Annals of Diagnostic Pathology最新文献

{"title":"Histopathologic patterns in isthmocele pregnancies.","authors":"Badr AbdullGaffar, Tasnim Keloth, Fatma B Zarooni, Eman Al-Zahmi","doi":"10.1016/j.anndiagpath.2024.152432","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2024.152432","url":null,"abstract":"<p><p>Isthmoceles are defects related to Caesarean section (CS) scars, known to cause secondary infertility and interfere with in-vitro fertilization in women who have had Caesarean deliveries. The etiologies are multifactorial. Isthmoceles, similar to dehiscent CS scars, can be potential sites for ectopic pregnancies and abnormal placentation. There are a few case reports of pregnancies occurring within isthmoceles. However, there is a lack of studies focusing on the histopathologic details of gestations occurring within isthmoceles. Our main aim is to address this gap by illustrating the different histopathologic patterns of products of conception and gestational trophoblastic lesions involving isthmoceles. We also aim to determine the potential clinical relevance of gestational isthmoceles. We have conducted a retrospective review study of isthmocele specimens obtained from hysteroscopic isthmoplasty and hysterectomies. We found 14 (7.4 %) isthmocele ectopic pregnancies. The involved pouches were large, wide-based, predominantly low-level endocervical mucosa-lined isthmoceles. Six patients (43 %) presented with placental site nodule and plaque, four patients (28 %) with incomplete abortus material, two patients with atypical placental nodules, one patient with an exaggerated placental site, and one patient with epithelioid trophoblastic tumor. The features were highlighted by special stains and accentuated by appropriate immunohistochemistry. Some small and focal placental site nodule gestational trophoblastic lesions were found to have been missed, overlooked or misinterpreted by the original pathologists. The presence of zonation layers, typified by a hemosiderotic inflammatory stromal band, was found to be a useful clue in order to perform deeper levels to uncover small hidden residual trophoblastic foci. The larger atypical placental site nodule and epithelioid trophoblastic cell tumor lesions were initially confused with cervical squamous cell carcinoma, which was excluded by trophoblast-specific immunomarkers. Large, wide-based, low-level endocervical mucosa-lined isthmoceles are more prone to harboring ectopic pregnancies. A history of previous scar pregnancies was found to be a risk factor for developing subsequent isthmocele ectopic pregnancies. Gestational isthmocele is a common phenomenon that exhibits a variety of histopathologic changes. Pathologists should be aware of these changes in resected isthmocele specimens in order to properly guide gynecologists in patient management and avoid potential diagnostic pitfalls.</p>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"152432"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933432","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":"Ki-67 as a marker for differentiating borderline and benign phyllodes tumors of the breast: A meta-analysis and systematic review.","authors":"Lucas Antônio Fernandes Torres, Davi Said Gonçalves Celso, Maria L R Defante, Victoria Alzogaray, Mayara Bearse, Ana Claudia Frota Machado de Melo Lopes","doi":"10.1016/j.anndiagpath.2024.152429","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2024.152429","url":null,"abstract":"<p><p>Previously published studies raise the possibility of a link between breast phyllodes tumors (PT) grading and Ki-67 expression. In the current study, the authors conducted a literature review and meta-analysis to evaluate the association between the histological grades of PT and Ki-67 positivity, as well as the potential role of this immunomarker for the grading of PT. Observational studies grading PT and providing Ki-67 expression levels were retrieved from databases searches up to 11 August 2024, with 10 % or more of positive stromal cells being considered the cut-off point. A subgroup analysis included studies using the World Health Organization (WHO) criteria for PT grading. A total of 416 PT from 10 studies were included, with 25 % (106/416) showing increased Ki-67 expression. A significant association was found with increased Ki-67 expression in borderline PT compared to benign PT (OR 19.44; CI 3.11-121.74; P = 0.008; I² = 71 %). When comparing malignant and borderline tumors, a significant difference between the groups was observed (OR 7.87; 95 % CI 2.31-26.81; P < 0.01; I²: 49 %). However, in the subgroup of tumors using only the WHO classification, the association was non-significant (OR 5.50; 95 % CI 0.89-34.03; P = 0.07; I² = 64 %). Our meta-analysis showed an association between increased Ki-67 expression and borderline PT compared to benign tumors. The findings suggest Ki-67 may be a tool in the classification of PT, especially in histologically challenging cases.