necessary in patients undergoing sigmoidectomy for diverticular disease? A retrospective study.

The purpose of this study was to assess the utility of routine histopathological examination in patients undergoing elective sigmoidectomy for diverticular disease after full colonoscopy 1 year prior to surgery. We retrospectively analysed medical records of all patients undergoing sigmoidectomy for diverticular disease with a documented colonoscopy within 1 year before surgery from January 2013 to December 2023. We collected preoperative, intraoperative and postoperative data of all patients. The primary endpoint was the percentage of patients with an unexpectedly abnormal histopathological report compared to colonoscopy. During the study period, 207 patients undergoing sigmoidectomy for diverticular disease were included. Mean age was 62.7 ± 13.0 years and 97 (46.9%) patients were men. In eight (3.9%) cases an unexpected finding was noted on the histopathological examination: five (2.4%) of them were hyperplastic polyps with no dysplasia and no clinical relevance, two (1.0%) were polyps with low-grade dysplasia and in one case (0.5%) a diffuse large B-cell lymphoma was present in a patient with history of lymphoma treated in the past 10 years. The Goodman and Kruskal's G index was 0.953 (95% lower limit of 0.913), which indicated high concordance between the colonoscopy and the definitive histopathological examination. In our series, the preoperative colonoscopy reliably predicted the result of the histopathological specimen findings in patients undergoing sigmoidectomy for diverticular disease. Only one (0.5%) high-risk patient had an unexpected clinically significant finding. Therefore, routine histopathological examination may not be justified for all patients.

Cancer Genomic Panel Testing and Handling of Histopathological Specimens

Cancer Genomic Panel Testing and Handling of Histopathological Specimens

Immunohistochemical Expression of ROS1 in invasive ductal carcinoma of breast in association with hormonal receptor status and Her2Neu expression

Objective: To determine the frequency of immunohistochemical expression of ROS1 in invasive ductal carcinoma of the breast in relation to hormonal receptor status and HER2 expression. Study Design and Setting: Descriptive cross-sectional study. Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from May 2022 to Dec 2022. Methodology: This study was conducted on a sample size comprising 137 patients diagnosed with invasive breast carcinoma (ductal carcinoma) on histopathological biopsy specimen. Immunohistochemistry was performed using ROS1, estrogen receptor, progesterone receptor and HER2 antibodies on patients’ tissue samples. Results were interpreted by two independent histopathologists. Finally data was analyzed using SPSS version 25. Results: The mean age of sample population was 50.85 ± 12.17 years. 131 patients were women and 6 were men. ROS1 was positive in 54 cases. ROS1 shows weak staining in 41 cases and moderate to strong staining in 13 cases. ER and PR showed no significant statistical correlation with ROS1 expression. HER2 was positive in 37 cases, equivocal in 11 cases and negative in 89 cases. A significant statistical correlation was seen between ROS1 and HER2 as 23 of HER2 positive cases showed ROS1 expression (p=<0.001). Conclusion: Significant number of ROS1 expressing cases in invasive breast carcinoma can be more revealing in the understanding of pathogenesis of breast carcinoma. In addition, it can also lead to use of certain recent tyrosine kinase inhibitors for treatment of this most common carcinoma in females.

Association Between Thrombus Histopathology and Hemodynamic Outcomes Among Patients With Chronic Thromboembolic Pulmonary Hypertension Undergoing Pulmonary Endarterectomy

Pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). Although most have normalization of pulmonary artery (PA) pressures, development of residual pulmonary hypertension (RPH) is challenging to predict. Among patients with CTEPH undergoing PEA, is there a relationship between specimen histopathology and postoperative hemodynamics? In this single-center retrospective cohort study, patients with CTEPH who underwent PEA were classified by thrombus chronicity: organized (chronic), organizing (subacute), or mixed (combined organizing and organized). Change in mean PA pressure, pulmonary vascular resistance (PVR), and transpulmonary gradient (TPG) were examined by thrombus organization. Associations with RPH were assessed with multivariable logistic regression. A total of 163 patients were identified: 34%had organized thrombi, 17%had organizing thrombi, and 49%had mixed thrombi. Pre-PEA mean TPG and PVR were highest in the mixed group (TPG: 37mmHg [29-42]; PVR: 8.7 Wood units [interquartile range (IQR), 5.6-11.2]) compared with the organized (TPG: 30mmHg [24-38]; PVR: 6.2 Wood units [IQR, 4.2-8.8]) and organizing (TPG: 24mmHg [19-37]; PVR: 4.2 Wood units [IQR, 3.5-9.2]) groups (TPG: P= .05; PVR: P= .01). The adjusted change in mean PA pressure among the mixed group was -19.8mmHg (-21.7 to -17.8), significantly greater than -16.2mmHg (-18.4 to -14.1) in the organized group and -14.1mmHg (-17.3 to -10.9) in the organizing group (P= .004). Fifty-two patients (32%) had RPH. Mixed thrombus organization was associated with lower odds of RPH (OR, 0.35; 95%CI, 0.14-0.85; P= .02), whereas preoperative mean PA pressure (OR, 1.10; 95%CI, 1.06-1.16; P< .001) and age (OR, 1.04; 95%CI, 1.01-1.07; P= .02) were associated with higher odds of RPH. Patients with mixed thrombi were less likely to have RPH, suggesting there may be an optimum time to perform PEA after the clot has mostly organized, but prior to development of irreversible small vessel disease.

