WHO Histological Classification Research Articles

Clinicopathological Characteristics and Risk Factors of Young-Onset Gastric Carcinoma: A Systematic Review and Meta-analysis.

The characteristics of gastric carcinoma in young individuals differ from that in older individuals. We conducted a systematic review and meta-analysis to explore the clinicopathological features and risk factors associated with young-onset (younger than 50 years) gastric carcinoma. We searched for studies published between January 1, 1990, and September 1, 2023, on patients with young-onset gastric carcinoma in PubMed, EMBASE, Web of Science, and MEDLINE to explore clinicopathological characteristics among this specific patient group. Extracted information included the proportion of patients with symptoms or family history of gastric cancer, tumor location, and histological features such as Lauren or World Health Organization histological classification and degree of differentiation. Additional analyses were conducted on risk factors such as positive family history, Helicobacter pylori infection, or high-risk nutritional or behavioral factors. The estimates were derived using random or fixed-effect models and included subgroup analyses based on different sex and age groups. This study was registered in PROSPERO (CRD42023466131). We identified 5,696 records, 1,292 were included in the quality assessment stage. Finally, 84 studies from 18 countries or regions including 89,447 patients with young-onset gastric carcinoma were included. Young-onset gastric carcinoma has slight female predominance (53.7%, 95% confidence interval [CI]: 51.6-55.7%), with most having symptoms (87.0%, 95% CI: 82.4%-91.7%). Family history was reported in 12.1% (95% CI: 9.5%-14.7%). H. pylori infection was detected in 60.0% of cases (95% CI: 47.1%-72.8%). Most of these carcinomas were in the non-cardia region (89.6%, 95% CI: 82.4%-96.8%), exhibiting Lauren diffuse-type histology (71.1%, 95% CI: 66.8%-75.3%) and poor/undifferentiated features (81.9%, 95% CI%: 79.7-84.2%). A positive family history of gastric cancer was the most important risk factor associated with the development of gastric carcinoma in young individuals (pooled odds ratios 4.0, 95% CI: 2.8-5.2), followed by H. pylori infection (odds ratio 2.3; 95% CI: 1.4-3.2) and dietary and other lifestyle risk factors. Young-onset gastric carcinoma exhibits specific clinicopathological characteristics, with positive family history being the most important risk factor. Most of the patients were symptomatic at diagnosis. These findings could help to inform future strategies for the early detection of gastric carcinoma among young individuals.

Evaluation of the effect of PET/CT Fluorodeoxyglucose inclusion on mortality and survival in operated thymoma patients.

In recent years, the use of fluorodeoxyglucose PET-computed tomography (PET-CT) has become widespread to evaluate the diagnosis, metabolism, stage and distant metastases of thymoma. In this study, it was aimed to investigate the connection of malignancy potential, survival and maximum standardized uptake value (SUV max ) measured by PET-CT before surgery according to the histological classification of the WHO in patients operated for thymoma. In addition, the predictive value of the Glasgow prognostic score (GPS) generated by C-reactive protein (CRP) and albumin values on recurrence and survival was investigated and its potential as a prognostic biomarker was evaluated. Forty-five patients who underwent surgical resection for thymoma and were examined with PET-CT in the preoperative period between January 2010 and January 2022 were included in the study. The relationship between WHO histological classification, tumor size and SUV max values on PET-CT according to TNM classification of retrospectively analyzed corticoafferents were evaluated. Preoperative albumin and CRP values were used to determine GPS. The cutoff value for SUV max was found to be 5.65 in the patients and the overall survival rate of low-risk (<5.65) and high-risk (>5.65) patients was compared according to the SUV max threshold value (5.65) and found to be statistically significant. In addition, the power of PET/CT SUV max value to predict mortality (according to receiver operating characteristics analysis) was statistically significant ( P = 0.048). Survival expectancy was 127.6 months in patients with mild GPS (O points), 96.7 months in patients with moderate GPS (1 point), and 25.9 months in patients with severe GPS (2 points). PET/CT SUV max values can be used to predict histological sub-type in thymoma patients, and preoperative SUV max and GPS are parameters that can provide information about survival times and mortality in thymoma patients.

