Latest WHO Classification Research Articles

Feasibility and utility of the custom RNA-seq for the identification of therapeutic targets and diagnostic biomarkers in glioma.

e14029 Background: The detection of novel therapeutic targets is increasingly important in oncology. The Todai OncoPanel (TOP) RNA panel is a custom target RNA-seq using the junction capture method to maximize the sensitivity in detecting of known 456 fusion gene transcripts, which is scheduled to be approved for clinical application in Japan in April 2023. Above, TOP RNA panel interrogates aberrantly spliced transcripts and analyzes the expression profiles of 1,390 genes. Malignant brain tumors, including gliomas, require various molecular profiles to be classified based on the latest WHO classification criteria, while their poor prognosis also necessitates new therapeutic targets. In this study, we aimed to classify gliomas and identify the molecular targets by TOP RNA panel. Methods: Among 131 frozen tumor samples of malignant gliomas, 124 samples passed quality control for further validation and were subjected to TOP RNA panel to classify based on the molecular profiles and to identify the molecular targets. Fusion detection and RNA expression analysis were conducted with the original pipeline. Cluster analysis and Gene Set Enrichment Analysis (GSEA) were performed to identify gene sets specific for individual subtypes. Copy numbers of tyrosine kinase genes, MDM2 and CDK4 were evaluated by digital droplet PCR (ddPCR). Results: Among 58 cases of glioblastoma, gene fusions were detected in 11 cases (19.0%) including novel MET fusions, and overexpression of seven tyrosine kinase genes were observed in 21 cases (36.2%). Of the 34 overexpressed genes, gene amplification was observed in 17 genes (50%) by ddPCR. In contrast to IDH-wildtype glioblastoma, IDH-mutant tumors including astrocytomas and oligodendrogliomas hardly harbored fusion genes or gene overexpression. GSEA to compare astrocytomas and oligodendrogliomas identified that the gene sets related to 1p36 and 19q were relatively enriched in astrocytoma, suggesting that regional genomic DNA copy number alterations can be evaluated by gene expression analysis. Conclusions: TOP RNA panel is utilized not only for the detection of molecular targets but also for the molecular classification of glioma, both of which is essential for providing treatments optimized for the individual patients.

Histomorphologic analysis of ovarian tumors according to the New 2020 WHO classification of female genital tumors.

In terms of female genital tract-related cancers, ovarian tumors account for 3% of all tumors. On the basis of gross, radiological, and clinical features alone, ovarian neoplasms cannot be diagnosed. Therefore, a clear histological diagnosis is necessary before beginning a permanent course of therapy. Cross-sectional analytical study. In this ambispective study, a total of 480 patients with ovarian tumors were included from January 2015 to July 2022 at a tertiary care center in western Maharashtra. Descriptive statistics-percentages, mean, and Chi-square test (to calculate P value) were used to analyze the collected data. To determine clinical presentation, age distribution and incidence of various morphological and histological variants of ovarian tumors. Out of 480, 250 cases (52%) in 41-50 years of age, followed by 154 cases (32%) in 21-30 years of age. Our study showed 301 cases of benign, 42 cases of borderline, and 137 cases of malignant neoplasms of ovary out of 480 cases studied. Out of 480 cases, 244 cases (50.83%) were cystic, 138 cases (28.75%) were solid, and 98 cases (20.42%) were mixed (cystic/solid). Out of 480 cases, 326 cases (67.91%) were surface epithelial ovarian neoplasms. In this research, most frequent ovarian neoplasms were serous tumors in 216 cases (45%) followed by mucinous tumors in 78 cases (16.25%). In 96% cases, clinical diagnosis matched with histopathological diagnosis. In our research, benign ovarian neoplasms were most frequent. Serous tumors were the most frequent type of surface epithelial neoplasms followed by mucinous tumors. Peak incidence was seen in fifth decade. Higher risk of malignancy was seen in nulliparity or low parity and early menarche not associated with risk of malignancy. Cystic morphology more common in benign neoplasms and complex or solid morphology showed greatest increase in incidence of malignancy. Latest WHO classification has important impact on prognosis and therapy of the patient.

