Resected Specimens Research Articles

Effects of sampling methods on evaluating post-treatment pathological response in resected non-small cell lung cancer specimens with diameter greater than 3 cm

Objective: To investigate the effects of sampling methods on pathological assessment of resected non-small cell lung cancer (NSCLC) specimen with tumor maximum diameter >3 cm after neoadjuvant therapy. Methods: NSCLC patients with a large tumor (diameter >3 cm) that were resected after neoadjuvant therapy from June 2020 to July 2023 were retrospectively collected in the Department of Pathology, Shanghai Pulmonary Hospital, Shanghai, China. Sampling methods of the tumor bed were performed in accordance with the international and Chinese experts recommendations for resection specimens following neoadjuvant therapy (recommended sampling method, RSM), and all remaining tumor bed lesions were completely sampled after recommended sampling (complete sampling method, CSM). The difference of pathological response assessment of residual viable tumor (RVT) between RSM and CSM was examined. Results: A total of 90 cases were identified and analyzed, including 39 cases of squamous cell carcinoma and 51 cases of adenocarcinoma, treated with neoadjuvant therapy including chemotherapy in 22 cases (24.4%), targeted therapy in 14 cases (15.6%), and chemoimmunotherapy in 54 cases (60.0%). There were 62 males and 28 females with an average age of (62.7±17.9) years. The average tumor maximum diameter was 4.3 cm (range, 3.1-8.0 cm). The average number of sampled blocks was 8 blocks (range, 5 to 16) and 15 blocks (range, 8 to 36) per case by RSM and CSM, respectively. According to the definition of major pathological response (MPR) in which RVT is ≤10%, the numbers of patients with MPR were 34 cases by RSM and 30 cases by CSM, respectively. Four cases showed inconsistent RVT between the two methods, including one case of squamous cell carcinoma and three cases of adenocarcinoma. The RVT of the four inconsistent cases was 7%, 7%, 5% and 9% (MPR by RSM), and 15%, 15%, 15% and 20% (non-MPR by CSM), respectively. The kappa values of MPR consistency evaluated by the two sampling methods were 0.893 for all cases, 0.906 for squamous cell carcinoma cases and 0.751 for adenocarcinoma cases. According to MPR cut-off of 65% for invasive primary adenocarcinoma, 24 cases and 20 cases achieved MPR by RSM and CSM, respectively. Of the four inconsistent cases, the RVT by RSM was 60% in three cases and 65% in one case (MPR), whereas the RVT by CSM was 70% in three cases and 75% in one case (non-MPR). The kappa value of the two sampling methods was 0.741. Conclusions: There is high consistency between RSM and CSM in the pathological assessment of post-treatment responses in resected NSCLC specimens with tumor maximum diameter larger than 3 cm. When the percentage of RVT cells is close to MPR, re-evaluation of the specimen is required and CSM may be necessary to accurately evaluate the degree of pathological remission, assist in clinical postoperative treatment, and predict patient prognosis.

Combined Clinical and Histopathological Risk Stratification for Prediction of (severe) Endoscopic Postoperative Recurrence in Patients with Crohn's Disease after Ileocolic Resection: Results from A Prospective Multicenter Cohort Study.

This study assessed the association of histopathological features in the resection specimen of CD patients with (severe) endoscopic postoperative recurrence (ePOR) in a large prospective, multicenter cohort study. The predictive value of histopathologic features of the intestinal resection specimen for the risk of Crohn's disease (CD) recurrence after ileocolic (re-)resection (ICR) remains a matter of debate. CD patients (≥16y) scheduled for ICR (n=293) were included. Outcome measures were ePOR (modified Rutgeerts' score ≥i2b) and severe ePOR (≥i3) at six months postoperatively. Histopathological assessment of resection margins and mesentery/mesocolon was performed by expert gastrointestinal pathologists. Logistic regression was performed and ROC curves were delineated to explore the association and accuracy of histopathology with (severe) ePOR. ePOR and severe ePOR was observed in 37% and 9% of patients. Only moderate to severe inflammation at the ileal resection margin (OR 2.5; 95%CI 1.1-5.6) was associated with ePOR in multivariable analysis. Area under the curve for individual histopathological risk factors varied between 0.53-0.58 for ePOR (active inflammation at the resection margins, submucosal plexitis and transmural inflammation) and 0.69-0.71 for severe ePOR (submucosal plexitis, transmural inflammation and mesenteric granulomas). Clinical risk factors alone (active smoking and postoperative prophylactic medication) had an AUC of 0.66 and 0.74 for ePOR and severe ePOR. Combined histopathological and clinical risk stratification increased the AUC up to 0.71 for ePOR and up to 0.79 for severe ePOR. Only moderate to severe inflammation at the ileal margin was independently associated with ePOR. A combined approach of clinical risk stratification and assessment of histopathological features in the resection specimen provides an adequate predictive value for (severe) ePOR after ICR in patients with CD.