WHO histological classification and tumor size are predictors of the locally aggressive behavior of thymic epithelial tumors

ObjectiveThe aim of this study was to explore the influencing factors that affect the local invasive behavior of thymic epithelial tumors (TETs). MethodWe retrospectively analyzed 524 patients with TETs who underwent surgical treatment at our center from January 2010 to January 2022. Cox regression analysis was applied to identify predictors associated with the prognosis of TET. Logistic regression analysis was used to analyze the factors associated with the locally invasive behavior of TETs. Receiver operating characteristic analysis and the Youden index were applied to determine the predictive efficiency and cutoff value. ResultsThere were 275 males and 249 females with a median age of 56 years. Seventy-seven patients had locally invasive behavior. The prognosis of local invasive TETs was significantly worse that of noninvasive TETs (P < 0.001). WHO classification and tumor size were two hazard factors for tumor invasive behavior. The risk of local invasion increased by 2.196 (OR (95 % CI): 1.813–2.659) times for each grade in WHO classification with a change from type A to thymic carcinoma. The tumor size cutoff of 6 cm represented a distinct boundary in predicting the hazard of local invasion (AUC: 0.784, specificity: 0.711, sensitivity: 0.726). ConclusionWHO classification and tumor size are important factors in predicting the locally aggressive behavior of TETs. The invasion capability of TETs is constantly increasing with an escalation in WHO classification. Tumors greater than 6 cm in size have a higher risk for local invasion.

Expression of SMARCA2 and SMARCA4 in gastric adenocarcinoma and construction of a nomogram prognostic model.

Aberrant expression of SWI/SNF complex subunits is closely associated with tumorigenesis. The clinicopathological and prognostic significance of altered SMARCA2 and SMARCA4 subunits has not been well evaluated in gastric adenocarcinoma. We collected 1271 postoperative cases of gastric adenocarcinoma and then constructed tissue microarrays (TMA), from which we obtained the immunohistochemistry expression of SMARCA2 and SMARCA4. Next, we screened the variables related to the loss of SMARCA2 and SMARCA4 by univariate correlation analysis and multivariate logistic regression analysis. Then, we identified the variables related to prognosis by univariate and multivariate Cox regression analysis. Finally, we constructed a nomogram prognostic model and evaluated it. The loss of SMARCA2 and SMARCA4 occurred in 236 (18.57%) and 86 (6.77%) cases, respectively, including 26 cases of co-loss. After multivariate logistic regression, variables independently associated with SMARCA2 loss were T stage, differentiation status, WHO histological classification, and EBER. Variables independently associated with SMARCA4 loss were differentiation status, WHO histological classification, PD-L1, and MMR. Survival analysis revealed that the SMARCA2 and SMARCA4 lost groups showed worse survival than the corresponding present groups (P = 0.032 and P = 0.0048, respectively). Univariate and multivariate Cox analyses identified independent prognostic factors, including age, T stage, N stage, M stage, SMARCA2, and chemotherapy. The loss of SMARCA2 and SMARCA4 correlated with poor differentiation, leading to a worse prognosis. SMARCA2, as an independent prognostic factor, combined with other clinicopathological variables, established a novel nomogram prognostic model, which outperformed the AJCC TNM model.

Prognostic factors in patients with thymoma who underwent surgery

PurposeThymoma is the most common primary tumor in the anterior mediastinum. The prognostic factors of patients with thymoma still need to be clarified. In this study, we aimed to investigate the prognostic factors of patients with thymoma who received radical resection and establish the nomogram to predict the prognosis of these patients.Materials and methodsPatients who underwent radical resection for thymoma with complete follow-up data between 2005 and 2021 were enrolled. Their clinicopathological characteristics and treatment methods were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared by the log-rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors. According to the results of the univariate analysis in the Cox regression model, the predictive nomograms were created.ResultsA total of 137 patients with thymoma were enrolled. With a median follow-up of 52 months, the 5-year and 10-year PFS rates were 79.5% and 68.1%, respectively. The 5-year and 10-year OS rates were 88.4% and 73.1%, respectively. Smoking status (P = 0.022) and tumor size (P = 0.039) were identified as independent prognostic factors for PFS. Multivariate analysis showed that a high level of neutrophils (P = 0.040) was independently associated with OS. The nomogram showed that the World Health Organization (WHO) histological classification contributed more to the risk of recurrence than other factors. Neutrophil count was the most important predictor of OS in patients with thymoma.ConclusionSmoking status and tumor size are risk factors for PFS in patients with thymoma. A high level of neutrophils is an independent prognostic factor for OS. The nomograms developed in this study accurately predict PFS and OS rates at 5 and 10 years in patients with thymoma based on individual characteristics.

