Routine Pathological Examination Research Articles

Incidental gynecologic cancers in women who underwent surgery for pelvic organ prolapse

Aims: Despite symptom inquiry and preoperative sampling are performed for endometrial, cervix and ovarian pathologies in the preoperative evaluation, it is not clear whether cancer will be detected in the surgical specimen of an asymptomatic patient for pelvic organ prolapse surgery. In our study, we aimed to investigate the incidental cancer rates in patients who underwent vaginal or abdominal surgery due to pelvic organ prolapse. Methods: In this retrospective study, all patients who underwent surgery for pelvic organ prolapse at Istanbul Training and Research Hospital between 2019 and 2023 were included in the study. Patients who had diagnosis of cancer were preoperatively excluded from the study. Preoperative transvaginal ultrasound were made for all patients using sonography by 5 MHz probe, (Voluson E8, GE Healthcare, Milwaukee, WI) or MRI. Accompanying endometrial, myometrial and adnexial pathologies were recorded. Routine endometrial thickness at preoperative evaluation was saved. Type of the surgery for pelvic organ prolapse, complications and final pathology reports were recorded. Approval for this study was obtained from İstanbul Training and Resarch Hospital Education Planning and Coordination Department (Date 13.10.2023, Decision No. 277). This study had been performed in accordance with the ethical standards described in Declaration of Helsinki. Results: 107 patients had surgery due to pelvic organ prolapse between between 2019 and 2023. Mean endometrial thickness before surgery was 4.72+-4.27 mm. After surgery, all of the hysterectomy +- salpingooferectomy specimen sent to pathology. In our study there was a statistical difference between preoperative and postoperative diagnosis of endometrial polyps as p:0.0001. Due to the fact that Pipel is more effective in postmenopausal patients, the false-negative rate of office endometrial sampling, and that the main evaluation should be endometrial sampling accompanied by hysteroscopy. We did not evaluate endometrium by hysteroscopy preoperatively, so endometrial polyps can be found incidentally. In our study there was no incidental diagnosis of cancer. Conclusion: Despite the risk of incidental cancer detection is different and controversial in the literature, it was ultimately decided to send the hysterectomy material for routine pathological examination.

Prognostic value of isolated tumor cells and micrometastasis of lymph nodes in invasive urinary bladder cancer.

The prognostic significance of nodal micrometastasis and isolated tumor cells (ITC) in urinary bladder cancer (UBC) is unknown. We aimed to evaluate the prevalence, clinical impact, and clinicopathological characteristics of nodal micrometastasis and ITC in UBC. A total of 124 patients with UBC undergoing surgery were investigated. Detection of micrometastasis and ITC was performed using pancytokeratin immunohistochemistry (IHC). Histopathologic and clinical findings were correlated with patients' outcome. IHC detected nodal micrometastasis and ITC (pNmi group) in 12.9% (13/101) of originally node-negative patients and in 26.1% (6/23) of originally node-positive patients (pN+ group). The remaining 88 were truly node-negative patients (pN0 group). After IHC, all 13 patients in the pNmi group were upstaged from pN0 to pN1-2 and one patient in the pN+ group was changed from pN1 to pN2. Nodal micrometastasis and ITC were significantly associated with mixed urothelial carcinoma (UC) (p = 0.002), UC with discohesive pattern (p = 0.006), glandular differentiation (p = 0.043), lymphovascular invasion (p = 0.009), and budding-like tumor cell clusters (p = 0.002). The pNmi group had significantly worse cancer-specific survival than the pN0 group in univariate (p = 0.004) and multivariate (p = 0.040) analysis. IHC frequently identified nodal micrometastasis and ITC in originally node-negative UBC patients on routine pathological examination. Nodal micrometastasis and ITC were independently associated with cancer-related mortality in UBC. IHC might be selectively used to detect micrometastasis and ITC in UBC having specific pathological features.

Staged operations of acquired lymphangiectasia of the vulva: 10 cases clinical analysis