Pathological assessment and prognosis of SMARCA4-deletion non-small cell lung cancer with neoadjuvant therapy

Objective: To investigate the clinicopathological features, treatment-effect assessment and prognosis of SMARCA4-deletion non-small cell lung cancer (NSCLC) that was treated with neoadjuvant therapy. Methods: Eleven consecutive cases of SMARCA4-deletion NSCLC treated with neoadjuvant therapy in Guangdong Provincial People's Hospital, Guangzhou, China from January 2007 to October 2024 were collected. Their clinicopathological features, pathological assessment of treatment effect, and prognosis were retrospectively analyzed. Results: All the 11 patients were male. Their median age at diagnosis was 56 (49,64) years. Nine patients were smokers (9/11). Ten patients received neoadjuvant chemoimmunotherapy, and one received neoadjuvant targeted therapy. Eleven biopsy samples showed SMARCA4 complete loss, including 7 cases of invasive non-mucinous adenocarcinoma, 1 case of invasive mucinous adenocarcinoma, 1 case of non-keratinizing squamous cell carcinoma, and 2 cases of NSCLC, not otherwise specified. The histological response to neoadjuvant therapy in resected specimens varied, including tumor necrosis, foam cell aggregation, cholesterol clefts, immune cell infiltrates, reactive granulomas, and stromal fibrosis. Three cases of the primary lesion achieved major pathological response (MPR), and 2 cases achieved complete pathological response (CPR). The MPR rate of neoadjuvant chemoimmunotherapy was 3/10 while its CPR ratio was 2/10. Of the 9 resected specimens that did not achieve CPR, 5 showed a post-treatment histological type different from the pre-treatment one. Eight tumors showed complete SMARCA4 loss, while 1 showed heterogeneous expression. Of the 11 biopsy specimens examined using next generation sequencing, 9 cases showed class 1 SMARCA4 mutations (including 7 nonsense mutations and 2 acquired nonsense mutations), and 2 cases showed wild-type SMARCA4. Taking immunohistochemistry as the gold standard, the sensitivity of next generation sequencing for the detection of SMARCA4-deletion NSCLC was 9/11. After follow-up of 6.9 to 46.6 months, five patients experienced postoperative recurrence, and 6 patients were disease free. The disease-free survival ranged from 0.7 to 27.5 months (median, 7.6 months). Conclusions: The surgical specimens of SMARCA4-deletion NSCLC with neoadjuvant therapy show varying degrees of treatment response. The tumor components sensitive to chemoimmunotherapy and targeted therapy are mostly adenocarcinoma and squamous cell carcinoma, while large cell carcinoma, spindle cell carcinoma and giant cell carcinoma are relatively less sensitive to treatment. Assessment of MPR and CPR suggests that some NSCLC patients with SMARCA4-deletion can benefit from neoadjuvant therapy.

Clinicopathological and molecular characteristics of renal cell carcinomas with TFEB gene amplification

