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1.
Int J Surg Pathol ; 32(2): 230-238, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37170625

RESUMEN

Introduction. Small cell carcinoma can arise from various sites. Herein, we analyze the ability of 2 thyroid transcription factor-1 (TTF-1) antibodies (SPT24 and 8G7G3/1) to separate pulmonary from nonpulmonary small cell carcinoma. Materials and Methods. We analyzed 26 pulmonary and 83 nonpulmonary small cell carcinomas, and 14 Merkel cell carcinomas. Each tumor was stained with SPT24 and 8G7G3/1. Extent of nuclear staining was scored as diffuse (>50%), focal (11%-50%), rare (1%-10%), or negative (<1%). Results. All pulmonary small cell carcinomas were positive for SPT24 and 8G7G3/1. Four Merkel cell carcinomas (29%) were positive for SPT24 (ranging from rare-to-diffuse), while 2 (14%) showed rare expression with 8G7G3/1. For nonpulmonary small cell carcinomas, 69 (83%) were positive for SPT24 and 40 (48%) were positive for 8G7G3/1. For SPT24 positive tumors, the extent of 8G7G3/1 expression was equal in 17 (25%) and less in 52 tumors (75%), including 29 (42%) that were negative for 8G7G3/1. No nonpulmonary small cell carcinoma had more staining with 8G7G3/1 compared to SPT24. The differences in staining between 8G7G3/1 and SPT24 in the nonpulmonary cohort were statistically significant (P < 0.0001) with no significant difference between primary and metastatic lesions for 8G7G3/1 (P = 0.66) or SPT24 (P = 0.77). Conclusion. Most pulmonary small cell carcinomas are diffusely positive for both SPT24 and 8G7G3/1, whereas most nonpulmonary small cell carcinomas exhibit focal-to-no staining with 8G7G3/1 and significantly less staining with 8G7G3/1 compared to SPT24. However, these trends are not absolute and should be interpreted in conjunction with clinical and radiological findings.


Asunto(s)
Carcinoma de Células de Merkel , Carcinoma de Células Pequeñas , Neoplasias Cutáneas , Humanos , Carcinoma de Células Pequeñas/diagnóstico , Anticuerpos , Coloración y Etiquetado
2.
Int J Surg Pathol ; 31(8): 1458-1465, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36843539

RESUMEN

Gastric mucosal biopsies and resections from patients treated with neoadjuvant radiation and/or chemotherapy are frequently encountered. These samples may show histologic features related to therapy including inflammation, ulceration, and epithelial atypia. In some cases, epithelial atypia may be marked, prompting the use of adjunct p53 immunohistochemistry. We examined p53 expression by immunohistochemistry in gastric mucosa following therapy.We evaluated the histology and p53 immunohistochemical expression in gastric mucosa from 57 resections and 3 mucosal biopsies, from 60 patients treated with radiation and/or chemotherapy for gastroesophageal carcinoma (n = 33) or pancreatic carcinoma (n = 27).We identified histomorphologic features of therapy-related epithelial changes in 50 of 60 cases (83%). Abnormal p53 expression was present at least focally in nearly half the cases (27 of 60 cases; 45%), all of which showed morphologic evidence of therapy-related epithelial changes. Neuroendocrine cell micronests were present in 37 of 60 cases (62%). Next-generation sequencing (NGS) of foci with therapy-related epithelial changes showing abnormal p53 expression and carcinoma from the same patient was attempted and yielded results in 1 patient. Interestingly, differing TP53 alterations in the patient's adenocarcinoma and in a histologically benign esophageal submucosal gland with therapy-related epithelial changes and abnormal p53 expression were identified.Our results demonstrate that abnormal p53 expression is relatively common in gastric mucosal samples following radiation and/or chemotherapy and suggest that p53 expression should be avoided when distinguishing therapy-related changes from dysplasia or carcinoma. Furthermore, our NGS results raise interesting biological questions, which may warrant further investigation.