A Systematic Review and Meta-Analysis of the Diagnostic Accuracy of Endometrial Sampling Tests for Detecting Endometrial Cancer

Abstract Objectives to determine the diagnostic accuracy of different endometrial sampling tests for detecting endometrial carcinoma. Design a systematic review and meta-analysis of studies of diagnostic accuracy. Eligibility Criteria We included published diagnostic test accuracy studies of women, of all ages, who had an endometrial sampling for preoperatively detecting endometrial cancer with verification using histopathology of hysterectomy specimens as the reference standard. We excluded case control and case series studies. Information Sources We searched the Cochrane library, MEDLINE/PubMed, CINAHL, Web of Science, and Scopus from the date of inception of the databases to January 18, 2023. We did not apply any restrictions on language or date of publication. We searched the references of included studies and other systematic reviews. Risk of Bias We extracted study data and assessed study quality using the revised quality assessment tool for diagnostic accuracy studies (QUADAS-2). Synthesis of Results We used bivariate diagnostic random-effects meta-analysis and presented the results in a summary receiver operating characteristic curve. We assessed the certainty of evidence as recommended by the GRADE approach. Results Twelve included studies, published between 1986 and 2022, recruited 1607 participants. Seven studies were low risk of bias in all domains and all studies had low applicability concerns. The most examined index tests were Pipelle and conventional dilation and curettage. For diagnosing endometrial carcinoma, the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio (95% confidence intervals), for Pipelle were 0.774 (0.565, 0.900), 0.985 (0.927, 0.997), 97.000 (14.000, 349.000), and 0.241 (0.101, 0.442) and for conventional dilation and curettage were 0.773 (0.333, 0.959), 0.987 (0.967, 0.995), 62.300 (18.600, 148.000), and 0.268 (0.042, 0.676); respectively. Conclusion High certainty evidence indicates that pre-operative endometrial sampling particularly using Pipelle or conventional curettage is accurate in diagnosing endometrial cancer. Studies assessing other endometrial sampling tests were sparse. Systematic review Registration Center for Open Science, osf.io/h8e9z

The Value of Intra-Voxel Incoherent Motion (IVIM) in Evaluation of Inflammatory Bowel Diseases

Abstract Background Crohn’s disease is a chronic inflammatory segmental bowel disorder characterized by attacks of remission and exacerbation that can significantly affect the patients’ quality of life. Hence monitoring the disease activity is crucial to achieve longer symptom free intervals which may result either from active inflammation and its complications as deep ulceration, fistulae formation and abscesses or sequelae from longstanding inflammatory process as fibrotic scarring and strictures. Aim of the Work to determine the efficacy of intravoxel incoherent motion (IVIM) in assessing inflammatory activity in IBD. Patients and Methods The study conducted at the Diagnostic Radiology Unit; Radiology Department, Ain Shams University Hospitals. From 6 to 9 months. Convenience sample of 32 patients who met the inclusion and exclusion criteria of the study based on clinical suspicion, biomarkers, endoscopy and histopathological specimens referred for MR enterography Results We studied the correlation between IVIM parameters with the four known parameters used for IBD activity evaluation (Biochemical, clinical, endoscopy, and MRE) and presence of complications. We studied the correlation of the previously mentioned prameters to each other Conclusion IVIM-DWI seems to be a potential noninvasive imaging approach that could provide specific quantitative markers, such as D*, ADC and f values, to objectively assess bowel inflammation with no concern about contrast agent complications.