Volumetric hippocampal changes in glioblastoma: a biomarker for neuroplasticity?

PurposeThe pleiotropic effect of gliomas on the development of cognitive disorders and structural brain changes has garnered increasing interest in recent years. While it is widely accepted that multimodal therapies for brain cancer can foster cognitive impairment, the direct effect of gliomas on critical cognitive areas before anti-tumor therapies is still controversial. In this study, we focused on the effect of IDH1 wild-type glioblastoma on the human hippocampus volume.MethodsWe carried out a case-control study using voxel-based morphometry assessment, analyzed with the Computational Anatomy Toolbox software. Glioblastoma diagnosis was performed according to the latest 2021 WHO classification. Due to stringent inclusion criteria, 15 patients affected by IDH1 wild type glioblastoma were included and compared to 19 age-matched controls.ResultsWe observed a statistically significant increase in the absolute mean hippocampal volume (p = 0.017), as well as in the ipsilateral (compared to the lesion, p = 0.027) and the contralateral hippocampal volumes (p = 0.014) in the group of patients. When the data were normalized per total intracranial volume, we confirmed a statistically significant increase only in the contralateral hippocampal volume (p = 0.042).ConclusionsTo the best of our knowledge, this is the first study to explore hippocampal volumetric changes in a cohort of adult patients affected by IDH1 wild-type glioblastoma, according to the latest WHO classification. We demonstrated an adaptive volumetric response of the hippocampus, which was more pronounced on the side contralateral to the lesion, suggesting substantial integrity and resilience of the medial temporal structures before the initiation of multimodal treatments.

Neuroendocrine Neoplasms of the Breast, The Latest WHO Classification: Features and Prognostic Factors

Neuroendocrine Neoplasms of the Breast, The Latest WHO Classification: Features and Prognostic Factors

Primary endometrial gastric (gastro-intestinal)-type carcinoma: A practical approach

The latest WHO classification of the female genital tract tumors introduces a new type of carcinoma: the primary gastric-type (or gastro-intestinal type) carcinoma of the endometrium. This type of neoplasm tends to have a poor outcome, making its correct diagnostic important. As little is known about this entity and given its quite challenging diagnosis, we aim to review existing data about it and propose a practical diagnostic approach. There are currently 11 cases published in 8 articles fitting the precise definition of a primary gastric-type carcinoma of the endometrium. Three main differential diagnoses must be excluded before considering this tumor: endometrioid adenocarcinoma with mucinous (Müllerian-type) differentiation, endocervical primary, and gastro-intestinal primary. Morphological aspects of this tumor can be heterogeneous and confusing; in this context, immunochemistry can be helpful to highlight the gastric or intestinal differentiation, but also to eliminate a mucinous endometrioid adenocarcinoma of Müllerian-type, by the constant negativity of estrogen receptors. A metastasis of a primary gastro-intestinal tract carcinoma must also be excluded by clinical, endoscopic and imaging work-up. Finally, an endometrial extension of a primary endocervical gastric-type carcinoma should be ruled out by complete sampling of the cervix. Intestinal type endocervical adenocarcinoma is easier to eliminate since this is an HPV-associated neoplasm.

Mixed neuroendocrine and non-neuroendocrine neoplasia (MiNEN) of the stomach

From the latest WHO classification of neuroendocrine neoplasms (NENs), the term MiNENs refers to mixed neuroendocrinenon-neuroendocrine tumors. A neuroendocrine component coexists with a non-neuroendocrine one in them. They are morphologically and/or immunohistochemically validated. The non-neuroendocrine component implicates adenocarcinoma, apart from other histological subtypes of carcinomas, such as squamous cell carcinoma. The neuroendocrine component can be represented by a high-grade tumour (HGNEC) in addition to neuroendocrine cancer. Gastric NENs also have subgroups of MiNENs such as mixed adenoneuroendocrine carcinoma (Mixed-adenocarcinoma-NEC), which includes both, small or large cell type, neuroendocrine carcinoma (NEC) and mixed adenoneuroendocrine tumor (Mixed-adenocarcinoma-NET). Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) is a rare disease. Based on the available data, neuroendocrine component has a highly aggressive biological behaviour represented by a low-differentiated neuroendocrine tumor in the majority of MiNENs cases. The treatment is based on the principles of neuroendocrine tumour therapy. The foregoing shows that it is not possible to provide precise epidemiological data, prognosis and approve treatment strategies.

