Pathological Evaluation Research Articles

Alterations in corneal sensitivity according to age and gender in healthy population in Turkey

ABSTRACT Clinical relevance Knowing the changes in corneal sensitivity according to age and gender is important for the correct evaluation of pathologies. Background The aim of this work was to analyse variability of corneal sensitivity according to age and gender in the healthy population in Turkey. Methods Healthy volunteers between the ages of 20 and 84, who applied to outpatient clinic due to routine examination, were included. Exclusion criteria were any ocular diseases other than refractive error, any systemic disease, contact lens use, chronic ocular and systemic drug use, and previous ocular surgery. Central and 4 quadrants (superior, inferior, nasal, temporal) corneal sensitivity measurements were performed with a Cochet-Bonnet esthesiometer (Luneau Ophthalmology, France). The patients were divided into 5 groups according to their ages (Group 1:20-29, Group 2:30-39, Group 3:40-49, Group 4:50-59, Group 5 ≥ 60). The data were evaluated in terms of groups and gender. Results The right eyes of 324 volunteers were included. The mean age was 44.31 ± 15.65 (20–84) and the female/male ratio was 165/159. The mean central, superior, inferior, nasal, and temporal sensitivities were 50.15 ± 9.7,48.62 ± 10.3,48.59 ± 10.3,47.73 ± 10.2,47.71 ± 10.3 mm, respectively. Sensitivities in all quadrants decreased significantly depending on age (p = 0.001 for all, central, superior, inferior, nasal and temporal correlation coefficients,r = −0.783, −0.791, −0.789, −0.760, −0.775, respectively). The decrease accelerated in Group 4 and 5. Gender-related changes were detected as significant in central and temporal quadrants (p = 0.038, p = 0.019). When sensitivity according to gender was evaluated within each decade, significant difference was detected in Group 2 and 4 (p < 0.05). Conclusion Corneal sensitivity decreases with age, most significantly in 5th and 6th decades. Sensitivity differs between genders in central and temporal quadrants. Geographic location, gender, and ethnicity may affect sensitivity values. The present study defines normal values in aTurkish population and may guide the evaluation of pathologies that impair corneal sensitivity.

Comprehensive pathological evaluation of risk factors for metastasis after endoscopic resection of superficial esophageal squamous cell carcinoma.

Esophageal cancer is a major cause of cancer mortality worldwide. Endoscopic resection (ER) is a curative treatment for esophageal squamous cell carcinoma (ESCC). Predicting risk of metastasis is crucial for post-ER management. In this study, we aimed to identify predictors of metastasis by examining endoscopically resected specimens. The cohort of this retrospective multicenter study comprised 422 patients who had undergone ER for ESCC from 1994 to 2017. Inclusion required a histological diagnosis of pT1a-muscularis mucosa or pT1b-submucosa (SM) cancer. Central pathological review comprehensively evaluated depth of invasion, lymphovascular invasion (LVI), droplet infiltration (DI), infiltrative growth pattern, histological differentiation, intraductal and intraglandular involvement, solitary nest, resected margin, and other factors. Logistic regression was used to identify predictors of metastasis. Metastases were identified in 103 patients. Univariate analysis identified LVI, depth of invasion, and DI as significant predictive factors. Multivariate analysis identified LVI, depth of invasion pT1b-SM2 (odds ratio 2.72) and indeterminate (positive vertical margin) (odds ratio 3.63) compared with the reference category of pT1b-SM1 as independent predictors of metastasis. Conversely, there were no significant associations between metastasis and lesion size, differentiation, cytological atypia, or infiltration pattern. Subgroup analysis showed that both the number and layer of LVI were associated with metastasis risk. In addition, four or more foci of DI was an independent predictor of LVI. LVI and depth of invasion were significant predictors of metastasis in ESCC. Detailed pathological evaluation and standardized criteria are essential for accurately assessing risk of metastasis and guiding post-ER treatment strategies.