WHO Histological Classification of Pituitary Tumors

The major changes in the upcoming 5th edition of the "2022 WHO Classification of Endocrine and Neuroendocrine Tumors" include:(1)evolution of the nomenclature: from pituitary adenoma to pituitary neuroendocrine tumour(PitNET),(2)detailed subtyping of a PitNET based on the tumor lineage, cell type, and related characteristics,(3)endorsement of the routine use of immunohistochemistry for pituitary transcription factors(PIT1, TPIT, SF1, GATA3, and ER-alpha),(4)introduction of some additional clinicopathologically distinct PitNET subtypes,(5)introduction of the term "metastatic PitNET" to replace the previous terminology "pituitary carcinoma," and(6)unifying posterior lobe tumors, the family of pituicyte tumors that invariably express TTF1, et al. Currently, no widely agreed grading or staging systems for PitNETs exist. Prognosis varies by tumor subtype and certain tumor subtypes are recognized as more aggressive(high-risk PitNETs)than others. Potentially aggressive PitNETs should be identified on an individual basis upon considering the tumor subtype, proliferative potential, and tumor invasion assessment.

Role of fluorine-18-fluorodeoxyglucose positron emission tomography in selecting candidates for a minimally invasive approach for thymic epithelial tumour resection.

We evaluated the potential of preoperative fluorine-18-fluorodeoxyglucose positron emission tomography to predict invasive thymic epithelial tumours in patients with computed tomography-defined clinical stage I thymic epithelial tumours ≤5 cm in size who are generally considered to be candidates for minimally invasive approaches. From January 2012 to July 2022, we retrospectively analysed patients who exhibited tumour-node-metastasis (TNM) clinical stage I thymic epithelial tumours with lesion sizes ≤5 cm as determined by computed tomography. All patients underwent fluorine-18-fluorodeoxyglucose positron emission tomography preoperatively. We analysed the association of maximum standardized uptake values with both the World Health Organization histological classification and the TNM staging classification. A total of 107 patients with thymic epithelial tumours (thymomas, 91; thymic carcinomas, 14; carcinoids, 2) were evaluated. Nine patients (8.4%) were pathologically upstaged: TNM pathological stage II in 3 (2.8%), III in 4 (3.7%) and IV in 2 (1.9%). Among these 9 upstaged patients, 5 had thymic carcinoma with stage III/IV, 3 had type B2/B3 thymoma with stage II/III and 1 had type B1 thymoma with stage II. Maximum standardized uptake values were a predictive factor that distinguished pathological stage >I thymic epithelial tumours from pathological stage I [best cut-off value, 4.2; area under the curve = 0.820] and thymic carcinomas from other thymic tumours (best cut-off value, 4.5; area under the curve = 0.882). Thoracic surgeons should carefully determine the surgical approach for high fluorodeoxyglucose-uptake thymic epithelial tumours and keep in mind the issues associated with thymic carcinoma and potential combined resections of neighbouring structures.

