{"title":"Diagnostic challenges of endocrine pathology: three cases highlighting potential diagnostic pitfalls in endocrine glands","authors":"Dinuke Shehan de Silva, Tristan Rutland","doi":"10.1016/j.mpdhp.2025.06.002","DOIUrl":"10.1016/j.mpdhp.2025.06.002","url":null,"abstract":"<div><div><span><span><span><span>This article presents three cases illustrating potential diagnostic pitfalls in endocrine gland neoplasms<span>. The first case is of a 69 year old male with a new diagnosis of multiple myeloma<span> along with radiologically detected lung and bilateral adrenal gland masses. Biopsies revealed a poorly differentiated </span></span></span>lung adenocarcinoma that was positive for neuroendocrine markers and CD138, which can lead to confusion with a primary </span>pheochromocytoma<span> and plasma cell neoplasm, respectively. The second case presented is of a 62 year old male with a lesion in the right adrenal gland which on histology was revealed to be a metastatic </span></span>clear cell renal cell carcinoma<span> (ccRCC) that occurred 14 years after resection of the primary. This case highlights that ccRCC metastases<span> can occur many years after the initial excision. The case also highlights the differentials for clear cell tumours of the adrenal glands which includes </span></span></span>adrenocortical adenoma<span><span>. The final case presented is of a 63 year old male with a past history of Merkel cell carcinoma with a large left sided </span>adrenal gland metastasis<span>. Core biopsies revealed a basaloid tumour positive for CK20 and neuroendocrine markers, confirming a diagnosis of metastatic Merkel cell carcinoma. Metastatic Merkel cell carcinoma may be mistaken for pheochromocytoma due to co-expression of neuroendocrine markers and both having a superficial basaloid appearance.</span></span></div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 9","pages":"Pages 506-513"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An overview of pertinent immunohistochemistry and molecular pathology of phaeochromocytoma","authors":"Runjan Chetty","doi":"10.1016/j.mpdhp.2025.06.005","DOIUrl":"10.1016/j.mpdhp.2025.06.005","url":null,"abstract":"<div><div><span><span><span>While morphologically distinct, immunohistochemistry for </span>tyrosine<span> hydroxlase is a sensitive and specific immunohistochemical marker for phaeochrmocytomas. Other useful negative routine markers include cytokeratin, melanocytic markers, TTF-1 and PAX-8. Markers that indicate specific </span></span>genetic<span><span> syndromic cases include succinate dehydrogenase<span> A and B, myc-associated factor X<span>, fumarate hydratase<span><span> and 2-Succinocysteine. Prognostic markers include: Ki-67, p53, heat shock protein-90, TERT and N-cadherin. Hereditary </span>phaeochromocytomas with </span></span></span></span>germline<span><span> gene mutations are grouped into several pathways: pseudohypoxia, </span>kinase signalling<span>, wnt signalling, mitochondrial pathways and miscellaneous. Key genes in these pathways include: </span></span></span></span><span><em>HRAS</em></span>, <em>HIF2A</em>, <em>RET</em> and <span><em>NF1</em></span>. Prognostic genes are <span><span>SDHB</span></span>, <span><span>ATRX</span></span> and <span><em>TERT</em></span><span>. Understanding the pathological, immunohistochemical and genetic landscape of phaeochromocytomas enables a multimodal approach to determining behaviour and targeted therapy.</span></div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 9","pages":"Pages 521-523"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infiltrating epitheliosis of the breast: a case report on an uncommon and challenging complex sclerosing lesion","authors":"Ankurita Kuppasad, Gayathri Wathuge","doi":"10.1016/j.mpdhp.2025.06.007","DOIUrl":"10.1016/j.mpdhp.2025.06.007","url":null,"abstract":"<div><div><span>Infiltrating epitheliosis<span> (IE) of the breast is a complex sclerosing lesion uncommonly encountered in routine diagnostic practice. Histologically, all cases demonstrate florid usual ductal hyperplasia-like proliferation with irregular epithelial foci that appear to infiltrate into the adjacent scleroelastotic stroma. IE can easily be misdiagnosed as </span></span>invasive carcinoma<span> due to its infiltrative growth pattern and focal loss of myoepithelial cells. Most pathologists classify IE in the radial scar/complex sclerosing (RS/CSL) spectrum. Although association with oncogenic PIK3 mutations has been found, its propensity to behave as a neoplastic proliferation is still uncertain. It is currently considered a florid hyperplastic entity requiring a complete excision. Given its rarity and potential for misdiagnosis, recognising the subtle but distinctive features of IE is essential. Further studies are needed to clarify its behaviour, association with carcinoma and its potential as a precursor lesion.</span></div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 9","pages":"Pages 527-530"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul Hankinson, Gayani Pitiyage, Stuart Richards, Fawzia Tahir