</p>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"152429"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900186","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":"A novel histologic index for polyomavirus nephropathy in comparison with the Banff scoring system: Clinical validation, prognostic implication, and correlation with plasma viral load.","authors":"Rajesh Nachiappa Ganesh, Edward A Graviss, Duc Nguyen, Stephanie G Yi, Ziad El-Zaatari, Lillian Gaber, Roberto Barrios, Luan Truong","doi":"10.1016/j.anndiagpath.2024.152430","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2024.152430","url":null,"abstract":"<p><p>BK Polyomavirus nephropathy (PVN) with definitive diagnosis on biopsy, presents incidentally or with varying degrees of graft dysfunction. Banff working group on PVN has proposed a novel scoring system in renal biopsies, to identify patients with higher risk of graft failure. In this study, we attempted to validate the Banff scoring system at index biopsies and correlate with a novel index score, plasma BK-virus load and graft outcome. 48 patients with index biopsies of PVN diagnosed from 2019 to 2022, with simultaneous plasma BKV-virus loads and SV-40 stains were chosen. Biopsies were scored for Banff PVN Class and by novel PVN index. Inter-observer reproducibility was tested between 3 renal pathologists for all parameters and findings were correlated with graft outcome, in a median follow-up of 42 months. Banff PVN classes 2 and 3 and novel index 3 were associated with higher percentage of graft failure and persistent viremia. The novel index score showed a stronger and consistent temporal association with plasma BK-virus levels. Kappa scores revealed a 68 % agreement for Banff PVN class scoring. Our study highlights the prognostic utility of Banff PVN scheme and novel PVN index in correlation with plasma BKV viremia and graft outcome.</p>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"152430"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903957","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":"Evaluation of whole-slide imaging for diagnosing frozen sections.","authors":"Muhammad Ahsan, Fizza Jahangir, Saira Rathore, Mahrukh Mumtaz, Samina Zaman","doi":"10.1016/j.anndiagpath.2024.152431","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2024.152431","url":null,"abstract":"<p><p>A promising application of digital pathology is the use of Whole slide imaging (WSI) for rapid and remote intraoperative consultations. Based on recommendations from the College of American Pathologists, we compared diagnostic accuracy and technical analysis of WSI with optical microscopy (OM) for reporting frozen sections (FS). A series of 105 consecutive FS cases were included in our study and were categorized as primary diagnosis, assessment of margin status, and lymph node status. A surgical pathologist reviewed all WSI digital slides of FS cases online and their corresponding glass slides using OM after a 2-week washout period. Technical and diagnostic parameters for remote reporting of frozen sections using WSI were compared to routine OM. Diagnostic agreement between WSI and OM in the FS cases was 100 %. In comparison with the reference standard (original sign-out diagnosis), the overall diagnostic accuracy of WSI and OM was 99.04 %. Scan time per slide averaged 103.89 s. Mean diagnostic assessment time for OM was 17.48 s, while it was 26.62 s for WSI, with a mean difference of 9.14 s (P < .001). The overall mean turnaround time was 3.8 min for reporting a single slide using WSI based digital pathology system. The diagnostic accuracy of WSI is comparable to that of conventional OM. Therefore, we conclude that WSI based digital pathology systems can be safely implemented and integrated into a laboratory workflow as an alternative to conventional OM.