Objective: To investigate the characteristics, diagnosis and therapeutic effect of acquired lymphangiectasia of the vulva (ALV). Methods: A retrospective analysis of clinicopathological and follow-up data was conducted on the patients treated in Capital Medical University Affiliated Beijing Shijitan Hospital due to female ALV from July 2009 to July 2023. The patients who completed the staged operations [partial labiectomy and reconstruction + thoracic ductplasty and (or) perineal lymphovenous anastomosis] were included in the study and followed up. The improvement of perineal swelling, blister range, fluid leakage volume and frequency were evaluated through outpatient visits by the symptom rating scale of ALV (hereinafter referred to as the symptom rating scale) before and after surgery. Results: A total of 48 patients were treated due to ALV from July 2009 to July 2023, of which 98% (47/48) were postoperative pelvic malignant tumors and 94% (45/48) had a history of radiotherapy. A total of 10 patients with ALV who completed the staged operations were included in this study. (1) Clinical characteristics and diagnosis: 10 patients had a median age of 60 years old (50, 63 years old ). The median duration from cervical cancer surgery and radiation therapy to vulvar swelling was 1.5 years (0.0, 2.0 years), and the median duration from vulvar swelling to blister formation and leakage was 0.0 years (0.0, 4.8 years). Seven patients (7/10) had a history of recurrent erysipelas; 7 patients (7/10) had the most severe symptom (widespread blisters, persistent fluid leakage, and large amount of fluid leakage); noncontrast magnetic resonance lymphography (NCMRL) showed edema signals in the perineal region of all the patients, and increase of agent in the perineal region was observed in lymphoscintigram (LS). (2) Surgical treatment and postoperative pathological examination: of the 10 ALV patients who completed staged surgical treatment, 6 cases (6/10) were diagnosed with thoracic duct outlet obstruction and underwent thoracic ductplasty and partial labiectomy and reconstruction. Perineal lymphovenous anastomosis and partial labiectomy and reconstruction were performed in 4 cases (4/10) without thoracic duct outlet obstruction. Postoperative routine pathological examination of 10 patients (10/10) showed dermal papilla lymphangiectasia. Immunohistochemical tests were performed on 5 patients, all of which were positive for D2-40 and negative for CD34. (3) Efficacy: 8 patients completed the postoperative follow-up, and the median follow-up time was 31.0 months (17.5, 78.3 months). The perineal swelling and the blister fluid leakage were all significantly improved after the staged operations. All indexes of the symptom rating scale, including the degree of perineal swelling, blister range, fluid leakage volume and frequency, were significantly improved in 8 follow-up patients, and 3 (3/8) of them were cured; the median symptom score decreased significantly from 11.0 before surgery to 3.0 after surgery (P<0.001). The incidence of erysipelas was significantly reduced from 7/10 before surgery to 2/8 after surgery (P=0.035). Conclusions: The main causes of female ALV are pelvic tumor surgery and radiotherapy. The clinical diagnosis is made from relevant medical history, clinical manifestations, LS and magnetic resonance imaging. The diagnosis is confirmed by histopathological findings. Pathological results show lymphangiectasia in the dermal papilla, and immunohistochemical staining show positive for D2-40 and negative for CD34. The effect of staged surgery on ALV is remarkable and even cured, and could effectively reduce the incidence of erysipelas.

Evaluation of vascular invasion in pancreatic head tumors and its impact on radical surgical treatment

Objective. To evaluate the informativeness and sensitivity of radiological criteria for vascular invasion in pancreatic head tumors in comparison with intraoperative data and results of routine pathological examination. Materials and methods. The study included 98 patients with ductal adenocarcinoma of the pancreatic head with suspected venous invasion and spread of tumor growth along the vessels of the portomesenteric axis, who were operated on at the Department of Pancreatic and Bile Duct Surgery of the National Research Center of Surgery and Transplantation named after O. A. Shalimov in the period from 2019 to 2023. Group 1 included 51 (52.0%) patients who underwent radical surgery with resection of the superior mesenteric/hepatic portal vein and extended lymph and neurodissection, and group 2 included 47 (48.0%) patients who had positive vascular margins of pancreatic resection according to routine pathological examination. Diagnostic criteria for vascular alterations were developed. A comparative analysis of the informativeness of the developed criteria and the results of a routine pathological examination was performed. The edges of the pancreatic resection were evaluated, including the neck of the gland, common bile duct, duodenum/gastric duct, and the bed of the superior mesenteric/hepatic portal vein and superior mesenteric artery separately. R1 status was defined as the presence of tumor cells at a distance of less than 1 mm to the resection margin. Results. According to the criteria of the National Comprehensive Cancer Network (NCCN) 2023.2, 61 (62.2%) patients had a marginally resectable stage of ductal adenocarcinoma of the pancreatic head and tumor contact with the superior mesenteric/hepatic veins according to multislice computed tomography of the abdominal cavity. In group 1, there were 36 (70.6%) such patients, in group 2 – 25 (53.2%). According to the proposed radiologic criteria for vascular invasion, tumor contact with the superior mesenteric/hepatic portal veins was suspected in 76 (77.6%) patients, which is higher than in the standard approach. Determination of vascular alterations according to the results of our study is a more reliable method for diagnosing invasion of the superior mesenteric/hepatic portal vein (χ2 = 5.46, p = 0.019) and predicting the performance of radical surgery, including vascular resection. Conclusions. The proposed criteria for the radiological diagnosis of vascular invasion at the preoperative stage increased the sensitivity of this method from 62.2 to 77.6%. The most frequent radiological signs of vascular alteration are vascular wall irregularity (47.7%) and parapancreatic tissue density (62.5%). In the presence of any of the radiological signs of vascular alteration, resection of the affected area of the superior mesenteric/hepatic portal vein with extended lymph and neurodissection is indicated, which allows a statistically significant increase in the number of R0 resections.

Histopathological patterns and immunophenotyping of feline lymphomas and incidence in Metropolitan Bangkok, Thailand.

