Routine Histopathological Examination Research Articles

The diagnostic utility of cell block as an adjunct to routine cytology

Despite the diagnostic utility of cell block in FNAC and fluid cytology, known for better cellular yield and improved diagnostic accuracy, the technique remains to be underutilized for diagnosing neoplastic lesions.In this paper, a hospital based prospective study of 195 samples was conducted on cytological samples with the aim (a) to evaluate the diagnostic utility of cell block as an adjunct to routine cytological evaluation of aspiration and effusion fluid specimens, (b) To correlate the findings of routine cytology, cell block and routine histopathological examination wherever possible and (c) to explore the possibility of using ancillary techniques such as immunohistochemistry on cell blocks. The study revealed, most of the patients were between 51- 60 years with female preponderance. Among 195 samples, 79 (40.5%) were peritoneal fluids and 85 (43.5%) were lymph node. The diagnosis on conventional smear and cell block showed 71 (36.5%) cases and 68 (35%) cases were negative for malignancy respectively. 6 (3%) cases and 4 (2%) cases were suspicious for malignancy respectively. 118 (60.5%) cases and 123 (63%) cases were positive for malignancy respectively. Amongst the peritoneal effusion the most common primary site was ovary whereas majority of the primary site was unknown in lymph node FNAC. Peritoneal effusion showed 8 additional cases as positive for malignancy in CB preparation which were negative or suspicious for malignancy on CS. In FNAC, two additional positive case was found in CB preparation of lymph node. A Kappa value of 89.5 % for statistical correlation between Conventional smear and cell block preparation was calculated. The use of Cell block technique increases the detection of malignancy when used as an adjunct to conventional smears. Cell block technique is simple, inexpensive and reliable adjuvant to smears and it is recommended for routine cytological diagnosis and for application of immunomarkers and molecular studies.

Is a routine histopathological examination justified for all tumours resected from the upper extremity?

We analysed the results of histopathological examinations of benign tumours resected in 346 patients and malignant tumours resected in 6 patients. Our analysis showed a 100% concordance between the initial (clinical) diagnoses of the tumours as benign or malignant and their final histopathological diagnoses. Only in 12 cases (3.5%) of initially benign tumours did the clinical presentation and/or intraoperative findings raise doubts. The results of this study show that a routine histological evaluation of all tumours resected from the upper extremity is not justified and may be confined to selected cases in which clinical presentation and/or intraoperative findings raise doubts.

HISTOPATHOLOGICAL PARAMETERS AND INTRATUMORAL LYMPHOCYTES: CORRELATION WITH SURVIVAL OUTCOMES IN TRIPLE-NEGATIVE BREAST CANCER - A COMPREHENSIVE RETROSPECTIVE ANALYSIS

OBJECTIVE: Triple-negative breast cancer (TNBC) is a subtype characterized by aggressive tumor behavior and limited treatment options. This study aimed to investigate the relationship among age, pathological stage, proliferative index, presence of tumor infiltrating lymphocytes (TILs), and survival outcomes in TNBC. MATERIAL AND METHODS: Tumoral slides and blocks of 31 patients with triple negative breast cancer were retrieved from the pathology archive and retrospectively re-evaluated. The relationship among patient age, histopathological subtype of the tumor, tumor grade, lymph node grade, Ki-67 proliferation index and survival was evaluated. TILs were scored as mild, moderate and severe and the relationship with survival was evaluated. RESULTS: Regarding age and tumor stage, there was no significant correlation found (p=0,81 and p=0,89 respectively). However, when analyzing the N stage, a clear association was observed, with a higher proportion of patients aged 65 years or older displaying advanced N3 stage breast cancer (p=0.000013). A significant relationship was found between TILs and the Ki-67 proliferative index, with cases exhibiting high TILs also demonstrating a high proliferative index (p=0.003). Furthermore, increased TIL concentration was associated with a positive response to therapy and improved overall survival in TNBC patients (p=0.001). CONCLUSIONS: These findings emphasize the importance of considering age, pathological stage, proliferative index, and the presence of TILs in TNBC prognosis. Evaluation of TILs in routine histopathologic examination and inclusion in pathology reports, particularly in postmenopausal patients, could provide valuable information for future studies and guide treatment decisions. Additional research on immune-modulating therapies targeting TILs may hold promise for improving outcomes in TNBC patients.