Histologic Diversity of Thymic Epithelial Tumors in Patients with Myasthenia Gravis

Background and Objective:Thymic epithelial tumors (TETs) include thymic carcinomas and thymomas, the latter of which can be further categorized by the World Health Organization (WHO) histologic classification based on the morphology of epithelial cells and the ratio of lymphocyte to epithelial cells. TETs are rare malignancies with an incidence of 0.15 per 100,000 in the United States. While their etiologies remain unknown, these tumors are associated with distinctly high rates of autoimmune disorders and paraneoplastic syndromes. Approximately 30% of patients with thymoma also carry a diagnosis of myasthenia gravis (MG). For the present retrospective study, we created a database of patients with TETs and examined prevalence of each histologic subtype in patients with MG.&#x0D; Methods:Drs. Patrick Loehrer, Kenneth Kesler, and colleagues have collaborated at the Indiana University Simon Comprehensive Cancer Center to care for over 1000 patients with TETs. The electronic health records of these patients were accessed via Cerner and used to input demographic, diagnostic, and histologic data into a REDCap database. These tumors were further categorized by WHO classification, and those comprising multiple histologic types were included separately in each subgroup.&#x0D; Results:Of 626 patients deemed to have sufficient documented histologic and diagnostic data, 110 had both MG and a TET diagnosis confirmed by pathology report. The greatest prevalence of WHO histologic type in patients with thymoma and MG was Type B2 (47), followed by Type B3 (34), Type B1 (22), Type A (9), Type AB (7), and unspecified thymoma (7). Notably, only 3 of 159 (1.87%) total patients with thymic carcinoma had comorbid MG in contrast to 107 of 467 (22.91%) patients with thymoma and MG; this suggests a uniquely favorable microenvironment of thymoma in patients with MG.&#x0D; Clinical Impact and Implications:Future work will aim to determine whether histologic classification has a predictive value for tumor prognosis in patients with and without MG. Furthermore, patterns of gene expression associated with thymoma in patients with and without MG may elucidate the etiologic mechanisms for the development of this autoimmune disorder.

Retrospective study of tumors from cattle slaughtered in Lombardy (Italy): preliminary evaluation on the establishment of a bovine cancer registry.

Forty‑one tumors were detected in a population of 1,649,003 cattle slaughtered in 4 abattoirs in Lombardy over a 5‑year period, for an overall prevalence of 2.5 tumors per 100,000 cattle. Tumors were classified according to the WHO histological classification of tumors of domestic animals. Alimentary and hemopoietic systems were commonly affected with 9 cases each. Other affected sites were the respiratory (n = 3), urinary (n = 2), endocrine (n = 2), musculoskeletal (n = 2), nervous (n = 1), and cardiovascular (n = 1) systems. The peritoneum was affected by 6 cases, while the primary location of 3 tumors of the connective tissues and 3 metastatic carcinomas was unidentified. Liver tumors and mesotheliomas, for which environmental risk factors are well‑known in humans, were common, as well as tumors typically encountered in pediatric human patients (tumors of mesenchymal tissues, pulmonary blastomas and nephroblastomas). These findings suggest the useful role of bovines as sentinel and model for human carcinogenesis. Our study indicates that the establishment of a bovine cancer registry in Lombardy is feasible considering its potential contribution to understanding the role of environmental risk factors in the genesis of tumors in animals and humans.

The Clinical Significance of Preoperative 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Predicting Distant Recurrence in Thymoma

AimsThymomas sometimes require treatment for various recurrence patterns, despite their relatively good survival rates after resection. We focused on their maximum standardised uptake value (SUVmax) on preoperative 18F-fluorodeoxyglucose positron emission tomography as a tumour recurrence predictor in completely resected thymomas. Those with a high SUVmax might be at an increased recurrence risk, irrespective of tumour size. We categorised cases into axes (tumour size and SUVmax) and determined whether cluster analysis predicts recurrence patterns and freedom from recurrence (FFR). Materials and methodsOf the 115 patients who underwent primary surgery for thymoma between 2005 and 2018, 66 were evaluated. According to the Masaoka stage and World Health Organization (WHO) histological type, all histological diagnoses were obtained after resection. All recurrences were diagnosed using computed tomography and categorised into three patterns: distant, local and regional recurrences. A multiple regression analysis was carried out to identify predictors for each recurrence pattern. Cluster analysis was carried out based on tumour size and SUVmax. The FFR rate was evaluated. ResultsAll patients with preoperative SUVmax <3.4 were free from recurrence regardless of Masaoka stage, WHO histological classification and tumour size. Multiple regression analysis revealed that the SUVmax was the only significant predictor for distant recurrence. All cases were divided into three clusters. Cluster 3, with average tumour size and a high SUVmax, showed a higher risk of distant recurrence rate (60%) and a significantly lower FFR rate (P = 0.003). ConclusionsThe preoperative positron emission tomography/computed tomography SUVmax could be a useful thymoma recurrence predictor, especially for distant recurrences. In addition, cluster analysis revealed that cases with average tumour sizes and extremely high SUVmax were identified to have a higher recurrence risk and a significantly lower FFR rate than those in other clusters. Even after complete resection, such cases should be closely followed-up and screened for distant recurrence.