Feline lymphomas are categorized based on the location of tumor cells, with anatomical classifications including alimentary, mediastinal, multicentric, and extranodal forms. Accurate diagnosis and classification of feline lymphoma are paramount for enhancing treatment and prognosis. T-cell lymphomas are CD3 positive, while B-cell lymphomas exhibit positive forCD20, CD79α, and paired box 5 (PAX5). The aims of this study were (1) to classify feline lymphoma in each anatomical subtype using the World Health Organization (WHO) classification to provide information on epidemiological findings; (2) to investigate the expression and detection of B-cell lymphoma, various antibodies will be used, with the addition of PAX5, for clearer results; and (3) to gather more extensive information about feline lymphoma in Thailand, particularly in the Bangkok area. From 2011 to 2023, 86 sample tissues were submitted for routine pathological examination at the Department of Pathology, Faculty of Veterinary Science, Chulalongkorn University. Immunohistochemistry (IHC) was performed to detect an immunophenotype of PAX5, CD79α, CD20 (B-cell lineage), and CD3 (T-cell lineage). Eighty-six formalin-fixed, paraffin-embedded lymphoma tissues were prepared on silane-coated slides. After IHC, all cases were classified according to the WHO classification. The most common form of lymphoma in this study was extranodal lymphoma at 37.2% (32/86), followed by multicentric lymphoma at 31.3% (27/74), mediastinal lymphoma at 17.4% (15/86), and alimentary lymphoma at 14% (12/86). Most extranodal lymphoma cases were in the nasal region. From the anatomical form, multicentric and extranodal lymphomas were predominantly diffuse large B-cell high-grade, while mediastinal lymphomas were small low-grade B-cell lymphomas. Alimentary lymphomas occur in various types, with most being the B-cell type. This study indicates that extranodal lymphoma and extranodal lymphoma are the most frequent presentations found in cats in Bangkok. Mediastinal and alimentary lymphomas still occur. The utilization of various B-cell markers in combination could aid pathologists in distinguishing between various stages of B-cell maturation, assessing tumor cell heterogeneity, and determining the phenotype in scenarios where there is a loss of common B-cell markers diffuse large B-cell lymphomas is the most prevalent subtype of feline lymphoma. Significantly, relying solely on immunochemistry with one parameter may not be sufficient for a definitive diagnosis of B-cell lymphoma, as another parameter may also be necessary.

Potential predictor of prognosis in breast carcinoma: Tumor budding

ABSTRACT Background: Breast cancer is the most common cancer in women, with invasive breast carcinoma of no special type (IBC-NST) accounting for the majority of cases. Aim: This study aimed to evaluate the relationship between tumor budding (TB), which is the earliest histological indicator of tumor spread and represents epithelial–mesenchymal transition, and prognostic factors as well as the effect of TB on survival in patients with IBC-NST, thereby demonstrating its potential prognostic value. Materials and Methods: This study included 278 cases of breast resection diagnosed with IBC-NST from 2014 to 2019. Total tumor buds were counted in 10 high-power fields of a hematoxylin and eosin–stained section with the most infiltrative area at 400× magnification. The cutoff value for TB was obtained using receiver operating characteristic analysis for mortality and recurrence risk; this cutoff value was used to classify TB into two categories: low and high grades. The relationship between TB and prognostic factors and the effect of TB on the survival of patients were investigated. Results: This study revealed a statistically significant relationship between high-grade TB and increased tumor size, advanced pathological primary tumor (pT) category, lymph node metastasis, lymphatic invasion, blood vessel invasion, increased recurrence, and mortality as well as reduced overall and disease-free survival. Conclusion: TB in breast carcinomas may have significant predictive value for prognosis. It emerges as a simple, reproducible, and cost-effective histological marker. With the standardization of evaluation criteria, TB may be readily integrated into routine pathological examination, thereby increasing its value in clinical patient management.

Clinical and prognostic significance of follicular helper and regulatory T cells in bladder cancer draining lymph nodes

Follicular helper and regulatory T cells (Tfh/TFR) cells are distinct subsets of CD4+ cells that have been recognized for their critical role in regulating cellular reactions within the germinal centers of lymphoid follicles. In the present study, we aimed to determine the presence and the frequency of these cells in draining lymph nodes of patients with bladder cancer (BC). Forty-six patients with BC who had undergone radical cystectomy and pelvic lymph node dissection were enrolled. Following routine pathological examination, a portion of the dissected lymph nodes was minced to obtain a single-cell suspension. Mononuclear cells were then separated using Ficoll-Hypaque gradient centrifugation, and the samples with proper viability (> 95%) were subjected to further analysis. To phenotype the follicular subsets, cells were stained with appropriate fluorochrome-conjugated antibodies specific for CD4, CXCR5, BCL6, and FOXP3. The cells were then acquired on a four-color flow cytometer. The data were analyzed with the FlowJo software version 10.8.1 package. Our analysis indicated that, on average 37.89 ± 16.36% of CD4+ lymphocytes in draining lymph nodes of patients with BC expressed CXCR5. The majority of them were negative for FOXP3, representing helper subsets (28.73 ± 13.66). A small percent simultaneously expressed BCL6 transcription factor (1.65% ± 1.35), designated as Tfh (CD4+BCL6+CXCR5+FOXP3-). While less than 10% of CD4+ lymphocytes expressed CXCR5 and FOXP3, 1.78 ± 2.54 were also positive for BCL6, known as TFR. Statistical analysis revealed that the frequency of both Tfh and TFR cells was higher in draining lymph nodes of patients with tumor-infiltrated nodes (P = 0.035 and P = 0.079, respectively) compared to those with negative ones. The percentage of these cells was also higher in high-grade tumors compared to low-grade ones (P = 0.031 for both). Our data collectively indicated that however approximately one third of CD4+ lymphocytes expressed CXCR5 and accordingly had the capacity to enter the follicles, less than 2% of them represented Tfh and TFR phenotypes. The percentage of these cells increased in progressed tumors and showed an association with negative prognostic factors.