Subtype distribution of lymphomas in northwestern Iran: a retrospective analysis of 659 cases according to World Health Organization classification

BackgroundThe distribution of lymphoma subtypes differs strikingly by geographic variations. However, there is limited information on this research in northern Iran. This study aims to evaluate the incidence, subtype, age, sex, and extranodal distribution of lymphomas diagnosed according to the latest WHO classification in a large referral center in northwest Iran.MethodsIn a retrospective study, the medical records of all patients with a diagnosis of lymphoma made between 2018 and 2021 were retrieved from the pathology archive of Imam Reza Medical Center, Tabriz. Lymphoma diagnosis was also made based on the appreciation of morphologic and immunophenotypic features and genetic characteristics in the context of clinical presentation.ResultsThis study includes a total of 659 patients with lymphoma diagnosed from 2018 to 2021. The number of lymphoma patients were increased each year, with 51 (7.7%), 96 (14.6%), 244 (40.7%), and 268 (40.7%) reported from 2018 to 2021, respectively. 59% of the patients were men. The participants’ mean age was 50.5 ± 19.8 years, while the mean age at diagnosis was 49.3 ± 19.6 years. 2.1% were precursor lymphoid neoplasm, 61.6% were mature B cell neoplasm, 8.8% were mature T cell neoplasm, and 27.5% were Hodgkin lymphoma. The most prevalent subtype of mature B-cell lymphoma was DLBCL (55.1%), followed by SLL (18.7%). Extranodal involvement was seen in 40.5% of all cases.ConclusionThe subtype distribution of lymphomas in northwest Iran is reported and compared with studies all over the world and inside Iran.

Progression from Malignant Mesothelioma in Situ to Malignant Mesothelioma: A Case Report Spanning 13 Years

Malignant mesothelioma is an aggressive neoplasm associated with poor prognosis. Identification of in-situ phase of malignant mesothelioma can help detect disease at an earlier stage and potentially improve outcome by early therapeutic intervention. The concept of malignant mesothelioma in-situ (MIS) has re-emerged, diagnostic criteria based on use of immunohistochemistry and molecular techniques have been described recently and the latest WHO classification of lung tumors includes MIS as a distinct diagnostic entity. Here we present morphologic and immunohistochemical findings from a patient presenting with multiple peritoneal and pleural in-situ malignant mesothelioma lesions with eventual progression to pleural invasive malignant mesothelioma over a protracted period of 13 years. There are very few well documented cases of malignant mesothelioma in-situ and this unique case provides insight into the morphologic variants and natural behavior of malignant mesothelioma in-situ over an extended period of time.

Pathological and Molecular Features of Nodal Peripheral T-Cell Lymphomas.

Peripheral T-cell lymphomas (PTCLs) are uncommon neoplasms derived from mature T cells or NK cells. PTCLs comprise numerous disease entities, with over 30 distinct entities listed in the latest WHO classification. They predominantly affect adults and elderly people and usually exhibit an aggressive clinical course with poor prognosis. According to their presentation, PTCLs can be divided into nodal, extranodal or cutaneous, and leukemic types. The most frequent primary sites of PTCLs are lymph nodes, with over half of cases showing nodal presentation. Nodal PTCLs include ALK-positive and ALK-negative anaplastic large cell lymphoma; nodal T-cell lymphoma with T follicular helper cell origin; and PTCL, not otherwise specified. Adult T-cell leukemia/lymphoma also frequently affects lymph nodes. Recent pathological and molecular findings in nodal PTCLs have profoundly advanced the identification of tumor signatures and the refinement of the classification. Therefore, the therapies and pathological diagnosis of nodal PTCLs are continually evolving. This paper aims to provide a summary and update of the pathological and molecular features of nodal PTCLs, which will be helpful for diagnostic practice.