Objective: To investigate the clinicopathological characteristics, molecular features, differential diagnosis and prognosis of renal cell carcinoma (RCC) with TFEB gene amplification. Methods: A total of 113 cases of unclassified RCCs and RCCs with TFEB positive expression were collected from the Affiliated Hospital of Qingdao University and Navy 971 Hospital from January 2010 to December 2024. Eight cases of RCCs with TFEB amplification were identified using tissue microarrays, immunohistochemistry, and fluorescence in situ hybridization (FISH) techniques. The clinicopathological data and prognosis of the 8 cases were summarized, and relevant literature was reviewed. Results: Among the 8 cases, there were 5 males and 3 females. The average age was 63.4 (54, 77) year and the median age was 63.5 (59.0, 65.5) year. Seven cases were detected through physical examination, and 1 case presented with initial symptoms of metastasis to bones and lungs. The cohort included 1 biopsy specimen and 7 surgical resection specimens. The tumor diameters ranged from 2.5 to 15.0 cm. The cut surfaces of 5 cases were grayish-yellow or grayish-red, and 2 cases exhibited a colorful appearance, among which 3 cases involved renal sinus and 1 case showed invasion of the perirenal fat tissue. Microscopically, 4 cases were composed of clear cells arranged in solid sheets or acinar structures, along with varying numbers of eosinophilic cells. Two cases exhibited the morphology of high-grade eosinophilic RCC, and 1 case presented biphasic morphology with diffuse polygonal eosinophilic tumor cells and dense small cell components. The remaining 1 case exhibited the morphology of clear cell RCC. According to the WHO/ISUP nuclear grading system, 6 cases were Grade 3 and 2 cases were Grade 2. Multifocal necrosis was observed in 4 cases. In 4 surgical specimens, the tumor tissue invaded the renal parenchyma, with 2 cases showing nodular infiltration to surrounding tissues and 1 case with intravascular tumor thrombus. Immunohistochemical results showed varying degrees of TFEB nuclear positivity in 6 cases (6/8). Melanocytic markers such as Melan A (5/8) and HMB45 (3/8) were expressed at varying degrees. Cathepsin K (6/8), GPNMB (6/8), P504s (7/8) and CD10 (7/8) were positively expressed in most cases. FISH results revealed high-copy amplification of TFEB gene in 4 cases (partially showing clustered amplification) and low-copy amplification in 4 cases. During the follow-up period of 3 to 64 months of the 8 cases, 3 cases metastasized and 2 cases died of disease (both with high-copy TFEB gene amplification). Conclusions: RCC with TFEB gene amplification is rare and exhibits diverse morphological features. A common morphological characteristic of this type of tumor is a mixture of sheet-like clear cells and high nuclear grade eosinophilic cells. Combined immunohistochemical staining for TFEB, melanocytic markers, and GPNMB is helpful for the diagnosis of the tumor, and FISH detection of TFEB gene amplification is the most definitive method in diagnosing this tumor. RCC with TFEB gene amplification usually presents with strong aggressiveness and poor prognosis. Combining surgical resection with immunotherapy or VEGFR-targeted drugs might have therapeutic effects on the tumor.

Surgical and Oncological Outcomes of Conversion Surgery After Hepatic Arterial Infusion Chemotherapy for Initially Unresectable Locally Advanced Hepatocellular Carcinoma

ABSTRACTBackgroundSince 2013, we have performed conversion surgery after hepatic arterial infusion chemotherapy (HAIC) for initially unresectable locally advanced hepatocellular carcinoma (LA‐HCC).MethodsBetween 2013 and 2021, we assessed the surgical and oncological outcomes and pathological findings of patients with LA‐HCC without extrahepatic spread (EHS) whose tumors converted from unresectable to resectable status with the New‐FP regimen HAIC.ResultsWe censored 153 patients with LA‐HCC (Child‐Pugh A, without EHS) indicated for HAIC. Among them, 25 converted to resectable status after HAIC. Antitumoral effects were Response Evaluation Criteria in Solid Tumors (RECIST) partial response in 13/25 cases (52%) and modified RECIST complete response in 14/25 cases (56%). We performed hepatectomy for 24 cases because one case was lost to unexpected liver failure after portal vein embolization. No severe complications were recorded after hepatectomy. The 5‐year overall survival rate was 56%. When resected specimens were assessed as whole tissue sections, all showed various degrees of necrosis (median rate of necrotic nodules: 90%), and 7 had complete necrosis. We also classified patterns of residual tumors into intratumoral and peritumoral types, with the former divided into a peripheral and a nonperipheral type. All cases with complete necrosis survived, and recurrence of the peripheral type was less frequent than other residual patterns (p = 0.0451). All patients whose residual tumors contained a peritumoral pattern experienced recurrence within roughly 12 months.ConclusionsNew‐FP regimen HAIC achieved favorable surgical and oncological outcomes and could be adopted as a conversion chemotherapy. In addition, different residual tumor patterns demonstrated different prognoses.