Comparing the diagnostic value of 68Ga-prostate-specific membrane antigen PET/CT and multiparametric MRI in pelvic lymph node metastasis of locally advanced prostate cancer.

Multiparametric magnetic resonance imaging (mpMRI) is a commonly used method to diagnose pelvic lymph node metastasis (PLNM) in prostate cancer (PCa) patients, but there are few comparative studies on mpMRI and 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) in locally advanced PCa (LAPC) patients. Therefore, we designed a retrospective study to compare the diagnostic value of 68Ga-PSMA PET/CT and mpMRI for PLNM of LAPC. A retrospective study was performed on 50 patients with LAPC who underwent radical prostatectomy (RP) in Tongji Hospital from 2021 to 2023. All patients underwent PET/CT and mpMRI examination, and were diagnosed as LAPC before surgery, followed by robot-assisted laparoscopic prostatectomy or laparoscopic RP and extended pelvic lymph node dissection (ePLND). Routine postoperative pathological examination was performed. According to the results, the sensitivity, specificity, positive predictive value, and negative predictive value of 68Ga-PSMA PET/CT and mpMRI for the diagnosis of PLNM of LAPC were compared. Among the 50 patients, the mean age was 65.5±10.3 years, the preoperative total serum prostate-specific antigen (PSA) was 30.7±12.3 ng/mL, and the Gleason score was 7 [7, 8]. The difference in diagnostic efficacy between 68Ga-PSMA PET/CT and mpMRI in the preoperative diagnosis of PLNM of PCa was determined by postoperative pathological results. Based on the number of patients who developed PLNM, the sensitivity, specificity, positive predictive value, and negative predictive value of 68Ga-PSMA PET/CT were as follows: 93.75%, 100.00%, 100.00%, 97.14%, and 68.75%, 97.06%, 91.67%, 86.84% for mpMRI, respectively. Based on the number of pelvic metastatic lymph nodes, the sensitivity, specificity, positive predictive value, and negative predictive value of 68Ga-PSMA PET/CT were 95.24%, 100.00%, 100.00%, 99.48%, and 65.08%, 99.13%, 89.13%, 96.30% for mpMRI, respectively. It turned out that PET/CT was more sensitive than mpMRI in detecting PLNM of PCa, and the difference was statistically significant. 68Ga-PSMA PET/CT is more sensitive than mpMRI in the detection of PLNM in patients with LAPC. It is a promising method in the diagnosis and preoperative assessment of PLNM in LAPC.

The potential of indocyanine green fluorescence detection in surgical cut margin of breast conserving surgery.

Fluorescence-guided surgery (FGS) is a cutting-edge technology that uses near-infrared (NIR) fluorescence imaging to guide surgeons in surgery. Indocyanine green (ICG) is a fluorescent dye, which can be used for in vivo imaging of tumor cells. We aimed to explore the use of ICG fluorescence-guided technology as a rapid intraoperative margin assessment method for breast cancer surgery. In addition, we also compared the dose selection of ICG. This was a non-randomized prospective cohort study. Data were collected between August 2021 and October 2022 in the Division of Breast Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University. Upon specimen removal, tumor margins were immediately analyzed by ICG fluorescence detection and then sent to the pathology department for intraoperative frozen section analysis and subsequent routine pathological examination. Abnormal margin rates were calculated and compared using intraoperative frozen section analysis and under the guidance of ICG fluorescence. The study included 69 cases of breast cancer patients who underwent tumor resection assisted by ICG fluorescence-guided technology, including 18 patients with a 0.5 mg/kg dose and 51 patients with a 1.0 mg/kg dose. According to the study findings, the ICG test achieved a sensitivity of 81.82% and a specificity of 75.82%. At a dose of 0.5 mg/kg, the sensitivity was 66.67% whereas the specificity was 93.33%. At the dose of 1 mg/kg, the sensitivity was 87.5%, and the specificity was 74.42%. Similarly, for intraoperative frozen section analysis, the sensitivity was 81.82%, but the specificity was enhanced to 94.83%. Positive surgical cut margin was not identified in 2/69 by ICG fluorescence and frozen section analysis respectively. The sensitivity of ICG fluorescence detection is comparable to that of frozen section analysis, but the specificity is poor. The sensitivity increased and the specificity decreased at 1 mg/kg compared to the 0.5 mg/kg dose. ICG fluorescence can be used as a supplementary tool for frozen section analysis. These findings support further development and clinical performance assessment of ICG fluorescence.