Comparison of the Patient Demographics, High-Resolution Computed Tomography Features of the Pulmonary Ground-Glass Opacity and Its Diagnostic Value Analysis

Introduction Pulmonary ground-glass opacity (GGO) observed on computed tomography (CT) is widely regarded as a diagnostic feature of lung adenocarcinoma; however, a significant radiological predictive sign remains controversial. In this retrospective study, we conducted a comprehensive analysis of 206 patients with GGO to establish a correlation analysis model between CT images and diagnosis of GGO nodules. Methods Histopathologic specimens were obtained from 206 patients (130 women, 76 men; age range 24–77). The clinical data, pathologic findings, and thin-section CT features of solid, pure GGO (pGGO), and mixed GGO (mGGO) nodules were compared using rigorous statistical methods, such as t-test, Fisher’s exact test, or univariate logistic regression analysis. Results Significant differences were observed among the 3 groups in terms of patient demographics, including gender (P = 0.016), smoking history (P = 0.002), and nodule size (P = 0.002). Morphologic CT characteristics, such as the presence of spiculated sign, lobulated sign, vascular sign, bubble-lucency sign, or pleural retraction, exhibited significant differences among the solid nodule, pGGO, and mGGO groups. However, no significant differences were observed in terms of air-bronchogram sign. Notably, the incidence of malignancy was significantly higher in pGGO nodules (76.52%) than in solid (48.48%) and mGGO (73.86%) nodules. Patients with mGGO had up to 2.988 times higher hazard of malignant lesions than those with solid nodules [P = 0.036, hazard ratio (HR) = 2.988]. Similarly, the hazard of malignant lesions was 2.941 times higher in patients with pGGO than in those with solid nodules (P = 0.007, HR = 2.941). Conclusion Clinical, pathological, and thin-section CT features of solid, pGGO and mGGO nodules were found to be significantly different. Based on our comprehensive analysis, patients presenting with a mGGO or pGGO on CT scans were more likely to be diagnosed with lung cancer.

Radio-Histopathological Spectrum of Ovarian Specimens Following Cystectomy

Ovarian cysts can be benign or malignant and requires accurate diagnosis for efficient treatment. Objective: To characterize the radiological and histopathological spectrum of ovarian specimens following cystectomy. Methods: This retrospective study was conducted at Pakistan Atomic Energy Commission General Hospital, Islamabad from 1st April 2022 to 31st December 2022.Eighty patient’s samples from cystectomy patients who were suffering from ovarian cysts were included. Each patient underwent radiological examination before ovarian cystectomy through laparoscopic surgery except two cases of urgent laparotomy. Gross histopathological specimen examination was conducted. The data were analysed using SPSS version 26.0, wherein p value &lt;. 0.05 was considered as significant. Results: The mean age of the patients enrolled in this study was 35.5±5.9 years. Hemorrhagic cysts were having a reticular pattern of internal echoes with soli appearing area with concave margins and no internal flow, while endometrioma cysts were having homogenous low level internal echoes with non-solid component and tiny echogenic foci in the walls. While within the neoplastic cysts 4/8 werehaving cystic external surface and 1/8 presented with ovarian mass.The surface epithelial tumor presented of 2 cases with carcinoma detection on histopathology slides while in the germ cell tumor 1 cases each of strumaovarii, dysgerminoma and mixed germ cell tumor was observed. Conclusions: Surface epithelial tumors were the most common category of ovarian tumors and majority of the cysts were benign cystadenomas. Radiological imaging provides a precise non-invasive tool for categorizing various ovarian cysts and histopathological findings further confirms the exact category of tumors.

Routine Histopathology in Laparoscopic Sleeve Gastrectomy Over 10 Years.