Stoma Rate and Oncological Outcomes of Primary TaTME Vs Completion TaTME in Patients With Early-Stage Rectal Cancer.

Local excision as a first step in the treatment of early rectal cancer has gained interest. However, in the presence of histopathological risk factors, (inter)national guidelines recommend completion total mesorectal excision. Although oncologically safe, completion total mesorectal excision is associated with an increased end-colostomy rate compared to primary total mesorectal excision, especially in distal lesions. Transanal total mesorectal excision may facilitate lower anastomoses, potentially reducing end-colostomy rates. To compare the end-colostomy rate and oncological outcomes of primary transanal total mesorectal excision with local excision followed by completion transanal total mesorectal excision in patients with cT1-2N0M0 rectal cancer. Data were prospectively collected from 6 Dutch high-volume centers experienced in transanal total mesorectal excision and retrospectively analyzed. All patients with cT1-2N0M0 rectal cancer who underwent primary transanal total mesorectal excision or local excision followed by completion transanal total mesorectal excision between 2012 and 2022. The primary outcome was end-colostomy rate. Secondary outcomes included anastomotic leakage, involvement of the circumferential resection margin, specimen quality, local recurrence, distant metastases, overall survival and disease-free survival. A total of 150 patients were included with a median follow-up of 32 and 23 months for primary transanal total mesorectal excision and local excision followed by completion transanal total mesorectal excision, respectively. The end-colostomy rate was significantly lower in the local excision followed by completion transanal total mesorectal excision group (21%) compared to the primary transanal total mesorectal excision group (42%, p = 0.022). More anastomotic leakages occurred in the local excision followed by completion transanal total mesorectal excision group (33% vs 18%, p = 0.064). No differences were observed in circumferential resection margin involvement and specimen quality. Two-year local recurrence rates were 4% for primary transanal total mesorectal excision and 3% for local excision followed by completion transanal total mesorectal excision (p = 0.343), while distant metastases occurred in 8% and 10% (p = 0.424), respectively. There were no significant differences in 2-year overall survival (88% vs 97%, p = 0.101) and 2-year disease free survival (82% vs 90%, p = 0.463) between groups. The small sample size, which precluded correction for group differences, and selection bias. This study demonstrated that local excision followed by completion transanal total mesorectal excision for cT1-2N0 rectal cancer did not increase the end-colostomy rate, nor compromise oncological outcomes compared to primary transanal total mesorectal excision in experienced centers. See Video Abstract.

Application of the New Hugo Robotic-assisted Surgery System in Oncological Upper Abdominal Surgery: First Description of a Transhiatal Oesophagectomy in a Patient with AEG Siewert Type 2

In 2023, the Hugo robotic-assisted surgery system was introduced to the field of general and visceral surgery. The Hugo robotic-assisted surgery system promises to further improve robotic surgery, through its modularity, flexibility, and open console design. However, due to the novelty of the system, there is currently little experience in its clinical application.The case report describes a patient with an AEG Siewert type 2. The staging revealed the following tumour stage: uT3; uN1, cM0. After neoadjuvant chemotherapy (4 cycles of FLOT), oncologic resection was indicated. Due to the reduced lung function, the patient was considered for a transhiatal extended oesophageal resection. The operation was performed using the Hugo robotic-assisted surgery system with 4 robotic arms and 2 assistant trocars.The operation time was a total of 240min. The histopathological examination of the resection specimen confirmed an R0 resection. The resection was performed with robotic assistance, while the reconstruction (double-tract reconstruction) was performed via a mini-laparotomy.Here, we describe for the first time the surgical procedure of distal transhiatal oesophagectomy using the Hugo robotic-assisted surgery system in a patient with an AEG Siewert type 2.

Largest dimension of ground-glass nodule-like lung cancer: Comparison of computed tomography imaging and resected pathological specimens.

