Human pathologyPub Date : 2025-01-01DOI: 10.1016/j.humpath.2025.105717
Jerzy Lasota , Maciej Kaczorowski , Małgorzata Chłopek , Justyna Miłek-Krupa , Magdalena Szczepaniak , Kris Ylaya , Miłosz Chodyna , Ewa Iżycka-Świeszewska , Anna Scherping , Piotr Czapiewski , Ireneusz Dziuba , Yukinari Kato , Agnieszka Hałoń , Artur Kowalik , Markku Miettinen
{"title":"An immunohistochemical and molecular genetic study of 60 colorectal carcinoma brain metastases in pursuit of predictive biomarkers for cancer therapy","authors":"Jerzy Lasota , Maciej Kaczorowski , Małgorzata Chłopek , Justyna Miłek-Krupa , Magdalena Szczepaniak , Kris Ylaya , Miłosz Chodyna , Ewa Iżycka-Świeszewska , Anna Scherping , Piotr Czapiewski , Ireneusz Dziuba , Yukinari Kato , Agnieszka Hałoń , Artur Kowalik , Markku Miettinen","doi":"10.1016/j.humpath.2025.105717","DOIUrl":"10.1016/j.humpath.2025.105717","url":null,"abstract":"<div><div>Colorectal carcinoma brain metastases (n = 60) were studied using next-generation sequencing and immunohistochemistry. <em>RAS</em> and <em>BRAF</em> mutations were detected in 58.2% and 7.3% of cases, respectively. Patients with <em>RAS</em>- and <em>BRAF</em>-mutant tumors could potentially benefit from the treatment with inhibitors. <em>TP53</em> mutations were detected in 69.1% of metastases. Moreover, altered p53 expression was seen in 91.2% of cases. <em>APC</em> mutations were present in 41.8% of tumors. Diffuse nuclear accumulation of β-catenin was seen in 10.2% of metastases, although only 1 <em>CTNNB1</em> mutant was identified. Nevertheless, targeting p53 and Wnt/β-catenin pathways may have potential therapeutic implications. Casein kinase 1α1 expression indicating susceptibility to protein kinase inhibitors, was seen in 95% metastases including 10 with strong immunoreactivity. The immune checkpoint marker CD276, a promising target for immunotherapy, was present on tumor cells in 50.8% of metastases and on stromal cells in almost all cases. PRAME, another immunotherapy target, was expressed in 21.7% of tumors. HER2 membrane immunostaining detected in 13.3% of cases implicated potential treatment with HER2 inhibitors. Expression of SLFN11, a predictor of response to DNA-damaging chemotherapies, and a biomarker of sensitivity to PARP inhibitors was seen in 8.3% of tumors. In 6.7% of metastases loss or partial loss of MTAP expression suggested sensitivity to PRMT5 inhibitors. CD44v5 expressed in 35% of cases indicated potential therapeutic utility of anti-CD44v5 monoclonal antibody treatment. Identification of predictive biomarkers through genomic profiling and proteomic analyses is a crucial step toward individually tailored therapeutic regimens for patients with colorectal carcinoma brain metastases.</div></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"155 ","pages":"Article 105717"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Auerbach's plexus invasion as a key pathological factor for predicting outcomes in ampullary carcinoma","authors":"Taro Shioga , Yoshiki Naito , Masamichi Nakayama , Masahiko Tanigawa , Yuta Yano , Eiji Sadashima , Hiroya Terabe , Daiki Miyazaki , Toru Hisaka , Jun Akiba , Hirohisa Yano","doi":"10.1016/j.humpath.2025.105733","DOIUrl":"10.1016/j.humpath.2025.105733","url":null,"abstract":"<div><h3>Background</h3><div>Ampullary carcinoma (AC) has a poor prognosis in patients with pancreatic and perineural invasion beyond the duodenal muscularis propria. However, no studies were focused on evaluating Auerbach's plexus (AP) invasion in AC, and its clinical pathological significance remains unclear. In this study, we examined the clinical significance of AP invasion in patients with AC.