Laparoscopic sleeve gastrectomy (LSG) is one of the world's most commonly performed types of bariatric surgery. Routine histopathology of the surgical specimen is undertaken at most institutions, regardless of the lack of clinical suspicion of any sinister pathology. We evaluated the histopathology reports of LSG cases done for morbid obesity at our hospital over 10 years to determine the distribution of gastric changes and the prevalence of Helicobacter pylori infection in these specimens. A retrospective study was conducted. All LSGs performed at Shifa International Hospital, Islamabad,Pakistan, from July 1, 2014, to June 30, 2024, were assessed. A total of 538 cases were included. Histopathology reports were reviewed for all these patients, and the histopathological diagnosis and the presence or absence of H. pylori infection were recorded. The mean age was 36.9 ± 11.4 years. There were 201 (37.4%) males. No abnormality was found in 105 (19.5%) cases. Gastritis was present in 433 (80.5%) cases. Intestinal metaplasia was present in eight (1.5%) cases in a background of gastritis. There were no cases of gastric atrophy or dysplasia. There was one case of submucosal lipoma (0.2%) and one case of gastrointestinal stromal tumor (GIST) (0.2%). Both cases were associated with gastritis. H. pylori infection was present in 140 (26.0%) cases. All of these were associated with gastritis. Among the gastritis cases, 319 (73.7%) had chronic gastritis, while 114 (26.3%) had both active and chronic gastritis. The severity of gastritis, as designated by the histopathologist in their report, was minimal in 24 (4.5%) cases, mild in 228 (42.4%), moderate in 176 (32.7%), and severe in five (0.9%). There was one case of granulomatous gastritis (non-caseating) (0.2%). There was no difference in the prevalence of gastritis or H. pylori infection based on age or gender. Histopathological examination of the LSG specimen revealed a very high prevalence of gastritis, with normal findings in less than a fifth of all cases. The prevalence of H. pylori infection (26.0%) is much higher in comparison to other studies. Routine histopathology of LSG specimens should continue to be performed in every case.

Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-diagnostic cross-sectional imaging

BackgroundBiliary dilatation without obvious etiology on cross sectional imaging warrants further investigation. This study aimed to assess yield of endoscopic ultrasound in providing etiologic diagnosis in such situation.MethodsProspective cohort of consecutive patients with biliary dilatation & non diagnostic computed tomography (CT) and /or magnetic resonance imaging (MRI) underwent endoscopic ultrasound (EUS) with/without fine needle aspiration cytology (FNAC) and were followed clinically, biochemically with/without radiology for up to six months. The findings of EUS were corroborated with histopathology of surgical specimens and endoscopic retrograde cholangiography (ERCP) findings in relevant cases.ResultsMedian age of 121 patients completing follow up was 55 years. 98.2% patients were symptomatic and median common bile duct (CBD) diameter was 13 mm. EUS was able to identify lesions attributable for biliary dilatation in (67 out of 121) 55.4% cases with ampullary neoplasm being the commonest (29 out of 67 i.e. 43%). Multivariate logistic regression analysis identified jaundice as the predictor of positive diagnosis on EUS, of finding ampullary lesion and pancreatic lesion on EUS. EUS had sensitivity, specificity, positive predictive value and diagnostic accuracy of 95.65%, 94.23%, 95.65% and 95.04% respectively in providing etiologic diagnosis. Threshold value for baseline bilirubin of 10 mg%, for baseline CA 19.9 of 225 u/L and for largest CBD diameter of 16 mm were determined to have specificity of 98%, 95%, 92.5% respectively of finding a positive diagnosis on EUS.ConclusionEUS provides considerable diagnostic yield with high accuracy in biliary dilatation when cross sectional imaging fails to provide etiologic diagnosis.

The impact of histopathological criteria for definite vasculitis in giant cell arteritis: retrospective analysis of temporal artery biopsies.

Histopathological findings associated with definite vasculitis in temporal artery biopsy (TAB) defined in 2022 ACR/EULAR classification criteria for Giant Cell Arteritis (GCA) was published in 2022. We aimed to evaluate the TAB of our GCA patients for histopathological findings associated with definite vasculitis. Patients who were diagnosed with GCA by clinicians and underwent TAB between January 2012 and May 2022 were included. Hospital electronic records and patients' files were reviewed retrospectively. A total of 90 patients' pathology reports were evaluated by a pathologist and a rheumatologist. In cases where microscopic findings were not specified in the pathology reports, histopathologic specimens were re-evaluated (n = 36). A standard checklist was used for histopathological findings of definite vasculitis. Patients were divided into two groups; (i) definite vasculitis-GCA and (ii) non-definite-GCA group, and the clinical and demographic characteristics for all patients were compared. The mean age of patients was 69.8 (± 8.5) years and 52.2% were female. In the first evaluation, 66 (73.3%) patients had a diagnosis of vasculitis according to pathology reports. In the re-evaluation of biopsy specimens, at least one definite finding of vasculitis was observed in TAB of 10/24 (41.6%) patients whose microscopic findings were not specified in the pathology reports. The ROC analysis showed that biopsy length had diagnostic value in predicting the diagnosis of definite vasculitis (AUC: 0.778, 95% CI: 0.65-0.89, p < 0.001). In those with a biopsy length of ≥ 1cm, sensitivity was 76.5%, specificity was 64.3%, and PPV value was 92. In multivariate analysis, the most significant factor associated with definite vasculitis was biopsy length (OR: 1.18 (1.06-1.31), p = 0.002). Microscopic findings were reported in over 70% of patients. Reinterpretation of results according to a standard check-list improved the impact of TAB in the diagnosis of GCA. A biopsy length ≥ 1cm was found to contribute towards a definitive histopathological vasculitis diagnosis.

