Machine Learning Quantification of Intraepithelial Tumor-Infiltrating Lymphocytes as a Significant Prognostic Factor in High-Grade Serous Ovarian Carcinomas.

The prognostic and predictive role of tumor-infiltrating lymphocytes (TILs) has been demonstrated in various neoplasms. The few publications that have addressed this topic in high-grade serous ovarian carcinoma (HGSOC) have approached TIL quantification from a semiquantitative standpoint. Clinical correlation studies, therefore, need to be conducted based on more accurate TIL quantification. We created a machine learning system based on H&E-stained sections using 76 molecularly and clinically well-characterized advanced HGSOC. This system enabled immune cell classification. These immune parameters were subsequently correlated with overall survival (OS) and progression-free survival (PFI). An intense colonization of the tumor cords by TILs was associated with a better prognosis. Moreover, the multivariate analysis showed that the intraephitelial (ie) TILs concentration was an independent and favorable prognostic factor both for OS (p = 0.02) and PFI (p = 0.001). A synergistic effect between complete surgical cytoreduction and high levels of ieTILs was evidenced, both in terms of OS (p = 0.0005) and PFI (p = 0.0008). We consider that digital analysis with machine learning provided a more accurate TIL quantification in HGSOC. It has been demonstrated that ieTILs quantification in H&E-stained slides is an independent prognostic parameter. It is possible that intraepithelial TIL quantification could help identify candidate patients for immunotherapy.

Difficult to Diagnose Cutaneous Melanoma in a Patient with BAP1 Tumor Predisposition Syndrome.

BRCA1-associated protein 1 (BAP1)-inactivated melanomas can occur sporadically or in germline contexts, particularly in recently recognized BAP1-tumor predisposition syndrome. Diagnosis represents a clinical and histopathological challenge, requiring comprehensive analysis of morphology and sometimes molecular analysis in addition to immunohistochemistry. We report a BAP1-inactivated cutaneous melanoma initially diagnosed as an atypical Spitz tumor on the auricle in a patient with BAP1-tumor predisposition syndrome. Immunohistochemistry, fluorescence in situ hybridization, and comparative genomic hybridization allowed diagnosis. Cutaneous BAP1-inactivated melanocytic tumors, previously classified as atypical Spitz Nevi, may have a dermal mitotic activity that can resemble melanoma and on the other hand, atypical Spitz tumors are sometimes difficult to differentiate from BAP1-inactivated melanoma. Specific criteria, requiring molecular diagnosis have been proposed in order to support melanoma diagnosis.

Fibrosis Severity as a Determinant of Cause-Specific Mortality in Patients With Advanced Nonalcoholic Fatty Liver Disease: A Multi-National Cohort Study.

BACKGROUND & AIMS: Little is known about the natural course of nonalcoholic fatty liver disease (NAFLD) with advanced fibrosis. We describe long-term outcomes and evaluate the effects of clinical and histologic parameters on disease progression in patients with advanced NAFLD. METHODS: We conducted a multi-national study of 458 patients with biopsy-confirmed NAFLD with bridging fibrosis (F3, n = 159) or compensated cirrhosis (222 patients with Child-Turcotte-Pugh scores of A5 and 77 patients with scores of A6), evaluated from April 1995 through November 2013 and followed until December 2016, death, or liver transplantation at hepatology centers in Spain, Australia, Hong Kong, and Cuba. Biopsies were re-evaluated and scored; demographic, clinical, laboratory, and pathology data for each patient were collected from the time of liver biopsy collection. Cox proportional and competing risk models were used to estimate rates of transplantation-free survival and major clinical events and to identify factors associated with outcomes. RESULTS: During a mean follow-up time of 5.5 years (range, 2.7-8.2 years), 37 patients died, 37 received liver transplants, 88 had initial hepatic decompensation events, 41 developed hepatocellular carcinoma, 14 had vascular events, and 30 developed nonhepatic cancers. A higher proportion of patients with F3 fibrosis survived transplantation-free for 10 years (94%; 95% confidence interval [CI], 86%-99%) than of patients with cirrhosis and Child-Turcotte-Pugh A5 (74%; 95% CI, 61%-89%) or Child-Turcotte-Pugh A6 (17%; 95% CI, 6%-29%). Patients with cirrhosis were more likely than patients with F3 fibrosis to have hepatic decompensation (44%; 95% CI, 32%-60% vs 6%, 95% CI, 2%-13%) or hepatocellular carcinoma (17%; 95% CI, 8%-31% vs 2.3%, 95% CI, 1%-12%). The cumulative incidence of vascular events was higher in patients with F3 fibrosis (7%; 95% CI, 3%-18%) than cirrhosis (2%; 95% CI, 0%-6%). The cumulative incidence of nonhepatic malignancies was higher in patients with F3 fibrosis (14%; 95% CI, 7%-23%) than cirrhosis (6%; 95% CI, 2%-15%). Death or transplantation, decompensation, and hepatocellular carcinoma were independently associated with baseline cirrhosis and mild (<33%) steatosis, whereas moderate alcohol consumption was associated with these outcomes only in patients with cirrhosis. CONCLUSIONS: Patients with NAFLD cirrhosis have predominantly liver-related events, whereas those with bridging fibrosis have predominantly nonhepatic cancers and vascular events.