</div></div><div><h3>Methods</h3><div>Clinicopathological examinations for AP invasion were performed in 80 patients with AC (median age: 70 years, male-to-female ratio: 43:37) who underwent endoscopic and surgical resection at Kurume University Hospital between 2005 and 2022. Statistical analysis was performed using the Kaplan–Meier method (log-rank test) and Cox proportional hazards models.</div></div><div><h3>Results</h3><div>The median AC tumor size was 20 mm, and the most common histological type was well-differentiated adenocarcinoma (59/80, 74%). Tumor invasion beyond the duodenal muscularis propria occurred in 38 patients (48%), of whom 21 (55%) had AP invasion. Univariate analysis identified several prognostic factors, including histological type, tumor depth, stage, AP invasion, and lymph node metastasis. Multivariate analysis confirmed AP invasion (hazard ratio = 2.716, 95% confidence: 1.130–6.529, p = 0.026) as an independent prognostic factor. Additionally, patients with AP invasion had a significantly worse prognosis than those without AP invasion (p < 0.001).</div></div><div><h3>Conclusions</h3><div>AP invasion is a critical prognostic factor in patients with AC. Closer monitoring and more aggressive treatment strategies may be warranted for patients with AP invasion to improve their prognosis.</div></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"155 ","pages":"Article 105733"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unravelling the difference of immune microenvironment characteristics between esophageal basaloid squamous cell carcinoma and conventional esophageal squamous cell carcinoma","authors":"Dongxian Jiang , Yuhao Xiao , Zixiang Yu , Minying Deng, Qi Song, Jie Huang, Jieakesu Su, Chen Xu, Yingyong Hou","doi":"10.1016/j.humpath.2025.105716","DOIUrl":"10.1016/j.humpath.2025.105716","url":null,"abstract":"<div><h3>Objectives</h3><div>Esophageal basaloid squamous cell carcinoma (basaloid ESCC) is an uncommon variant of esophageal squamous cell carcinoma (ESCC). We characterized the tumor immune microenvironment features of basaloid ESCC, and compared them with conventional ESCC.</div></div><div><h3>Methods and results</h3><div>One hundred and four basaloid ESCC patients and 55 conventional ESCC patients were included in Cohort 1. Among 104 basaloid ESCC, 81 were pure basaloid ESCC, and 23 were mixed basaloid ESCC with invasive basaloid ESCC components and ESCC components. In pure basaloid ESCC, there were more immature desmoplastic reaction (<em>P</em> < 0.001), fewer peritumoral tertiary lymphoid structures (TLSs) (<em>P</em> < 0.001), and lower tumor proportional score (TPS) and combined positive score (CPS) (<em>P</em> < 0.001 and <em>P</em> = 0.004) than in conventional ESCC. In mixed basaloid ESCC, the number of mature or intermediate desmoplastic reaction (<em>P</em> < 0.001), the tumor-infiltrating lymphocytes (TILs) score (<em>P</em> = 0.043), the proportion of stromal CD8<sup>+</sup> TILs (<em>P</em> = 0.047), the number of intratumoral CD20<sup>+</sup> TILs (<em>P</em> < 0.001), the number of peritumoral TLSs (<em>P</em> = 0.001), the number of peritumoral matureTLSs (<em>P</em> = 0.021), and the PD-L1 (22C3) CPS (<em>P</em> = 0.016) were lower in the basaloid ESCC components than in the conventional ESCC components. In addition, the data of 141 ESCC patients with neoadjuvant chemoimmunotherapy (nICT) were collected to compare immunotherapeutic outcomes. Among 141 nICT-treated patients, 115 patients had residual tumor cells remaining, including 101 with conventional ESCC and 11 with basaloid ESCC. In basaloid ESCC, 18.2% patients had less than 10% residual viable tumor in the esophageal wall (effective response), which was lower than 58.6% in conventional ESCC (<em>P</em> = 0.025).</div></div><div><h3>Conclusions</h3><div>Our data indicated that basaloid ESCC had less benefits from immunotherapy than conventional ESCC, and manifested as immune “cold” with immature-type desmoplastic reaction, lower TILs, lower peritumoral TLSs, and lower PD-L1 expression than conventional ESCC.</div></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"155 ","pages":"Article 105716"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human pathologyPub Date : 2024-12-01DOI: 10.1016/j.humpath.2024.105707
