{"title":"Histologically Confirmed Adult Tracheomalacia at Autopsy After Single-Lung Transplantation.","authors":"Reiko Okimoto, Mikiko Aoki, Tomohisa Hirata, Takeshi Shiraishi, Ryuichi Waseda, Makoto Hamasaki","doi":"10.1111/pin.70192","DOIUrl":"https://doi.org/10.1111/pin.70192","url":null,"abstract":"<p><p>A man in his 50s developed persistent ventilator dependence, recurrent pneumonia, and lung abscess after right single-lung transplantation, and later died following complications from native lung pneumonectomy. Autopsy confirmed the diagnosis of tracheomalacia, allowing detailed histological examination that revealed extensive cartilage degeneration, disruption, and fibrosis of the trachea. Because histopathological studies of adult tracheomalacia are extremely rare, this case provides valuable insight into its pathology.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70192"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julius Bodemeyer, Mara Elisa Mierzwa, Jörg Seraphin, Rizkallah Maroun, Wolfgang Körber, Christoph Engelke, Felix Bremmer, Tessa Rosenthal, Tim Heißenberg, Kirsten Reuter-Jessen, Philipp Ströbel, Alexander Marx, Hanibal Bohnenberger
{"title":"Pleural Mesothelioma With Unusual Squamous Differentiation: A Clinicopathological Case Report With Molecular Insights From Whole-Exome Sequencing.","authors":"Julius Bodemeyer, Mara Elisa Mierzwa, Jörg Seraphin, Rizkallah Maroun, Wolfgang Körber, Christoph Engelke, Felix Bremmer, Tessa Rosenthal, Tim Heißenberg, Kirsten Reuter-Jessen, Philipp Ströbel, Alexander Marx, Hanibal Bohnenberger","doi":"10.1111/pin.70190","DOIUrl":"10.1111/pin.70190","url":null,"abstract":"<p><p>Pleural mesothelioma is an aggressive tumor with a poor prognosis and limited therapeutic options. While histological heterogeneity is common, true squamous differentiation is extremely rare and diagnostically challenging. We report an 81-year-old man with asbestos exposure who presented with recurrent right-sided pleural effusion. Thoracoscopic biopsies revealed two distinct tumor components. The first expressed mesothelial immunohistochemical markers, whereas the second showed a squamous profile. Both components demonstrated loss of BAP1 expression and homozygous deletion of CDKN2A, supporting a common mesothelial origin. Whole-exome sequencing revealed a tumor mutational burden above the average reported for mesothelioma (8-9 mutations per megabase), with 69 somatic mutations in total, 43 shared between the two components. In addition to canonical mesothelioma alterations (BAP1, CHEK2), the squamous component harbored 18 unique variants, including oncogenic alterations in NFE2L2 and PIK3CA. A novel SOX9 missense variant of uncertain significance (p. Thr243Pro) was also identified within the transactivation middle (TAM) domain; its functional consequence remains unknown. This case highlights a rare histological variant of pleural mesothelioma with partially squamous differentiation, characterized by a mutational burden above the mesothelioma average and squamous carcinoma-associated alterations. Integrated histology, immunohistochemistry, and genomic profiling are essential to avoid misdiagnosis and to improve understanding of tumor plasticity in mesothelioma.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70190"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mari Watanabe, Shun Hasegawa, Yoshihiro Miyauchi, Daisuke Matsubara, Masashi Fukayama
{"title":"Histopathologic Assessment of Pulmonary Capillaritis Using Combined Immunohistochemical and Special Stains: An Autopsy Case Double-Positive for MPO-ANCA and Anti-GBM Antibodies.","authors":"Mari Watanabe, Shun Hasegawa, Yoshihiro Miyauchi, Daisuke Matsubara, Masashi Fukayama","doi":"10.1111/pin.70196","DOIUrl":"https://doi.org/10.1111/pin.70196","url":null,"abstract":"<p><p>Anti-glomerular basement membrane (anti-GBM) disease may coexist with antineutrophil cytoplasmic antibodies (ANCA), a clinicopathologic entity termed double-positive disease, in which diffuse alveolar hemorrhage (DAH) is common but histologic confirmation of pulmonary capillaritis remains difficult. A 93-year-old woman presented with rapidly progressive renal failure, and serologic evaluation revealed markedly elevated myeloperoxidase (MPO)-ANCA and anti-GBM antibody levels. Despite