The largest dimension of the tumor (LDT) remains a key determinant of local tumor control regardless of surgical resection, radiotherapy, and image-guided thermal ablation. This prospective study aimed to determine the consistency of LDT by comparing computed tomography (CT) images of ground-glass nodule (GGN)-like lung cancer with resected pathological specimens. A total of 163 patients (54 males and 109 females, a mean age of 56.2 ± 10.9 years) with 163 lesions demonstrating GGN-like lung cancer (the largest dimension of ≤20 mm, pure GGNs in 49 and mixed GGNs in 114) underwent surgical resection from May 2023 to July 2024, with adenocarcinoma as the pathology type of all included patients. LDT for each patient with GGN-like lung cancer was evaluated by two-dimensional (2D) CT imaging (cross-section, 2D-LDT), a three-dimensional (3D) reconstruction system (3D-LDT), and pathological specimens (P-LDT). R version 4.2.1 software was used for statistical analyses. The median LDT for measuring all lesions with GGN-like lung cancer were 10.0 mm, 11.6 mm, and 11.7 mm in 2D-LDT, 3D-LDT, and P-LDT, respectively. A significant difference was observed in the 2D-LDT compared with the 3D-LDT (P = 0.0002) as well as between the 2D-LDT and P-LDT (P = 0.0000118), but no statistically significant difference was found between the 3D-LDT and P-LDT (P = 0.7394). 3D-LDT demonstrated high consistency with P-LDT for determining GGN-like lung cancer of ≤20 mm. Preoperative 2D-CT may be underestimated in comparison with pathological invasive LDT.

Accuracy of Post-Neoadjuvant Therapy MRI for the Assessment of Anal Sphincter Involvement in Patients with Rectal Cancer.

Purpose To assess the accuracy of post-neoadjuvant therapy (NAT) MRI, as compared with that of pathologic evaluation, to determine anal sphincter involvement in patients with rectal cancer. Materials and Methods This retrospective study included patients diagnosed with rectal cancer between January 2015 and December 2017 whose baseline MRI showed anal sphincter involvement and who then underwent NAT, post-NAT MRI, and abdominoperineal resection. Four radiologists (with 20 years, 5 years, 2 years, and 1 year of experience) independently reviewed MRI findings. Resected specimens were reviewed by a gastrointestinal pathologist. Interreader agreement between the radiologists and pathologist was assessed using the Cohen κ statistic. Conditional sensitivity, specificity, and positive predictive value (PPV) of the radiologists were calculated among patients for whom the radiologists and the pathologist agreed that the anal canal was involved. Results Thirty-two patients were included (mean age ± SD, 60 years ± 15; 19 male, 13 female). For the post-NAT assessment of anal sphincter involvement, agreement between readers 1, 2, and 4 and the pathologist was moderate (κ = 0.55 [95% CI: 0.18, 0.91], 0.45 [95% CI: -0.06, 0.82], and 0.53 [95% CI: 0, 0.89], respectively). There was fair agreement between reader 3 and the pathologist (κ = 0.30 [95% CI: -0.09, 0.67]). Radiologists had high sensitivity for the detection of anal sphincter involvement (88%-100%), high PPV (88%-96%), and moderate to high specificity (50%-80%); the senior radiologist had the highest sensitivity, PPV, and specificity. Conclusion Radiologists had fair to moderate interreader agreement with the pathologist for post-NAT assessment of anal sphincter involvement in patients with rectal cancer and showed high conditional sensitivity regardless of their level of experience. Keywords: Abdomen/GI, Rectum, Oncology, Post-Neoadjuvant Therapy MRI Supplemental material is available for this article. © RSNA, 2025.

Expression of Heat Shock Protein 90 in Testicular Cancer: A Retrospective Cohort Study.