Fifty-five cases of hepatic alveolar echinococcosis combined with lymph node metastasis: A retrospective study.

Lymph node metastasis is a specific type of metastasis in hepatic alveolar echinococcosis (AE). Currently, there is a scarcity of describing the clinical characteristics and lymph node metastasis rules of patients with hepatic AE combined with lymph node metastasis and its mechanism and management are still controversial. Radical hepatectomy combined with regional lymph node dissection is a better treatment. To analyse the clinical features of hepatic AE combined with lymph node metastasis to explore its treatment and efficacy. A total of 623 patients with hepatic AE admitted to the First Affiliated Hospital of Xinjiang Medical University from 1 January 2012 to 1 January 2022 were retrospectively analysed. Fifty-five patients with combined lymph node metastasis were analysed for their clinical data, diagnosis and treatment methods, follow-up efficacy, and characteristics of lymph node metastasis. Finally, we comparatively analysed the lymph node metastasis rates at different sites. Categorical variables are expressed as frequencies and percentages, and the analysis of difference was performed using the χ 2 test. The Bonferroni method was used for pairwise comparisons when statistical differences existed between multiple categorical variables. A lymph node metastasis rate of 8.8% (55/623) was reported in patients with hepatic AE, with a female predilection (69.1%) and a statistically significant sex difference (χ 2 = 8.018, P = 0.005). Of the 55 patients with lymph node metastasis, 72.7% had a parasite lesion, neighbouring organ invasion, and metastasis stage of P3N1M0 and above, of which 67.3%, 78.2%, and 34.5% of hepatic AE lesions invaded the bile ducts, blood vessels, and distant metastases, respectively. Detection rates of lymph node metastasis of 16.4%, 21.7%, and 34.2% were reported for a preoperative abdominal ultrasound, magnetic resonance imaging, and computed tomography examinations. All patients were intraoperatively suspected with enlarged lymph nodes and underwent radical hepatectomy combined with regional lymph node dissection. After surgery, a routine pathological examination was conducted on the resected lymph nodes. A total of 106 positive lymph nodes were detected in six groups at various sites, including 51 single-group metastasis cases and four multi-group metastasis cases. When the metastasis rates at different sites were statistically analysed, we observed that the metastasis rate in the para-hepatoduodenal ligament lymph nodes was significantly higher than that of the other sites (χ 2 = 128.089, P = 0.000 < 0.05). No statistical difference was observed in the metastasis rate between the five other groups. Clavien-Dindo grade IIIa complication occurred in 14 cases, which improved after administering symptomatic treatment. Additionally, lymph node dissection-related complications were not observed. Recurrence after 2 years was observed in one patient. Lymph node metastasis is a rare form of metastasis in hepatic AE, which is more frequent in women. Para-hepatoduodenal ligament lymph nodes are commonly observed. Radical hepatectomy combined with regional lymph node dissection is a safe, effective, and feasible treatment for liver AE combined with lymph node metastasis.

(004) ROUTINE PATHOLOGY EXAMINATION OF EXCISED SPECIMEN FROM PATIENTS WITH NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is suspected in individuals with vulvas with complaints of entrance dyspareunia, vestibular allodynia and hyperalgesia, after ruling out other causes. When conservative biopsychosocial treatments for suspected NPV are unsuccessful, vestibulectomy may be an appropriate option. Excised vestibular surgical specimens are routinely sent for pathologic assessment including hematoxylin and eosin (H&amp;E) staining. Objective To review reports of gross and microscopic pathology examinations of excised vestibular specimens from a cohort of patients with NPV and compare immunohistochemical staining density among subgroups classified by severity of subepithelial inflammatory infiltrate. Methods Excised specimens from vestibulectomy surgeries were placed in 10% neutral buffered formalin prior to pathology examination. Routine pathology assessment included gross examination and cytological characterization of H&amp;E-stained vestibular tissue for malignancy, viral nuclear changes (in addition to P16 staining as needed), and quality of the vestibular epithelium and subepithelial inflammatory infiltrate. Severity of this infiltrate was classified by the pathologist as mild, mild-moderate, moderate, or severe. Additional vestibular tissue sections were processed for immunohistochemical staining for CD117 and PGP9.5, protein markers consistent with mast cells and nerves, respectively. Separating the tissues into subgroups based on severity of subepithelial inflammatory infiltrate, they were compared to mast cell counts and immunopositive mean fractional area for CD117 and PGP9.5 using the Kruskal-Wallis test. Results Gross examinations of the 1:00-11:00 (n = 63) and 12:00 (n = 54) regions of vestibular tissue showed mean dimensions (length, width, thickness) to be 5.8 x 2.1 x 0.6 cm and 1.0 x 0.7 x 0.3 cm, respectively. Microscopic examinations revealed no malignant cells in any specimen, and viral nuclear findings were consistent with HPV in 3 specimens. Vestibular tissue was characterized as non-reactive squamous epithelium in 91% and 93% of specimens for the 1:00-11:00 and 12:00 regions, respectively. Mature lymphocytes were found in the subepithelial stromal infiltrate of 67% of specimens in both the 1:00-11:00 and 12:00 regions. Severity of subepithelial stromal infiltrate was reported as: mild in 67% and 65%; mild-moderate in 5% and 4%; moderate in 14% and 15%; and severe in 14% and 17% of cases for the 1:00-11:00 and 12:00 regions, respectively. Among the subgroups categorized by severity of inflammatory infiltrate, there were no significant differences for CD117-immunopositive cell counts or mean fractional area of CD117 and PGP9.5 in the 1:00-11:00 and 12:00 regions. Conclusions Routine pathology examination including H&amp;E staining is standard for vestibulectomy specimens. There were no significant differences found among subgroups comparing severity of subepithelial inflammatory infiltrate with immunohistochemical data. Thus, information gleaned from routine pathology examination did not provide confirmation of the diagnosis of NPV. To better understand NPV, excised vestibular tissue should also be immunostained for CD117 and PGP9.5. Disclosure No.

Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience.

Endoscopy prior to bariatric surgery is not always performed, and in sleeve gastrectomy (SG), the surgical specimen is not always sent for pathological examination. There is limited data on the frequency of clinically significant findings in SG specimens or correlation with preoperative endoscopy. We reviewed 426 consecutive SG patients to determine the concordance of preoperative endoscopy findings in patients with clinically significant postoperative pathology. Preoperative endoscopy was performed on 397 patients (93.2%). Three hundred seventy-three patients had preoperative endoscopy and surgical pathology results available. Then, 20/373 (5.4%) patients had potentially significant postoperative pathology, including intestinal metaplasia, autoimmune metaplastic atrophic gastritis (AMAG), gastrointestinal stromal tumors, and/or gastric cancer. The overall incidence of AMAG in the entire cohort was 2.3%. Preoperative gastric biopsies (to include gastric body) identified AMAG in nearly 1/2 of patients. Patients with clinically significant postoperative pathology results had a median [interquartile range] of 3 [3-5] tissue blocks examined as compared to 3 [1-3] for the remainder of the cohort (p < 0.001). This is one of the largest studies describing clinically significant postoperative pathology after SG. AMAG, in particular, is of particular importance as it is associated with a 3-fivefold increase in risk for gastric cancer. The incidence of significant postoperative pathology in this population is small but potentially clinically significant and requires validation in larger studies. We recommend wider sampling in preoperative endoscopy (body and antrum), especially in patients being planned for gastric bypass, consideration for routine pathological examination of SG surgical specimens, with careful gross examination and targeted sampling.

The role of mir96 in predicting CTC status and prognostic evaluation in gastric cancer patients.

In this study, 20 patients clinically diagnosed with advanced gastric cancer were selected as subjects. Circulating tumor cells (CTCs) in the peripheral blood of gastric cancer patients were detected and counted by collecting peripheral blood samples at Ningbo No. 2 Hospital and using the Cell Rich TM system combined with a negative enrichment strategy. In addition, routine pathological examination and immunohistochemical staining were performed on surgical specimens, including HER2, EBER, E-cadherin, and vimentin indicators. These indicators were correlated and analyzed with CTC counts and routine clinical tests. At the same time, miRNA groups were performed to explore the miRNAs with or without correlation with CTC and to try to construct a predictive model for CTC status. Tumor tissue from patients whose CTC counts did not match the results of the miRNA prediction model was subjected to second-generation gene sequencing to analyze indicators such as tumor heterogeneity and immune microenvironment. The results of the study showed that CTCs were detected in the peripheral blood of 50% (10/20) of gastric cancer patients using the Cell Rich TM system, serum fibrinogen was negatively correlated with CTC counts, whereas TNM staging elements, HER2 receptor and p53 were not correlated with CTC counts. miRNA assays showed that the expression levels of miR218, miR1207, miR96, miR409, miR149, miR148a, miR155, miR370 and miR223 were significantly different between the two groups of CTC≥2 and CTC<2. Among them, miR-96 showed good efficacy as an indicator for predicting CTC status and assisting in determining the prognosis of gastric cancer. In conclusion, the present study demonstrated that the Cell Rich TM system combined with the negative enrichment strategy can effectively detect CTCs in the peripheral blood of gastric cancer patients and that the expression of miR-96 can be used as an effective indicator to predict CTC status and assist in determining the prognosis of gastric cancer. These findings have important implications for the diagnosis and treatment of gastric cancer and provide new clues for the further study of the tumor immune microenvironment and tumor heterogeneity.

The Limited Utility of Routine Pathologic Examination of Ganglion Cyst Excision From the Hand and Digits.

