A Robust Deep Learning Method with Uncertainty Estimation for the Pathological Classification of Renal Cell Carcinoma Based on CT Images.

This study developed and validated a deep learning-based diagnostic model with uncertainty estimation to aid radiologists in the preoperative differentiation of pathological subtypes of renal cell carcinoma (RCC) based on computed tomography (CT) images. Data from 668 consecutive patients with pathologically confirmed RCC were retrospectively collected from Center 1, and the model was trained using fivefold cross-validation to classify RCC subtypes into clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). An external validation with 78 patients from Center 2 was conducted to evaluate the performance of the model. In the fivefold cross-validation, the area under the receiver operating characteristic curve (AUC) for the classification of ccRCC, pRCC, and chRCC was 0.868 (95% CI, 0.826-0.923), 0.846 (95% CI, 0.812-0.886), and 0.839 (95% CI, 0.802-0.88), respectively. In the external validation set, the AUCs were 0.856 (95% CI, 0.838-0.882), 0.787 (95% CI, 0.757-0.818), and 0.793 (95% CI, 0.758-0.831) for ccRCC, pRCC, and chRCC, respectively. The model demonstrated robust performance in predicting the pathological subtypes of RCC, while the incorporated uncertainty emphasized the importance of understanding model confidence. The proposed approach, integrated with uncertainty estimation, offers clinicians a dual advantage: accurate RCC subtype predictions complemented by diagnostic confidence metrics, thereby promoting informed decision-making for patients with RCC.

FTO-mediated DSP m6A demethylation promotes an aggressive subtype of growth hormone-secreting pituitary neuroendocrine tumors.

BACKGROUND: Growth hormone-secreting pituitary neuroendocrine tumors can be pathologically classified into densely granulated (DGGH) and sparsely granulated types (SGGH). SGGH is more aggressive and associated with a poorer prognosis. While epigenetic regulation is vital in tumorigenesis and progression, the role of N6-methyladenosine (m6A) in aggressive behavior has yet to be elucidated. METHODS: We performed m6A-sequencing on tumor samples from 8 DGGH and 8 SGGH patients, complemented by a suite of assays including ELISA, immuno-histochemistry, -blotting and -fluorescence, qPCR, MeRIP, RIP, and RNA stability experiments, aiming to delineate the influence of m6A on tumor behavior. We further assessed the therapeutic potential of targeted drugs using cell cultures, organoid models, and animal studies. RESULTS: We discovered a significant reduction of m6A levels in SGGH compared to DGGH, with an elevated expression of fat mass and obesity-associated protein (FTO), an m6A demethylase, in SGGH subtype. Series of in vivo and in vitro experiments demonstrated that FTO inhibition in tumor cells robustly diminishes hypoxia resistance, attenuates growth hormone secretion, and augments responsiveness to octreotide. Mechanically, FTO-mediated m6A demethylation destabilizes desmoplakin (DSP) mRNA, mediated by the m6A reader FMR1, leading to prohibited desmosome integrity and enhanced tumor hypoxia tolerance. Targeting the FTO-DSP-SSTR2 axis curtailed growth hormone secretion, therefor sensitizing tumors to octreotide therapy. CONCLUSION: Our study reveals the critical role of FTO in the aggressive growth hormone-secreting pituitary neuroendocrine tumors subtype and suggests FTO may represent a new therapeutic target for refractory/persistent SGGH.

Laryngeal Neuroendocrine Neoplasms: Analysis of 11 Cases in a Single-Center Study.

Objective: Laryngeal neuroendocrine neoplasms (LNEN) are rare, and there have been previous uncertainties regarding their classification and treatment modalities. This article aims to share our treatment experience, elucidate changes in LNEN classification, and discuss the treatment implications of different types and stages. Methods: A retrospective analysis was conducted on 11 cases of LNEN treated through surgical intervention at the Department of Otolaryngology, Qilu Hospital of Shandong University, Qingdao, from January 2014 to November 2023. Among the 11 cases, there were 9 males and 2 females, with ages ranging from 61 to 77 years. Pathological classifications included neuroendocrine tumors (NET) G1 (1 case), G2 (2 cases), G3 (5 cases), small-cell neuroendocrine carcinoma (2 cases), and large-cell neuroendocrine carcinoma (1 case). The follow-up period ranged from 1 to 115 months. Results: Treatment modalities varied among the cases: 5 patients underwent transoral laser microsurgery (TLM) without neck dissection, 1 patient underwent TLM with unilateral neck lymph node dissection, 1 patient underwent open partial supraglottic laryngectomy (OPSL) with ipsilateral neck lymph node dissection, and 4 patients underwent OPSL with bilateral neck lymph node dissection. Among the 11 patients, 4 died, with 2 succumbing to distant metastasis, 1 to local recurrence, and 1 to other diseases. Conclusion: The prognosis of LNEN is closely associated with the latest pathological classification and TNM staging. For a more detailed and specific clinical staging, further research involving multicenter large-scale data is needed.