Dena Khaefpanah, Somaye Zare, Farnaz Hasteh, Wangpan J. Shi, Omonigho Aisagbonhi, Andres A. Roma, Oluwole Fadare
{"title":"Characterization of gastric/gastrointestinal-like immunophenotypes in endometrial endometrioid adenocarcinomas, including endometrioid adenocarcinomas with mucinous differentiation","authors":"Dena Khaefpanah, Somaye Zare, Farnaz Hasteh, Wangpan J. Shi, Omonigho Aisagbonhi, Andres A. Roma, Oluwole Fadare","doi":"10.1016/j.humpath.2024.105707","DOIUrl":"10.1016/j.humpath.2024.105707","url":null,"abstract":"<div><div>Endometrial mucinous carcinoma of the gastric [gastrointestinal] type (MCG) is a rare, possibly aggressive subtype of endometrial cancer that should be distinguished from its potential mimics, including endometrioid carcinoma (EEC). Herein, we assess the frequency of gastric and gastrointestinal immunophenotypes in EEC without any discernible gastric/gastrointestinal-type morphology. Immunohistochemical analyses for KRT(CK)7, KRT20, CDX2, ER, SATB2, MUC6, PAX8, and HIK1083 were performed on 81 EEC, inclusive of consecutively archived low grade [with (n = 22) and without (n = 47) mucinous differentiation] and high grade (n = 12) cases. None displayed gastric-type morphology or goblet cells. Expression levels were semi-quantified as H-scores (combining intensity and extent of staining) on a standardized 0–300 scale. Among the gastric/gastrointestinal-type markers, 56%, 62%, 23%, 25%, and 0% of cases expressed MUC6, CDX2, KRT20, SATB2, and HIK1083 respectively. The expression levels for positive cases were generally limited, with average H-scores being 49.5 [range 1–250] for MUC6, 33.7 [1–285] for CDX2, 24.0 [1–270] for CK20, and 30.5 [2–220] for SATB2. Ten (12.35%) cases showed high expression (H ≥ 200) of at least 1 gastric/gastrointestinal-type marker, including 1, 2, 2 and 6 cases that were high positive for KRT20, SATB2, CDX2 and MUC6 respectively. Immunoreactive foci were generally indistinguishable from background at the morphologic level. There was no statistically significant correlation between the expression of any of the gastric/gastrointestinal-type markers and ER, KRT7 or PAX8 expression. In summary, gastric/gastrointestinal-type proteins are not uncommonly expressed at low levels in EEC. As such, positivity for these markers cannot be the sole basis for distinguishing EEC from MCG.</div></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"154 ","pages":"Article 105707"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142835526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human pathologyPub Date : 2024-12-01DOI: 10.1016/j.humpath.2024.105710
Zhengfan Xu , Brian K. Theisen , Qing Chang , Daniel Schultz , Beena U. Ahsan
{"title":"Survival outcomes of poorly differentiated colorectal carcinoma variants: Insights from a single teaching institute","authors":"Zhengfan Xu , Brian K. Theisen , Qing Chang , Daniel Schultz , Beena U. Ahsan","doi":"10.1016/j.humpath.2024.105710","DOIUrl":"10.1016/j.humpath.2024.105710","url":null,"abstract":"<div><div>The morphologic diagnosis of colorectal carcinoma (CRC) is typically straight forward. However, there are certain subtypes of CRC that pose diagnostic challenges for daily practice due to sometimes overlapping morphologic and immunohistochemical features. These subtypes include poorly differentiated adenocarcinoma NOS, in the absence of conventional morphology (PDA-NOS), large cell neuroendocrine carcinoma (LCNEC), medullary carcinoma (MC), undifferentiated carcinoma (UC) and lymphoepithelioma-like carcinoma (LELC). This