Case report: The outcomes of neoadjuvant immunotherapy combined with chemotherapy in pulmonary sarcomatoid carcinoma: case series and literature review

BackgroundPulmonary sarcomatoid carcinoma (PSC) is a highly aggressive malignancy with a significant risk of recurrence even after surgical intervention, leading to a dismal prognosis. In recent years, perioperative immunotherapy has demonstrated promising results in resectable non-small cell lung cancer (NSCLC). However, there is a lack of studies reporting the efficacy of perioperative immunotherapy in PSC.Case presentationWe report the clinical outcomes of four patients diagnosed with locally advanced PSC who underwent neoadjuvant immunotherapy in combination with chemotherapy from 2021 to 2023 in our hospital. Prior to surgery, these patients received 2 to 4 cycles of neoadjuvant treatment. Post-treatment imaging assessments indicated a partial response (PR) in all cases, and each patient successfully achieved R0 resection. Pathological evaluations demonstrated significant pathological responses: one patient attained Pathological Complete Response (PCR), two patients exhibited Major Pathological Response (MPR), and one patient showed PR. Currently, all four patients remain alive without evidence of tumor progression. Notably, the patient who achieved PCR has maintained a disease-free survival (DFS) exceeding 32 months post-surgery, while their event-free survival (EFS) has surpassed 36 months.ConclusionsNeoadjuvant immunotherapy in combination with chemotherapy has provided new promise for the treatment of locally advanced PSC with surgical potential. But these findings still need to be verified by further prospective researches.

Combining tissue biomarkers with mpMRI to diagnose clinically significant prostate cancer. Analysis of 21 biomarkers in the PICTURE study.

Serum PSA and digital rectal examination remain the key diagnostic tools for detecting prostate cancer. However, due to the limited specificity of serum PSA, the applicability of this marker continues to be controversial. Recent use of image-guided biopsy along with pathological assessment and the use of biomarkers has dramatically improved the diagnosis of clinically significant cancer. Despite the two modalities working together for diagnosis biomarker research often fails to correlate findings with imaging. We looked at 21 prostate cancer biomarkers correlating our results with mpMRI data to investigate the hypothesis that biomarkers along with mpMRI data make a powerful tool to detect clinically significant prostate cancer. Biomarkers were selected based on the existing literature. Using a tissue microarray comprised of samples from the PICTURE study, with biopsies at 5 mm intervals and mpMRI data we analysed which biomarkers could differentiate benign and malignant tissue. Biomarker data were also correlated with pathological grading, mpMRI, serum PSA, age and family history. AGR2, CD10 and EGR protein expression was significantly different in both matched malignant and benign tissues. AMACR, ANPEP, GDF15, MSMB, PSMA, PTEN, TBL1XR1, TP63, VPS13A and VPS28 showed significantly different expression between Gleason grades in malignant tissue. The majority of the biomarkers tested did not correlate with mpMRI data. However, CD10, KHDRBS3, PCLAF, PSMA, SIK2 and GDF15 were differentially expressed with prostate cancer progression. AMACR and PTEN were identified in both pathological and image data evaluation. There is a high demand to develop biomarkers that would help the diagnosis and prognosis of prostate cancer. Tissue biomarkers are of particular interest since immunohistochemistry remains a cheap, reliable method that is widely available in pathology departments. These results demonstrate that testing biomarkers in a cohort consistent with the current diagnostic pathway is crucial to identifying biomarker with potential clinical utility.

Comprehensive Clinical Genetics, Molecular and Pathological Evaluation Efficiently Assist Diagnostics and Therapy Selection in Breast Cancer Patients with Hereditary Genetic Background

Comprehensive Clinical Genetics, Molecular and Pathological Evaluation Efficiently Assist Diagnostics and Therapy Selection in Breast Cancer Patients with Hereditary Genetic Background

Clinical and pathological characteristics of immune checkpoint inhibitor-related fulminant myocarditis

The advent of immune checkpoint inhibitors (ICIs) has significantly improved cancer treatment. With the increasing use of ICIs, ICI-related myocarditis has been recognized. However, an evidence-based therapeutic strategy has not been established because of the limited knowledge on ICI-related myocarditis. Here, we present four cases of ICI-related fulminant myocarditis (FM). Three of the four cases resulted in fatal outcomes despite aggressive treatment with mechanical circulatory support and immunosuppressive therapy with corticosteroids. Given the poor prognosis of ICI-FM, the establishment of rapid and adequate therapeutic interventions on the basis of clinical and pathological evaluation is imperative.