It is routine practice at many institutions to send surgically excised ganglion cysts for pathologic analysis. This adds significant cost to the procedure with questionable benefit. The purpose of this study was to determine the necessity of routine pathologic examination of ganglion cysts excised from the hand. We conducted a retrospective review of 443 patients who underwent ganglion excision from the hand with routine pathologic examination between 2012 and 2022. The final pathologic diagnosis was compared with the treating surgeon's clinical diagnosis, and the rates of concordant, discrepant, and discordant diagnoses were identified. Discrepant diagnoses were defined as differing clinical and pathologic diagnoses that did not change clinical management. Discordant diagnoses were defined as differing clinical and pathologic diagnoses that altered the treatment plan. The prevalence of a concordant diagnosis was 96.2% (426 of 443; 95% confidence interval, 94.4%-98.0%). The prevalence of a discrepant diagnosis was 3.8% (17 of 443; 95% confidence interval, 2.1%-5.6%), and the prevalence of a discordant diagnosis was 0. The odds ratio was 0.04 for a discrepant diagnosis and 0 for a discordant diagnosis. Our study suggests abandoning routine pathologic analysis in patients undergoing ganglion cyst excision from the hand will not compromise quality of care when the surgeon is able to make a confident diagnosis. Discrepant diagnoses were rare and discordant diagnoses that did not occur. We recommend pathologic evaluation only when there is uncertainty in the clinical diagnosis.

Impact of deep muscle invasion on nodal status and survival in patients with pT2 esophageal squamous cancer.

Whether T2 esophageal squamous cell carcinoma should be subclassified remains controversial. We aimed to investigate the impact of the depth of muscularis propria invasion on nodal status and survival outcomes. We identified patients with pT2 esophageal squamous cell carcinoma who underwent primary surgery from January 2009 to June 2017. Clinical data were extracted from prospectively maintained databases. Tumor muscularis propria invasion was stratified into superficial or deep. Binary logistic regression was used to determine risk factors for lymph node metastases. The impact of the depth of muscularis propria invasion on survival was investigated using Kaplan‒Meier analysis and a Cox proportional hazard regression model. A total of 750 patients from three institutes were investigated. The depth of muscularis propria invasion (odds ratio [OR]: 3.95, 95% confidence interval [CI]: 2.46-6.35; p < 0.001) was correlated with lymph node metastases using logistic regression. T substage (hazard ratio [HR]: 1.37, 95% CI: 1.05-1.79; p < 0.001) and N status (HR: 1.51, 95% CI: 1.05-2.17; p < 0.001) were independent risk factors in multivariate Cox regression analysis. The deep muscle invasion was associated with worse overall survival (HR: 1.52, 95% CI: 1.19-1.94; p = 0.001) than superficial, specifically in T2N0 patients (HR: 1.38, 95% CI: 1.08-1.94; p = 0.035). We found that deep muscle invasion was associated with significantly worse outcomes and recommended the substaging of pT2 esophageal squamous cell carcinoma in routine pathological examination.

(268) The Limited Role of Routine Pathology Examination in Neuroproliferative Vestibulodynia

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is suspected in women with entrance dyspareunia, vestibular allodynia, and hyperalgesia, after ruling out other causes. If conservative biopsychosocial treatments in patients with suspected NPV are unsuccessful, vestibulectomy may be an appropriate option. Excised vestibular surgical specimens are sent for routine pathology assessment, including hematoxylin and eosin (H&amp;E) staining. Objective To review reports of gross and microscopic pathology examinations of excised vestibular specimens from a cohort of patients with NPV and compare immunohistochemical (IHC) staining density between subgroups classified by severity of subepithelial inflammatory infiltrate. Methods Excised specimens from NPV patients, the 1:00-11:00 region (n = 63) and 12:00 region (n = 54) of the vestibule, were placed in 10% formalin prior to pathology examination. Routine pathology assessment included gross examination and cytological characterization of H&amp;E-stained vestibular tissue for malignancy, viral nuclear changes (in addition to P16 staining), and quality of the vestibular epithelium and subepithelial inflammatory infiltrate. Severity of this infiltrate was classified by the pathologist as mild, mild-moderate, moderate, or severe. Additional vestibular tissue sections were processed for IHC staining for CD117 and PGP9.5, protein markers consistent with mast cells and nerves, respectively. Mast cell counts and immunopositive mean fractional area for CD117 and PGP9.5, separated into subgroups based on severity of subepithelial inflammatory infiltrate, were compared using Kruskal-Wallis test. Results Gross examinations of the 1:00-11:00 and 12:00 regions of vestibular tissue showed mean dimensions (length, width, thickness) to be 5.8 x 2.1 x 0.6 cm and 1.0 x 0.7 x 0.3 cm, respectively. Microscopic examinations revealed no malignant cells in any specimen and viral nuclear findings were consistent with HPV in 3 specimens. Vestibular tissue was characterized as non-reactive squamous epithelium in 90.5% and 92.6% of specimens for the 1:00-11:00 and 12:00 regions, respectively. Mature lymphocytes were found in the subepithelial stromal infiltrate of 67% of specimens in both the 1:00-11:00 and 12:00 regions. Severity of subepithelial stromal infiltrate was reported as: mild in 67% and 65%; mild-moderate in 5% and 4%; moderate in 14% and 15%; and severe in 14% and 17% of cases for the 1:00-11:00 and 12:00 regions, respectively. Amongst the subgroups categorized by severity of inflammatory infiltrate, there were no significant differences for CD117-immunopositive cell counts or mean fractional area of CD117 and PGP9.5 in the 1:00-11:00 and 12:00 regions. Conclusions No significant differences were found between subgroups of severity of subepithelial inflammatory infiltrate and IHC data. While routine pathology examination including H&amp;E staining is standard for vestibulectomy specimens, such standardized assessment did not provide any insight into the severe allodynia and hyperalgesia associated with NPV, and further, was not useful for confirmation of the diagnosis of NPV. To better understand NPV, excised vestibular tissue should also be stained for CD117 and PGP9.5. Disclosure No.