Molecular pathological classification of colorectal cancer-an update.

Colorectal cancer (CRC) has a broad range of molecular alterations with two major mechanisms of genomic instability (chromosomal instability and microsatellite instability) and has been subclassified into 4 consensus molecular subtypes (CMS) based on bulk RNA sequence data. Here, we update the molecular pathological classification of CRC with an overview of more recent bulk and single-cell RNA data analysis for development of transcriptional classifiers and risk stratification methods, taking into account the marked inter-tumoural and intra-tumoural heterogeneity of CRC. The importance of the stromal and immune components or tumour microenvironment (TME) to prognosis has emerged from these analyses. Attempts to remove the contribution of the tumour microenvironment and reveal neoplastic-specific transcriptional traits involved identification of the CRC intrinsic subtypes (CRIS). The use of immunohistochemistry and digital pathology to implement classification systems are evolving fields. Conventional adenoma versus serrated polyp pathway transcriptomic analysis and characterisation of canonical LGR5+ crypt base columnar stem cell versus ANXA1+ regenerative stem cell phenotypes emerged as key properties for improved understanding of transcriptional signals involved in molecular subclassification of colorectal cancers. Recently, classification by three pathway-derived subtypes (PDS1-3) has been developed, revealing a continuum of intrinsic biology associated with biological, stem cell, histopathological, and clinical attributes.

New pathological progress of lung adenocarcinoma in pulmonary nodular lesions / 中国综合临床

Pulmonary nodular lesions include benign and malignant pulmonary nodules. Lung adenocarcinoma is the most common type of malignant pulmonary nodules. Lung adenocarcinoma includes precursor gland lesions minimally invasive adenocarcinoma, invasive mucinous adenocarcinoma and invasive non mucinous adenocarcinoma. The surgical methods and prognosis vary depending on the pathological subtypes. At present, it is proposed that the proportion of micropapillary, solid components in tumor alveolar dissemination and subtypes directly affect surgical methods and prognosis. Therefore, this article proposes that wedge lung resection can be performed for precursor glandular lesions. Subpulmonary lobectomy can be performed for minimally invasive adenocarcinoma. Invasive adenocarcinoma requires lobectomy and lymph node dissection. Even if patients with stage Ia lung adenocarcinoma who contain solid components in tumor alveolar dissemination , micropapillary, and pleural invasion components are recommended for postoperative adjuvant treatment.

Clinical Features of Gastric Signet Ring Cell Cancer: Results from a Systematic Review and Meta-Analysis.

BACKGROUND: Conflicting results about the prognostic relevance of signet ring cell histology in gastric cancer have been reported. We aimed to perform a meta-analysis focusing on the clinicopathological features and prognosis of this subgroup of cancer compared with other histologies. METHODS: A systematic literature search in the PubMed database was conducted, including all publications up to 1 October 2021. A meta-analysis comparing the results of the studies was performed. RESULTS: A total of 2062 studies referring to gastric cancer with signet ring cell histology were identified, of which 262 studies reported on its relationship with clinical information. Of these, 74 were suitable to be included in the meta-analysis. A slightly lower risk of developing nodal metastases in signet ring cell tumours compared to other histotypes was found (especially to undifferentiated/poorly differentiated/mucinous and mixed histotypes); the lower risk was more evident in early and slightly increased in advanced gastric cancer. Survival tended to be better in early stage signet ring cell cancer compared to other histotypes; no differences were shown in advanced stages, and survival was poorer in metastatic patients. In the subgroup analysis, survival in signet ring cell cancer was slightly worse compared to non-signet ring cell cancer and differentiated/well-to-moderately differentiated adenocarcinoma. CONCLUSIONS: Most of the conflicting results in signet ring cell gastric cancer literature could be derived from the lack of standardisation in their classification and the comparison with the different subtypes of gastric cancer. There is a critical need to strive for a standardised classification system for gastric cancer, fostering clarity and coherence in the forthcoming research and clinical applications.