Organoid models of breast cancer in precision medicine and translational research.

One of the most famous and heterogeneous cancers worldwide is breast cancer (BC). Owing to differences in the gene expression profiles and clinical features of distinct BC subtypes, different treatments are prescribed for patients. However, even with more thorough pathological evaluations of tumors than in the past, available treatments do not perform equally well for all individuals. Precision medicine is a new approach that considers the effects of patients' genes, lifestyle, and environment to choose the right treatment for an individual patient. As a powerful tool, the organoid culture system can maintain the morphological and genetic characteristics of patients' tumors. Evidence also shows that organoids have high predictive value for patient treatment. In this review, a variety of BC studies performed on organoid culture systems are evaluated. Additionally, the potential of using organoid models in BC translational research, especially in immunotherapy, drug screening, and precision medicine, has been reported.

Measurable residual disease testing and allogeneic hematopoietic cell transplantation for AML: adapting Pre-MEASURE to clinical practice.

Measurable residual disease (MRD) testing in patients with acute myelogenous leukemia (AML) represents a heterogenous assessment process designed to quantify leukemia-specific biomarkers that are not ascertainable by routine pathologic evaluation. The most common tools used to assess MRD are multiparameter flow cytometry (MPFC), and polymerase chain reaction (PCR) based tools, including quantitative or digital droplet PCR (qPCR, ddPCR), or next-generation sequencing (NGS) technologies. Collectively, MRD assessments have become an important clinical tool in the management of patients with AML. Despite progress, significant questions remain with respect to the appropriate timing, frequency, and methodology of MRD assessment, and whether or how to adapt therapy based on MRD results. Recent data from the Pre-MEASURE study, a retrospective cohort analysis of error corrected NGS based MRD assessment prior to allogeneic hematopoietic cell transplantation (alloHCT) in patients with AML, provides additional key information with respect to the emerging role of NGS-based technology in MRD assessment. In the context of this review, we evaluate the Pre-MEASURE study as well as other recent, high-quality assessments of MRD in AML. Our focus is to provide a practical assessment of the use of emerging MRD technologies in patients with AML with an emphasis on the role of peri-transplant MRD for the practicing clinician.

A pictorial essay on the potential use of the transhepatic subcostal ultrasound view for the evaluation of lower lung lobe pathology.

Lung ultrasound has become indispensable in managing critically ill patients, offering bedside evaluation capabilities for intensive care unit physicians without ionizing radiation. This noninvasive technique demonstrates high sensitivity and specificity in diagnosing various lung pathologies, including pleural effusion and consolidation syndrome. A novel trans-hepatic subcostal approach enhances visualization of the lower right lung lobe, revealing the diaphragm dome and inferior lobe through oblique coronal sections. Challenges include inadequate liver visibility hindering right lung views and difficulties in left lung assessment due to gastric interference. Despite limitations, this method proves invaluable when conventional imaging is impractical, showcasing its utility in critical care settings.

Diagnostic comparison of bedside lung ultrasound and chest radiography in the intensive care unit

Bedside lung ultrasound (POCUS) offers advantages over chest X-ray, including better cost-effectiveness for diagnosing certain pulmonary pathologies. This study compares the diagnostic concordance between portable chest X-rays and bedside lung ultrasounds in the intensive care unit (ICU). Adult ICU patients were included. POCUS was performed using the abbreviated BLUE protocol. Diagnostic results from POCUS and chest radiographies were compared using the intensivist clinical diagnosis - based on clinical examinations and lung ultrasounds - as the reference. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the ultrasounds were calculated. A total of 100 patients were included, 71 with pulmonary pathologies. The average time to perform the ultrasound was 308 seconds. Ultrasound identified pathology in 20 patients with a normal chest radiographs. Diagnostic discrepancies occurred in 30 patients, highlighting ultrasound´s superior sensitivity in detecting atelectasis, pleural effusions, and pulmonary edema. Ultrasound demonstrated sensitivity (S) of 85%, specificity (E) of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 55%. Lung point-of-care ultrasound at ICU admission detects more pathologies and does not miss significant abnormalities seen on chest X-rays. It also shows good diagnostic accuracy. These findings suggest that pulmonary POCUS, using an abbreviated protocol, could be a viable alternative to chest radiography for initial evaluation and follow-up of pulmonary pathologies in critically ill patients, potentially improving care quality and management.