study aims to see if there is a survival difference between poorly differentiated variants of CRC, as well as other clinicopathological features that may affect prognosis. Additionally, we analyzed interobserver agreement among gastrointestinal pathologists (GP) at our institution in subclassifying poorly differentiated CRC. All consecutive patients with the diagnoses of PDA-NOS, MC, LCNEC, UC and LELC between July 2018 and July 2023 were included. Cox proportional regression test was used for multivariate analysis, while log-rank and Kaplan-Meier tests were used for univariate and survival analyses. Out of the same cohort of patients, 58 samples identified and reviewed by 3 GI-subspecialty-trained pathologists who were asked to assign the cases as PDA-NOS, LCNEC, MC, UC and LELC. Interobserver agreement was analyzed using Fleiss Kappa. Of the total 77 patients, 63 were PDA-NOS, 3 were LCNEC, 6 were MC, 4 were UC and 1 was LELC patients. Multivariate analysis using Cox proportional regression showed that tumor size (p = 0.001, HR = 1.22, 95% CI 1.08–1.38), patient age (p = 0.001, HR 1.73, 95% CI 1.24–2.40), and M stage (p = 0.02, HR 2.22, 95% CI 1.14–4.32) were significantly associated with worse OS. For the 58 cases analyzed, 3 GP agreed on 42 (72%) cases. The most common diagnosis was PDA-NOS and for 33 (57%) agreement was unanimous. There was moderate agreement (k 0.41–0.60) between all 3 GP. Our study evaluated the challenges associated with histological evaluation of colon cancers with poorly differentiated morphologies. Among the diagnoses considered in the study, MC and LCNEC had different prognostic implications compared to PDA-NOS and UC. Additionally, our GP showed moderate interobserver agreement, indicating that some level of variability in diagnosing poorly differentiated CRC subtypes may be inevitable.</div></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"154 ","pages":"Article 105710"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human pathologyPub Date : 2024-12-01DOI: 10.1016/j.humpath.2024.105701
Carol N. Rizkalla, Lisa Friedman, Vivek Charu, Ankur R. Sangoi
{"title":"Paneth cell-like differentiation in urothelial carcinoma: A hitherto unreported phenomena?","authors":"Carol N. Rizkalla, Lisa Friedman, Vivek Charu, Ankur R. Sangoi","doi":"10.1016/j.humpath.2024.105701","DOIUrl":"10.1016/j.humpath.2024.105701","url":null,"abstract":"","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"154 ","pages":"Article 105701"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human pathologyPub Date : 2024-12-01DOI: 10.1016/j.humpath.2024.105695
Florian Lutz , Sophie-Marie Hornburg , Katharina Möller , Florian Viehweger , Ria Schlichter , Anne Menz , Andreas M. Luebke , Martina Kluth , Claudia Hube-Magg , Andrea Hinsch , Maximilian Lennartz , Christian Bernreuther , Sören Weidemann , Patrick Lebok , Christoph Fraune , Guido Sauter , David Dum , Andreas H. Marx , Ronald Simon , Natalia Gorbokon , Till S. Clauditz
{"title":"PAX6 is a useful marker for pancreatic origin of neuroendocrine neoplasms: A tissue microarray study evaluating more than 19,000 tumors from 150 different tumor types","authors":"Florian Lutz , Sophie-Marie Hornburg , Katharina Möller , Florian Viehweger , Ria Schlichter , Anne Menz , Andreas M. Luebke , Martina Kluth , Claudia Hube-Magg , Andrea Hinsch , Maximilian Lennartz , Christian Bernreuther , Sören Weidemann , Patrick Lebok , Christoph Fraune , Guido Sauter , David Dum , Andreas H. Marx , Ronald Simon , Natalia Gorbokon , Till S. Clauditz","doi":"10.1016/j.humpath.2024.105695","DOIUrl":"10.1016/j.humpath.2024.105695","url":null,"abstract":"<div><div>PAX6 immunohistochemistry (IHC) was proposed as a tool to identify a pancreatic origin of neuroendocrine neoplasms (NENs). To evaluate the diagnostic utility of PAX6 IHC, a tissue microarray