[Pathological classification of malignant peritoneal mesothelioma and comparative analysis with peritoneal carcinomatosis].

Objective: To analyze the pathological classification of malignant peritoneal mesothelioma (MPeM) and screen the immunohistochemical markers that can distinguish MPeM from peritoneal metastatic carcinoma (PC) . Methods: In June 2020, the pathological results of peritoneal biopsy of 158 MPeM and 138 PC patients from Cangzhou Central Hospital, Cangzhou People's Hospital, and Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2011 to July 2019 were retrospectively analyzed, and the pathological classifications of MPeM in Cangzhou were summarized. Immunohistochemical markers of MPeM and PC patients were analyzed, and receiver operating characteristic curve (ROC curve) was drawn for differential diagnosis of MPeM and PC. Results: There were 55 male and 103 female MPeM patients in Cangzhou, with an average age of 57.1 years old. The asbestos exposure rate was 91.14% (144/158). The most common pathological classifications were cutaneous type, accounting for 90.51% (143/158). There were significant differences in the expression of calreticulum protein, CK5/6, vimentin, D2-40, carcinoembryonic antigen (CEA) and tail type homologous nuclear gene transcription factor 2 (CDX-2) between MPeM and PC (P<0.05). Among the 6 positive markers, the sensitivity of calreticulum protein was the highest (0.905) and CEA was the lowest (0.428) . Conclusion: Calreticulum protein, CK5/6, vimentin, D2-40, CEA and CDX-2 may be used as specific markers to distinguish the diagnosis of MPeM from PC.

Clinicopathological Characteristics and Impacts on Clinical Outcomes of Thrombotic Microangiopathy Lesions in Patients with Immunoglobulin A Nephropathy in Thailand.

INTRODUCTION: More reports of thrombotic microangiopathy (TMA) in immunoglobulin A (IgA) nephropathy suggest its association with poor clinical outcomes. However, the prevalence and clinical significance of TMA in IgA nephropathy have not been widely studied in different populations. METHODS: Kidney biopsies of all patients with primary IgA nephropathy from 1995 to 2015 at the King Chulalongkorn Memorial Hospital, Thailand, were retrospectively reviewed and reclassified by two pathologists following the Oxford MEST-C classification. TMA lesions were detected based solely on light microscopic findings. Associations between the presence of TMA and clinical data, other pathologic findings, and clinical outcomes were studied. RESULTS: Among 267 patients with primary IgA nephropathy, 166 had adequate clinical data and kidney tissues for the analysis. TMA was observed in 21 patients (13%) and was associated with higher mean arterial pressure (MAP), history of malignant hypertension, higher proteinuria, and lower estimated glomerular filtration rate (eGFR) at diagnosis compared to those without TMA. According to the Oxford MEST-C classification, TMA showed a significant association with severe tubular atrophy/interstitial fibrosis (T2) but not with mesangial hypercellularity (M1), endocapillary hypercellularity (E1), segmental glomerulosclerosis (S1), or crescents (C1-2). After a median follow-up of 50 months, patients with TMA had a significantly higher risk of progression to end-stage kidney disease (ESKD) (hazard ratio [HR] 5.8, 95% confidence interval [CI]: 3.1-10.9) and all-cause mortality (HR 3.4, 95% CI: 1.3-8.8). After adjusting for baseline eGFR, MAP, proteinuria, and other pathological lesions, TMA remained an independent predictor of ESKD (adjusted HR 2.4, 95% CI: 1.1-5.4). CONCLUSIONS: Kidney TMA in IgA nephropathy is associated with advanced disease stages, carries a poor prognosis, and thus should be considered in the pathological classification of IgA nephropathy.

[Mucinous tumors of the peritoneum]. / Muzinöse Tumoren des Peritoneums.