Solitary Peutz-Jeghers polyp harboring a focus of high-grade dysplasia in the colon: a case report and literature review.

A solitary Peutz-Jeghers (PJ) polyp is a rare hamartomatous lesion without an associated PJ syndrome. However, little is known regarding malignancy arising in solitary PJ polyps. Here, we report a case of a solitary colonic PJ polyp with focal dysplasia. A 45-year-old asymptomatic man underwent total colonoscopy following a positive fecal occult blood test. The patient had no history of mucocutaneous pigmentation or family history of PJ syndrome. A 20mm erythematous pedunculated polyp was observed in the sigmoid colon. Magnified endoscopy revealed a tubular or branch-like pit pattern with localized areas of irregular pits. These findings were suggestive of colorectal adenoma with high-grade dysplasia, and endoscopic mucosal resection was performed. Histopathological examination revealed arborizing proliferation of hyperplastic epithelia with smooth muscle bundles. In addition, a small number of irregular crypts with high-grade dysplasia were observed in the hyperplastic epithelium. Based on these histological findings, we finally diagnosed the patient with a solitary colonic PJ polyp with high-grade dysplasia. The present case suggests that solitary colonic PJ polyps may harbor dysplastic changes and require pathological evaluation with en bloc resection of the polyps.

Tumor-Promoted Changes in Pediatric Brain Histology Can Be Distinguished from Normal Parenchyma by Desorption Electrospray Ionization Mass Spectrometry Imaging.

Background: Central nervous system (CNS) tumors are the second most frequent type of neoplasm in childhood and adolescence, after leukemia. Despite the incorporation of molecular classification and improvement of protocols combining chemotherapy, surgery, and radiotherapy, CNS tumors are still the most lethal neoplasm in this age group. Mass spectrometry imaging (MSI) is a powerful tool to map the distribution of molecular species in tissue sections. Among MSI techniques, desorption electrospray ionization (DESI-MSI) has been demonstrated to enable reliable agreement with the pathological evaluation of different adult cancer types, along with an acceptable time scale for intraoperative use. Methods: In the present work, we aimed to investigate the chemical profile obtained by DESI-MSI as an intraoperative surgical management tool by profiling 162 pediatric brain biopsies and reporting the results according to the histopathology and molecular profile of the tumors. Results: The 2D chemical images obtained by DESI-MSI allowed us to distinguish tumor-transformed tissue from non-tumor tissue with an accuracy of 96.8% in the training set and 94.3% in the validation set after statistical modeling of our data using Lasso. In addition, high-grade and low-grade tumors also displayed a distinct chemical profile when analyzed by DESI-MSI. We also provided evidence that the chemical profile of brain tumors obtained by DESI-MSI correlates with methylation-based molecular classes and specific immunophenotypes found in brain biopsies. Conclusions: The results presented herein support the incorporation of DESI-MSI analysis as an intraoperative assistive tool in prospective clinical trials for pediatric brain tumors management in the near future.

Abstract 4125497: Diagnostic Discrepancies Revealed by Explant Pathology at the Time of Cardiac Transplant in Patients Clinically Diagnosed with Nonischemic Cardiomyopathy: Role of Cardiac Magnetic Resonance Imaging