Prognostic factors for overall survival after surgical resection in patients with thymic epithelial tumors: A systematic review and meta-analysis.

Background:Thymic epithelial tumors (TETs) originate in the thymic epithelial cell, including thymoma and thymic carcinoma. Surgical resection is the first choice for most patients. However, some studies have shown that the factors affecting the prognosis of these patients are not consistent. To evaluate prognostic factors in patients with surgically resected thymic epithelial tumors, we performed a meta-analysis.Methods:We searched the Chinese biomedical literature database, Pubmed, Embase, Cochrane Library and other electronic databases. Studies including postoperative overall survival (OS) and predictors of TETs were included. We made a comprehensive analysis the hazard ratios (HRs) through a single proportional combination. HRs were combined using single proportion combinations.Results:The meta-analysis included 11,695 patients from 26 studies. The pooled OS was 84% at 5 years and 73% at 10 years after TETs operation. The age as continuous-year (HR 1.04, 95% confidence interval (CI) 1.02–1.04), incomplete resection (HR 4.41, 95% CI 3.32–5.85), WHO histologic classification (B2/B3 vs A/AB/B1 HR 2.76, 95% CI 1.25–6.21), Masaoka Stage (stage III/IV vs I/II HR 2.74, 95% CI 2.12–3.55,) were the poor prognostic factors.Conclusions:For patients with TETs after surgical resection, advanced age, incomplete resection, WHO classification B2/B3, and higher Masaoka stage are risk factors for poor prognosis.

Clinicopathological Pattern of Gynecological Malignancies at Tertiary Care Teaching Hospital

Objective: To view current clinicopathological pattern of gynecological malignancies at a tertiary care hospital in Karachi.&#x0D; Methods: This is a retrospective research performed in the department of obstetrics and gynecology unit 1 from January 2020 to December 2021. All cases of gynecological malignancies irrespective of age, race and cast were included for study. Around 164 cases with clinical or radiological diagnosis of malignancy were admitted for gynecological malignancy work up. Out of them 42 were confirmed on histopathology of biopsy or resected specimen. Patients with gestational trophoblastic disease and metastatic malignancies from another primary site were excluded. Data of these confirmed 42 cases fulfilling exclusion and inclusion criteria was included for study. Relevant data on pre-designed Performa was tabulated and histopathology according to WHO histological classification system.&#x0D; Results: Out of 164 cases of suspected gynecological malignancy 42 histopathological confirmed cases were selected for study. Frequency of gynecological malignancies out of 885 gynecological ad- mission is 4.7%. Ovarian cancers were commonest gynecological malignancy (54.7%), followed by cervical cancer (19.04%), uterine cancer (16.66%), and vulvar /vaginal cancers (9.5%). In ovarian can- cers epithelial cancers were (86.9%) and (13.04%) were non-epithelial. In epithelial (65%) serous, (15%) mucinous and (20%) were other less common types. In non-epithelial were dysgerminoma (66.66%) and (33.33) sex cord stromal cancers. In cervical (100%) were squamous cell carcinoma. In uterine (85.7%) were adenocarcinoma and (14.28%) were leiomyosarcoma. In vaginal cancers (50%) squamous cell carcinoma and (50%) was melanoma. In vulvar cancers all (100%) were squamous cell carcinoma.&#x0D; Conclusion: Ovarian cancer is commonest gynecological malignancy in our study. Common age group, parity, clinical presentation and histopathology is comparable with studies. Majority of cases came late in advanced stage of disease.