Asunto(s)
Carcinoma , Neoplasias Esofágicas , Humanos , Proteína p53 Supresora de Tumor/metabolismo , Terapia Neoadyuvante , Biopsia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia
3.
Am J Clin Pathol ; 159(3): 263-273, 2023 03 13.
Artículo en Inglés | MEDLINE | ID: mdl-36702577

RESUMEN

OBJECTIVES: The range of histopathologic features of gastric syphilis is not well described. Here we describe the clinicopathologic findings of eight patients with syphilitic gastritis. METHODS: A search of our Pathology Data System (2003-2022) and multiple other institutions identified eight patients with syphilitic gastritis. Clinical information, pathology reports, and available slides were reviewed. RESULTS: Lesions predominated in middle-aged adults (mean age, 47.2 years; range, 23-61 years) with a propensity for men (n = 7). Three patients had a documented history of human immunodeficiency virus. Clinical presentations included weight loss, abdominal pain, hematochezia, fever, dyspepsia, nausea and vomiting, hematemesis, anemia, and early satiety. Endoscopic findings included ulcerations, erosions, abnormal mucosa, and nodularity. All specimens shared an active chronic gastritis pattern with intense lymphohistiocytic infiltrates, variable plasma cells, and gland loss. Prominent lymphoid aggregates were seen in four specimens. The diagnosis was confirmed either by immunostain for Treponema pallidum (n = 7) or by direct immunofluorescence staining and real-time polymerase chain reaction (n = 1). All patients with available follow-up data showed resolution of symptoms after antibiotic therapy (n = 4). CONCLUSIONS: Recognition of the histologic pattern of syphilitic gastritis facilitates timely treatment, prevents further transmission, and avoids unnecessarily aggressive treatment.


Asunto(s)
Gastritis , Sífilis , Adulto , Masculino , Persona de Mediana Edad , Humanos , Sífilis/diagnóstico , Gastritis/diagnóstico , Gastritis/patología , Treponema pallidum , Antibacterianos
4.
Arch Pathol Lab Med ; 147(4): 390-402, 2023 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-35609332

RESUMEN

CONTEXT.­: The most common benign hepatic mass-forming lesions often display fairly specific imaging characteristics, whereas less familiar, rarer benign neoplasms and pseudotumors may pose a diagnostic challenge in clinical, radiology, and pathology practice because of either their rarity or their unusual features. OBJECTIVE.­: To review a selection of pseudotumors and unusual benign hepatic neoplasms encountered in consultation practices with a focus on nonepithelial tumors. DATA SOURCES.­: Sources include English-language literature and personal experiences. CONCLUSIONS.­: Several benign conditions (namely, segmental atrophy, infections, immunoglobulin G4 [IgG4]-related sclerosing disease, angiomyolipoma, mesenchymal hamartoma, and various vascular lesions) can lead to formation of hepatic masses. Because of their rarity and underrecognition, such lesions are often diagnostically challenging. Awareness of hepatic pseudotumors and various rare hepatic neoplasms and their potential mimics can forestall misdiagnosis and inappropriate management.


Asunto(s)
Neoplasias Encefálicas , Hamartoma , Enfermedad Relacionada con Inmunoglobulina G4 , Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patología , Enfermedad Relacionada con Inmunoglobulina G4/patología , Neoplasias Encefálicas/diagnóstico , Hamartoma/diagnóstico , Hamartoma/patología , Diagnóstico Diferencial
5.
BMC Cancer ; 22(1): 987, 2022 Sep 16.
Artículo en Inglés | MEDLINE | ID: mdl-36114487