corticosteroid therapy, the patient died of progressive renal failure. At autopsy, the kidneys demonstrated diffuse crescentic glomerulonephritis with linear IgG deposition along the glomerular basement membrane, consistent with anti-GBM nephritis, together with multiple cortical scars composed of clusters of globally sclerotic glomeruli and interstitial fibrosis. The lungs exhibited DAH with focal neutrophilic infiltration along the alveolar septa, accompanied by focal destruction of capillary walls with subtle leukocytoclasia. Immunohistochemical analysis using epithelial marker (cytokeratin AE1/AE3), endothelial markers (CD31, CD34, and ERG), and platelet markers (CD61 and CD42b) highlighted alveolar epithelial injury, loss of endothelial continuity, and extravascular platelet deposition, respectively, in areas where capillaritis was suspected. Spatial concordance of these findings supported the presence of structural injury associated with pulmonary capillaritis. This case highlights the diagnostic importance of rigorous histopathologic assessment complemented by combined immunohistochemistry in patients with DAH.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70196"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pathological Evolution of Fibrosis in IgG4-Related Ophthalmic Disease: A Retrospective Study of 100 Cases.","authors":"Natsuki Taniguchi, Akira Satou, Yasuharu Sato, Taishi Takahara, Yasuhiro Takahashi, Toshinobu Kubota, Akari Iwakoshi, Toyonori Tsuzuki","doi":"10.1111/pin.70193","DOIUrl":"10.1111/pin.70193","url":null,"abstract":"<p><p>IgG4-related ophthalmic disease (IgG4-ROD) is a common manifestation of IgG4-related disease, but its clinicopathologic features and the mechanisms underlying fibrosis remain incompletely understood. We retrospectively analyzed 100 cases of IgG4-ROD and investigated fibrosis using immunohistochemistry for IgG4, FOXP3, CD68, and CD163, together with RNA in situ hybridization for TGFB1. IgG4-ROD was histologically categorized into four patterns (Patterns 1-4) reflecting progressive fibrosis, demonstrating a spectrum from lymphoplasmacytic inflammation to marked fibrosis. Fibrosis was absent or minimal in 51% of cases, indicating that fibrosis is not essential for diagnosis, whereas obliterative phlebitis was rare. Compared with non-fibrotic cases, fibrotic cases showed significantly increased numbers of CD68-positive and CD163-positive macrophages (p < 0.001), predominantly localized at the interface between lymphoid and fibrotic areas. In contrast, fibrosis was not associated with IgG4-positive plasma cells, FOXP3-positive regulatory T cells, or EBV status. TGFB1 expression was significantly higher in lymphocyte-rich than fibrotic areas (p < 0.001), suggesting a closer association with lymphocyte-rich inflammation than established fibrosis. These findings demonstrate progressive histologic changes from Pattern 1 to Pattern 4 and suggest that accumulation of CD163-positive macrophages is associated with fibrosis in IgG4-ROD.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70193"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Awareness of Partial Loss is Essential in Interpreting Merlin Immunohistochemistry When Diagnosing Pleural Mesothelioma.","authors":"Kazuki Nabeshima, Tomomi Furukawa, Makoto Hamasaki, Kei Kushitani, Yukio Takeshima, Shigeki Shimizu, Kenzo Hiroshima, Maiko Takeda, Hironori Ninomiya, Katsumi Takizawa, Yuko Goto, Makiko Adachi","doi":"10.1111/pin.70195","DOIUrl":"https://doi.org/10.1111/pin.70195","url":null,"abstract":"<p><p>Ancillary assays, including BAP1 (BRCA-1-associated protein 1), MTAP (methylthioadenosine phosphorylase), and Merlin immunohistochemistry (IHC), are effective in discriminating pleural mesothelioma (PM) from reactive mesothelial proliferations (RMP). IHC of Merlin, a protein product of the neurofibromin 2 gene, was most recently developed. Our previous study suggested uneven occurrence of Merlin loss within PM tissues. This was further investigated here in a total of 41 tissues of PM obtained from seven institutions. Partial or diffuse Merlin loss was detected with excellent interobserver agreement (kappa: 0.82). Of the 34 PM cases with interobserver consensus, partial and diffuse loss of Merlin expression were each observed in 13 cases (38%). PM with partial Merlin loss exhibited either discrete or intermingled spatial distribution of Merlin-lost cells. BAP1 or MTAP showed partial loss in none or only 5% of PM cases, respectively. The diagnostic sensitivity for PM was enhanced to 91% with addition of diffuse and partial Merlin loss to a combination of BAP1 and MTAP loss while maintaining 100% specificity. Although detection of Merlin loss as well as BAP1 and MTAP losses is effective for distinguishing PM from RMP, pathologists should be familiar with partial Merlin loss when interpreting Merlin IHC results.