Telomerase Reverse Transcriptase Promoter Mutations in A Cohort Of Adult Gliomas - Clinicopathological Correlates.

Introduction: Gliomas were previously classified histologically, although now the latest WHO classification incorporates several molecular markers to classify these. Detection of TERT promoter mutations is assuming increased importance due to its relevance to prognostication. : The aim of this study was to determine the frequency of TERT promoter mutations, association of TERT promoter mutations with other molecular alterations and to assess the role of TERT promoter mutations in overall survival and progression-free survival in relation to histological and molecular glioma subtypes. This study analyzed a cohort of 107 adult patients with diffuse gliomas, WHO grades II and III and glioblastoma, by immunohistochemistry for IDH and ATRX mutations, FISH for 1p/19q co-deletions and PCR sequencing for TERT promoter mutation. Further, five glioma molecular sub-groups were derived using three molecular alteration and included the sub-groups with: i) IDH mutations only, ii) IDH and TERT mutations only, iii) IDH and 1p/19q co-deletion only, iv) Triple negative, and v) Triple positive. IDH mutations and 1p/19q co-deletions were individually and significantly associated with an improved progression free (P = 0.001 and P = 0.002, respectively) and overall survival (P = 0.000 and P = 0.005, respectively) in the present cohort of gliomas. TERT promoter mutations occurred frequently in anaplastic oligodendrogliomas (94%), oligodendrogliomas (87.5%) and glioblastomas (54%). Sub-division into molecular sub-groups showed that the triple-positive tumors carried the best prognosis, followed by IDH only, triple negative and finally the TERT mutation only tumors (P < 0.000). : This indicates that sub-classification using these molecular markers separates tumors into prognostically relevant categories.

176: YAP/TAZ ACTIVATION IS A MECHANISM OF TUMOR PROGRESSION IN THE POORLY COHESIVE GASTRIC CANCER PHENOTYPE

Abstract Background and aim Poorly Cohesive Gastric Cancer (PC-GC), according with the latest WHO classification, has a poor prognosis and its relative incidence is increasing. Disregulation of the Hippo pathway and/or activation of YAP/TAZ signaling pathway are emerging as central determinants for tumor initiation, progression and chemoresistance. The role of YAP/TAZ in human GC has not been defined to date. We hypothesized that RhoA-YAP/TAZ axis is a mechanisms of tumor progression in PC-GC, influencing prognosis. Methods We retrospectively analysed 131 PC-GC patients, treated at two European surgical centres from 2004 to 2014. YAP/TAZ nuclear expression was analysed with immunohistochemistry. Both YAP and TAZ nuclear expression was coded as ‘negative’ (complete absence of nuclear reactivity) or ‘any positive’ (both low and high nuclear expression). Results 21 patients showed absence of nuclear reactivity YAP−/TAZ-, while 110 showed any positivity: YAP+ (85/133 = 63.9%), TAZ+ (93/131 = 69.9%). Pathological tumor stage were significantly earlier in YAP−/TAZ- patients; 38% of YAP−/TAZ- were pT1–2 compared with only 17% of cases showing any expression (P = 0.041). Patients without nuclear YAP/TAZ expression were pN0 in 55% of cases compared with 26% of cases with any positive nuclear reaction (P = 0.020). In negative group 5-year OS was 57% compared with 29% in any positive group (P = 0.030). 5-year survival was the highest in YAP−/TAZ- group, intermediate when only one of the two biomarkers was expressed, and the lowest in YAP+/TAZ+ group (P = 0.010). Conclusion Nuclear negativity to both YAP and TAZ identify a subgroup of PC-GC with more favourable prognosis. Higher clinic-pathological stage and a worse OS was associated to YAP/TAZ positive patients supporting the involvement of this pathway in the progression of PC gastric carcinoma. Our results provide new insights into the role of YAP/TAZ signalling cascade as a mechanism of cancer progression in sporadic PC-GC.