RESUMEN

BACKGROUND: Previous assessments of peritumoral inflammatory infiltrate in colorectal cancer (CRC) have focused on the role of CD8+ T lymphocytes. We sought to compare the prognostic value of CD8 with downstream indicators of active immune cell function, specifically granzyme B (GZMB) and CD68 in the tumour microenvironment. METHODS: Immunohistochemical (IHC) staining was performed for CD8, GZMB, CD68 and CD163 on next-generation tissue microarrays (ngTMAs) in a primary cohort (n = 107) and a TNM stage II validation cohort (n = 151). Using digital image analysis, frequency of distinct immune cell types was calculated for tumour proximity (TP) zones with varying radii (10 µm-100 µm) around tumour cells. RESULTS: Associations notably of advanced TNM stage were observed for low density of CD8 (p = 0.002), GZMB (p < 0.001), CD68 (p = 0.034) and CD163 (p = 0.011) in the primary cohort. In the validation cohort only low GZMB (p = 0.036) was associated with pT4 stage. Survival analysis showed strongest prognostic effects in the TP25µm zone at the tumour centre for CD8, GZMB and CD68 (all p < 0.001) in the primary cohort and for CD8 (p = 0.072), GZMB (p = 0.035) and CD68 (p = 0.004) in the validation cohort with inferior prognostic effects observed at the tumour invasive margin. In a multivariate survival analysis, joint analysis of GZMB and CD68 was similarly prognostic to CD8 in the primary cohort (p = 0.007 vs. p = 0.002) and superior to CD8 in the validation cohort (p = 0.005 vs. p = 0.142). CONCLUSION: Combined high expression of GZMB and CD68 within 25 µm to tumour cells is an independent prognostic factor in CRC and of superior prognostic value to the well-established CD8 in TNM stage II cancers. Thus, assessment of antitumoral effect should consider the quality of immune activation in peritumoral inflammatory cells and their actual proximity to tumour cells.


Asunto(s)
Neoplasias Colorrectales , Linfocitos T CD8-positivos , Recuento de Células , Neoplasias Colorrectales/patología , Granzimas , Humanos , Pronóstico , Microambiente Tumoral
6.
Front Physiol ; 13: 923917, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35634156

RESUMEN

[This corrects the article DOI: 10.3389/fphys.2022.856803.].

8.
Front Physiol ; 13: 856803, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35309060

RESUMEN

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest types of cancer worldwide. There are many reasons for this dismal prognosis, including the advanced stage at the time of diagnosis and the lack of effective therapeutic approaches. Intraductal papillary mucinous neoplasms (IPMNs) represent detectable and treatable precursor lesions of PDAC. Our understanding of the pathology of IPMNs has evolved over the past few decades, and new advances in diagnostic tools have emerged. The new World Health Organization (WHO) classification scheme now recognizes the previously considered variants of IPMNs, such as intraductal oncocytic papillary neoplasms (IOPNs) and intraductal tubulopapillary neoplasms (ITPNs), as distinct neoplasms. New imaging and molecular diagnostic tests are being developed to recognize these PDAC precursor lesions better. Here, we review the advances in diagnostic tools for IPMNs, IOPNs, and ITPNs, emphasizing the new (5th edition, 2019) WHO classification for pathological diagnosis, molecular markers, new laboratory tests, and imaging tools.

9.
Exp Clin Transplant ; 20(4): 429-432, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34981707

RESUMEN

Although liver transplant is a life-saving measure for individuals with end-stage liver disease, the perioperative management may be challenging in individuals with concomitant sickle cell disease. We report a case of a 50-year-old man with sickle cell disease genotype SC (HbSC) and cirrhosis secondary to autoimmune hepatitis who underwent liver transplant. His postoperative course included upper extremity deep vein thrombosis, pulmonary embolus, stroke via a patent foramen ovale after a line removal, and posterior reversible encephalopathy syndrome. Fortunately, he is alive with a functioning graft at 10 months after liver transplant. This case highlights the feasibility of liver transplant in sickle cell disease given the support of meticulous multidisciplinary care and the unique aspects of autoimmune hepatitis and sickle cell disease for liver transplant consideration.