3D Approaches to Culturing Bovine Skin: Explant Culture versus Organotypic Skin Model

Introduction: Digital dermatitis (DD) in cattle appears with high prevalence; nevertheless, the knowledge on its pathogenesis is still limited. In this context, in vitro skin models represent a valuable tool to facilitate the study of DD. Methods: Two in vitro skin models were established using bovine distal limb skin: a skin explant model and an organotypic skin model. For the skin explant model, skin samples were cultured with an air-liquid interface for up to 7 days. Besides routine histopathological examination, readout parameters were Ki-67 and cleaved Caspase-3 stainings. For the organotypic model, primary keratinocytes were layered on top of a dermal equivalent containing mainly mitotically inactive fibroblasts and maintained for up to 21 days. At regular intervals (days 7, 14, and 21), cultured skin samples were taken for (immuno)histological analysis. Results: Both cultures could be maintained for the entire duration of the intended culture period. In the histopathological assessment, explant skin cultures showed ballooning degeneration of keratinocytes and segmental necrosis starting at day 5 of culturing. Initially, basal keratinocytes in the organotypic model differentiated as demonstrated by positive Keratin 14, Desmoglein-1, Loricrin, and Involucrin immunofluorescent stainings. Ki-67 was observed occasionally and suprabasally still after 21 days of culture. Conclusion: Both in vitro models proved dependable and constitute a viable option for replacing experiments on live animals, each with its own benefits. Whereas skin explants include all cell types available in vivo and can therefore reflect realistic cell-cell interactions and signaling pathways, the organotypic model offers a higher standardization and reproducibility. Depending on the focus of future studies, both models can be used for specific experimental purposes of bovine dermatological research in general or specialized questions concerning (infectious) claw diseases as, e.g., DD.

5. DIAGNOSTIC ACCURACY OF EX-VIVO FUSION CONFOCAL MICROSCOPY IN BREAST CANCER

Abstract Introduction Ex-Vivo fusion confocal microscopy (EVFCM) provides a fast examination of breast tissues with the potential to reduce the rate of positive surgical margins and the need for additional interventions. This is an observational study aimed at verifying the diagnostic accuracy of EVFCM in diagnosing neoplasia and histologic subtypes. Methods Thirty-six breast tissue samples, including non-neoplastic (n=20) and neoplastic (n=16), underwent scanning using EVFCM. These samples were also processed through routine histopathological examination with hematoxylin and eosin, and the two techniques were subsequently compared. The assessment was performed by a Mohs surgeon dermatologist familiar with EVFCM (evaluator A) and two breast pathology experts (evaluators B and C) without experience in EVFCM, in a blinded diagnosis analysis. Results The ability to recognize neoplasia in the EVFCM images obtained a high level of concordance, as indicated by all kappa values (κ) presenting a p-value <0.001. Investigator A demonstrated a sensitivity and specificity of 100% in diagnosing neoplasia. Evaluators B and C exhibited a sensitivity >87% and a specificity >94% in diagnosing neoplasia, with positive predictive values (PPV)>95% and the negative predictive values (NPV) of 81% and 94%, respectively. The accuracy in recognizing the histological subtype was >86,1%, with a sensitivity >82%, specificity >88%, PPV>75% and NPV>92%. Conclusion EVFCM demonstrates excellent diagnostic accuracy for breast cancer, with high levels of concordance, sensitivity and specificity. Based on our data, we suggest and propose that EVFCM will be an excellent tool for intra-operative and definitive margin assessment, guiding breast conserving surgeries.