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70195"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to \"Cancer-Associated Fibroblasts in Invasion Front Can Be a Prognostic Predictor for Oral Squamous Cell Carcinoma\".","authors":"","doi":"10.1111/pin.70201","DOIUrl":"https://doi.org/10.1111/pin.70201","url":null,"abstract":"","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70201"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinicopathologic Characteristics and Prognostic Value of Rhabdoid Features in Pancreatic Undifferentiated Carcinoma.","authors":"Akihiro Nakamura, Takafumi Ogawa, Yasuo Ueda, Fumitaka Niiya, Akane Wada, So Murai, Yuki Takahashi, Yuichi Takano, Kenichi Matsuo, Kuniya Tanaka, Nobuyuki Ohike","doi":"10.1111/pin.70200","DOIUrl":"https://doi.org/10.1111/pin.70200","url":null,"abstract":"<p><p>Undifferentiated carcinoma (UC) is a rare, highly aggressive subtype of pancreatic cancer; UC with rhabdoid features (UCRF) is particularly associated with poor prognosis. This study aimed to compare clinicopathologic characteristics and outcomes of UC between groups of patients defined by presence versus absence of RF. We retrospectively reviewed patients diagnosed with UC by EUS-guided tissue acquisition from 2017 to 2024. Histologically, 11 patients were classified as anaplastic UC and two had UC with osteoclast-like giant cell. Six patients had UCRF. Only 2 patients underwent surgery, while 8 received chemotherapy; 5 of these were treated with gemcitabine plus nab-paclitaxel. One patient (17%) in the UCRF group was INI-1-negative. CK7 was positive in 3 UCRF patients (50%) and in all 7 UC patients without RF. In the overall cohort, median OS showed no statistically significant difference between UCRF and UC without RF (3.9 vs. 12.9 months; log-rank p = 0.188). However, after excluding two patients with UCOGC, Kaplan-Meier analysis demonstrated a significantly shorter OS in UCRF (p = 0.009). These findings suggest that RF represents a potential adverse prognostic factor in pancreatic UC. Further studies are warranted to clarify biologic significance and treatment implications of RF in pancreatic UC.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70200"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Why Most Cancer Cells Cannot Form Tumors: Replicative Lifespan, Damage Partitioning and Stem Cell Induction.","authors":"Mitsuyasu Kato","doi":"10.1111/pin.70188","DOIUrl":"https://doi.org/10.1111/pin.70188","url":null,"abstract":"<p><p>Tumors grow because the total number of cancer cells increases without limit. The prevailing explanation is that each proliferating cancer cell has acquired unlimited replicative capacity, yet this does not explain why the overwhelming majority of cancer cells fail to initiate tumors on transplantation, why the cancer stem cell fraction of serially passaged cultures remains nearly constant, or why the measured cell loss factor of human tumors is so high. This review proposes an alternative reading of these observations. Non-stem cancer cells may possess a replicative lifespan that is set not by telomere attrition but by the progressive accumulation of damaged proteins, protein aggregates and dysfunctional mitochondria, so that each lineage eventually terminates in growth arrest or death. Persistent expansion would then depend on th e rate at which non-stem cancer cells are converted back into stem cells. Work on transforming growth factor-β associated molecules, including TMEPAI/PMEPA1, MAFK-GPNMB and THG-1, is reviewed in this light, together with evidence from budding yeast and mammalian stem cells that damage is partitioned asymmetrically at division. Established observations, reasonable inferences and untested assumptions are distinguished explicitly, and experimental tests are proposed.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70188"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji-In Jeong, Jiwoo Lee, Mee-Hye Oh, Hyun Deuk Cho, Ji-Hye Lee, Youn Soo Jeon, Si-Hyong Jang