Background: Differentiating between causes of non-ischemic cardiomyopathy is important for disease-directed treatment. Cardiac MRI (CMR) and the use of late gadolinium enhancement (LGE) have proven useful for enhancing diagnostic accuracy. Definitive assessment of cardiomyopathy etiology by explant pathology facilitates direct evaluation of CMR utility. Hypothesis: We hypothesized direct comparison between pre-transplant (Tx) CMR and explant pathology will improve the characterization of undifferentiated cardiomyopathy through examination of cases where pre- and post-Tx diagnoses were discordant. Aims: To evaluate discrepant cases to describe imaging patterns in relation to post-Tx diagnosis. Methods: Institutional Tx recipients between 2000 and June 2023 were queried for pre-Tx MRI (n=122). Discrepant cases were identified (n=8). Pre-Tx diagnostic modalities, including CMR, were reviewed, and CMR patterns were evaluated in association with ultimate explant diagnosis. Results: Of the eight patients with discrepant diagnoses, five carried clinical diagnosis of dilated cardiomyopathy, one hypertrophic cardiomyopathy, one peripartum cardiomyopathy, and one congenital heart disease having undergone tricuspid valve and ASD repair. Pathologic evaluation most frequently identified biventricular or left ventricular arrhythmogenic cardiomyopathy (ARVC) (n=6), where CMR disclosed a diffuse pattern of subepicardial LGE and pre-Tx diagnosis of DCM was most common. Two of these pathologic descriptions represented a different disease on genetic evaluation: one patient had Danon disease, another had a LMNA pathogenic variant. The presumed peripartum cardiomyopathy was identified as Fabry’s disease on pathology (however, genetic testing consistent with Danon disease). Both Danon disease patients had primarily subendocardial LGE on CMR. One patient with a DCM phenotype had HCM pathologically. Results summarized in Table 1. Conclusions: Cardiac MRI can be a useful modality for the evaluation of underlying cardiomyopathy and should prompt appropriate genetic testing. Diffuse subepicardial LGE frequently accompanied the diagnosis of ARVC whereas a non-subepicardial pattern reflected alternative etiologies identified only through genetic testing.

Breast metastasis from large cell neuroendocrine carcinoma of the lung: a case report

BackgroundPrimary breast carcinoma is far more common than breast metastases. Common breast metastases usually come from lymphoma, leukemia, melanoma, and ovarian cancers. Breast metastases from neuroendocrine carcinomas are considered an exceeding rare entity. It has been reported in the literature that the pathological presentation of this particular metastatic tumor is very challenging as it shares many morphological characteristics with primary breast carcinoma.Case presentationWe report a case of a patient with large cell neuroendocrine carcinoma of the lung metastasizes to both breasts. The patient was initially presented with brain metastasis of unknown origin. Further radiological imaging workup showed multiple bilateral breast masses and bilateral lymphadenopathy, which raised concern for secondary lymphoma of the breast. The histopathology of this case was challenging, particularly when triple negative invasive ductal carcinoma diagnosis had been made. Multidisciplinary meetings between medical oncologists, radiologists, and pathologists profoundly helped confirming the diagnosis of metastatic large cell neuroendocrine tumor to the breast.ConclusionLarge cell neuroendocrine carcinoma of the lung is a relatively uncommon diagnosis with generally poor prognosis. Large cell neuroendocrine carcinoma that metastasizes to the breast is even scarcer. Correlation between clinical assessment, radiological imaging, and pathological evaluation is the key in making such an unusual and complex diagnosis. Additionally, radiologists should be aware of metastatic presentations of the breast and avoid confusion with mimicking benign entities or primary breast carcinomas.

Radiation dose assessment during dental cone beam computed tomography procedures in Sri Lanka towards establishing a dose reference level.

This study assesses radiation doses in cone beam computed tomography (CBCT) procedures in Sri Lanka, with the goal of establishing initial diagnostic reference levels (DRLs). Data from 1162 retrospective scans across four institutions were analyzed, and the medians of the pooled dose distribution for seven clinical indication categories were presented as the DRL values. The proposed DRLs based on clinical indications are 1013mGy·cm2 for pathological conditions including cysts, tumors, and lesions, 1307mGy·cm2 for implant planning, 1266mGy·cm2 for presurgery assessment, and 1585mGy·cm2 for evaluation of sinus and nasal pathology, temporomandibular disorder, and facial trauma. Considerable variability in doses across facilities was observed, driven by differences in equipment and imaging practices. Therefore, this study recommends adopting suggested DRL values as benchmarks, standardizing protocols to reduce dose variability, and implementing a national framework for regular updates of DRL values.

Unexpected Pathology During Pelvic Organ Prolapse Repair in an Urban Population.