Intra-adrenal Paraganglioma and Paraaortic Paraganglioma in 15 Years Old Boys

Intra-adrenal paraganglioma (also called pheochromocytoma) is a chromaffin cell tumor that arises in the adrenal medulla and produces excess catecholamines. Paraganglioma can also be located in the extra-adrenal area. The incidence rate of intra-adrenal and extra-adrenal paraganglioma is about 1 case per 2.500-6.500 population, highest incidence at 40-50 years old, and distribution is the same in males and females. Intra-adrenal paraganglioma in pediatrics is more familial, bilateral, multifocal, and malignant. In children, the incidence rate of these tumors was 8.86%, the ratio of boys to girls was 2:1, and the average age of 11. This article reports a case, of a 15 years old boy with severe headaches, recurrent seizures, and a hypertension crisis (143/103-220/110 mmHg). MSCT scan of abdominal showed solid mass heterogeneous with central necrotic multiple in the supero-anterior of the left and right kidneys and on the right anterolateral aorta as high as CV L2, impressive adrenal gland mass and extra-adrenal, suspect pheochromocytoma. Performed surgery, routine histopathological examination, and Immunohistochemistry. Macroscopic examination showed an oval round shape mass of left and right adrenal tumors as well as the paraaortic, a smooth outer surface of the capsular, with yellowish brown color mass tumor at cut surface, supple consistency. Microscopic examination showing adrenal gland and paraaortic tissue with fibrous capsule contains proliferation of neoplastic cells forming a nested alveolar (Zellballen) pattern with a round oval to polygonal cells, granular eosinophilic cytoplasm, round oval nuclei, surrounded by sustentacular cells. Chromogranin A and S-100 are positive. The case was concluded by clinical findings, histopathological, and immunohistochemistry as intra-adrenal paraganglioma and paraganglioma of paraaortic.

Mixed chorangioma of the placental disk of a 29-year-old pregnant woman: A case report with literature review

A Chorangioma is a rare benign non-trophoblastic placental vascular neoplasm that develops from the placental primitive chorionic mesenchyme. It happens in 1% of pregnancies. Because Chorangioma may hurt the health of both the mother and the fetus, it is crucial to distinguish it from other placental disorders. In this article, we present a case study of an incidental Mixed Chorangioma variant found in a 29-year-old mother's placental disk during routine histopathological examinations as part of a large-scale prospective histopathological survey of the placenta in a tertiary healthcare facility in Uyo, Akwa Ibom State, Nigeria. In addition, we offer a comprehensive overview of the existing literature on Chorangiomas, focusing on their pathology, clinical importance, and treatment. This article aims to advance the understanding of Chorangiomas and increase clinicians' and pathologists' awareness of the need for early detection and suitable treatment.

Correlation between fine-needle aspiration biopsy and routine histopathology in the diagnosis of spontaneous feline mammary gland tumours

The present study evaluated the correlation between fine-needle aspiration biopsy and routine histopathological examination in the diagnosis of spontaneous mammary gland tumours in cats. From the studied 120 neoplastic growths, cytological diagnosis was correct in 111 cases (92.5%), and incorrect in 9 (7.5%) patients. Out of all studied tumours, 3 false positive (2.5%) and 6 false negative (5%) results were found out. Among benign tumours, cytological diagnosis was correct in 17 cases (94.44 %). Only one false negative diagnosis was demonstrated (5.56% of all benign tumours). As to malignant tumours, cytological diagnosis was correct in 94 (92.15%), and incorrect in 8 patients (7.85%). For diagnostics of feline mammary neoplasms, the sensitivity of cytology was 95.23%, the specificity - 75%, positive predictive value: 97.5% and negative predictive value: 60% compared to routine histopathology. The analysis with Cohen’s kappa test showed agreement of 99.17% (Cohen’s κ 0.96) between cytology and histopathology for benign and 94.17% (Cohen’s κ 0.75) for malignant mammary neoplasms.

Is Routine Histologic Examination of the Pilonidal Sinus Required? A Retrospective Analysis

Objective To assess whether routine histopathologic examination of the pilonidal sinus is necessary. Background Pilonidal sinus disease (PSD) is an acquired condition of the hair follicles and is thought to be an obstruction of the infundibulum of a hair follicle. The follicle enlarges and ruptures, causing secondary infection, the development of fistulae and abscesses, and other complications. Methods This is a retrospective study including all patients who had pilonidal sinus excision from January 2015 to December 2021 at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. A review of pathologic slides took place in the Department of Pathology, and the chart review was conducted in the Department of Surgery through patients' electronic medical records. Results All of the excised sinuses (100%) were benign, and none of the patients in the study population had any cancerous lesions. Approximately 90% of the patients had no history of recurrence, and 84.8% had no history of surgical abscess drainage. With respect to the histopathologic subtype of a benign sinus, the most common type was chronic inflammation, followed by granulation and fibrosis. Conclusions This study's findings reveal that none of the patients were diagnosed as having malignancy after excision of the pilonidal sinus. However, the findings reveal no need for performing an unnecessary histopathologic examination unless someone is at risk of developing cancer based on whether they have palpable lymph nodes and a history of recurrence.

