Annals of Diagnostic Pathology最新文献

{"title":"Clinicopathologic features and diagnostic challenges of small cluster pattern appendiceal neuroendocrine tumors","authors":"Benjamin Gertsen ,&nbsp;Juwairiya Arshi ,&nbsp;Rena X. Li ,&nbsp;Jennifer J. Findeis-Hosey ,&nbsp;Aaron R. Huber ,&nbsp;Yansheng Hao","doi":"10.1016/j.anndiagpath.2023.152250","DOIUrl":"10.1016/j.anndiagpath.2023.152250","url":null,"abstract":"<div><p><span><span><span>Appendiceal neuroendocrine neoplasms (NENs) can present with various growth patterns including the traditional triad of histologic patterns-insular, trabecular and tubular. A small cluster pattern was also found in this study and the literature on this specific morphology is limited. In this study, we conducted a comprehensive review of appendiceal NENs from our institution over a ten-year period. Clinical and demographic data were obtained from medical records. Immunohistochemical stains were performed with antibodies specific for </span>synaptophysin, </span>chromogranin<span>, INSM1, CD56, serotonin and peptide YY. The small cluster pattern was found in 29.4 % of all cases evaluated. The tumor cells in these cases were predominantly located at the distal tip of the appendix, associated with fibrous obliteration. These tumors were smaller in size and tended towards less advanced tumor stage, with reduced incidence of lymphovascular and/or </span></span>perineural invasion<span>. Chromogranin expression was identified in 76 % of these cases. There is a heterogeneous hormone profile with 46.7 % serotonin and 33.3 % peptide YY. In conclusion, the small cluster pattern NENs present with unique histological features and hormone expression profile. Among the various neuroendocrine markers, INSM1 showed superior diagnostic performance, with high sensitivity and minimal non-specific staining.</span></p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138820984","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":"Interobserver agreement of pathologic classification and grading of tumoral intraductal pre-invasive neoplasms of the bile duct","authors":"Yasuni Nakanuma ,&nbsp;Yasunori Sato ,&nbsp;Yuko Kakuda ,&nbsp;Yoshiki Naito ,&nbsp;Yuki Fukumura ,&nbsp;Mana Fukushima ,&nbsp;Hiroshi Minato ,&nbsp;Shinichi Aishima ,&nbsp;Nobuyuki Ohike ,&nbsp;Toru Furukawa","doi":"10.1016/j.anndiagpath.2023.152247","DOIUrl":"10.1016/j.anndiagpath.2023.152247","url":null,"abstract":"<div><p><span>Current WHO terminology and recent publications have classified tumoral (grossly visible) intraductal pre-invasive neoplasms of bile duct (TIDN) into three categories: intraductal papillary neoplasm of bile duct (IPNB), intraductal papillary oncocytic neoplasm (IOPN), and intraductal tubulopapillary neoplasm (ITPN). A total of 227 cases of TIDN and related lesions ≥3 mm in height were examined by 10 biliary </span>pathologists referring to these 3 categories and two pathologic gradings: two-tiered system (low- and high-grade dysplasia) and modified types 1 and 2 subclassification. Among them, IPNB was the most frequent (183 cases), followed by IOPN (28 cases), while ITPN was rare (2 cases), and interobserver agreement in this classification was “substantial” (κ-value, 0.657). The interobserver agreement of two-tiered grading system of TIDN was “slight” (κ-value, 0.201), while that of modified types 1 and 2 subclassification was “moderate” (κ-value, 0.515), and 42 % were of type 1, and 58 % were of type 2. Type 1 TIDN showed occasional stromal invasion (6.7 %), whereas type 2 TIDN was frequently associated with stromal invasion (49.6 %) (p &lt; 0.01). In conclusion, the classification of TIDN into three categories and modified types 1 and 2 subclassification are a practically applicable classification and grading system for TIDN.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138715847","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":"Intraoperative pathologic diagnosis of central nervous system lymphomas: A comparison of frozen and permanent section diagnoses, and the significance of preoperative imaging","authors":"Aslı Kahraman ,&nbsp;Fikret Dirilenoğlu ,&nbsp;İsmail Güzeliş ,&nbsp;Kenan Çetinoğlu","doi":"10.1016/j.anndiagpath.2023.152246","DOIUrl":"10.1016/j.anndiagpath.2023.152246","url":null,"abstract":"<div><h3>Background</h3><p><span>Central nervous system (CNS) lymphomas, either primary or secondary in origin, are rare malignant tumors affecting the brain, spinal cord, or </span>leptomeninges<span>. Diagnosis of CNS lymphomas is complicated by their diverse clinical presentations, radiological features, and histopathological characteristics. Although frozen section (FS) analysis is commonly employed for various CNS tumors, its role and accuracy in CNS lymphoma diagnosis are less explored. In this study, we conducted a comparative analysis to assess the impact of knowledge of preoperative imaging on enhancing the accuracy of FS diagnosis in CNS lymphomas.