Histopathologic and Clinical Characterization of Brentuximab Vedotin-associated Rash.

Rash is one of the commonly observed adverse events with brentuximab vedotin (BV), a CD30-targeted antibody-drug conjugate used to treat cutaneous T-cell lymphoma (CTCL). However, clinical and histopathologic characterization of BV-associated rash (BVAR) is limited. Distinguishing BVAR from a patient's underlying CTCL can be challenging and can lead to treatment interruptions or even premature drug discontinuation. We performed a thorough clinical and histopathologic retrospective characterization of BVAR from a single institution. Utilizing polymerase chain reaction (PCR) and T-cell receptor high-throughput sequencing (TCR-HTS), we were able to isolate skin biopsy specimens from rash clinically suggestive of BVAR that also lacked a dominant TCR clone. A retrospective evaluation was performed of 26 biopsy specimens from 14 patients. Clinical features of BVAR included predominantly morbilliform or maculopapular morphology, delayed onset, and the trend toward moderate to severe classification, often requiring oral steroids. Most histopathologic specimens (25/26) showed spongiotic dermatitis as the primary reaction pattern. Many cases showed subtle findings to support a background interface or lichenoid eruption. Langerhans cell microabscesses were seen in one-fourth of specimens, and eosinophils were present in over one-half of the specimens. There were focal features mimicking CTCL, but these were not prominent. In 17 specimens with immunohistochemistry, the CD4:CD8 ratio in intraepidermal lymphocytes was relatively normal (1-6:1) in 65% (11/17) and 1:1 in 35% (6/17), demonstrating a trend toward increased CD8-positive cells compared with baseline CTCL. We have identified features that can help distinguish BVAR from a patient's CTCL, which can, in turn, help guide appropriate clinical management.

Rarely Observed Histopathological Subtypes of Endometrial Malignant Tumors in a Tertiary Care Center: A Case Series.

Introduction Endometrial cancer, one of the most prevalent gynecological malignancies, represents a significant contributor to global mortality and morbidity. The histological subtype of this cancer is pivotal in treatment planning and patient risk stratification. This case series, comprising seven cases, underscores the significance of rare endometrial cancer variants and the importance of ancillary studies, specifically immunohistochemistry, in comprehending and diagnosing the condition. Materials and methods The data of all the rare histological subtypes of malignant endometrial tumors encountered from April 2021 to April 2024 were collected. The data collected included age; risk factor; histological type; tumor, node, metastasis (TNM) stage; the International Federation of Gynecology and Obstetrics (FIGO)grade; P53; and mismatch repair (MMR) status. The histopathology specimens were reviewed using a Labomed microscope (LX500) manufactured in India. Images were taken and added wherever necessary, and the results were studied, analyzed, clinically correlated, and are shown in tables. Results Seven rare histopathological subtypes of malignant endometrial tumors were encountered in this period in this tertiary care center. This included mesonephric like adenocarcinoma, high-grade carcinosarcoma, carcinosarcoma with the serous and chondrosarcomatous components, clear cell carcinoma of endometrium, endometrial stromal sarcoma with smooth muscle differentiation, endometrial stromal sarcoma, and undifferentiated sarcoma with focal myxoid degeneration. Conclusion Diagnosis of uncommon endometrial carcinomas proves to be challenging due to their various histological subtypes, most often with overlapping features. The cornerstone of effective care lies in collaboration with clinicians, radiologists, and pathologists to identify these lesions as early as possible using a multidisciplinary approach for optimal patient outcome management.

Clinical spectrum of tuberculosis in adolescents (10–19 years) in a tertiary care center of North India

Background\\objectivesThere is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.

Examination of the thickness of the different components of gallbladder wall in cases with mucocele and/or cholecystitis.