This study quantifies the occult pathology risk among our urogynecologic patient population and highlights the importance of preoperative counseling, particularly in patients who have been underrepresented in prior studies. The aim of the study was to estimate unexpected gynecologic pathology incidence among a low-risk, racially, and ethnically representative patient population undergoing surgery for symptomatic pelvic organ (POP) prolapse. This was a retrospective study of patients undergoing hysterectomy for POP at an urban academic medical center. Patients with abnormal preoperative pathologic evaluation were excluded. Data were abstracted from the electronic health record, including demographic and clinical history, preoperative laboratory evaluation, and clinical risk factors for gynecologic malignancy. Two hundred ninety-nine nononcologic patients who underwent POP repair with hysterectomy were assessed. Thirty-six percent of patients identified as Hispanic, 17% as non-Hispanic Black, and 38% as non-Hispanic White. Twenty-three percent of patients reported abnormal uterine bleeding, 36% underwent a preoperative ultrasound examination, and 15% underwent endometrial biopsy. Two patients (0.9%) were diagnosed with endometrial carcinoma. Two patients (0.9%) were diagnosed with cervical dysplasia. No patients with concurrent oophorectomy or salpingectomy had ovarian or tubal pathology. The overall incidence of unexpected gynecologic pathology at the time of hysterectomy for prolapse was 1.7%. The rate of endometrial cancer in our cohort is on the higher end of previously published data, although absolute rates of unanticipated malignancy remain low. Future studies should examine the pathological findings of larger, racially, and ethnically diverse cohorts of patients undergoing POP surgery with hysterectomy, which can aid in providing relevant estimates for preoperative counseling.

Clinical and radiological features of atypical adrenal masses- a multicenter retrospective study.

The natural history and malignant potential of cases classified as atypical adrenal masses (AAMs) are unknown. To describe the radiological characteristics and clinical outcomes of AAMs. A multicenter retrospective study. Patients ≥18 years old with AAMs (diameter of 10-39 mm on first imaging study and pre-contrast attenuation of >10 Hounsfield units [HU] on computed tomography) were studied. We excluded adrenal metastasis, pheochromocytoma, sarcoma, lymphoma, infiltrative lesions, and adrenal hemorrhage, as well as patients with genetic predisposition to adrenal neoplasms. Data are presented as percentages and median values with interquartile ranges (IQRs). . We included 217 patients with 224 adrenal masses (61.3% women); the median age was 58 years (IQR, 49-65 years). The median size was 20.5 mm (IQR, 15-27 mm), with a median pre-contrast attenuation of 23.5 HU (IQR, 17-30 HU). The median AAM growth rate was 0.3 mm/year (IQR, 0-1.8 mm/year). Seventy-one masses (31.7%) underwent pathological evaluation. Adrenal adenoma (n=38; 17%) and adrenocortical carcinoma (ACC) (n=25; 11.2%) were the two most common diagnoses. For the adenomas, the growth rate was 0.3 mm/year (IQR, 0-2.3 mm/year) and for ACCs, the growth rate was 12.9 mm/year (IQR, 3.5-22 mm/year). The absolute contrast washout was >60% in 5 out of 7 (71.4%) ACC cases. The best growth rate cutoff for predicting malignancy was 2.68mm/year (AUC 0.939; sensitivity 87.5%, specificity 88.8%). AAMs carry significant malignant potential, and long-term follow-up is warranted when surgery is not pursued. Contrast washout is not reliable in predicting malignant potential of AAMs.

Relationship between bone union and degree of bone marrow fibrosis at resection margins of advanced mandibular ORN

BackgroundThe pathological evaluation of cancellous bone at resection margins of mandibular osteoradionecrosis (ORN) has not been well elucidated. Here, we developed a unique classification system for evaluating the degree of bone marrow fibrosis, one of most common pathological features, in patients with mandibular ORN, based on which we investigated its relationship with treatment outcome.MethodsThis study included 15 patients who underwent mandibulectomy and free fibula osteocutaneous flap reconstruction. The extent of mandibulectomy was determined, with safety margins of approximately 10 mm from the apparent osteolytic areas on preoperative computed tomography image. Special staining was performed on thin sections from center of the osteolytic areas (medial area) and bilateral resection margins, and the degree of bone marrow fibrosis was evaluated and investigated its relationship with presence of bone union as a treatment outcome.ResultsThe degree of bone marrow fibrosis of medial area was significantly higher than those of resection margins. Although most resection margins had collagen fibers which indicate severe fibrosis, all transferred fibula flaps achieved bone union.ConclusionWhen mandibulectomy is performed with safety margins of approximately 10 mm from the apparent osteolytic areas, all transferred fibula flaps achieved bone union regardless of the degree of bone marrow fibrosis at resection margin. In other words, the association between severe bone marrow fibrosis at resection margins and treatment outcome was not seen.Clinical RelevanceSetting safety margins of approximately 10 mm may achieve bone union, but further study is needed.

