The WHO 2022 Classification of Renal Neoplasms (5th Edition): Salient Updates.

The first categorization for renal tumours was made by the WHO in 1981 and included only renal cell carcinoma (RCC). After that, classification was continuously altered over five decades. The WHO 2022 Classification of Urinary and Male Genital Tumours 2022 (5th edition) is molecular-driven and contains major revisions compared to the earlier classification from 2016. This revised edition divided renal tumours into four major broad categories: clear cell renal tumours, papillary renal cell tumours, oncocytic and chromophobe renal tumours, and collecting duct tumours. 'Other renal tumours' and 'molecularly defined renal carcinomas' are two other categories that were also included. Transcription factor binding to IGHM enhancer 3 (TFE3)-rearranged, TFEB-altered, elongin C (ELOC)-mutated (formerly TCEB1)-mutated, fumarate hydratase (FH)-deficient, succinate dehydrogenase (SDH)-deficient, anaplastic lymphoma kinase (ALK)-rearranged, and SWI/SNF-related matrix-associated actin-dependent regulator of chromatin subfamily B member 1 (SMARCB1)-deficient renal cell carcinomas are molecularly defined entities. Eosinophilic vacuolated tumours and low-grade oncocytic tumours are classified as emerging entities. Molecularly characterized renal tumours include those with SMARCB1 deficiencies, TFE3 rearrangements, TFEB alterations, ALK rearrangements, ELOC mutations, etc. Thyroid-like follicular carcinoma, eosinophilic vacuolated tumour, and low-grade oncocytic tumour are a few emerging entities of renal tumours. Improved therapy targets for each kidney tumour can be achieved using immunohistochemistry (IHC) and molecular definition updates. This study aims to highlight new developments in the WHO 2022 categorization of renal tumours with regard to diagnostic, morphological, molecular, IHC, clinical, and prognostic updates.

Dermatological Enigma Unveiled: A Rare Case Report on Dowling-Degos Disease.

Dowling-Degos disease (DDD) is an extremely rare hereditary skin condition characterized by the development of painless, small-sized pigmented patches known as macules or keratotic papules. Typically inherited in an autosomal dominant manner, DDD primarily manifests in adulthood, with onset occurring between the ages of 30 and 40 years, and a higher prevalence among females. Although DDD shares clinical similarities with other reticulated pigmentary disorders such as dyschromatosis symmetrica hereditaria, dyschromatosis universalis hereditaria, and reticulate acropigmentation of Kitamura, its distinctive histopathological features set it apart. A 50-year-old female patient presented with hyperpigmented lesions since infancy, predominantly located in flexural areas, prompting consideration of endogenous eczema or DDD. Despite the absence of a family history and normal laboratory test results, a biopsy confirmed the diagnosis based on characteristic histological findings. The identification of DDD underscores the importance of considering rare dermatological entities in differential diagnosis, especially when clinical presentation aligns with established criteria. Further research and awareness are essential for enhancing our understanding and management of this intriguing skin condition.

Lupus Miliaris Disseminatus Faciei: A Report of a Rare Case and Its Differential Diagnosis.

Lupus miliaris disseminatus faciei (LMDF), often known as "acne agminata," is an uncommon illness that causes facial papules. Clinically, it has monomorphic reddish-brown, dome-shaped central papules with periorbital location. Histopathologically, a cutaneous granulomatous response is common around hair follicles and is accompanied by central necrosis. In the dermatology outpatient clinic, a 51-year-old woman had many tiny papules on her right side malar area for one to two months. Few of them started to regress and demonstrated healing with superficial scarring. The pathology showed a granulomatous response on microscopy, and histology and clinical correlation confirmed the case as Lupus miliaris disseminatus faciei. LMDF must be distinguished from tuberculous granuloma, granulomatous rosacea, and perioral dermatitis. The patient was prescribed systemic dapsone and topical tacrolimus therapy, and the lesion improved at the follow-up visit.

WHO 2022 updates on follicular cell and c-cell derived thyroid neoplasm.

The latest edition of the WHO Classification of thyroid tumors was released in 2022 and incorporates novel concepts vital to patient management. Thyroid follicular nodular disease is a term used to collectively represent a wide variety of benign and non-neoplastic lesions, including both clonal and non-clonal proliferations that manifest clinically as multinodular goiter. Thyroid neoplasms develop from follicular cells and can be either benign, low-risk, or malignant. To avoid classifying all lesions under 1 cm in diameter as low-risk illnesses, the new classification method highlights the need for subtyping papillary thyroid cancer based on histomorphologic indicators rather than tumor size. Formerly known as the cribriform-morular variety of papillary thyroid carcinoma, this tumor is now more commonly referred to by its more accurate name, cribriform-morular thyroid carcinoma. Its histogenesis is unknown. Similar to the traditional definition of 'poorly differentiated thyroid carcinoma' according to the Turin criteria, the newly defined 'differentiated high-grade thyroid carcinoma' encompasses papillary thyroid cancer, follicular thyroid carcinomas, and oncocytic carcinomas with high-grade characteristics linked to worse prognosis. The squamous cell subtype of anaplastic thyroid cancer has also recently been characterized as a distinct morphologic pattern. In this article, we will discuss the latest revision to the World Health Organization's classification system for thyroid cancer.