Leiomioma de la uretra, localización inusual del tumor pélvico femenino más frecuente / An unusual location of urethral leiomyoma, the most common pelvic tumour in the female

El leiomioma de la uretra es un raro tumor de origen mesenquimal que deriva del músculo liso de la uretra. Suele aparecer en mujeres en edad fértil. Actualmente se han publicado poco más de 100 casos de este tumor. La mayoría de las mujeres presentan síntomas como hematuria, infección urinaria y otros con relación al efecto masa del tumor. Presentamos el caso de una mujer de 42 años que debuta con hematuria esporádica, disuria y dispareunia, confirmándose en el estudio histológico la presencia de un leiomioma de la uretra (AU)

Urethral leiomyoma is a rare benign mesenchymal tumour arising from the smooth muscle of the urethra. It most often appears in females of reproductive age. Approximately 100 cases have been reported to date. The most usual presentation is urinary infection, hematuria or a mass. We report a case of a 42 year old woman who presented with sporadic hematuria, dysuria and dyspareunia. Histopathological studies confirmed urethral leiomyoma (AU)

[An unusual location of urethral leiomyoma, the most common pelvic tumour in the female]. / Leiomioma de la uretra, localización inusual del tumor pélvico femenino más frecuente.

Urethral leiomyoma is a rare benign mesenchymal tumour arising from the smooth muscle of the urethra. It most often appears in females of reproductive age. Approximately 100 cases have been reported to date. The most usual presentation is urinary infection, hematuria or a mass. We report a case of a 42 year old woman who presented with sporadic hematuria, dysuria and dyspareunia. Histopathological studies confirmed urethral leiomyoma.

[From tumour to tumour: Metastasis of invasive ductal breast carcinoma to chromophobe renal cell carcinoma]. / Tumor a tumor: metástasis de carcinoma ductal infiltrante de mama sobre carcinoma de células cromófobas de riñón.

The coexistence of two or more tumours in the same patient is unusual, but even rarer is the metastasis of one tumour to another. Most reports are based on evidence from autopsies; very few refer to surgical specimens. The most common primary tumour is pulmonary carcinoma and most frequent metastatic tumour is renal clear cell carcinoma. We present the case of a 54 year-old female with a past history of infiltrating ductal carcinoma of the breast with metastases in lung, lymph nodes and bone. Three months previously to her referral to us, she had developed a renal mass and underwent nephrectomy. Histopathology revealed a renal chromophobe cell carcinoma with intratumoral breast cancer metastasis. We describe the histopathological, immunohistochemical and molecular features and review the recent literature.