Label-free and non-destructive histology of unprocessed biological tissues with ultraviolet single-plane illumination microscopy

Histopathology has remained the gold standard for surgical margin assessment for decades. However, routine pathological examination based on formalin-fixed and paraffin-embedded (FFPE) tissues is laborious and time-consuming, failing to guide surgeons intraoperatively. Here, we propose a rapid, label-free, and non-destructive histological imaging method, termed microscopy with ultraviolet single-plane illumination (MUSI). With intrinsic fluorescence from deep ultraviolet excitation, MUSI enables both ex vivo and in vivo imaging of fresh and unprocessed tissues at the subcellular level with an imaging speed of 0.5 mm2/s, generating high-quality optically sectioned surface images from irregular surgical tissues with a long depth-of-field. We demonstrate that MUSI could differentiate between different subtypes of human lung adenocarcinomas (e.g., lepidic, acinar, papillary, and micropapillary), revealing diagnostically important features that are comparable to the gold standard FFPE histology. As an assistive imaging platform, MUSI can provide immediate feedback to surgeons and pathologists for intraoperative decision-making, holding great promise to revolutionize the current clinical practice in surgical pathology.

Muhtemelen Atlanılan Bir Tanı: Rubeola Lenfadeniti, Yeniden Alarm Veren Bir Salgın

Because Rubeola (measles) infection is not observed in our country after eradication and is especially on the agenda again after migrations, pathologists may find it challenging to histopathologically recognize cases of Rubeola lymphadenitis and establish an accurate diagnosis. Here we describe the histopathological features of a rare Rubeola case. A 15-year-old Syrian migrant male patient was admitted with a complaint of lymph node swelling in the postauricular region for 2 months. Lymph node excision was performed with a preliminary diagnosis of lymphoma. The excised lymph node was subjected to a routine pathological examination in our clinic. Histopathological examination revealed that the basic structure was preserved under the thick fibrous capsule in the lymph node. Warthin-Finkeldey-type giant cells attracted attention in the interfollicular areas. The appearance compatible with lymphoproliferative neoplasia was not detected. The relevant clinic was informed that there were histological signs of Rubeola lymphadenitis upon detection of Rubeola IgM positivity in the examination, the case was evaluated as Rubeola infection. Rubeola was a common deadly infectious disease in the past century before the vaccine was developed. Today, there has been an epidemic again due to vaccine hesitancy, migration, and sociocultural conditions. Because it is exceptionally rare, we hope that the case we present will provide insights to pathologists for recognizing cases of Rubeola lymphadenitis and making precise diagnoses.

Identification of gastric cancer types based on hyperspectral imaging technology.

Gastric cancer is becoming the second biggest cause of death from cancer. Treatment and prognosis of different types of gastric cancer vary greatly. However, the routine pathological examination is limited to the tissue level and is easily affected by subjective factors. In our study, we examined gastric mucosal samples from 50 normal tissue and 90 cancer tissues. Hyperspectral imaging technology was used to obtain spectral information. A two-classification model for normal tissue and cancer tissue identification and a four-classification model for cancer type identification are constructed based on the improved deep residual network (IDRN). The accuracy of the two-classification model and four-classification model are 0.947 and 0.965. Hyperspectral imaging technology was used to extract molecular information to realize real-time diagnosis and accurate typing. The results show that hyperspectral imaging technique has good effect on diagnosis and type differentiation of gastric cancer, which is expected to be used in auxiliary diagnosis and treatment.

Relationship between molecular genetic and clinical and morphological parameters in patients with stage I–IIIA non-small cell lung cancer

Purpose: to study the molecular genetic landscape of the Russian cohort of patients with stage I–IIIA non-small cell lung cancer, to identify correlations between molecular genetic and clinical and morphological parameters of the tumor. Materials and methods: routine pathological examination and targeted sequencing of tumor material (and paired material of normal lung tissue) in 90 patients diagnosed with non-small cell lung cancer. Collection of clinical information. Statistical processing of the obtained material using the SPSS Statistics 23.0 program, based on the collected database. Descriptive statistics methods were used to analyze the socio-demographic and clinical characteristics of patients. Results: data were obtained on the frequency of occurrence of somatic mutations included in the study panel among patients of the Russian population, the correlation between clinical and morphological (stage, gender, age, histological subtype) and genetic parameters of the tumor was studied. Conclusion: An in-depth study of the genetic profile in patients with localized NSCLC using the Next generation sequencing (NGS) method allows us to determine the mutational landscape of this group of patients in more detail. More detailed, per-exon sequencing makes it possible to more accurately determine the clinical significance of the identified mutations, which improves diagnosis and makes subsequent treatment tactics more precise.