INTRODUCTION: Disseminated peritoneal seeding of mucin-forming tumors is a rare malignant disease with variable prognosis. Histomorphological criteria are instrumental in the prognostic assessment. The past 10 years have led to a standardization of nomenclature and subsequently to the establishment of therapeutic standards. This article aims to provide the current status of the pathological classification, staging, and grading. METHOD AND MATERIAL: Selective literature search in PubMed and Medline RESULTS: The vast majority of disseminated peritoneal mucinous diseases that correspond to the clinical presentation of pseudomyxoma peritonei (PMP) arise from mucinous tumors of the vermiform appendix. Here are to be distinguished: 1) low-grade appendiceal mucinous neoplasms (LAMN), 2) (very rare) high-grade appendiceal mucinous neoplasms (HAMN), 3) mucinous adenocarcinoma without signet ring cells (G2) and 4) mucinous adenocarcinoma with signet ring cells or signet ring cell carcinoma (G3). Other primary tumors only rarely induce PMP. Terms such as mucocele or mucinous cystadenoma of the appendix correspond to LAMN and should no longer be used. Prognostic distinctions are further made between low-grade PMP, which usually arises from LAMN, and the prognostically less favorable high-grade PMP, which usually arises from mucinous/signet ring cell adenocarcinoma or the rare HAMN. Disseminated peritoneal mucinous disease/PMP must then be further distinguished from prognostically excellent local mucin formation of the peri-appendix region. DISCUSSION: The currently valid nomenclature, as it has emerged from consensus meetings and in parts has also found its way into the current WHO 2019, has significantly contributed to the fact that the prognosis of patients today can be better estimated and effective forms of treatment could be developed.

Castleman disease: a case report of an unusual adrenal incidentaloma and literature review.

Adrenal incidentaloma (AI) is an incidental detection of an adrenal mass on an image not performed for a suspected adrenal problem. AI has become a commonly encountered lesion that requires further investigations for evidence of hormonal hypersecretion or malignancy potential. According to guidelines, surgical intervention is the standard of care for unilateral AI. We report on a case of a 64-year-old female who presented with a nonfunctional adrenal mass associated with compressive symptoms, which was revealed to be a mixed hyaline vascular and plasma cell variant Castleman disease (CD) after surgical resection. Although hyaline vascular variant and plasma cell variant of CD has been identified in adrenal glands, this is the first report of a mixed hyaline vascular and plasma cell variant in an adrenal mass.

MRI and Trouillas' grading system of pituitary tumors: the usefulness of T2 signal intensity volumetric values.

PURPOSE: To classify pituitary macroadenomas according to the Trouillas' grading system; to compare this grading system with T2 values of volumetric signal intensity to determine T2 values able to predict the final grade. METHODS: A total of 106 patients with macroadenomas were grouped according to the grading system score combining proliferation and invasiveness criteria of Trouillas' classification. Normalized volumetric signal intensity values were extracted from coronal T2-weighted images (nT2mean, nT2Max, nT2min) and were compared with the final grading score system. RESULTS: Thirty-three patients were in grade 1a (non-invasive, non-proliferative tumors), 17 patients in grade 1b (non-invasive, proliferative tumors), 36 patients in grade 2a (invasive, non-proliferative tumors), and 20 patients in grade 2b (invasive, proliferative tumors). No patient was in grade 3 (metastatic tumors). nT2Max and nT2min were the best quantitative values to discriminate invasive from non-invasive grades; in invasive grades, nT2Max intensity values were higher, and nT2min intensity values were lower than in non-invasive grades. Receiver operating characteristic analysis of nT2 values showed that nT2min values had a better diagnostic performance than nT2Max values because they allowed differentiating with a moderate accuracy invasive tumors (2a or 2b grades) from both non-invasive proliferative tumors (1b) and non-invasive-non proliferative tumors (1a) (2a vs 1b: AUCnT2min = 0.78, 2b vs 1b: AUCnT2min = 0.72, 2a vs 1a: AUCnT2min = 0.72, 2b vs 1a AUCnT2min = 0.69). CONCLUSION: Volumetric nT2Max and nT2min values of MRI might be practical and non-invasive markers for assessing tumor invasiveness although nT2 min signal intensity values have more effects in discriminating tumor's invasive behavior.

The genetic and phenotypic spectra of adult genetic leukoencephalopathies in a cohort of 309 patients.