Tumor a tumor: metástasis de carcinoma ductal infiltrante de mama sobre carcinoma de células cromófobas de riñón / From tumour to tumour: metastasis of invasive ductal breast carcinoma to chromophobe renal cell carcinoma

La coexistencia de 2 o más tumores en un paciente es un hecho poco frecuente y más infrecuentes son las metástasis de tumor a tumor. La mayoría de las publicaciones incluyen hallazgos autópsicos y, en menor número, hallazgos en piezas quirúrgicas-biopsias. El origen primario más frecuente es el carcinoma de pulmón, siendo el receptor más frecuente el carcinoma de células claras renal. Describimos el caso de una paciente de 54años con historia remota de carcinoma ductal infiltrante de mama derecha, que presentó en el transcurso afectación metastásica a nivel pulmonar, ganglionar, óseo y hace 3 meses una lesión en riñón derecho. Se sometió a nefrectomía. El estudio anatomopatológico reveló un carcinoma renal de células cromófobas con metástasis intratumoral de carcinoma ductal infiltrante de mama. Se describen los hallazgos histológicos, inmunohistoquímicos y moleculares, con revisión de la literatura reciente (AU)

The coexistence of two or more tumours in the same patient is unusual, but even rarer is the metastasis of one tumour to another. Most reports are based on evidence from autopsies; very few refer to surgical specimens. The most common primary tumour is pulmonary carcinoma and most frequent metastatic tumour is renal clear cell carcinoma. We present the case of a 54 year-old female with a past history of infiltrating ductal carcinoma of the breast with metastases in lung, lymph nodes and bone. Three months previously to her referral to us, she had developed a renal mass and underwent nephrectomy. Histopathology revealed a renal chromophobe cell carcinoma with intratumoral breast cancer metastasis. We describe the histopathological, immunohistochemical and molecular features and review the recent literature (AU)

Carcinoma mucinoso tubular y fusocelular renal. Descripción de los hallazgos citológicos de un caso pobre en mucina / Mucinous tubular and spindle cell renal carcinoma. Cytological findings in a case with poor mucin content

La clasificación de la OMS 2004 describe el carcinoma renal mucinoso tubular y fusocelular (CRMTF), como una neoplasia de bajo grado, que histológicamente se caracteriza por presentar en distintas proporciones, un estroma mucinoso y una población de células cuboides y fusiformes dispuestas en túbulos y fascículos. El diagnóstico citológico de este carcinoma se sustenta en identificar en los extendidos una proliferación celular de bajo grado sobre un fondo mixoide. Recientemente han sido descritas variantes pobres en mucina del CRMTF y que, junto a las formas clásicas, completan el espectro morfológico del tumor. En estos casos, el diagnóstico citológico se ve dificultado ante la ausencia o escasez de sustancia mixoide. En este artículo se presenta un nuevo caso de CRMTF variante pobre en mucina de predominio tubular, con especial mención al cuadro citológico. Las características citológicas de esta variante específica no han sido descritas previamente en la literatura. El cuadro descrito contribuye a completar el espectro citológico que puede adoptar el CRMTF(AU)

The 2004 WHO classification describes mucinous tubular and spindle cell renal carcinoma (MTSC) as a low grade neoplasm with a characteristic histological picture of varying proportions of mucinous stroma and cuboid and spindle cells arranged in tubules and fascicles. The cytological diagnosis of this carcinoma is made by identifying low grade cellular proliferation against a myxoid background. Recently, MTSC variants with poor mucin content have been described which, together with the classical forms, complete the morphological spectrum of this tumour. In these cases, the cytological diagnosis is difficult due to the absence or scarcity of the myxoid component. We present a case of a new, predominantly tubular, MTSC variant which had a poor mucin content. Special emphasis is placed on the cytological findings of this previously unreported variant which completes the cytological range of appearances that can be adopted by MTSC(AU)

Pat-UniNet: creación y desarrollo de un foro internacional, multilingüe,de diagnóstico en Patología / Pat-UniNet: Creation and development of an International Forum for Pathology Image Diagnosis

Las nuevas tecnologías de telecomunicaciones, y especialmente Internet, son nuevas oportunidades en beneficio de la Patología y los patólogos, que permiten el desarrollo y creación de foros y Comunidades Virtuales de Usuarios Patólogos integrando los diversos recursos temáticos telemáticos. Una de las actividades más relevantes es la telepatología en Internet. Este trabajo describe la creación y desarrollo del Foro Pat-UniNet de diagnóstico por imagen, al que acceden cerca de un millar de profesionales en su mayoría patólogos y su rentabilidad científica y profesional. Se revisan someramente otros recursos semejantes, y se analizan los resultados obtenidos (AU)