Explanted malignancies after lung transplantation: the University of Michigan experience

The management of patients with an explanted malignancy after lung transplantation is not well understood. We reviewed our institutional experience and outcomes at a single academic medical centre between December 1997 and April 2021 for patients with malignancies of all histologic types identified on explant pathology. Primary lung cancers were reclassified using the 8th Edition TNM staging and the 2021 World Health Organization histologic classification of lung cancers. Of the 733 patients undergoing lung transplantation, 15 (2.05%) were found to have malignancy on the explanted lungs, including 6 (0.82%) primary lung cancers. Four patients were found to have early-stage lung cancers, while 2 patients had advanced-stage IV disease. Survival ranged from 0 to 109 months for the entire cohort with median 23.2 [49.9] months in those with primary lung cancers. There were 2 recurrences following explanted stage I (15 months) and stage IV (53 months) diseases. Other explant pathologies included carcinoid tumourlets in 6 patients, lymphoma in 2 and metastatic leiomyosarcoma in 1. In conclusion, explanted lung malignancies are an infrequent but significant finding on explant pathology. Further data are needed to better characterize and stratify this patient cohort.

The Studies of Prognostic Factors and the Genetic Polymorphism of Methylenetetrahydrofolate Reductase C667T in Thymic Epithelial Tumors.

ObjectiveTo describe the clinical features of a cohort of patients with thymic epithelial tumors (TETs) and to analyze their prognostic factors. In particular, we investigated the correlation between the genetic polymorphism of methylenetetrahydrofolate reductase (MTHFR) C667T and the incidence of TETs.MethodsPathological records were reviewed from the database of the Second Affiliated Hospital of Jiaxing University, from January 2010 to December 2020, and 84 patients with TETs were recruited for this study. Univariate and multivariate analyses were performed to determine the prognostic factors. The genetic polymorphism of MTHFR C667T was examined in the patients with TETs and in a group of healthy individuals. The correlation between MTHFR transcriptional levels and methylation was analyzed using The Cancer Genome Atlas (TCGA) thymoma dataset from the cBioPortal platform.ResultsKaplan–Meier univariate survival analysis showed that sex, age, the maximum tumor diameter, surgery, chemotherapy, radiotherapy, WHO histological classification, Masaoka–Koga stage, and 8th UICC/AJCC TNM staging, were statistically significantly correlated with the prognosis of patients with TETs. The Masaoka–Koga stage and 8th UICC/AJCC TNM staging were strongly correlated with each other in this study (r=0.925, P<0.001). Cox multivariate survival analysis showed that the maximum tumor diameter, Masaoka–Koga stage, and 8th UICC/AJCC TNM staging were independent prognostic factors affecting the overall survival (OS) of patients with TETs (P<0.05). The MTHFR C667T genotype (χ 2 = 7.987, P=0.018) and allele distribution (χ 2 = 5.750, P=0.016) were significantly different between the patients and healthy controls. CT heterozygous and TT homozygous genotypes at this MTHFR polymorphism significantly increased the risk of TETs (odds ratio [OR] =4.721, P=0.008). Kaplan–Meier univariate survival analysis showed that there was no correlation between different genotypes and the prognosis of TETs (CC versus CT + TT, χ2 = 0.003, P=0.959). Finally, a negative correlation between the transcriptional and methylation levels of MTHFR was observed in the TCGA thymoma dataset (r=-0.24, P=0.010).ConclusionsThe Masaoka–Koga stage, 8th UICC/AJCC TNM staging, and maximum tumor diameter were independent prognostic factors for TETs. Reduced methylation levels of MTHFR and particular polymorphic variants may contribute to the susceptibility to developing TETs.