containing 19,214 samples from 150 tumor types was analyzed. Data on progesterone receptor (PR) and glutamate decarboxylase 2 (GAD2) expression were available from previous studies. PAX6 staining occurred in 2.6% of 17,224 analyzable tumors and 60 tumor categories showed PAX6 positivity in at least one case. The highest rates of PAX6 positivity occurred in pancreatic (42.9–70.8%) and other NENs (up to 50.0%), testicular tumors (up to 58.3%), basal cell carcinomas of the skin (51.9%), squamous cell carcinomas of different organs (1.5–11.8%), and in gynecological tumors (up to 30%). For detection of pancreatic origin of NENs, sensitivity was highest for PAX6 (68.7%) followed by GAD2 (62.6%) and PR (52.5%) while specificity was highest for GAD2 (95.2%), followed by PR (91.3%), and PAX6 (91.1%). Of the analyzed combinations, the highest sensitivity (53.8%) and specificity (100%) was found for PAX6/GAD2, although combinations of PAX6/PR (49.5%/99.3%), PR/GAD2 (40.7%/98.9%), and PAX6/PR/GAD2 (40.6%/100%) did also result in high specificity. Only 14% of the 118 NENs with negativity for all three antibodies were of pancreatic origin. It is concluded that PAX6 IHC is useful to identify a pancreatic origin in case of NEN metastases of unknown origin. The combination with GAD2 and PR further increase the diagnostic performance of PAX6 and results in a >98% specificity in case of positivity for at least 2 of these markers.</div></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"154 ","pages":"Article 105695"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human pathologyPub Date : 2024-12-01DOI: 10.1016/j.humpath.2024.105681
Qingqing Wu, Ezra Baraban, John M. Gross
{"title":"Perinephric myxoid pseudotumor of fat: A series of 13 cases and literature review","authors":"Qingqing Wu, Ezra Baraban, John M. Gross","doi":"10.1016/j.humpath.2024.105681","DOIUrl":"10.1016/j.humpath.2024.105681","url":null,"abstract":"<div><div>Perinephric myxoid pseudotumor of fat (PMPF) is a recently described and rare retroperitoneal mass-forming lesion whose clinical significance chiefly involves mimicry of a variety of soft tissue tumors. For unknown reasons, it commonly occurs in male patients with underlying non-neoplastic renal diseases and/or type 2 diabetes (DMT2). A total of 55 cases have been reported in the literature. Recently, we have encountered 13 such masses with peculiar histologic features; thus, we sought to investigate our experience and review the clinicopathologic characteristics of the literature. Our series confirms that PMPF frequently occurs in adult male patients (11/13, 85%), with an average age of 66 years, and commonly co-occurs with renal disease, such as DMT2 (2/13, 15%), end-stage renal disease (ESRD) (5/13, 39%), renal cysts (4/13, 31%), concurrent or prior renal neoplasia (2/13; 15%), and myeloma/lymphoma (2/13; 15%). Histologic evaluation shows lipomatous masses commonly showing variable amounts of fat necrosis, myxoid degeneration, lymphoplasmacytic inflammation and lacking atypical hyperchromatic stromal spindle cells. Unusual histologic features include extramedullary hematopoiesis (1/13, 8%), hemosiderin deposition (4/13, 31%), and small wisps of mature smooth muscle (6/13, 46%). All cases tested were negative for MDM2 and did not show an increased ratio of IgG4<sup>+</sup>/IgG<sup>+</sup> plasma cells. Our study confirms the clinical and pathologic features of PMPF and expands its histologic spectrum, underscoring the importance of this entity as a benign pseudotumor which should be included in the differential diagnosis of other fat-containing retroperitoneal masses, particularly well-differentiated liposarcoma.</div></div>","PeriodicalId":13062,"journal":{"name":"Human pathology","volume":"154 ","pages":"Article 105681"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}