Perineural Invasion (PNI) Definition, Histopathological Parameters of PNI in Oral Squamous Cell Carcinoma With Molecular Insight and Prognostic Significance.

Oral squamous cell carcinoma is associated with severe morbidity, recurrence of tumor, and reduced survival rate despite advances in treatment. Perineural invasion (PNI) is associated with neurotropic malignancy. PNI is due to the tropism of cancer cells toward nerve bundles in tissue. The aim of this literature review is to study the definition, patterns of PNI, Prognostic and therapeutic significance, and mechanism of PNI along with a molecular insight into oral cavity squamous cell carcinoma. Liebig type A pattern defines PNI as the presence of tumor cells within the peripheral nerve sheath & infiltration into the epineurium, perineurium, or endoneurium. Liebig type B pattern defines PNI as a tumor encircling at least 33% of a nerve. Few studies demonstrated an association between PNI and cervical metastasis which indicate poor prognosis. A higher level of expression of nerve growth factor and tyrosine kinase is associated with PNI in OSCC which can be considered as a biomarker of PNI. PNI needs to be studied in detail as it is associated with the aggressiveness of the tumor and decreased survival.

Histopathology spectrum of skin lesions in teaching institution.

Introduction: The skin has many functions and is a complex organ. Epidermis with skin adnexa, melanocytic system, dermis and subcutis are three main anatomic components of skin. Skin diseases are common in developing countries, prevalent among all age groups and up to 2000 skin diseases are known until now. Skin diseases show many different geographical patterns which range from simple vesicular non-neoplastic lesion to fatal neoplastic lesion. Histopathological examination of skin biopsy is necessary for accurate diagnosis, to identify etiological agents and to guide dermatologist or clinician for deciding appropriate management. Aim and Objectives: Present study was carried out to understand prevalence and spectrum of various skin lesion in correlation with age, sex and site of involvement at tertiary care hospital and so to educate community and physicians accordingly after study results. Material and Methods: Study Design: Non-interventional, cross-sectional, retrospective study was carried out on all skin biopsies at department of pathology, government medical college Bhavnagar, Gujarat, irrespective of age, sex and clinical diagnosis for Study Duration: from January 2017 to January 2020 for three years. Results: Out of 610 biopsies, Seborrheic keratosis, Leprosy and Basal cell carcinoma were commonly observed non-neoplastic, infective and neoplastic skin lesions, respectively. In our study, most common involved age group is >60 years and male preponderance. Conclusion: Leprosy and Basal cell carcinoma were most commonly observed infective and neoplastic skin lesion in our study respectively. Therefore, community should be educated to prevent airborne droplet transmission and repeated unprotected ultraviolet light sun exposure to reduce the prevalence of both these diseases. We suggest such type of study in different geographical area to plan preventive strategy to reduce morbidity due to various skin lesion.

Autopsy study of spectrum of lung lesions in Tertiary care hospital.

BACKGROUND: Inflammation, Infections, occupational diseases and neoplastic lesions are common in lungs. In Autopsy internal organs including lungs are studied to decide cause of death and figure out prevalence of various lung lesions. So, prophylactic prevention plan can be prepared for prevention of various lung lesions induced mortality and reducing need for invasive biopsy as well. AIM & OBJECTIVE: To find out frequency of various lung lesions in relation to age and sex and analyze histopathological spectrum of lung lesions. MATERIAL & METHODS: Non interventional, record based cross sectional, retrospective autopsy study was done on 139 cases of lung autopsy samples at department of pathology of tertiary care hospital, Bhavnagar, Gujarat for 2 years on samples received from January 2016 to January 2018. Lungs were fixed in 10% formalin & processed. Paraffin wax embedding was done & sections stained with H&E stain. Gross and microscopic examination of samples done and diagnosis was done. All findings were recorded and tabulated. CONCLUSION: Pneumonia is most common observed pathological lung lesion in our study which suggest that infections of lungs are common cause for mortality. Therefore, we suggest effective implementation of measures to prevent hospital acquired pneumonia may reduce mortality. Smoking was associated in nearly 70% patients. Autopsy study of such lung lesions can provide vision to plan preventive strategy to reduce mortality due to lung pathology.