Asunto(s)
Enfermedad de la Hemoglobina SC , Hepatitis Autoinmune , Trasplante de Hígado , Síndrome de Leucoencefalopatía Posterior , Hepatitis Autoinmune/complicaciones , Hepatitis Autoinmune/diagnóstico , Hepatitis Autoinmune/cirugía , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
10.
Am J Surg Pathol ; 46(2): 200-212, 2022 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-34411028

RESUMEN

Venous invasion (VI) is a powerful yet underreported prognostic factor in colorectal cancer (CRC). Its detection can be improved with an elastin stain. We evaluated the impact of routine elastin staining on VI detection in resected CRC and its relationship with oncologic outcomes. Pathology reports from the year before (n=145) and the year following (n=128) the implementation of routine elastin staining at our institution were reviewed for established prognostic factors, including VI. A second review, using elastin stains, documented the presence/absence, location, number, and size of VI foci. The relationship between VI and oncologic outcomes was evaluated for original and review assessments. VI detection rates increased from 21% to 45% following implementation of routine elastin staining (odds ratio [OR]=3.1; 95% confidence interval [CI]: 1.8-5.3; P<0.0001). The second review revealed a lower VI miss rate postimplementation than preimplementation (22% vs. 48%, respectively; P=0.007); this difference was even greater for extramural VI-positive cases (9% vs. 38%, respectively; P=0.0003). Missed VI cases postimplementation had fewer VI foci per missed case (P=0.02) and a trend towards less extramural VI than those missed preimplementation. VI assessed with an elastin stain was significantly associated with recurrence-free survival (P=0.003), and cancer-specific survival (P=0.01) in contrast to VI assessed on hematoxylin and eosin alone (P=0.053 and 0.1, respectively). The association between VI and hematogenous metastasis was far stronger for elastin-detected VI (OR=11.5; 95% CI: 3.4-37.1; P<0.0001) than for hematoxylin and eosin-detected VI (OR=3.7; 95% CI: 1.4-9.9; P=0.01). Routine elastin staining enhances VI detection and its ability to stratify risk in CRC and should be considered for evaluation of CRC resection specimens.


Asunto(s)
Neoplasias Colorrectales/química , Elastina/análisis , Venas/química , Adulto , Anciano , Anciano de 80 o más Años , Compuestos Azo , Biomarcadores de Tumor , Biopsia , Colectomía , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Colorantes , Eosina Amarillenta-(YS) , Femenino , Humanos , Masculino , Verde de Metilo , Persona de Mediana Edad , Invasividad Neoplásica , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Coloración y Etiquetado , Resultado del Tratamiento , Venas/patología , Adulto Joven
11.
Pathology ; 54(2): 184-194, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34645567

RESUMEN

A host of human papillomavirus (HPV)-associated squamous and glandular lesions may be identified in the anal canal in men and women. Given their relative rarity, familiarity with the morphological spectrum associated with HPV-driven anal neoplasia is important for proper identification and diagnosis. In this article, we review the classification and basic histopathological features of HPV-related squamous intraepithelial and invasive lesions as well as associated pitfalls. In addition, we provide an update on recently described HPV-driven, non-squamous tumours. As our experience with these lesions evolves, we expect the histological spectrum to further expand, particularly as it relates to non-squamous HPV-driven neoplasia.


Asunto(s)
Alphapapillomavirus , Neoplasias del Ano/patología , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/virología , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/patología , Canal Anal/anatomía & histología , Canal Anal/patología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/virología , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Humanos
12.
J Pers Med ; 11(8)2021 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-34442393

RESUMEN

INTRODUCTION: LAG-3 is an inhibitory immune checkpoint molecule that suppresses T cell activation and inflammatory cytokine secretion. T cell density in the tumor microenvironment of colon cancer plays an important role in the host's immunosurveillance. We therefore hypothesized that LAG-3 expression on tumor-infiltrating lymphocytes (TILs) predicts outcome in patients with stage II colon cancer. PATIENTS AND METHODS: Immunohistochemical staining for LAG-3 was performed on tissue microarrays (TMAs) of formalin-fixed paraffin-embedded tissue from 142 stage II colon cancer patients. LAG-3 expression was assessed in TILs within both the tumor front and tumor center and scored as either positive or negative. The primary endpoint was disease-free survival (DFS). RESULTS: In patients diagnosed with stage II colon cancer, the presence of LAG-3 expression on TILs was significantly associated with better 5-year DFS (HR 0.34, 95% CI 0.14-0.80, p = 0.009). The effect on DFS was mainly due to LAG-3-positive TILs in the tumor front (HR 0.33, 95% CI 0.13-0.82, p = 0.012). CONCLUSION: Assessment of LAG-3 might help to predict outcomes in patients with stage II colon cancer and potentially identify those patients who might benefit from adjuvant chemotherapy. Therefore, LAG-3 may serve as a prognostic biomarker in stage II colon cancer.