Genetic leukoencephalopathies (gLEs) are a highly heterogeneous group of rare genetic disorders. The spectrum of gLEs varies among patients of different ages. Distinct from the relatively more abundant studies of gLEs in children, only a few studies that explore the spectrum of adult gLEs have been published, and it should be noted that the majority of these excluded certain gLEs. Thus, to date, no large study has been designed and conducted to characterize the genetic and phenotypic spectra of gLEs in adult patients. We recruited a consecutive series of 309 adult patients clinically suspected of gLEs from Beijing Tiantan Hospital between January 2014 and December 2021. Whole-exome sequencing, mitochondrial DNA sequencing and repeat analysis of NOTCH2NLC, FMR1, DMPK and ZNF9 were performed for patients. We describe the genetic and phenotypic spectra of the set of patients with a genetically confirmed diagnosis and summarize their clinical and radiological characteristics. A total of 201 patients (65%) were genetically diagnosed, while 108 patients (35%) remained undiagnosed. The most frequent diseases were leukoencephalopathies related to NOTCH3 (25%), NOTCH2NLC (19%), ABCD1 (9%), CSF1R (7%) and HTRA1 (5%). Based on a previously proposed pathological classification, the gLEs in our cohort were divided into leukovasculopathies (35%), leuko-axonopathies (31%), myelin disorders (21%), microgliopathies (7%) and astrocytopathies (6%). Patients with NOTCH3 mutations accounted for 70% of the leukovasculopathies, followed by HTRA1 (13%) and COL4A1/2 (9%). The leuko-axonopathies contained the richest variety of associated genes, of which NOTCH2NLC comprised 62%. Among myelin disorders, demyelinating leukoencephalopathies (61%)-mainly adrenoleukodystrophy and Krabbe disease-accounted for the majority, while hypomyelinating leukoencephalopathies (2%) were rare. CSF1R was the only mutated gene detected in microgliopathy patients. Leukoencephalopathy with vanishing white matter disease due to mutations in EIF2B2-5 accounted for half of the astrocytopathies. We characterized the genetic and phenotypic spectra of adult gLEs in a large Chinese cohort. The most frequently mutated genes were NOTCH3, NOTCH2NLC, ABCD1, CSF1R and HTRA1.

Pathological classification of malignant peritoneal mesothelioma and comparative analysis with peritoneal carcinomatosis / 中华劳动卫生职业病杂志

Objective: To analyze the pathological classification of malignant peritoneal mesothelioma (MPeM) and screen the immunohistochemical markers that can distinguish MPeM from peritoneal metastatic carcinoma (PC) . Methods: In June 2020, the pathological results of peritoneal biopsy of 158 MPeM and 138 PC patients from Cangzhou Central Hospital, Cangzhou People's Hospital, and Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2011 to July 2019 were retrospectively analyzed, and the pathological classifications of MPeM in Cangzhou were summarized. Immunohistochemical markers of MPeM and PC patients were analyzed, and receiver operating characteristic curve (ROC curve) was drawn for differential diagnosis of MPeM and PC. Results: There were 55 male and 103 female MPeM patients in Cangzhou, with an average age of 57.1 years old. The asbestos exposure rate was 91.14% (144/158). The most common pathological classifications were cutaneous type, accounting for 90.51% (143/158). There were significant differences in the expression of calreticulum protein, CK5/6, vimentin, D2-40, carcinoembryonic antigen (CEA) and tail type homologous nuclear gene transcription factor 2 (CDX-2) between MPeM and PC (P<0.05). Among the 6 positive markers, the sensitivity of calreticulum protein was the highest (0.905) and CEA was the lowest (0.428) . Conclusion: Calreticulum protein, CK5/6, vimentin, D2-40, CEA and CDX-2 may be used as specific markers to distinguish the diagnosis of MPeM from PC.