To assess the thickness of each layer of the gallbladder wall with different diseases in dogs. 72 gallbladders. Retrospective study of dogs that underwent cholecystectomy. Histopathological specimens of the gallbladders were reviewed. Histopathological diagnosis was made as gallbladder mucocele or cholecystitis, and cholecystitis was further categorized into chronic cholecystitis, acute-on-chronic cholecystitis, acute cholecystitis, and necrotic cholecystitis. The thickness of each layer of the gallbladder wall was measured. 22 dogs were diagnosed with gallbladder mucocele without cholecystitis, 24 with gallbladder mucocele and cholecystitis, 20 with only cholecystitis, and 6 as normal. Histopathological subclassification of cholecystitis in 44 gallbladders led to diagnosis of chronic cholecystitis in 21 gallbladders, acute-on-chronic cholecystitis in 10 gallbladders, acute cholecystitis in 6 gallbladders, and necrotic cholecystitis in 7 gallbladders. The thickness of the entire wall of the gallbladder (P < .0001) and the thickness of the mucosa (P < .0001) and subserosa (P < .0001) were affected by the different disease processes. Layers of the gallbladder wall were affected by diseases present in the gallbladder. It resulted in a difference in the thickness of the wall of the gallbladder among the gallbladder diseases in this study. Histopathological changes should be taken into consideration before surgery while deciding what technique to use to perform a cholecystectomy.

Baseline systemic inflammatory indices and clinicopathological features to predict the outcome of acute tubulointerstitial nephritis : Asingle-center retrospective study.

Acute tubulointerstitial nephritis (AIN) is an immune-mediated disorder that can cause acute kidney injury (AKI). We aimed to investigate the characteristics of patients with AIN and predictive factors for treatment response. In this study, thirty-one patients diagnosed with AIN on kidney biopsy between 2006 and 2021 were included. Baseline clinical, histopathological, and laboratory findings, including complete blood count (CBC), creatinine, erythrocyte sedimentation rate, C‑reactive protein, C3, C4, systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and urinalysis were evaluated. Treatment response, mortality, and creatinine levels at the time of last follow-up were also noted. The median age was 46 years and 80.6% were female. Median baseline creatinine and proteinuria levels were 4.1 mg/dL and 0.84 gram/day. The median follow-up period was 14months and 93.5% received immunosuppressives. End-stage kidney disease (ESKD) developed in five patients (16.1%). Renal recovery (creatinine < 1.4 mg/dL) was observed in 17 patients (54.8%). Higher degrees of interstitial fibrosis, tubular atrophy, granuloma formation, global glomerulosclerosis, and higher baseline hemoglobin levels, in addition to alonger interval between first symptom to initiation of immunosuppressives were associated with renal nonrecovery, statistically. Also, patients who progressed to ESKD had higher baseline hemoglobin (p = 0.033) and lymphocyte (p = 0.044) and lower PLR levels (p = 0.016), as well as higher degrees of global glomerulosclerosis (p = 0.014), interstitial fibrosis (p = 0.042), and tubular atrophy (p = 0.030). Treatment response rates are low for AIN, which may lead to ESKD. Besides chronicity in histopathology specimens, higher baseline hemoglobin levels and lower platelet-to-lymphocyte ratio might be prognostic. Further studies should be conducted on new markers for AIN.

Trend of Helicobacter pylori Infection in Childhood: A Single-Center Experience.

Helicobacter pylori (HP) is the most common bacterial infection in humans. Helicobacter pylori infection, which frequently increases with age, is seen in 30%-56.6% of children in Turkey, although it varies by region. In this study, we aimed to determine the frequency of HP in children and adolescents who underwent upper gastrointestinal endoscopy and gastric biopsy in our region and to compare the changes over the years. Cases who underwent upper gastrointestinal endoscopy for various indications between 2007 and 2022 in our pediatric gastroenterology unit were included in the study. The clinical and endoscopic characteristics of 1737 cases whose histopathologic specimens were obtained, have been retrospectively analyzed from their records. The diagnosis of HP infection was based on the presence of HP on histopathologic examination of gastric biopsy specimens. Of 1737 cases, 504 (29%) were HP positive. The HP positive case rates were 14.5%, 26.9%, and 33.6% in the 0-6, 7-12, and 13-18 age groups, respectively. H. pylori positivity was detected in 65.7% of patients with duodenal ulcers, and the relationship between duodenal ulcers and HP positivity was significant (P < .001). The average HP positivity rates were 44%, 28.6%, and 24.2% in 2007-2012 (group 1), 2013-2017 (group 2), and 2018-2022 (group 3). H. pylori positivity rates significantly decreased in years (P = .001/P = .056/P < .001). We found that the frequency of HP infection in children decreased in our region over the years. Helicobacter pylori positivity was higher in older than younger children. A decrease in HP frequency prevalence may be possible in parallel with awareness and socioeconomic development.