13.
Clin Colorectal Cancer ; 20(3): 256-264, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34099382

RESUMEN

BACKGROUND: Tumor budding (TB) is an adverse prognostic factor in colorectal cancer (CRC). International consensus on a standardized assessment method has led to its wider reporting. However, uncertainty regarding its clinical value persists. This study aimed to (1) confirm the prognostic significance of TB, particularly in stage II CRC; (2) to determine optimum thresholds for TB risk grouping; and (3) to determine whether TB influences responsiveness to chemotherapy. METHODS: TB was assessed in CRC sections from 1575 QUASAR trial patients randomized between adjuvant chemotherapy and observation. Optimal risk group cutoffs were determined by maximum likelihood methods, with their influence on recurrence and mortality investigated in stratified log-rank analyses on exploratory (n = 504), hypothesis-testing (n = 478), and final (n = 593) data sets. RESULTS: The optimal threshold for high-grade TB (HGTB) was ≥ 10 buds per 1.23 mm2. High-grade TB tumors had significantly worse outcomes than those with lower TB: 10-year recurrence 36% versus 22% (risk ratio, 2.00 [95% CI, 1.62-2.45]; 2P < .0001) and 10-year mortality 50% vs. 37% (risk ratio, 1.53 [95% CI, 1.34-1.76]; 2P < .0001). The prognostic significance remained equally strong after allowance for other pathological risk factors, including stage, grade, lymphovascular invasion, and mismatch repair status. There was a nonsignificant trend toward increasing chemotherapy efficacy with increasing bud counts. CONCLUSIONS: TB is a strong independent predictor of recurrence. Chemotherapy efficacy is comparable in patients with higher and lower TB; hence, absolute reductions in recurrence and death with chemotherapy should be about twice as large in patients with ≥ 10 than < 10 TB counts.


Asunto(s)
Neoplasias Colorrectales , Quimioterapia Adyuvante , Neoplasias Colorrectales/tratamiento farmacológico , Neoplasias Colorrectales/patología , Humanos , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos
14.
Langenbecks Arch Surg ; 406(8): 2643-2655, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34047827

RESUMEN

BACKGROUND: Intraductal papillary mucinous neoplasms (IPMNs) represent a unique opportunity to treat and prevent a curable neoplasm before it has the chance to progress to incurable cancer. This prospect, however, has to be balanced with the real risk of over treating patients with lesions that would, in fact, never progress during the life of the patient. PURPOSE: Informed clinical decisions in the treatment of IPMNs are first and foremost based on a deep understanding of the pathology of these lesions. CONCLUSIONS: Here we review the pathology of IPMNs, with an emphasis on the clinical relevance of the important features that characterize these lesions.


Asunto(s)
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Carcinoma Ductal Pancreático/cirugía , Humanos
15.
Am J Surg Pathol ; 45(11): 1550-1560, 2021 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-33999553