A Clinical-morphological Study of Colorectal Polyps with Emphasis on Serrated Lesions

Abstract Background: The World Health Organization introduced the entities of sessile serrated adenoma and traditional serrated adenoma, and hyperplastic polyps (HPs) under the serrated lesions category in 2010. Indian studies on demographic, clinical, and histopathological characteristics of colorectal polyps, especially on serrated lesions, are limited. Our study aimed to study the morphology of the colorectal polyps and estimate the percentage of serrated lesions in the polyps studied. Methodology: A cross-sectional hospital-based study was conducted on colorectal polyps received for routine histopathological examination from July 2013 to August 2015. The polyps were classified according to the WHO 2010 colon and rectum tumors classification. Data were compiled and analyzed using IBM SPSS statistics version 20.0. The interpretation was done in frequencies and percentages. Results: We studied a total of 200 colorectal polyps. The polyps were mostly seen in the descending colon (41%). Histologically, the majority of the colorectal polyps were adenomatous in nature (59%). The serrated lesions accounted for 29% of all colorectal polyps. The polyps were mostly seen in patients who were more than 40 years old. Conclusion: Adenomas were the most prevalent type of colorectal polyps, seen more in males, at a higher age, and distally located. Serrated lesions predominantly included HPs, mostly <1 cm in size.

IS HISTOPATHOLOGICAL EXAMINATION OF EXCISION MATERIAL IN PILONIDAL SINUS SURGERIES A WASTE OF COST, TIME AND LABOR?

INTRODUCTION
 Pilonidal sinus (PS) surgery is one of the most common operations performed in general surgery. Although different treatments are used nowadays, the main treatment of the disease is still surgical excision. Malignant degeneration is very low in patients with chronic pilonidal sinus.Cases have been reported in the literature as case reports. In this study, we aimed to reveal the necessity of routine histopathological examination of the excision material in PS surgery.
 
 MATERIAL & METHODS 
 We have considered patients in our hospital database, who had pilonidal sinus surgery with a diagnosis of PS retrospectively. 939 patients , whose histopathological examination reports of PS excision specimen were accessed , were included in the study.
 
 RESULTS
 Of the 939 patients included in the study, 721 of which (76.8%) are male and 218 of which (23.2%) are female. The mean age of the patients is 25.6 ± 7.4 (min- max :59) years. The number of patients over 50 years was 24 (2.6%). The number of patients operated with recurrent pilonidal sinus was 26 (2.8%). No malignancy was observed in any of the histopathological examinations of 939 excision materials.
 
 CONCLUSION
 No malignancy has been detected in any of our PS cases in the histopathological examination. The necessity of routine histopathological examination of PS excision materials should be questioned and discussed. It causes both a waste of time and money. However, it can be considered for the patients over 50, since the literature shows an increase in risk of malignancy after this age.

BRAF V600E Mutation Test in Fine Needle Aspiration (FNA) Specimens of Thyroid Nodules by Competitive Allele-Specific TaqMan PCR (castPCR)

Background: BRAF V600E mutation has been confirmed as a significant molecular indicator for the diagnosis and prognosis of papillary thyroid carcinoma (PTC). Sanger sequencing is the recognized approach for BRAF V600E mutation analysis, yet it is not proficient at detecting mutations that occur at low frequencies, especially in thyroid fine needle aspiration (FNA) specimens. This study aimed to evaluate the diagnostic value of Competitive Allele-Specific TaqMan PCR (castPCR) as a new reliable method for BRAF V600E mutation test in thyroid FNA specimens compared to Sanger sequencing. Methods: Thirty patients with thyroid nodules were enrolled prospectively at Dharmais Cancer Hospital Jakarta from 2013–2014. The BRAF V600E mutation was analyzed from FNA specimens using castPCR and Sanger Sequencing methods. The sensitivity and specificity of those methods were compared with routine diagnostic histopathological examination as a gold standard for PTC assessment.Results: A total of 66.6% (20/30) cases were confirmed as PTC by postsurgical histopathological examination. Among these, the BRAF V600E mutation was found in 60.0% (12/20) by castPCR and 40.0% (8/20) by Sanger sequencing. Neither castPCR nor Sanger sequencing detected BRAF V600E mutation in other nodular thyroid diseases. The sensitivity and specificity of castPCR were 60.0% and 100.0%, while Sanger sequencing was 40.0% and 100.0%, respectively. Conclusions: This study indicated that castPCR has a higher sensitivity for the BRAF V600E mutation test than Sanger Sequencing, especially in samples with a low abundance of mutant alleles. A sensitive, rapid, and easy castPCR method is reliable for evaluating BRAF V600E mutation and can improve PTC preoperative diagnosis in clinical settings.