Study on ultrasound diagnosis of different types of fetus with simple ventricular septal defect and neonatal closure period / 中国现代医生

Objective To investigate the diagnosis of different types of fetuses with simple ventricular septal defect by ultrasound and to analyze the results of neonatal follow-up during the closed period.Methods A total of 100 fetuses diagnosed with simple ventricular septal defect from January 2019 to December 2021 were selected from the 903rd Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,and echocardiography was performed to observe the type and defect diameter.The healing rate of the children was observed after 1 year follow-up.Results In 100 cases,64 cases were medial defect,21 cases were infundibular defect,11 cases were muscular defect and 4 cases were superior ventricular ridge defect.In the membrane defect type,the proportion of defect diameters>5mm was highest at 46.88%,followed by 3-5mm at 34.38%,and<3mm at 18.75%.In the infundibular defect type,the defect diameter<3mm was higher(66.67%),followed by 3-5mm(33.33%).The probability of<3mm defect mouth diameter and 3-5mm defect mouth diameter were 45.45%and 54.55%,respectively.The diameter of the defect<3mm and 3-5mm were the same,both of which were 50.00%.The healing rate of intrauterine and 1 year after birth was the highest in muscular defect type(72.73%),followed by membrane defect type(26.56%),infundibular defect type and superior ventricular crest defect type did not heal in intrauterine and 1 year after birth.Conclusion Simple ventricular septal defect is common in the membranous part,while the membranous part and muscle part defect can heal naturally.Echocardiography is a reliable examination method in the prenatal diagnosis and postnatal follow-up of the fetus with simple ventricular septal defect,which can provide a reliable basis for future treatment.

Oral verrucous xanthoma with oral lichen planus: a case report.

Verrucous xanthoma is a rare benign muco-cutaneous lesion, whereas oral lichen planus is a chronic inflammatory disease relatively common in the clinical setting. Verrucous xanthoma and oral lichen planus can reportedly coexist according to foreign literature. Owing to the low incidence of verrucous xanthoma and the rarity of co-occurrence of these two diseases, the mechanism underlying the co-occurrence of the two diseases remains inconclusive. In this work, a case of oral verrucous xanthoma complicated with oral lichen planus was reported. Related literature was reviewed to discuss the clinical classification, pathological classification, and possible pathogenesis of the two diseases.

Diagnostic value of dual-layer spectral detector CT in differentiating lung adenocarcinoma from squamous cell carcinoma.

Background and objective: The pathological type of non-small cell lung cancer is considered to be an important factor affecting the treatment and prognosis. The purpose of this study was to investigate the diagnostic value of spectral parameters of dual-layer spectral detector computed tomography (DLCT) in determining efficacy to distinguish adenocarcinoma (AC) and squamous cell carcinoma (SC), and their combined diagnostic efficacy was also analyzed. Methods: This is a single-center prospective study, and we collected 70 patients with lung SC and 127 patients with lung AC confirmed by histopathological examination. Morphological parameters, plain scan CT value, biphasic enhanced CT value, and spectral parameters were calculated. The diagnostic efficiency of morphological parameters, spectral parameters, and spectral parameters combined with morphological parameters was obtained by statistical analysis. Results: In univariate analysis, seven morphological CT features differed significantly between SC and AC: tumor location (distribution), lobulation, spicule, air bronchogram, vacuole sign, lung atelectasis and/or obstructive pneumonia, and vascular involvement (all p < 0.05). In the arterial phase and the venous phase, the spectral parameters of AC were higher than those of SC (AP-Zeff: 8.07 ± 0.23 vs. 7.85 ± 0.16; AP-ID: 1.41 ± 0.47 vs. 0.94 ± 0.28; AP-NID: 0.13 ± 0.04 vs. 0.09 ± 0.03; AP-λ: 3.42 ± 1.10 vs. 2.33 ± 0.96; VP-Zeff: 8.26 ± 0.23 vs. 7.96 ± 0.16; VP-ID: 1.18 ± 0.51 vs. 1.16 ± 0.30; VP-NID: 0.39 ± 0.13 vs. 0.29 ± 0.08; VP-λ: 4.42 ± 1.28 vs. 2.85 ± 0.72; p < 0.001). When conducting multivariate analysis combining CT features and DLCT parameters with the best diagnostic efficacy, the independent predictors of AC were distribution on peripheral (OR, 4.370; 95% CI, 1.485-12.859; p = 0.007), presence of air bronchogram (OR, 5.339; 95% CI, 1.729-16.484; p = 0.004), and presence of vacuole sign ( OR, 7.330; 95% CI, 1.030-52.184; p = 0.047). Receiver operating characteristic curves of the SC and AC showed that VP-λ had the best diagnostic performance, with an area under the curve (AUC) of 0.864 and sensitivity and specificity rates of 85.8% and 74.3%, respectively; the AUC was increased to 0.946 when morphological parameters were combined, and sensitivity and specificity rates were 89.8% and 87.1%, respectively. Conclusion: The quantitative parameters of the DLCT spectrum are of great value in the diagnosis of SC and AC, and the combination of morphological parameters and spectral parameters is helpful to distinguish SC from AC.