HISTOPATHOLOGICAL PROFILE OF GASTROINTESTINAL NEUROENDOCRINE TUMORS IN A TERTIARY CARE HOSPITAL

Background. Recently there has been a lot of discussion about the terminology and classification of neuroendocrine tumours of the gastrointestinal tract. The WHO has recommended a change of terminology and classification of these tumours. In 2019 a significant update was done in the WHO classification of neuroendocrine tumours of GIT in which neuroendocrine carcinomas (NECs) are all considered high-grade tumours. Previously, grade 1 and 2 tumours were regarded as neuroendocrine tumours (NETs) and grade 3 neoplasms as NECs. The new classification avoids confusion between these two clinically and molecularly distinct notions. Objective. The aim of the research was to study GI neuroendocrine neoplasms and classify them as per location and Histopathological classification of GI neuroendocrine neoplasms according to the recent WHO classification. To use IHC whenever and wherever required for categorization of GI NET’s. Methods. Over a period of 15 years, a total of 85 cases of neuroendocrine neoplasms of GIT were studied. The histopathological material of patients was reviewed and histopathological diagnosis confirmed. Paraffin embedded tissue blocks were used to study and review the material. Sections from tissue blocks were stained. Five-micron sections were cut and stained. The sections were stained using DAKO LSAB-2® system HRP glass slides coated with 0.5% poly-lysine. Results. Out of 85 cases 40 involved male and 45 female patients. The mean age was 46.4 years; age range 9-85 years. In our study, appendix 24 (28.23%) and stomach 11 (12.95%) were the commonest sites of primary involvement followed by colon (10), ileum (10), duodenum (5), GE junction (5), jejunum (3), oesophagus (2), rectum (2) and gall bladder (1). Metastasis to the liver were observed in 12 patients with known and unknown primary diagnosis. Based on the latest WHO classification 5 patients were classified under NECs and the rest under NETs. Conclusions. Neuroendocrine tumours (NETs) are uncommon malignancies of GIT. Appendix followed by stomach was the most common anatomical site. NET Grade 1 was the most common histological type. IHC markers NSE, Synaptophysin and Chromogranin can be used in diagnosis of NETs.

Sarcomatoid carcinoma of the prostate presenting as bilateral cervical lymphadenopathy: a rare case report

BackgroundSarcomatoid carcinoma (also called carcinosarcoma in the latest WHO classification 2016) of the prostate gland is a biphasic malignant neoplasm which exhibits epithelial and mesenchymal differentiation [1]. Sarcomatoid carcinoma is a rare tumour, considered as a variant of acinar adenocarcinoma in the WHO classification, with less than 200 reported cases in the literature to date [2]. Sarcomatoid carcinoma of prostate presenting with bilateral cervical lymph node deposits as the first clinical manifestation, is even rarer, and reported cases were not found in the literature; hence, this is the first case report of such, to the best of our knowledge.Case presentationWe report a case of sarcomatoid carcinoma of the prostate in a 72-year-old Sri Lankan man who presented with bilateral cervical lymphadenopathy. He had hard nodular prostate on digital rectal examination (DRE). Ultrasound scan of abdomen (USS) revealed the presence of paraaortic lymphadenopathy, in addition. The excision biopsy of the right cervical lymph node revealed deposit of a carcinoma of epithelioid histomorphology, which showed patchy strong positivity for immunohistochemical marker (IHCm), PSA. His serum PSA value was 48 ng/ml (reference < 5.40 ng/ml). Contrast-enhanced computed tomography (CECT) showed mildly enlarged prostate gland with irregular outline, sclerotic lesions in cervico-thoracic and lumbosacral vertebrae and generalized lymphadenopathy. Transrectal ultrasound guided biopsy of the prostate revealed sarcomatoid carcinoma. Disseminated sarcomatoid carcinoma of prostate was diagnosed. The patient has undergone bilateral orchidectomy, marking a serum PSA value of 5.4 ng/ml two months thereafter. He is surviving for six months after diagnosis and is currently under chemotherapy with docetaxel for the disseminated disease.ConclusionSarcomatoid carcinoma can present with cervical lymphadenopathy with absent lower urinary tract symptoms. In elderly patients with cervical lymphadenopathy, serum PSA, DRE and trans-rectal ultrasound scan are advocated to rule out prostate cancer. Immunohistochemical markers are required for the diagnosis of primary tumour and secondary deposit of sarcomatoid carcinoma of prostate.