P-227 Overexpression of survivin-1, TAG-72 and HERC5 in patients diagnosed with hepatocellular carcinoma in the Black Sea Coast geographical area

Epidemiological data regarding hepatocellular carcinoma (HCC) report unsatisfactory morbimortality rates despite the global efforts to decrease the incidence and prolong patient survival. Current guidelines lack diagnostic biomarkers to better characterize patients with HCC. We aimed to validate the overexpression of Survivin-1, tumor-associated glyocoprotein 72 (Tag-72), and HECT and RLD domain containing E3 ubiquitin protein ligase 5 (HERC5) as tissue biomarkers for HCC characterization in patients from our geographical area and to standardize a local biomarker panel to be introduced in the current management guideline. Thirty liver specimens of HCC and a similar number of liver tissue specimens of benign liver tumors were selected from the Gastroenterology file database and Pathology Clinic registries from St. Apostle Andrew Emergency Clinical Hospital, Constanta and Fundeni Institute, Bucharest and compared in terms of Survivin-1, Tag-72, and HERC5 overexpression. The morphological features of the tumors were noted based on the WHO Histological Classification for digestive tumors. Demographic data of all patients providing the liver specimens, as well as liver diseases background like chronic viral infections, other co-morbidities and laboratory parameters recorded at the time of hospital admission were noted. For the IHC assessment, the representative samples were chosen, and 4-μm sections of formalin-fixed, paraffin-embedded tissue blocks were obtained for each case enrolled. Epitope retrieval was conducted prior to incubation of tissue sections with a panel of three primary antibodies (ready-to-use) from Novus Biological: survivin-1 (NB100-911 clone), Tag-72 (CC49 clone), and HERC5 (NBP-91985 clone). The immunostaining protocol for each antibody used was provided by the manufacturer. As chromogen, we used 3,3'diaminobenzidine (DAB), and brown staining was obtained. The final step was represented by counterstaining all slides with Mayer's Hematoxylin. Comparisons of the studied biomarker overexpression from HCC tissue samples with a matched non-HCC group of normal liver tissue specimens were made.Student t-test, Mann-Whitney U-test and Chi-square test were used to find differences between the two studied groups and to compare the categorical variables. The discriminative power of Survivin -1, Tag-72, and HERC5 overexpression was assessed using ROC curves. The multivariate linear regression analysis revealed that Survivin-1, Tag-72, and HERC5 were significantly overexpressed upon IHC analysis in HCC samples in patients older than 50 years (P=0.003, P=0.006, P=0.004), male gender (P=0.031, P=0.004, P=0.020), patients with increased AFP over 180 ng/dl (P=0.012, P=0.004, P=0.029), with low serum albumin < 3 mg/dl (P=0.031, P=0.021, P=0.003, respectively), with imaging features of portal thrombosis (P=0.004, P=0.020, P=0.004, respectively), ascites (P=0.002, P=0.004, P=0.019, respectively) and in BCLC B and C classes patients (P=0.045, P=0.036, P=0.045, and P=0.033, P=0.001, P=0.027, respectively). The diagnostic performance of Survivin-1, Tag-72 and HER-C5 tissue biomarkers for HCC characterization was superior to that of AFP, considered the gold standard biomarker used in clinical guidelines (Survivin-1: Z statistic=2.911, P=0.0039; Tag-72: Z statistic=2.789, P=0.0049, respectively; HERC5: Z statistic=2.844, P=0.0043) and AFP assay alone (Z statistic=5.022, P < 0.0001). Our study results validate the overexpression of Survivin-1, Tag-72, and HERC5 as tissue biomarkers for HCC characterization in patients from our geographical region and could be standardized in the current HCC management guideline.

THYROID-LIKE FOLLICULAR CARCINOMA OF THE KIDNEY IN A CHRONIC DIALYSIS PATIENT: ONE CASE REPORT AND REVIEW OF THE LITERATURE

Thyroid-like follicular carcinoma of the kidney (TLFCK) is an extremely rare subtype of renal cell carcinoma (RCC) that histologically mimics primary follicular carcinoma of the thyroid gland. This new entity has not yet been integrated into the current WHO classification of renal tumors due to the limited data available. We report a further case of this rare histological entity, discuss the clinical, histological and immunohistochemical findings and provide an update on the review of the literature. A 73-year-old woman was found to have a left renal mass during her annual medical checkup. Her past medical history included high blood pressure and renal failure at hemodialysis stage. The patient underwent a nephrectomy with simple postoperative course. The tumor was described as being round, well circumscribed and dark brown in color. Histologically, the tumor showed follicular architecture with macro and micro follicles containing eosinophilic secretions or colloid-like material. Immunohistochemical studies demonstrated that the tumor cells exhibited no immunoreactivity for thyroid transcription factor-1 and thyroglobulin. The tumor cells showed intensive staining for cytokeratin 7 (CK7). The tumor cells were completely negative for CK20, WT1 and PAX8. Molecular biology was not carried out for lack of means. These findings are dissimilar to previously classified renal neoplasm. Thyroid-like follicular renal cell carcinoma represents a unique histologic subtype of renal cell carcinoma of low malignant potential and its primary importance is to distinguish it from metastatic carcinoma from the thyroid. A correct histopathologic diagnosis has important clinical and therapeutic implications. The current consensus from ISUP is not to recommend TLFCK as a new WHO histologic classification due to the small number of cases therefore, documentation of all cases available seems to be important to gain additional knowledge.