</p>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"152431"},"PeriodicalIF":1.5,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873375","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":"Mass-forming isolated ischemic necrosis of the cecum mimicking malignancy: Clinicopathologic features of 11 cases.","authors":"Xiaoyan Liao, Douglas K Rex, Dongwei Zhang","doi":"10.1016/j.anndiagpath.2024.152428","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2024.152428","url":null,"abstract":"<p><p>Isolated ischemic necrosis of the cecum (INC) is an uncommon benign condition that occurs most often in elderly patients. The clinical presentation and radiographic findings often mimic acute appendicitis or malignancy. This study aimed to investigate the clinicopathologic features of mass-forming INC. Eleven INC patients who presented with cecal masses were identified by searching the electronic medical record system in two large academic centers. The clinical and pathological features, including symptoms, imaging, endoscopic and surgical findings, histomorphology, and follow-up, were retrospectively analyzed. The study cohort included 4 males and 7 females, with a median age 72 (range 43-87) years. Common clinical presentations included right lower quadrant abdominal pain, nausea and vomiting, and bloody diarrhea. Nine patients had hypertension and cardiovascular diseases, including coronary artery disease, congestive heart failure, atrial fibrillation, and heart valve disease. All patients had a mass in the cecum by endoscopy and/or imaging studies, clinically suspicious for malignancy. The median mass size was 5 (range 3.1-6) cm. Six patients received non-surgical treatment after the biopsy specimen proved a benign histologic pattern of ischemic necrosis. The remaining 5 patients underwent right hemicolectomy. Pathologic examination of the biopsy or resection specimens showed similar histologic changes such as mucosal denudation, ulceration, necrosis, crypt withering and loss, and lamina propria hyalinization, findings consistent with ischemic necrosis. No malignancy was identified in any case. After a median follow-up of 78 (range 3-121) months, 10 patients were still alive. Only 1 patient died and this was from other causes and 96 months later. Mass-forming INC is a rare and unique variant of ischemic colitis that occurs in elderly patients with a low flow state. It is a benign condition with a favorable prognosis. INC should be considered in patients with long-standing hypertension or cardiovascular disease who present with right lower quadrant abdominal pain and cecal mass. Biopsy of the mass with pathologic examination helps make a diagnosis, assess the disease severity, and rule out malignancy. Awareness of this rare entity is important to avoid unnecessary resections in these patients.</p>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"152428"},"PeriodicalIF":1.5,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142865881","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":"Correlation of large cribriform carcinoma and \"unfavorable histology\" with other Gleason pattern 4 subtypes: A proof-of-principle study evaluating 485 radical prostatectomy specimens with proposal for the concept of \"borderline histology\".","authors":"Jane K Nguyen, Jianbo Li, Chien-Kuang C Ding, Christopher J Weight, Jesse K McKenney","doi":"10.1016/j.anndiagpath.2024.152427","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2024.152427","url":null,"abstract":"<p><p>Prostatic adenocarcinomas with large cribriform glands/intraductal carcinoma (LC/IDC), or the recently proposed unfavorable histology, are associated with adverse outcomes after radical prostatectomy. However, Gleason pattern 4 carcinomas without LC/IDC (or unfavorable histology) have minimal risk for aggressive clinical behavior after prostatectomy. As proof-of-principle study, we collected a cohort of 485 radical prostatectomy specimens to assess correlations between different subtypes of Gleason pattern 4 disease and the presence of adjacent high-risk prostatic adenocarcinoma, defined as LC/IDC or unfavorable histology. All prostatectomies were completely embedded, and all slides re-reviewed to record Gleason score/Grade Group, diameter of the largest cribriform gland (i.e. the longest cross-sectional distance), and all architectural patterns of carcinoma utilizing previously described Canary methodology. The presence and percent of LC/IDC (defined as >0.25 mm) was determined. We also evaluated correlation with the recently proposed \"unfavorable histology\" as a secondary endpoint. Complex Gleason pattern 4 subtypes, distinct from LC/IDC and unfavorable histology, were termed \"borderline histology\" and defined as the presence of any of the following patterns: small cribriform/glomeruloid architecture (≤0.25 mm), dominant population of poorly formed glands/small nests, simple glomerulations, and epithelial complexity associated with extravasated mucin (beyond typical mucinous fibroplasia pattern and not containing cribriform >0.25 mm). Comparisons between recorded variables and LC/IDC (or unfavorable histology) utilized the Wilcoxon test for continuous