Prevalence of Gallbladder Malignancy in Gallstone Diseases

Background & objective: Carcinoma (Ca) of the gallbladder is a rare disease. But its prognosis is poor. Early diagnosis of Ca gallbladder, though important, is rarely achieved due to lack of symptoms and physical signs. However, it is frequently associated with gallstone diseases. It is, therefore, of utmost importance to do a routine histopathological examination of all gallbladder specimens after cholecystectomy is done for gallstone diseases. The present study was undertaken to find the prevalence of Ca gallbladder in gallstone diseases. Methods: This descriptive study was conducted in the Department of Surgery, BSMMU Hospital, and in the Public Medical College Hospitals of Dhaka over a period of eight months from July 2011 to February 2012. A total of 1012specimens of gallbladder were taken from the patients who underwent either laparoscopic or open cholecystectomy for gallstone diseases in the above-mentioned hospitals during the study period. Following the operation, the resected specimens or the biopsies taken from the gallbladder were collected in 10% formaldehyde solution and were sent to the Histopathology Departments of the respective hospitals, for confirmation of diagnoses as well as for histological grading and typing. Result: Of the 1012 cases of operated gallbladder for cholelithiasis, 28(2.7%) cases were histopathologically diagnosed as having Ca gallbladder. The age incidence of Ca gallbladder varied from 43 – 71 years. The highest incidence was observed in the 6th decade (53.6%) followed by the 5th decade of life (28.5%). Out of 28 cases of Ca gallbladder, 15(53.6%) exhibited increased wall thickness. All 28 cases were adenocarcinoma; of them, 25(89.3%) were poorly differentiated and 3(10.7%) were well-differentiated carcinoma. Non-squamous cell carcinoma or other variants were found. The majority (82.1%) of the cases was of infiltrative scirrhous (a hard slow-growing malignant tumor having a preponderance of fibrous tissue) type and the rest (17.9%) fungating type. Staging of the disease stratified 4(14.3%) cases as Stage-IV, 3(10.7%) cases as Stage-Ill, 8(28.6%) cases as Stage-II, and 13(46.4%) cases of Stage-I. Conclusion: The study concluded that the prevalence of malignancy in gallstone disease is rare. The incidence is highest in the 6th decade of life and females are more often affected than males. As older people with gallstone diseases are at increased risk of having gallbladder malignancy, it is imperative that older patients with gallstone diseases should be routinely examined for evidence of carcinoma. Ibrahim Card Med J 2022; 12 (2): 59-63

Biological effects of molybdenum(IV) sulfide nanoparticles and microparticles in the rat after repeated intratracheal administration.

In this study, molybdenum(IV) sulfide (MoS2 ) nanoparticles (97 ± 32 nm) and microparticles (1.92 ± 0.64 μm) stabilized with poly (vinylpolypyrrolidone) (PVP) were administered intratracheally to male and female rats (dose of 1.5 or 5mg/kg bw), every 14 days for 90 days (seven administrations in total). Blood parameters were assessed during and at the end of the study (hematology, biochemistry including glucose, albumins, uric acid, urea, high density lipoprotein HDL, total cholesterol, triglycerides, aspartate transaminase, and alanine transaminase ALT). Bronchoalveolar lavage fluid (BALF) analyses included cell viability, biochemistry (total protein concentration, lactate dehydrogenase, and glutathione peroxidase activity), and cytokine levels (tumor necrosis factor α, TNF-α, macrophage inflammatory protein 2-alpha, MIP-2, and cytokine-induced neutrophil chemoattractant-2, CINC-2). Tissues were subjected to routine histopathological and electron microscopy (STEM) examinations. No overt signs of chronic toxicity were observed. Differential cell counts in BALF revealed no significant differences between the animal groups. An increase in MIP-2 and a decrease in TNF-α were observed in BALF in the exposed males. The histopathological changes in the lung evaluated according to a developed classification system (based on severity of inflammation, range 0-4, with 4 indicating the most severe changes) showed average histopathological score of 1.33 for animals exposed to nanoparticles and microparticles at the lower dose, 1.72 after exposure to nanoparticles at the higher dose, and 2.83 for animals exposed to microparticles at the higher dose. In summary, it was shown that nanosized and microsized MoS2 can trigger dose-dependent inflammatory reactions in the lungs of rats after multiple intratracheal instillation irrespective of the animal sex. Some evidence indicates a higher lung pro-inflammatory potential of the microform.