Inflammatory myofibroblastic liver tumor

Inflammatory myofibroblastic tumors (inflammatory myofibroblastic tumors) IMT in the clinical practice of an oncologist are very rare diagnostic findings. Currently, the bulk of scientific publications about IMT are devoted to reviews of clinical cases. If initially IMT were considered as pseudo-tumors, now they are classified as intermediate fibroblastic/myofibroblastic tumors according to the WHO histological classification. Management of patients with hepatic IMT are debatable today. Hepatic IMT are mostly benign lesions and characterized by spontaneous regression without any treatment. However, sometimes therapeutic and surgical treatment of these lesions is necessary. Many authors recommend surgical treatment, as with conservative treatment, some patients develop relapses. This rare observation demonstrates our experience of liver resection for inflammatory myofibroblastic liver tumor in 76 year-old patient.

Pathological Features and Prognosis of Thymoma With or Without Myasthenia Gravis.

IntroductionTo evaluate the different pathological and clinical characters of thymoma with and without myasthenia gravis (MG) and to determine whether the presence of MG influences the prognosis in patients with thymoma.MethodsFour hundred and twenty-five consecutive patients operated was analyzed. A median sternotomy was used in 189 cases, and video-assisted thoracoscopic thymectomy was used in 236 cases. These patients with thymoma were subdivided into two groups: thymoma with myasthenia gravis MG (n = 220) and thymoma without MG (n = 205). All thymic epithelial tumors were classified according to the WHO histologic classification and the Masaoka clinical staging system. The result was evaluated according to the Myasthenia Gravis Foundation of America's criterion. The clinical features of the 2 test were compared between the two groups, and the survival analysis of Cox treatment effects was compared between the two groups.ResultsThere were no perioperative deaths. The proportions of type A and thymic carcinoma were 0% in the group with MG and 10.7% (22/205) and 11.2% (23/205), respectively, in the group without MG. Thymic hyperplasia around the thymoma was 29.1% (64/220) in patients with MG and only 6.3% (13/205) in patients without MG (χ2 = 23.63, P = 0.000). The overall survival curve showed that the 5- and 10-year survival rates in the group without MG were 89.2 and 77.4%, respectively, while those in the MG group were 91.1 and 80.5%.ConclusionsThe existence of MG has little influence on the prognosis of thymomas, but it is suitable for early diagnosis and treatment. Extended thymectomy should be performed on all patients with thymoma, whether they have MG or not.

Unusual Histology in Mesothelioma: A Report of Two Cases with a Brief Review.

Mesothelioma is often difficult to diagnose due to its rarity and its unusual histopathological features that could lend to diagnostic pitfalls and misdiagnosis. The WHO histological classification of pleural tumors in 2021 recommended a pathologic grading system for malignant pleural mesothelioma. Architectural aspects and cytological features, with nuclear grading, bent on a neoplastic score with fundamental prognostic and diagnostic value. Unusual features must be correctly assigned in the grading system to avoid misdiagnosis, especially toward metastatic lesions or reactive pleural processes. In this paper, we present two cases as examples of unusual morphological and architectural features with a brief literature review.

Thymectomy with angioplasty through a thoracoscopic subxiphoid approach with double elevation of the sternum in Masaoka stage III thymoma.

Thymectomy with angioplasty through a thoracoscopic subxiphoid approach with double elevation of the sternum in Masaoka stage III thymoma.