{"title":"A case of follicular thyroid carcinoma with bizarre nuclei and discussion of atypia in thyroid gland disease","authors":"Paul Hankinson, Gayani Pitiyage, Stuart Richards, Fawzia Tahir","doi":"10.1016/j.mpdhp.2025.06.006","DOIUrl":"10.1016/j.mpdhp.2025.06.006","url":null,"abstract":"<div><div><span><span><span>The presence of nuclear atypia is a potential pitfall in </span>thyroid<span><span> pathology with several causes ranging from benign disease to aggressive malignant neoplasms. Here we present a case of </span>follicular thyroid carcinoma<span> with bizarre nuclear atypia. Assessment of the type and location of the nuclear atypia as well as select molecular testing aided in diagnosis of this case, excluding other entities such as dyshormonogenetic goitre, papillary thyroid carcinoma, </span></span></span>anaplastic thyroid carcinoma and </span><em>DICER1</em><span> mutated follicular thyroid carcinoma (a recently described entity in the literature). An awareness of the diverse nuclear features and the causes of nuclear atypia in thyroid disease can prevent misinterpretation of this feature reducing the risk of overdiagnosis<span> of malignancy<span> in tissue and cytology specimens.</span></span></span></div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 9","pages":"Pages 524-526"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial intelligence in thoracic pathology: diagnostic and predictive applications","authors":"Jan von der Thüsen","doi":"10.1016/j.mpdhp.2025.06.008","DOIUrl":"10.1016/j.mpdhp.2025.06.008","url":null,"abstract":"<div><div>Artificial intelligence (AI) is rapidly transforming thoracic pathology through computational analysis of histological images. This brief review outlines the current state and future directions of clinical AI applications in histopathologic diagnosis of thoracic malignancies, including diagnostic classification, prognosis, prediction of molecular alterations, response to therapy, and assessment of the tumour microenvironment (TME). The technological foundations of AI in pathology are reviewed, highlighting the practical applications and diagnostic challenges in thoracic pathology, as well as issues in interpretability, validation, infrastructure, reimbursement, and regulation.</div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 8","pages":"Pages 486-490"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Staging in patients with multiple tumours: integrating morphology and molecular profiling","authors":"Matthew Evans","doi":"10.1016/j.mpdhp.2025.05.003","DOIUrl":"10.1016/j.mpdhp.2025.05.003","url":null,"abstract":"<div><div>With improvements in lung cancer diagnosis and management, the phenomenon of patients having more than one lung cancer is becoming increasingly frequent. Whether a second cancer is considered a separate primary lung cancer or an intrapulmonary metastasis fundamentally changes the staging and can have critical importance for treatment decisions. Histological comparison of cancers is often an effective tool in discriminating between separate primary lung cancer and intrapulmonary metastasis. The advent of genomic profiling has brought another powerful tool to our arsenal. While there is compelling evidence that both approaches accurately resolve the majority of cases, neither is without limitations and it is easy to succumb to pitfalls from both histological and genomic assessment. A combined approach by a pathologist who is skilled in recognizing discriminating histological features, and who has a good grounding in the molecular evolution of cancers and in the limitations of molecular techniques, is required to optimize these judgements. In this review, we discuss the tools which can be brought to bear on the dilemma of classifying multiple lung cancers. We begin by reviewing the clinical and radiological clues, before discussing the value of histological comparison, and finally the value which molecular profiling can bring.