Evaluation of micrometastasis and isolated tumor cells in node-negative early-stage oral tongue squamous cell carcinoma: a cross-sectional study in tertiary-level hospitals in eastern India

The present study aimed to investigate the incidence of micrometastasis (MMs) and isolated tumor cells (ITCs) in node-negative early-stage oral tongue squamous cell carcinoma (T1-T2 N0). The secondary objective was to correlate the incidence with the clinicopathologic parameters of age, sex, depth of invasion, pattern of invasion, host lymphocytic response, and size and grade of primary tumor. Micrometastasis and ITCs in cervical nodes of 30 patients with early-stage oral tongue squamous cell carcinoma were detected and compared using 3 methods: routine hematoxylin and eosin staining, serial-sectioning at intervals of 150 microns employing hematoxylin and eosin, and serial sectioning pan-cytokeratin immunostaining. Associations with clinicopathological variables were analyzed. Metastatic tumor cells were detected in the cervical nodes of 2 patients using serial sectioning and immunohistochemistry, resulting in upstaging of 6.6% of all cases. Level I and II lymph nodes were primarily involved. Early-stage oral tongue squamous cell carcinoma has a significant potential for MMs that frequently go undetected in routine histopathologic examination. However, laborious and technique-sensitive, serial sectioning in combination with pan-cytokeratin staining (AE1/AE3) may aid in detecting MMs and ITCs in patients with early-stage OTSCC.

Rapid multi-task diagnosis of oral cancer leveraging fiber-optic Raman spectroscopy and deep learning algorithms.

Oral cancer, a predominant malignancy in developing nations, represents a global health challenge with a five-year survival rate below 50%. Nonetheless, substantial reductions in both its incidence and mortality rates can be achieved through early detection and appropriate treatment. Crucial to these treatment plans and prognosis predictions is the identification of the pathological type of oral cancer. Toward this end, fiber-optic Raman spectroscopy emerges as an effective tool. This study combines Raman spectroscopy technology with deep learning algorithms to develop a portable intelligent prototype for oral case analysis. We propose, for the first time, a multi-task network (MTN) Raman spectroscopy classification model that utilizes a shared backbone network to simultaneously achieve different clinical staging and histological grading diagnoses. The developed model demonstrated accuracy rates of 94.88%, 94.57%, and 94.34% for tumor staging, lymph node staging, and histological grading, respectively. Its sensitivity, specificity, and accuracy compare closely with the gold standard: routine histopathological examination. Thus, this prototype proposed in this study has great potential for rapid, non-invasive, and label-free pathological diagnosis of oral cancer.

Routine Histopathologic Examination of Bone Obtained During Elective Primary Total Knee Arthroplasty May Not Be Necessary.

Many institutions require the routine collection of pathology samples from every primary total knee arthroplasty (TKA) performed. These policies are controversial, and their cost-effectiveness is difficult to define. We sought to judge the cost-effectiveness of one such policy according to World Health Organization recommendations. We analyzed 3200 consecutive primary TKAs, comparing our presumed preoperative diagnoses against the diagnoses made by the pathologist. Diagnoses were categorized as concordant (matching), discrepant (not matching but without impact to patient management), or discordant (not matching and resulting in a direct change to patient management). An incremental cost-utility ratio analysis was performed to determine the cost-effectiveness of our institution's policy to routinely collect pathology samples from every primary TKA performed. Cost-effectiveness was defined by World Health Organization guidelines as a cost of less than $228,090 per quality-adjusted life year gained. Twelve pathology samples were lost before reaching a pathologist. From the remaining 3188 samples, we identified 3158 concordant cases, 29 discrepant diagnoses, and 1 discordant diagnosis. It cost an estimated $10,522.60 to identify each discrepant diagnosis and an estimated $305,155.36 to diagnose one discordant case in our cohort. Our incremental cost-utility ratio analysis revealed that we spent $305,155.36 to gain 0 quality-adjusted life years for our patients. Routine histopathologic analysis of TKA samples was cost-ineffective in our patient cohort and may not be necessary during routine TKA.

Utility of histopathological examination in aseptic revision total hip arthroplasty: a preliminary analysis.