Novel Therapeutic Options for Solitary Fibrous Tumor: Antiangiogenic Therapy and Beyond.

Simple SummaryIn the latest WHO classification, solitary fibrous tumors (SFTs) are now subdivided into benign SFT (intermediate category (locally aggressive)), SFT NOS (intermediate category (rarely metastasizing)), and malignant SFT. Thanks to recent progress in molecular characterization, the identification of the NAB2–STAT6 fusion oncogene has emerged as a specific cytogenetic hallmark for SFT. Despite these recent advances in classification and understanding of the molecular pathophysiology of SFT, there are no consensus clinical guidelines regarding systemic treatment. Several new therapeutic options are of interest in this subtype of sarcoma considered as refractory to classical chemotherapy. In case of advanced disease, antiangiogenic therapy might be viewed as the best therapeutic option.SFT is an ultrarare mesenchymal ubiquitous tumor, with an incidence rate <1 case/million people/year. The fifth WHO classification published in April 2020 subdivided SFT into three categories: benign (locally aggressive), NOS (rarely metastasizing), and malignant. Recurrence can occur in up to 10–40% of localized SFTs, and several risk stratification models have been proposed to predict the individual risk of metastatic relapse. The Demicco model is the most widely used and is based on age at presentation, tumor size, and mitotic count. Total en bloc resection is the standard treatment of patients with a localized SFT; in case of advanced disease, the clinical efficacy of conventional chemotherapy remains poor. In this review, we discuss new insights into the biology and the treatment of patients with SFT. NAB2–STAT6 oncogenic fusion, which is the pathognomonic hallmark of SFT, is supposedly involved in the overexpression of vascular endothelial growth factor (VEGF). These specific biological features encouraged the successful assessment of antiangiogenic drugs. Overall, antiangiogenic therapies showed a significant activity toward SFT in the advanced/metastatic setting. Nevertheless, these promising results warrant additional investigation to be validated, including randomized phase III trials and biological translational analysis, to understand and predict mechanisms of efficacy and resistance. While the therapeutic potential of immunotherapy remains elusive, the use of antiangiogenics as first-line treatment should be considered.

Disseminated atypical choroid plexus papilloma in late young adulthood – A case report

Atypical choroid plexus papillomas (CPPs) are a rare variant of choroid plexus papillomas, extra-axial tumours that arise from the neuroepithelial lining of the choroid plexus. The latest WHO Classification defines as atypical CPPs as those choroid plexus papillomas that have increased mitotic activity, that is, at least 1 mitosis per mm2. Other features may include hypercellularity, cytological atypia, and necrosis. Atypical CPPs typically occur in the paediatric population.

NGS-based multi-gene panel testing in hematological malignancies: diagnosis and prognostic prediction

Diagnosis and classification of hematological diseases have been based on morphological and immunological findings, but the emergence of next-generation sequencing (NGS) technology has highlighted the importance of genomic alterations. With the advent of this novel technology, numerous genetic alterations have been identified in hematological malignancies. In fact, more than 300 genetic alterations have been listed in the latest WHO classification, such as NPM1 mutation, for the subcategorization of acute myeloid leukemia. In addition, increasing evidence has suggested that combining genetic information with clinical factors improves prognostic prediction in several hematological malignancies. Although NGS-based genomic profiling has been used to provide precision medicine in solid cancers, no comprehensive genomic profiling test for hematological diseases is covered by public health insurance both in Japan and abroad. Identification of targetable alterations is the main purpose of NGS-based genomic profiling in solid cancers, whereas genetic information is useful not only for treatment stratification but also for diagnosis and prognostic prediction. In addition, genetic profiles of solid and hematological malignancies are quite different. Therefore, the development of a comprehensive genomic profiling test for hematological disease is imperative. Here, we discuss the clinical utility of a comprehensive genomic profiling test for hematological malignancies with an emphasis on diagnosis and prognostic prediction.