The HSP90 marker is believed to play a constructive role in facilitating neoplastic transformation mainly via interaction with multiple pro-survival proteins. Welldesigned studies are needed to elucidate the role of HSP90 as a diagnostic marker and therapeutic target in testicular tumors. The current study aimed to investigate the expression of HSP90 in various types of testicular cancer and highlight its expression in embryonal testicular cancer. Immunohistochemical staining for HSP90 in 84 male patients, with nonmetastatic testicular cancer, who underwent orchiectomy from 2000 to 2023, was retrospectively performed at the Laboratory Department of General Hospital of Nikaia in Greece. A total of 84 males, with a mean age of 36.2 years, who have undergone high-cord radical orchiectomy, were included in this study. Out of the included males, 28.57% had embryonal carcinoma, 23.81% had seminoma, 19.05% had yolk sac tumor, 11.9% had mature teratoma, 9.52% had immature teratoma, and 7.14% had choriocarcinoma. HSP90b was positive in all embryonal carcinoma, seminoma, and choriocarcinoma cases, while it was positive in 75% of the yolk sac tumor, 75% of mature teratoma, and 75% of immature teratoma specimens. HSP90 was found negative in all choriocarcinoma, mature teratoma, and immature teratoma specimens, while it was positive in 25% of yolk sac tumor, 8.33% of embryonal carcinoma, and 10% of seminoma cases. Concerning the expression of HSP90b, a statistically significant relationship was found between excised tumor specimens and normal parenchyma specimens, especially in sac cases (p <0.001). Regarding HSP90a expression, a statistically significant relationship (OR=21.5, p =0.021) was found between excised tumor specimens and normal parenchyma specimens, especially in embryonal carcinoma cases (p <0.001). HSP90b is highly expressed in the majority of the types of testicular tumors, both in tumor and normal parenchyma specimens, while HSP90a staining is negative in resected specimens. Further well-designed studies are needed to elucidate the role of HSP90 as a diagnostic marker and therapeutic target in testicular tumors.

Deep learning-based pRb subtyping of pulmonary large cell neuroendocrine carcinoma on small hematoxylin and eosin-stained specimens.

Deep learning-based pRb subtyping of pulmonary large cell neuroendocrine carcinoma on small hematoxylin and eosin-stained specimens.

Predictive Factors for Procedure Time for Closure of Mucosal Defect Following Colorectal Endoscopic Submucosal Dissection.

The present study was conducted to clarify predictive factors related to procedure time for closure of a mucosal defect following colorectal endoscopic submucosal dissection. To prevent complications following a colorectal endoscopic submucosal dissection (ESD) procedure, closure of the resultant mucosal defect is considered to be most effective. However, closure after colorectal ESD is challenging, and technical difficulties can lead to a longer procedure time. Although it is important to clarify predictive factors related to the time needed for effective treatment planning, no such validated data obtained prior to the present study have been reported. Overall, 61 consecutive patients who underwent colorectal ESD for a colorectal neoplasm sized greater than 20 mm were enrolled. Immediately after performing colorectal ESD, closure of the mucosal defect was implemented using a loop clip closure method. Factors with influence on closure procedure time were evaluated using multiple linear regression analyses. Results obtained with a multiple linear regression model demonstrated that resected specimen size (β = 0.690, p < 0.01) and colon site (β = -0.209, p = 0.027) were factors with influence on the closure procedure. Those results were considered relevant to explain the 50.5% variance in time until completion of closure; thus, goodness of fit was considered to be high. Findings obtained in this study were helpful to clarify predictive factors with influence on procedure time. The fit of the model was good, thus allowing for closure performance based on outcome prediction.

Enhancing surgical precision in squamous cell carcinoma of the head and neck: Hyperspectral imaging and artificial intelligence for improved margin assessment in an ex vivo setting.

Head and neck cancers, constituting 3-5% of all cancer cases, often require surgical resection for optimal outcomes. Achieving complete resection (R0) is crucial, but current methods, relying on white light endoscopy and microscopy, have limitations. Hyperspectral imaging (HSI) offers potential benefits by capturing detailed spectral information beyond human vision. This study enrolled 32 patients with head and neck squamous cell carcinoma (HNSCC). Following surgical resection specimens underwent ex vivo HSI imaging. Annotated regions were utilized to train a Convolutional Neural Network (CNN) and Graph Neural Network (GNN). Imaging parameters were carefully optimized for efficiency. Our HSI imaging setup required around 12min per measurement and demonstrated feasibility with promising accuracy. The combination of HSI and artificial intelligence (AI) achieved an 86% accuracy in predicting tumor tissue. Challenges included data volume and extended capture times. Hyperspectral imaging, complemented by AI, shows promise in enhancing tissue differentiation for HNSCC. The study envisions real-time integration of HSI into surgery for margin assessment. Challenges such as data volume and capture times warrant further exploration, emphasizing the need for ongoing investigations to refine clinical applications.