variables and chi-squared test or Fisher's test for categorical variables. Pearson or phi correlation coefficients were used to assess the association between two variables. \"Borderline histology\" was significantly correlated to LC/IDC (r = 0.55) and unfavorable histology (r = 0.607), both p < 0.001. Specifically, small cribriform/small glomeruloid architecture had the strongest correlation, compared to the other \"borderline histology\" subtypes (r = 0.646). We demonstrate that \"borderline histology\" has a strong association with the concomitant presence of high-risk prostate cancer by current histologic definitions (i.e. LC/IDC and unfavorable histology). This proof-of-principle study suggests that large cohort biopsy-RP correlation studies are needed, as the presence of these patterns on biopsy could potentially aid preoperative risk stratification for patients without other high-risk features at initial evaluation.</p>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"152427"},"PeriodicalIF":1.5,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792728","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":"Unveiling the swirl sign: A radiologic-pathologic correlation in deep angiomyxoma.","authors":"Hiroshi Yoshida, Nao Kikkawa, Waku Takigawa, Masaya Uno, Mitsuya Ishikawa","doi":"10.1016/j.anndiagpath.2024.152426","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2024.152426","url":null,"abstract":"<p><p>Deep angiomyxoma (DA) is a rare, slow-growing soft tissue tumor typically affecting women of reproductive age. Despite its benign histology, it poses significant clinical challenges due to local invasiveness and high recurrence. Accurate diagnosis through radiologic imaging, particularly MRI, is essential for guiding treatment. One key imaging feature of DA is the \"swirl sign,\" a distinctive pattern on T2-weighted images. However, its histological basis remains unclear. Here, we present a case of DA in a 46-year-old woman, highlighting the correlation between radiologic and histopathologic findings. MRI showed the characteristic swirl sign, which histologically corresponded to straight-running blood vessels aligned with the tumor's long axis, supported by collagen fibers within an edematous stroma. This case offers novel insight into the origins of the swirl sign and provides research questions on this sign. Further research is needed to explore its potential as a biomarker for tumor growth and aggressiveness.</p>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"152426"},"PeriodicalIF":1.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781533","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":"Fungal Rhinosinusitis: An integrated diagnostic approach","authors":"R Soundarya ,&nbsp;H.C Deepa ,&nbsp;Peralam Yegneswaran Prakash ,&nbsp;V Geetha","doi":"10.1016/j.anndiagpath.2024.152415","DOIUrl":"10.1016/j.anndiagpath.2024.152415","url":null,"abstract":"<div><div>Classification of fungal rhinosinusitis (FRS) based on histomorphology and clinical presentation aids in early diagnosis and prompt patient management. In this retrospective observational study, clinicopathologic findings in patients diagnosed with fungal rhinosinusitis between January 2019 and December 2021 were evaluated. Clinical and imaging findings were retrieved from hospital records; slides from routine and histochemical studies were reviewed, and the cases were classified into non-invasive [fungal ball (FB) and allergic fungal rhinosinusitis (AFRS)] and invasive FRS [acute invasive fungal rhinosinusitis (AIFRS), chronic invasive fungal rhinosinusitis (CIFRS) and chronic invasive granulomatous fungal rhinosinusitis (CGFRS)]. Fungal cultures were also compared with histopathology. Of the 85 patients in the study, 34% were non-invasive (86% FB,10% AFRS, and 4% unclassified), and 66% were invasive (70% AIFRS, 21% CGFRS, and 9% CIFRS). The mean age of patients was 51 years, with a male-to-female ratio of 1.5:1. The most common comorbidity was diabetes with COVID-19 co-infection. Culture reports were available for 77 patients, of which 36 cases had growth, the majority of which were Aspergillus; 7 patients had coinfection with Aspergillus and Mucorales. Comparing histopathology to the gold standard mycology for Aspergillus, a sensitivity of 90%, specificity of 96%, and Cohen's Kappa of 0.8 was achieved. This study emphasizes the value of an integrated diagnostic approach in arriving at an appropriate diagnosis. In resource-limited settings, histopathological evaluation can be a valuable screening tool, aiding in early diagnosis.