Overview of the 2022 WHO Classification of Pituitary Adenomas/Pituitary Neuroendocrine Tumors: Clinical Practices, Controversies, and Perspectives.

The latest edition of the WHO classification of the central nervous system was published in 2021. This review summarizes the major revisions to the classification of anterior pituitary tumors. The most important revision involves preferring the terminology of pituitary neuroendocrine tumor (PitNET), even though the terminology of pituitary adenoma (PA) still can be used according to this WHO classification compared to the previous one. Moreover, immunohistochemistry (IHC) examination of pituitary-specific transcription factors (TFs), including PIT1, TPIT, SF-1, GATA2/3, and ERα, is endorsed to determine the tumor cell lineage and to facilitate the classification of PitNET/PA subgroups. However, TF-negative IHC staining indicates PitNET/PA with no distinct cell lineages, which includes unclassified plurihormonal (PH) tumors and null cell (NC) tumors in this edition. The new WHO classification of PitNET/PA has incorporated tremendous advances in the understanding of the cytogenesis and pathogenesis of pituitary tumors. However, due to the shortcomings of the technology used in the diagnosis of PitNET/PA and the limited understanding of the tumorigenesis of PitNET/PA, the application of this new classification system in practice should be further evaluated and validated. Besides providing information for deciding the follow-up plans and adjunctive treatment after surgery, this classification system offers no additional help for neurosurgeons in clinical practice, especially in determining the treatment strategies. Therefore, it is necessary for neurosurgeons to establish a comprehensive pituitary classification system for PitNET/PA that incorporates neuroimaging grading data or direct observation of invasiveness during operation or the predictor of prognosis, as well as pathological diagnosis, thereby distinguishing the invasiveness of the tumor and facilitating neurosurgeons to decide on the treatment strategies and follow-up plans as well as adjunctive treatment after surgery.

Remission from the 5-Fu-Based Chemotherapy to Gemcitabine-Based Chemotherapy-Based on the Pathological Classification of Periampullary Carcinoma: A Case Report and Literature Review.

Background: Periampullary carcinoma, which includes ampullary carcinoma, pancreatic head cancer, distal common bile duct cancer, and duodenal papillary cancer, is a relatively rare malignancy with uncertain therapeutic options. Although several studies have investigated the efficacy of multiple adjuvant chemotherapy regimens for periampullary carcinoma treatment, the optimal regimen remains to be determined. The inherent heterogeneity of the mucosal origin divides periampullary carcinoma into intestinal and pancreaticobiliary types. Therefore, the selection of chemotherapy regimens based on pathological type may have potential therapeutic significance. Case Presentation: A 72-year-old woman with moderately differentiated periampullary adenocarcinoma experienced disease progression after receiving FOLFOX regimen. Subsequently, the sample was subtyped first by H&E evaluation and then by the evaluation of an IHC panel composed of CK20, CDX2, MUC1, MUC2, and MUC5AC. The pathologists concluded that the patient's sample was of the pancreaticobiliary (PB) subtype. The subsequent change to gemcitabine plus S-1 adjuvant therapy achieved remission of liver metastases based on the pathological classification of the cancer. Conclusion: Based on the pathological classification, adjuvant chemotherapy with gemcitabine may be beneficial for patients with PB subtype periampullary carcinoma. 5-Fu-based adjuvant chemotherapy may be beneficial for patients with intestinal subtype periampullary carcinoma.

Parameters of Dual-layer Spectral Detector CT Could be Used to Differentiate Non-Small Cell Lung Cancer from Small Cell Lung Cancer.