Quantitative Ablation Confirmation Methods in Percutaneous Thermal Ablation of Malignant Liver Tumors: Technical Insights, Clinical Evidence, and Future Outlook.

Percutaneous image-guided thermal ablation is an established local curative-intent treatment technique for the treatment of primary and secondary malignant liver tumors. Whereas margin assessment after surgical resection can be accomplished with microscopic examination of the resected specimen, margin assessment after percutaneous thermal ablation relies on cross-sectional imaging. The critical measure of technical success is the minimal ablative margin (MAM), defined as the minimum distance between the tumor and the edge of the ablation zone. Traditionally, the MAM has been assessed qualitatively using anatomic landmarks, which has suboptimal accuracy and reproducibility and is prone to operator bias. Consequently, specialized software-based methods have been developed to standardize and automate MAM quantification. In this review, the authors discuss the technical components of such methods, including image acquisition, segmentation, registration, and MAM computation, define the sources of measurement error, describe available software solutions in terms of image processing techniques and modes of integration, and outline the current clinical evidence, which strongly supports the use of such dedicated software. Finally, the authors discuss current logistical and financial barriers to widespread use of ablation confirmation methods as well as potential solutions. Keywords: Ablation Techniques, CT, Image Postprocessing, Liver Supplemental material is available for this article. © RSNA, 2025.

High-grade Endometrial Carcinoma With Serous and Colorectal Carcinoma-like Components: Unique Morphology in Correlation With Immunohistochemical and Molecular Findings.

Endometrial carcinoma with intestinal differentiation/colorectal carcinoma-like (CRC-like) features is rare with few cases reported to date. Those described are mainly endometrioid carcinomas with intestinal differentiation. We report a case of high-grade endometrial carcinoma with serous and intestinal/CRC-like components. The gross, histologic, immunohistochemical, and molecular features are described for both components of the tumor in the initial diagnostic biopsy and subsequent resection specimen. The diagnosis of primary endometrial carcinoma with serous and CRC-like components is supported by immunohistochemical and molecular findings, as well as clinical workup. The rarity of this phenomenon poses diagnostic challenges. In addition, the literature is reviewed with specific emphasis on the molecular and pathologic features of mixed endometrial carcinomas, including those with intestinal/CRC-like features.

Solution-phase nucleic acid reaction weaves interfacial barriers on unmodified electrodes: Just-in-time generation of sensor interface for convenient and highly sensitive bioassays.

Solution-phase nucleic acid reaction weaves interfacial barriers on unmodified electrodes: Just-in-time generation of sensor interface for convenient and highly sensitive bioassays.

"Cat scratch colon" causing cecal perforation as a rare complication due to barotrauma during colonoscopy: A case report and literature review.

"Cat scratch colon" (CSC), characterized by spontaneous bright-red linear markings or mucosal laceration with bleeding due to air insufflation barotrauma, is a rare complication during colonoscopy. These mucosal lacerations can present as superficial tears that do not generally have clinical repercussions or as deeper tears that damage the muscularis and cause perforation. CSC occurs in the colon with submucosal stiffening disease, such as collagenous colitis; however, in cases unrelated to these diseases, CSC appears in the cecum or ascending colon for anatomical reasons. Herein, we report a case of CSC that caused cecal perforation. A 79-year-old woman underwent a colonoscopy for anal bleeding. Although insertion of the colonoscope was easy, as soon as the cecum expanded with air insufflation, the cecal mucosa was torn, and bleeding occurred. The endoscopist determined these findings as shallow mucosal tears and inactive bleeding, and a colonoscopy was completed. She visited our hospital 2 days after colonoscopy with a complaint of abdominal pain that appeared in the morning after colonoscopy. Computed tomography revealed inflammation around the cecum, with free air. Emergency surgery was performed to diagnose an iatrogenic colonic perforation caused by colonoscopy. During surgery, a necrotic area was found in the cecal wall, requiring ileocecal resection. The resected specimen showed cecal mucosal tears with necrosis, which were pathologically consistent with cecal rupture resulting from mucosal laceration. The postoperative course was uneventful. When CSC is encountered along with endoscopic findings of deep mucosal tears in the colon, the possibility of perforation after colonoscopy should be considered.

Correlation between PD-L1 expression and FDG-PET/CT visual assessments in non-small cell lung cancer resected specimens.