{"title":"MITF-Overexpressing Perivascular Epithelioid Cell Tumor of the Urinary Bladder Lacking TSC1/TSC2 Alterations and TFE3 Rearrangement: A Case Report and Review of the Literature.","authors":"Ji-In Jeong, Jiwoo Lee, Mee-Hye Oh, Hyun Deuk Cho, Ji-Hye Lee, Youn Soo Jeon, Si-Hyong Jang","doi":"10.1111/pin.70187","DOIUrl":"https://doi.org/10.1111/pin.70187","url":null,"abstract":"<p><p>Perivascular epithelioid cell tumors (PEComas) are mesenchymal neoplasms characterized by melanocytic and smooth muscle differentiation, commonly associated with TSC1/TSC2 alterations or TFE3 rearrangements. Herein, we report a rare case of urinary bladder PEComa with MITF overexpression and without identifiable TSC1/TSC2 mutations or TFE3 rearrangement. A 50-year-old man underwent partial cystectomy for a bladder mass. Histologically, the tumor was well circumscribed and composed of mixed spindle and epithelioid cells with cytologic atypia and low mitotic activity. Immunohistochemistry revealed diffuse expression of SMA, HMB45, and MITF, with negative staining for TFE3. Quantitative reverse-transcription PCR revealed increased MITF mRNA expression in PEComa tissue. Next-generation sequencing identified a truncating ATRX mutation but no alterations in TSC1/TSC2 or TFE3, and no MITF copy number gain. By Folpe criteria, the tumor was classified as malignant, whereas alternative models suggested a lower-risk category, highlighting the limitations of histologic risk stratification systems. The absence of canonical TSC/mTOR or TFE3 alterations, together with MITF overexpression, suggests a distinct molecular mechanism potentially involving dysregulation of the MiT/TFE pathway. This case expands the molecular spectrum of PEComa and supports the existence of a MITF-driven subset, highlighting the need for integrated histologic and molecular evaluation for prognostic assessment.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70187"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Masaki Suzuki, Aya Shinozaki-Ushiku, Junichi Takada, Koji Aze, Shinji Yuhara, Yue Cong, Mitsuaki Kawashima, Masaaki Sato, Tetsuo Ushiku
{"title":"Clinicopathological Significance of Extra-Alveolar Invasion in Lung Adenocarcinomas Treated With Sublobar Resection.","authors":"Masaki Suzuki, Aya Shinozaki-Ushiku, Junichi Takada, Koji Aze, Shinji Yuhara, Yue Cong, Mitsuaki Kawashima, Masaaki Sato, Tetsuo Ushiku","doi":"10.1111/pin.70191","DOIUrl":"10.1111/pin.70191","url":null,"abstract":"<p><p>Lung adenocarcinoma exhibits diverse pathological features, some of which for example, histological grading and tumor spread through air spaces (STAS), can be used for prognosis. Extra-alveolar invasion (EX) is a unique pathological factor focused on depth of invasion, and is defined as tumor infiltration into periarterial, peribronchiolar, or interlobular septal stroma. We recently suggested EX as a prognostic indicator, but its significance in sublobar resection remains unclear. We investigated the prognostic impact of EX in 116 patients with pT1mi-pT2a non-mucinous lung adenocarcinoma treated by segmentectomy or wedge resection. EX was evaluated using elastic fiber staining. Among 10 recurrent cases, 8 were EX-positive, and 2 were EX-negative and STAS-positive. The EX(-)/STAS(+) cases had local recurrence, while the EX(+) cases exhibited metastatic recurrence. The pT1abc EX(+) group showed significantly shorter recurrence-free survival (RFS) than the pT1abc EX(-) group, but no significant differences were observed when compared with the pT2 group. EX(+ )/STAS(-) and EX(+ )/STAS(+) groups showed significantly shorter RFS than EX(-)/STAS(-) group, but EX(-)/STAS(+) group did not. In conclusion, EX was associated with poor prognosis after sublobar resection of lung adenocarcinoma. Combined evaluation of EX and STAS may improve postoperative risk stratification.</p>","PeriodicalId":19806,"journal":{"name":"Pathology International","volume":"76 10","pages":"e70191"},"PeriodicalIF":1.9,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}