BACKGROUND AND OBJECTIVE: Differentiating non-small cell lung cancer (NSCLC) from small cell lung cancer (SCLC) remains a substantial challenge. This study aimed at evaluating the performance of dual-layer spectral detector CT (DLCT) in differentiating NSCLC from SCLC. METHODS: Spectral images of 247 cancer patients confirmed by pathology were retrospectively analyzed in both the arterial phase (AP) and the venous phase (VP), including 197 cases of NSCLC and 50 cases of SCLC. Effective atomic number (Z-eff), Spectral CT-Mono Energetic (MonoE [40keV~90keV]), iodine density (ID) and thoracic aorta iodine density (IDaorta) in contrast-enhanced images were measured and compared between the SCLC and NSCLC subgroups of tumors. The slope of the spectral curve (λ, interval of 10 keV) and normalized iodine density (NID) were also calculated between the SCLC and NSCLC. Through the statistical analysis, the diagnostic efficiency of each spectral parameter was calculated, and the difference in their efficiency was analyzed. RESULTS: Both in NSCLS and SCLC, all parameters in VP were significantly higher than those in AP (p<0.001), except for λ90. There were significant differences in all spectral parameters between NSCLS and SCLC, both in AP and VP (p < 0.001). Except for VP-λ90, there was no significant difference in ROC curves of all spectral parameters. VP-NID exhibited the best diagnostic performance with an AUC value of 0.917 (95%[CI]: 0.870~0.965), sensitivity and specificity of 92.9% and 80%, and a diagnostic threshold of 0.217. CONCLUSION: All parameters of DLCT have high diagnostic efficiency in differentiating NSCLC from SCLC except for VP-λ90, and VP-NID has the highest diagnostic efficiency.

Multiparametric Framework Magnetic Resonance Imaging Assessment of Subtypes of Intracranial Germ Cell Tumors Using Susceptibility Weighted Imaging, Diffusion-Weighted Imaging, and Dynamic Susceptibility-Contrast Perfusion-Weighted Imaging Combined With Conventional Magnetic Resonance Imaging.

BACKGROUND: Intracranial germ cell tumors (iGCTs) are classified into two pathological subtypes (germinomas [GEs] and nongerminomatous germ cell tumors [NGGCTs]), with distinct treatment strategy and prognosis. Accurate preoperative determination of iGCT subtypes is essential to guide clinical decision-making and prognosis assessment. PURPOSE: To investigate the diagnostic value of diffusion-weighted imaging (DWI), susceptibility weighted imaging (SWI), and dynamic susceptibility-contrast perfusion-weighted imaging (DSC-PWI) combined with conventional magnetic resonance imaging (cMRI) in finding subtypes of iGCTs. STUDY TYPE: Retrospective. POPULATION: A total of 40 patients (45% male and 55% female) with iGCTs. FIELD STRENGTH/SEQUENCE: A 3 T; <T1WI, T2WI, T1WI + C, DWI, SWI, DSC-PWI>. ASSESSMENT: The parameters of DWI and DSC-PWI were calculated based on extracted parameters of multiparametric MRIs. The characteristics of SWI and cMRI were also compared in GEs and NGGCTs. STATISTICAL TESTS: The diagnostic efficacy of the minimum apparent diffusion coefficient (ADCmin), time-to-peak (TTP), relative mean transit time (rMTT), relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV) maps, and cMRI features in iGCT classification was evaluated by receiver operating characteristic curve (ROC) analyses. We calculated the sensitivity, specificity, AUC, and Youden index of the hybrid MR evaluation methods. A prospective cohort (five GEs and five NGGCTs) was designed as a simulation set to test the model. The significance threshold was set at P < 0.01. RESULTS: The ADCmin (1039.100 ± 453.830 vs. 1400.050 ± 394.650), rCBF values (20.650 ± 6.260 vs. 51.170 ± 6.570), and TTP values (24.450 ± 3.160 vs. 28.950 ± 5.120) were significantly lower in GEs than in NGGCTs. The combination of ADCmin, DSC-PWI, and cMRI showed the heights AUC (AUC = 0.962). The iGCT multiparametric framework showed the AUC was 0.958 in the simulation set. DATA CONCLUSION: The iCGT multiparametric framework might be an effective diagnostic approach of iGCT subtype. The application of cMRI (T1WI, T2WI, and Gd-T1WI) with advanced imaging modalities (DWI, SWI, and PWI) had the best performance for classifying iGCT subtypes. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.