RESUMEN

We report a novel NIPBL-NACC1 gene fusion in a rare primary hepatic neoplasm previously described as the "cholangioblastic variant of intrahepatic cholangiocarcinoma." The 2 index cases were identified within our consultation files as morphologically distinctive primary hepatic neoplasms in a 24-year-old female and a 54-year-old male. The neoplasms each demonstrated varied architecture, including trabecular, organoid, microcystic/follicular, and infiltrative glandular patterns, and biphasic cytology with large, polygonal eosinophilic cells and smaller basophilic cells. The neoplasms had a distinctive immunoprofile characterized by diffuse labeling for inhibin, and patchy labeling for neuroendocrine markers (chromogranin and synaptophysin) and biliary marker cytokeratin 19. RNA sequencing of both cases demonstrated an identical fusion of NIBPL exon 8 to NACC1 exon 2, which was further confirmed by break-apart fluorescence in situ hybridization assay for each gene. Review of a tissue microarray including 123 cases originally diagnosed as well-differentiated neuroendocrine neoplasm at one of our hospitals resulted in identification of a third case with similar morphology and immunophenotype in a 52-year-old male, and break-apart fluorescence in situ hybridization probes confirmed rearrangement of both NIPBL and NACC1. Review of The Cancer Genome Atlas (TCGA) sequencing data and digital images from 36 intrahepatic cholangiocarcinomas (www.cbioportal.org) revealed one additional case with the same gene fusion and the same characteristic solid, trabecular, and follicular/microcystic architectures and biphasic cytology as seen in our genetically confirmed cases. The NIPBL-NACC1 fusion represents the third type of gene fusion identified in intrahepatic cholangiocarcinoma, and correlates with a distinctive morphology described herein.


Asunto(s)
Neoplasias de los Conductos Biliares/genética , Biomarcadores de Tumor/genética , Proteínas de Ciclo Celular/genética , Colangiocarcinoma/genética , Fusión Génica , Proteínas de Neoplasias/genética , Proteínas Represoras/genética , Neoplasias de los Conductos Biliares/patología , Neoplasias de los Conductos Biliares/cirugía , Colangiocarcinoma/patología , Colangiocarcinoma/cirugía , Femenino , Predisposición Genética a la Enfermedad , Hepatectomía , Humanos , Masculino , Persona de Mediana Edad , Fenotipo , Resultado del Tratamiento , Adulto Joven
16.
Histopathology ; 78(2): 276-280, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32705713

RESUMEN

AIMS: Paget's disease of the perianal skin is a rare form of extramammary Paget's disease, and may be a primary intraepithelial adnexal neoplasm or secondary due to spread from an underlying colorectal lesion, nearly always colorectal adenocarcinoma. Secondary perianal Paget's disease associated with non-invasive colorectal adenomas is exceedingly uncommon, with only a few reported cases. METHODS AND RESULTS: Herein, we present the clinical and pathological features of the largest series of secondary perianal Paget's disease arising in association with colorectal adenomas. There was gender parity and the median age was 72 years (range = 68-76 years). In all cases, perianal Paget's disease was associated with colorectal adenomas, including three (75%) conventional tubular adenomas and one (25%) tubulovillous adenoma with serrated foci. All adenomas had high-grade dysplasia and one had intramucosal adenocarcinoma (lamina propria invasion; Tis), but all lacked submucosal invasion. The intraepithelial Paget's cells showed a colorectal phenotype by immunohistochemistry in all cases. At follow-up, two patients had no evidence of disease at 6 and 87 months, one had residual perianal Paget's disease at 8 months and one developed invasive adenocarcinoma of the perianal tissue at 36 months. CONCLUSIONS: Similar to its mammary analogue, secondary perianal Paget's disease may arise in association with invasive and/or in-situ colorectal lesions. Although the latter is an uncommon presentation of a recognised rare disease, knowledge of this phenomenon is important to forestall overdiagnosis of invasion and potential overtreatment. The clinical course is variable, such that close follow-up is required.