A Clinicopathological Study of Malignant Tumors of the Uterine Corpus in a Tertiary Care Center

Aim: To study the clinicopathological spectrum of malignant tumors of the uterine corpus in a tertiary care center and classify it according to the latest WHO classification.&#x0D; Methods: A 2 year study was conducted on 22 diagnosed cases of malignant tumors of uterine corpus. Retrospectively clinical and histopathological details were collected and analyzed.&#x0D; Results: In our study majority (40.90%, 9 of 22) cases belong to the age group of 51-60 years. Abnormal uterine bleeding was the most common clinical presentation. A large share (81.81%) of the tumours was of epithelial origin, followed by mixed and mesenchymal tumors. Nearly 94% of the epithelial tumours were Endometrioid Adenocarcinomas. Majority of the cases were at pT1a stage (42.1%) at the time of diagnosis, followed by pT1b stage (31.57%). Very few cases (21%) presented with nodal metastasis. All the cases with nodal metastasis showed Lymphovascular invasion in the tumor proper and were usually high grade tumors.&#x0D; Conclusion: The prognosis of the patients with malignant tumors of uterine corpus depends on stage, grade, myometrial invasion, tumor size, lymphovascular invasion etc. Clinical findings in these tumors are not specific, so Histopathological examination plays a vital role in diagnosing and assessing the prognosis of these tumors. Classifying these tumors according to the recently proposed molecular classification will aid in patient specific targeted therapy.

Spectrum of lymphoma subtypes based on the latest World Health Organization classification in southern Iran from 2000 to 2011.

Background: Lymphoma, bothHodgkin and non-Hodgkin, is one of the most common malignancies, with adistinct subtype distribution throughout the world. Methods: A total of 453 lymphoma cases, identified retrospectivelyfrom January 2000 to October 2011,were studied to identify the subtype distribution of lymphoma in our center, located in southern Iran, according to the latest WHO classification. Results: The most common sites of involvement of all lymphomas were extranodal (59.16%). The highest frequency of extranodal sites in all lymphoid neoplasms were associated with diffuse large B-cell lymphoma (22.95%) and classical Hodgkin lymphoma(10.15%). Of 453 cases, 23 (5.32%) were T and natural killer cell neoplasms, of which the most common subtypeswereT-cell large granular lymphocytic leukemia and anaplastic large cell lymphoma. Conclusion: This study indicated that the subtype distribution of lymphoma (except for the higher prevalence of diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphomaand lower rate of follicular lymphoma)in this part of Iran is similar to that in the Middle Eastern countries. Mature B-cell neoplasms are less frequent compared with both western and far east Asian countries.

Diagnostic workup in front of an adult thrombocytosis

During a blood test, the discovery of thrombocytosis is a frequent phenomenon with multiple origins. False thrombocytosis linked to analytical interferences is rare but must be eliminated before confirming the anomaly. The reaction origin, often very easily demonstrated by the context and/or the presence of a biological inflammatory syndrome, is the most frequent. More rarely, the diagnosis is oriented towards a clonal hematological pathology not limited to essential thrombocythemia. Currently, many biological tools, which have largely contributed to the recommendations of the latest WHO classification of chronic myeloid neoplasms, are available to classify these pathologies as precisely as possible, allowing optimal management.

Of Open Pits and Valleys: Endoscopic Optical Diagnosis Juxtaposition of Pathologically Distinct Rectal Polyp Lesions

AbstractOptical diagnosis during colorectal cancer screening is instrumental in deciding whether or not to resect colorectal lesions, choose the appropriate technique and to properly communicate with the pathologist. The latter is even more important when it comes to serrated lesions with the latest WHO classification justifying a pathology diagnosis of a serrated lesion with a minimum criterion of characteristic findings in just one crypt, which may only be detectable when adequate sectioning and scrutinization is performed. Here, we present a unique case of comparatively small rectal lesions with typical endoscopic findings warranting a diagnosis of a serrated lesion (open pit pattern) and adenoma (valley sign).