The utility of a routine histopathological examination in aseptic revision total hip arthroplasty (THA) has not been well explored. We aim to describe the approach and present the results of histopathological examination, focusing on its clinical usefulness in the setting of aseptic revision THA. We retrospectively reviewed 285 performed aseptic revision THA with available histopathological reports between 2015 and 2017 at a single institution. We described histopathological requests by the surgical team. Preoperative diagnoses, intraoperative findings, as well as histopathology and culture results were analysed. 13 painful THAs (4.5%) had preoperatively unknown diagnoses. In 10 of them, potential causes of pain were intraoperatively identified. Histopathology confirmed these findings in 8 THAs. 19 THAs (6.7%) revealed unexpected positive cultures (UPC). Histopathology was negative for infection in 18 of them. Among 16 consultants, 3 surgeons requested histopathology in 47% of the cases (130/285), usually to exclude infection (101/285; 35%). Documentation for tissue sample location was lacking in 51% (145/285), and for question asked by the surgeon in 47% (135/285). Histopathology is deemed a useful confirmatory tool in the context of ruling out infection in UPCs, and in documenting intraoperative findings in painful THAs with unknown preoperative diagnoses. Importantly, the approach to requesting histopathology should be optimised. Further large-scale studies, including cost analyses, are warranted to explore the usefulness of histopathology in routine utility.

Moesin and Ezrin as New Promising Markers for Early Detection of Endometrial Carcinoma: An Immunohistochemical Study.

the aim of this study is to evaluate immunohistochemically the expression of ezrin, and moesin, in endometrial lesion cases in order to detect EC at early stages which will have an important implication on the patients' outcome. 100 stored, formalin-fixed, paraffin-embedded tissue blocks of endometrial curettage obtained due to abnormal uterine bleeding or postmenopausal bleeding were collected. Each paraffin block was re-cut by rotatory microtome at 4 μm thickness then mounted on a glass slide and stained by hematoxylin and eosin for routine histopathological examination and on charged slides for immunohistochemistry using an automated staining system (Dako autostainer link 48) with antibodies against Moesin and Ezrin. Cytoplasmic staining was evaluated for both Moesin and Ezrin based on the intensity and extent of staining and scored for each sample. Both Moesin and Ezrin were significantly higher in atypical endometrial hyperplasia compared to benign hyperplasia and significantly higher in endometrial carcinoma compared to atypical hyperplasia. Moesin also significantly correlated with higher tumor grades while Ezrin was significantly higher in postmenopausal women denoting their role in tumor progression and poor prognosis. Both Moesin and Ezrin could be potentially used as predictive markers for endometrial carcinoma screening programmes as well as indicators for cancer progression.

Kedilerin Yassı Hücreli Karsinomlarında İntermedier Filamentler, p53 Geni, Hücre Proliferasyonu, Metastaz ve Apoptozis

In this study, intermediate filaments, Pan Cytokeratin (Pan CK), Vimentin, Desmin and S-100 were evaluated to reveal the cellular origin of feline SCCs. Alpha-Smooth Muscle Actin (α-SMA) for cancer-related fibroblasts (CAFs) in the tumor microenvironment, and p53, a tumor suppressor gene, were investigated. Proliferating Cell Nuclear Antigen (PCNA) expression was evaluated for the cell proliferation index. Matrix Metalloproteinase-9 (MMP-9) immunoreactivity was evaluated for the metastasis and invasion capacity. In addition, it is aimed to reveal the expressions of proapoptotic Bax gene, antiapoptotic Bcl-2 gene, caspase-dependent pathway Caspase-3 and caspase-independent pathway Apoptosis Inducing Factor (AIF) for apoptosis mechanism. Biopsy samples taken from 7 cats brought to Department of Pathology for routine histopathological examination were used in this study. Tumor tissue samples were fixed in 10% formaldehyde solution. Serial sections of 5 μm thickness were taken from the paraffin blocks prepared after routine tissue follow-up procedures. Hematoxylin & Eosin (H&E) staining was performed on the sections. Avidin-Biotin Peroxidase-Technique (ABC) was used as immunohistochemical staining. It was determined that the tumors had epithelial-mesenchymal transition, exhibited a very high proliferation index, had p53 mutation, and showed low metastasis/high invasion capacity. It was revealed that Bax/Bcl-2 ratio increased in favor of proapoptotic Bax, and caspase-independent apoptosis was more dominant than caspase-dependent apoptosis.