Asunto(s)
Enfermedad de Paget Extramamaria , Adenocarcinoma/complicaciones , Adenocarcinoma/patología , Adenoma/complicaciones , Adenoma/patología , Anciano , Canal Anal/patología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/etiología , Neoplasias del Ano/patología , Neoplasias del Ano/secundario , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/patología , Femenino , Humanos , Inmunohistoquímica , Masculino , Enfermedad de Paget Extramamaria/diagnóstico , Enfermedad de Paget Extramamaria/etiología , Enfermedad de Paget Extramamaria/patología , Enfermedad de Paget Extramamaria/secundario
17.
Arch Pathol Lab Med ; 145(6): 664-677, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32233993

RESUMEN

CONTEXT.­: The 5th edition of the World Health Organization classification of digestive system tumors discusses several advancements and developments in understanding the etiology, pathogenesis, and diagnosis of several digestive tract tumors. OBJECTIVE.­: To provide a summary of the updates with a focus on neuroendocrine neoplasms, appendiceal tumors, and the molecular advances in tumors of the digestive system. DATA SOURCES.­: English literature and personal experiences. CONCLUSIONS.­: Some of the particularly important updates in the 5th edition are the alterations made in the classification of neuroendocrine neoplasms, understanding of pathogenesis of appendiceal tumors and their precursor lesions, and the expanded role of molecular pathology in establishing an accurate diagnosis or predicting prognosis and response to treatment.


Asunto(s)
Neoplasias del Apéndice/patología , Neoplasias del Sistema Digestivo/patología , Neoplasias Gastrointestinales/patología , Técnicas de Diagnóstico Molecular/métodos , Tumores Neuroendocrinos/patología , Neoplasias del Apéndice/genética , Apéndice/metabolismo , Apéndice/patología , Sistema Digestivo/metabolismo , Sistema Digestivo/patología , Neoplasias del Sistema Digestivo/clasificación , Neoplasias del Sistema Digestivo/genética , Neoplasias Gastrointestinales/genética , Genómica/métodos , Humanos , Tumores Neuroendocrinos/genética , Organización Mundial de la Salud
18.
Histopathology ; 78(3): 453-458, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32841414

RESUMEN

AIMS: Gastric dysplasia is a risk factor for synchronous and subsequent gastric carcinoma. Distinguishing gastric dysplasia from reactive changes is subject to interobserver disagreement and is a frequent reason for expert consultation. We previously used assessment of surface cell polarity (the 'four lines') as a key feature to decrease equivocal diagnoses in Barrett oesophagus. In the current study, we examined for the presence or absence of the four lines in gastric dysplasia and reactive gastropathy. MATERIALS AND METHODS: The study includes all (n = 91) in-house biopsies with at least gastric dysplasia from the surgical pathology archives of two academic institutions during a 5-year period from 2008 to 2012. A reactive gastropathy group (n = 60) was created for comparison. RESULTS: The dysplasia/neoplasia group was comprised of 14 biopsies of gastric foveolar-type dysplasia, 59 of intestinal-type dysplasia, 14 with dysplasia in fundic gland polyps, three pyloric gland adenomas and one oxyntic gland adenoma. Loss of surface cell polarity was seen in all 88 dysplasia cases with evaluable surface epithelium. All 57 reactive gastropathy cases with evaluable surface epithelium showed intact surface cell polarity except in focal areas directly adjacent to erosions in 17 cases, where the thin wisp of residual surface mucin could not be appreciated on haematoxylin and eosin. CONCLUSION: Surface cell polarity (the four lines) was lost in all gastric dysplasia biopsies with evaluable surface epithelium and maintained in all biopsies of reactive gastropathy. Caution should be taken in using this feature adjacent to erosions in reactive gastropathy.


Asunto(s)
Polaridad Celular , Mucosa Gástrica/patología , Adulto , Esófago de Barrett/diagnóstico , Esófago de Barrett/patología , Biopsia , Femenino , Gastritis/diagnóstico , Gastritis/patología , Humanos , Masculino , Persona de Mediana Edad , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/patología
19.
J Clin Pathol ; 74(3): 167-170, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32631943