</div></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"75 ","pages":"Article 152415"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743037","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":"Castleman disease-type histopathological patterns of lymph nodes in patients with plasma cell neoplasia and POEMS syndrome","authors":"Laura Rodriguez-Merino,&nbsp;Santiago Montes-Moreno","doi":"10.1016/j.anndiagpath.2024.152414","DOIUrl":"10.1016/j.anndiagpath.2024.152414","url":null,"abstract":"<div><div>Plasma cell neoplasia and POEMS syndrome patients may present Castleman disease (CD)-type features in lymph nodes. Our aim was to better characterize the histopathological patterns found in plasma cell neoplasia associated CD and to improve the detection of clonal plasma cell populations in the lymph node biopsies of these patients.</div><div>Lymph node and bone marrow samples from six cases with plasma cell neoplasia associated CD, including POEMS syndrome and multiple myeloma were analyzed. A complete analysis including morphology, IHC and PCR-based clonality detection in the lymph node biopsies and morphology; IHC and FCM in the bone marrow biopsies was done. Correlation with clinical and laboratory features was performed.</div><div>Both plasma cell rich and hyper vascular Castleman disease like histopathological features were found. In two out of six cases, sheets of plasma cells with light chain and isotype restriction were identified in the lymph nodes. B cell clonality analysis provided evidence of clonal populations in 5 out of 6 cases, increasing the sensitivity for the detection in cases without morphologically identifiable monotypic plasma cells. None of the twelve control cases with iMCD and HHV-8 positive CD showed clonal populations.</div><div>In conclusion, the combination of morphology, complete immunophenotyping and B cell clonality analysis in the lymph node biopsy may provide evidence of clonal populations in up to 83 % of cases with plasma cell neoplasia/POEMS syndrome associated Castleman disease. Clinical work-up for the confirmation of plasma cell dyscrasia is advisable in such cases.</div></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"74 ","pages":"Article 152414"},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748339","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":"Pathology of rheumatoid meningitis: A report of 5 cases highlighting the importance of clinical correlation","authors":"Samuel Guzman ,&nbsp;B.K. Kleinschmidt-DeMasters","doi":"10.1016/j.anndiagpath.2024.152412","DOIUrl":"10.1016/j.anndiagpath.2024.152412","url":null,"abstract":"<div><div>Rheumatoid meningitis (RM) presents with sufficiently wide-ranging, but non-specific, symptoms and neuroimaging features of pachy- and/or leptomeningeal thickening that it may be indistinguishable from subacute infectious meningitis. RA diagnosis variably antedates RM and serological confirmation by rheumatoid factor and anti-citrullinated peptide antibodies may not be present preoperatively. Thus, meningeal biopsy may be undertaken. Classic examples of RM show lymphoplasmacytic leptomeningeal inflammation and small vessel vasculitis, with rheumatoid nodules being less frequent. We reviewed our experience with 5 RM biopsies, as well as the literature, placing “classic” histological findings in perspective with biopsies showing less pathognomonic features. 5 RM cases were identified, 2 male: 3 female, ages 62–79 years. All patients had leptomeningeal enhancement by MRI and 2 had known negative RF serology prior to meningeal biopsy. In 1 case RF was initially negative, but on serological reassessment turned positive; 2 patients were diagnosed by clinical correlation. 4 leptomeningeal/superficial cortical biopsies manifested chronic lymphoplasmacytic inflammation with multinucleated giant cells, with discrete foci of deep blue/black necrosis with cellular debris (“dirty necrosis”) surrounded by a variably- developed palisade of histiocytes (rheumatoid nodules). The 5th showed only non-specific mononuclear cell inflammation. All showed variable degrees of diffuse astrocytosis and microgliosis of the cortex without microglial clusters or compact granulomas. Stains for microorganisms were negative. Diagnosis of RM can be suspected by the pathologist if the “classic” features of rheumatoid nodules are present on biopsy, but in some cases, only non-specific inflammation is present. Diagnosis necessitates correlation between clinical, serological, and histological features.</div></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":"74 ","pages":"Article 152412"},"PeriodicalIF":1.5,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142720667","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}