</div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 8","pages":"Pages 466-480"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The pulmonary pathology of air pollution: a review","authors":"Jessica K Maguire, Aurelie Fabre","doi":"10.1016/j.mpdhp.2025.05.001","DOIUrl":"10.1016/j.mpdhp.2025.05.001","url":null,"abstract":"<div><div>Exposure to ambient and household air pollution causes respiratory disease at all stages of life and is globally responsible for 6.7 million premature deaths annually. The major known contributory pollutants are PM, SO<sub>2</sub>, O<sub>3</sub>, NO<sub>2</sub> and CO. Extensive evidence has been published describing their various pathological effects. The WHO report that 99% of the earth's population breathe air with pollution levels outside the global air quality guidelines. Lack of access to clean fuel is a major risk factor, particularly in low- and middle-income countries. The effects of pollution on the respiratory system are broad, identified from intrauterine life to old age, with most risk at the extremes of age. Many pollutants damage the airways by the same mechanism; the induction of oxidative stress and production of reactive oxygen and nitrogen species, leading to chronic airway changes. Pathologies related to environmental pollution include, but are not limited to, defects in lung development, asthma and COPD, infectious disease and respiratory tract malignancies. While the cardiovascular effects of exposure to pollution have been well described, the purpose of this review article is to outline the major ambient air pollutant types associated with respiratory disease, and describe the pulmonary pathology associated with their exposure.</div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 8","pages":"Pages 451-457"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonathan Callaghan, Caroline Cartlidge, Selina Bhattarai, Azzam Ismail, Jo-An Roulson
{"title":"A neuroglial neoplasm in retroperitoneal lymph nodes: metastasis from a testicular teratoma with embryonic-type neuroectodermal tumour","authors":"Jonathan Callaghan, Caroline Cartlidge, Selina Bhattarai, Azzam Ismail, Jo-An Roulson","doi":"10.1016/j.mpdhp.2025.05.005","DOIUrl":"10.1016/j.mpdhp.2025.05.005","url":null,"abstract":"<div><div>Testicular germ cell tumours are a common solid malignancy amongst young men. Most non-seminomatous germ cell tumours in adults display mixed histological types, although can be purely one type. Rarely, some non-seminomatous germ cell tumours undergo somatic malignant transformation, whereby they can differentiate into diverse malignant phenotypes, which might resemble tumours found elsewhere in the body. Although uncommon, these transformations carry significant implications for prognosis and treatment. We present a case of a testicular teratoma with somatic malignant transformation to embryonic type neuroectodermal tumour. Unusually, the associated metastases to retroperitoneal lymph nodes show neuroglial differentiation without aggressive features. This case highlights the diagnostic challenges of teratomas with somatic malignant transformation, emphasizing the role of histopathology, immunohistochemistry, and molecular techniques in diagnosis and clinical decision-making.</div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 8","pages":"Pages 491-494"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Histological predictors of outcome in non-small cell lung cancer","authors":"Reena Khiroya","doi":"10.1016/j.mpdhp.2025.05.004","DOIUrl":"10.1016/j.mpdhp.2025.05.004","url":null,"abstract":"<div><div>The histopathological diagnosis and reporting of non-small cell carcinoma has been aided by an understanding of the factors which affect prognosis. In this review we will consider a few factors which can affect prognosis of patients with non-small cell lung carcinoma. These are: grading of non-small cell carcinomas, lymphovascular invasion, spread through air spaces, and pleural invasion. We discuss how to identify and quantify these factors, and the known evidence for their effect on prognosis. In conclusion, a better understanding of these factors and their inclusion in histopathology reports will help treatment planning and patient prognostication.</div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 8","pages":"Pages 481-485"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline Cartlidge, Edward E Carling, Bipin Mathew, Laura Wastall
{"title":"Pulmonary adenofibroma: a rare biphasic lung tumour in a young male","authors":"Caroline Cartlidge, Edward E Carling, Bipin Mathew, Laura Wastall","doi":"10.1016/j.mpdhp.2025.05.006","DOIUrl":"10.1016/j.mpdhp.2025.05.006","url":null,"abstract":"<div><div>We report a very unusual case of benign pulmonary adenofibroma (PAF) in a young man who presented with intermittent chest pain and was found to have a lung mass. PAF is extremely rare and is poorly characterized but thought to be benign based on the limited available literature. Indolent PAF may be misdiagnosed as solitary fibrous tumour (SFT), due to similar histological features. We review the morphological histopathological features and the relevant panel of immunohistochemical stains and molecular tests that can help, to prevent misdiagnosis and overtreatment.</div></div>","PeriodicalId":39961,"journal":{"name":"Diagnostic Histopathology","volume":"31 8","pages":"Pages 495-497"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}