RESUMEN

AIM: Blue nevus (BN) is a benign melanocytic proliferation that is typically cutaneous. Extracutaneous BN is infrequent and is reported in the mucosa of various organs. Gastrointestinal (GI) tract BN is rare. Here, we describe the clinicopathological findings of the largest series of GI tract BNs. METHODS: A search of our Pathology Data System (1984-2019) identified six GI tract blue nevi. Clinical information, pathology reports and available H&E-stained section slides were reviewed. RESULTS: Lesions predominated in the middle-aged adults (mean 54, range 27-80) with a slight female predominance (66%). Most cases arose in the rectum and colon (83%), with one gastric lesion (17%). Four cases were identified during endoscopic examination performed either for screening or for unrelated symptoms (66%). Two patients presented with rectal bleeding (33%) unassociated with the BN. Endoscopically, most lesions appeared as superficial hyperpigmented areas (83%). One case was described as abnormal mucosa (17%). Microscopically, the mucosa was involved in all of the cases (100%). One case showed submucosal extension in addition to the mucosal component (17%). Lesions showed a proliferation of bland spindle cells with abundant granular pigment. No nuclear atypia or mitoses were identified. Immunostains showed immunoreactivity for melanocytic markers. Follow-up information available for five patients showed no recurrences to date (mean follow-up 1 year). CONCLUSIONS: BN is a benign melanocytic proliferation. It is important to be aware of the occurrence of such lesions outside of the skin and consider the possibility of BN when pigmented lesions are encountered in the GI tract.


Asunto(s)
Enfermedades Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/diagnóstico , Nevo Azul/diagnóstico , Neoplasias Cutáneas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Proliferación Celular , Femenino , Enfermedades Gastrointestinales/patología , Neoplasias Gastrointestinales/patología , Tracto Gastrointestinal/patología , Humanos , Masculino , Melanocitos/patología , Persona de Mediana Edad , Membrana Mucosa/patología , Nevo Azul/patología , Neoplasias Cutáneas/patología
20.
Hum Pathol ; 106: 13-22, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-32991931

RESUMEN

Microscopic colitis (MC) is characterized by chronic watery diarrhea, endoscopically normal findings, and abnormal histology. While mostly encountered in adults, pediatric cases are rare and may show varying presentations. Our pathology data system was searched from 1984 to 2019 for patients ≤18 years of age with a lymphocytic colitis (LC) or collagenous colitis (CC) pattern of injury. Twenty-seven cases (23 LC and 4 CC) were retrieved. LC was more prevalent than CC (85% vs 15%, respectively) and affected slightly younger individuals (mean, 9.8 years versus 12.25 years). Immune dysregulation was documented in 11 (41%) patients. Most patients presented with watery diarrhea (n = 26, 96%) and either abdominal pain (n = 18, 67%), nausea/vomiting (n = 5, 19%), flatulence (n = 6, 22%), and/or weight loss (n = 1, 4%). A subset of patients (n = 10, 37%) demonstrated endoscopic abnormalities. Histologically, some patients with LC and CC displayed focal cryptitis or crypt abscess formation (n = 7, 26%) and focally increased crypt apoptosis (n = 9, 33%) in the absence of chronic injury. Clinical follow-up data were available for 23 (85%) patients with variable clinical responses recorded. Only 8 patients experienced complete symptom resolution. Twelve patients (11 LC and 1 CC) had subsequent biopsy material; of which, one developed histologic features of inflammatory bowel disease and another was found to have a CTLA-4 deficiency. Our study shows that pediatric patients with MC may have atypical clinical, histologic, and endoscopic findings and variable clinical responses. Underlying inflammatory and/or genetic conditions may be eventually unmasked, and genetic testing may be helpful in a small subset of patients.


Asunto(s)
Colitis Colagenosa/patología , Colitis Linfocítica/patología , Colon/patología , Adolescente , Factores de Edad , Biopsia , Antígeno CTLA-4/genética , Niño , Preescolar , Colitis Colagenosa/complicaciones , Colitis Colagenosa/inmunología , Colitis Linfocítica/complicaciones , Colitis Linfocítica/genética , Colitis Linfocítica/inmunología , Colon/inmunología , Colonoscopía , Análisis Mutacional de ADN , Bases de Datos Factuales , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Mutación , Pronóstico , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
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