This retrospective study aimed to investigate the validity of fluorodeoxyglucose PET (FDG-PET) visual assessments to predict programmed death-ligand 1 (PD-L1) expression levels in patients with non-small cell lung cancer (NSCLC). One hundred and seven NSCLC patients who underwent FDG-PET/computed tomography (CT) scans and PD-L1 expression tests were retrospectively identified. Patients were divided into two groups according to PD-L1 expression: PD-L1 high group (PD-L1 tumor proportion score ≥50%) and PD-L1 low group (<50%). We compared clinicopathological characteristics and PET assessments [maximum standardized uptake value (SUVmax) and Deauville score] between the two groups based on PD-L1 expression. High expression of PD-L1 was detected in 25 of 107 cases. In both univariable and multivariable analysis, there were significant differences in PET visual assessments in NSCLC (P < 0.05). Receiver operating characteristics for the PET visual assessments [area under the curve (AUC) = 0.712, 95% confidence interval (CI) 0.628-0.793] and SUVmax (AUC = 0.753, 95% CI 0.647-0.861) showed equivalent accuracy (P = 0.227). Based on histopathology, in adenocarcinoma patients, there were significant differences between PET visual assessments and PD-L1 expression (P < 0.05), while no significant differences were observed in squamous cell carcinoma patients. Based on epidermal growth factor receptor (EGFR) mutation analysis, in patients with EGFR wild type, there were significant differences between PET visual assessments and PD-L1 expression (P = 0.006), while in patients with EGFR mutations, there were no significant differences between PET visual assessments and PD-L1 expression. Results of PET visual assessments correlated with PD-L1 expression in NSCLC.

Giant Lipoma of The Cervico-Thoracic Junction in The Pediatric Population: A Case Report

Lipomas are benign, slow-growing tumors that develop from soft tissues. They are common tumors, but their occurrence in the cephalic region is significantly rarer. Objective: To report a case of a giant lipoma at the cervico-thoracic junction and describe the surgical approach used for its excision. Case presentation: A 15-year-old child presented with a progressively enlarging mass in the supraclavicular region. The patient was taken to the operating room for tumor excision. Histopathological examination confirmed the diagnosis of a large lipoma. Postoperative recovery was uneventful, and no recurrence was observed after 12 months of follow-up. Conclusion: Giant cervical lipomas are extremely rare. Their management relies exclusively on surgical excision, with definitive diagnosis based on histological examination of the resected specimen. Long-term postoperative surveillance is recommended due to the risk of recurrence.

Melanotic Neuroectodermal Tumor of Infancy: Clinicopathological Evaluation of a 10-Year Consecutive Case Series from a Tertiary Cancer Center.

Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a rare, locally aggressive tumor with distinct pathological features and treatment paradigms commonly occurring in the head and neck region. Microscopically, it consists of a biphasic population of small neuroblast-like cells and larger melanin-containing epithelioid cells. The main purpose of this study is to characterize clinicopathological and immunohistochemical features of MNTI at a single institution and discuss challenges in the differential diagnosis. We performed a retrospective analysis of MNTI cases diagnosed at our center during a 10-year period and discussed the differential diagnoses. Eleven MNTI cases were identified. Median patient age was 5 months. Male to Female ratio was 1.75:1. Tumor distribution was in the Maxilla (n = 8), Mandible (n = 1) greater wing of Sphenoid (n = 1), and Temporal bone (n = 1). All tumors revealed classic biphasic morphology in the resection specimens. By immunohistochemistry, 9/9 (100%) cases were positive for both AE1/AE3 and HMB45 in the larger epithelioid cells and 6/6 (100%) were positive for Synaptophysin in the smaller neuroblast-like cells. One patient had unique nested areas composed of mature glial tissue. One patient who had incomplete resection was given adjuvant radiotherapy. One patient developed a solitary ipsilateral lymph nodal metastasis. Follow-up period ranged from 1 to 93 months. All the patients were alive with no evidence of disease at the last follow-up (median: 16 months). Lack of consideration of MNTI in the differential diagnosis can lead to misdiagnosis and undue exposure to cytotoxic therapies. Awareness of the classic biphasic morphology and distinct immunoprofile of MNTI is essential.