Effect of warm and cold ischemia on pancreaticoduodenectomy specimen following robotic pancreaticoduodenectomy

BackgroundThe adoption of robotic pancreaticoduodenectomy (PD) has increased in recent years for the treatment of pancreatic head tumors and periampullary lesions. Some potential benefits seem to be demonstrated; however, obtaining specimens through this method can potentially compromise the diagnosis depending on the timing of the specimen retrieval, and the impact of longer perioperative time on ischemia and autolysis of the surgical specimen has not been analyzed. The aim of this study is to evaluate the histological changes associated with timing of specimen retrieval during robotic PD.MethodsA review of histopathology files was performed for all pancreatic specimens collected at our hospital from January 2022 to March 2024. Both warm ischemia time (WIT) and cold ischemia time (CIT) were collected. Histological features related to ischemic damage were evaluated in normal duodenal and pancreatic parenchyma as well as pancreatic tumor, and were graded as: absent, mild, moderate and severe. Univariate and multivariate analyses were performed to determine which variables were associated with moderate and severe ischemic changes.ResultsSixty surgical specimens were analyzed: 20 open PD, 17 robotic PD with cold ischemia, and 23 robotic PD. Median total WIT was 182 min (open PD 57 min vs. RPD 190 min vs. RPD-CI 198 min; p < 0.001). Median CIT was 760 min (740–835) in samples stored at 4ºC. Univariate analysis showed that longer intraoperative time, male gender and cold ischemia were associated with pancreatic tissue ischemic changes. In multivariate analysis, cold ischemia was the only independent factor associated with normal pancreatic tissue and tumor tissue moderate and severe ischemic changes.ConclusionsProlonged ischemia time, especially in the case of cold storage, has a strong effect on the degradation of normal and tumor tissue without affecting pathological evaluation. Operative teams should aim to optimize both the duration and efficiency of the surgical procedure, ensuring minimal ischemic time. Simultaneously, pathology departments must be equipped to process pancreatic specimens promptly, with protocols in place to minimize the time between resection and analysis.

Effect of Tissue Fragments Remain in the Karman Cannula on the Histopathological Diagnosis of Abnormal Uterine Bleeding.

The aim of this study was to perform histopathological analysis of residual material in the cannula by endometrial sampling using a Carmen injector, and to compare the results. The study was conducted in the Department of Gynaecology, Mardin Training and Research Hospital, Artuklu/Mardin, Turkiye, from December 2021 to June 2022. The study group consisted of 104 patients who presented to the outpatient clinic with complaints of abnormal uterine bleeding. Endometrial curettage material was collected from all patients using a Carmen injector. The collected material was discharged into the pathology container (Group 1). Subsequently, the residual material remaining in the injector was placed in a separate pathology container (Group 2). Specimens were sent to the pathology laboratory with buffered formol. The pathological evaluation was performed by the same pathologist without revealing the patients' names. Comparative histopathological results of the patients in Group 1 and Group 2 were found to be fully compatible in 64.4% of the patients. In 35.6% of the patients, the histopathological results were different from each other between Group 1 and Group 2. Pathological results were different from each other in 21.2% of patients with incompatible pathology results. In Group 1, 16.7% of the patients were over-diagnosed, while 7.7% of the patients were over-diagnosed in Group 2. It would be beneficial to carefully remove the material remaining in the cannula and send it for pathological examination as it may affect the histopathological results. Key Words: Abnormal uterine bleeding, Probe curettage, Karman cannula, Histopathological evaluation.