</span></p></div><div><h3>Methods</h3><p><span><span>Data collection involved a retrospective review of CNS lymphoma patients from January 2009 to August 2021. Patients who underwent intraoperative consultation were included, excluding those with prior cortisone<span> treatment. The dataset incorporated patient demographics, classification as primary or secondary lymphoma, radiological preliminary diagnoses, FS diagnosis, and permanent section diagnosis. We employed various archived materials, including FSs, touch imprint slides, crush </span></span>cytology slides, H&amp;</span><em>E</em>-stained sections, and immunohistochemical stains, and re-evaluated all slides for diagnostic validation.</p></div><div><h3>Results</h3><p>Our study included 25 patients, of whom 60 % were female and had a mean age of 56.5 years. Preoperative radiology<span><span> data were available for 80 % of cases, with preliminary diagnoses commonly including lymphoma and/or metastasis. Intraoperative consultation results indicated lymphoma in 18 (72 %) patients, with discordance observed in 28 % of cases when compared to permanent section diagnoses. Most permanent section diagnoses were diffuse large B-cell lymphomas (92 %), with the remainder being T-cell non-Hodgkin lymphoma (4 %) and </span>follicular lymphoma (4 %). Intraoperative misdiagnoses were significantly associated with the absence of knowledge of preoperative imaging.</span></p></div><div><h3>Conclusion</h3><p>Our study demonstrates the reliability of FS diagnosis for CNS lymphomas during surgery, with a favorable complete concordance rate of 72 % when compared to permanent diagnoses. Importantly, lack of knowledge of preoperative imaging significantly impaired diagnostic accuracy in FS, emphasizing the need for close collaboration between pathologists and radiologists.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138631481","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":"The liver in fatal COVID-19, the end of an era (or so we hope!)","authors":"Stephen M. Lagana","doi":"10.1016/j.anndiagpath.2023.152245","DOIUrl":"10.1016/j.anndiagpath.2023.152245","url":null,"abstract":"","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138631341","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":"Primary gallbladder melanoma: A systematic review of literature","authors":"Shafi Rehman ,&nbsp;Pravallika Venna ,&nbsp;Sissmol Davis ,&nbsp;Ragini Gopagoni ,&nbsp;Ritika Uttam ,&nbsp;Ameer Mustafa Farrukh ,&nbsp;Mahsa Salehi","doi":"10.1016/j.anndiagpath.2023.152244","DOIUrl":"10.1016/j.anndiagpath.2023.152244","url":null,"abstract":"<div><p><span><span>Primary gallbladder melanoma<span><span> (PGM) is a rare malignancy with only sporadic cases reported in the English literature. We performed a </span>systematic review<span><span> of the cases published in the PubMed, Science Direct and Google Scholar databases with the aim of describing the reported clinicopathologic features of PGM. Thirty-six articles reporting on 39 patients were reviewed. There was a male predominance, with 23 (64 %) of 36 patients being males. The mean age at presentation was 55 ±16 years. Pain in the right upper quadrant was reported in 20/27 (74 %). The average size of the tumor was 3.5 × 1.9 × 1.4 cm. Gallbladder calculi were reported in 7/27 (26 %). A </span>cholecystectomy was performed in 34/38 (89.5 %). Grossly, the tumor mostly (96.5 %) had polypoid appearances and on microscopic examination, the tumor were predominantly comprised of </span></span></span>epithelioid cells<span><span> 12/17 (70.6 %). Mitotic figures and prominent nucleoli were reportedly found in 8/8 (100 %) and 3/3 (100 %) respectively. Junctional melanocytic components were present in 13/21 (61.9 %). Tumor cells were reportedly immunoreactive for S-100 and HMB-45 in all tested cases. </span>Metastasis were reported in 25/36 (69.4 %), with lymph nodes being the most common site (</span></span><em>n</em> = 8), followed by brain (<em>n</em> = 6) and liver (<em>n</em> = 4) for metastasis. At a mean follow-up period of 19 +/− 3 months, 16 (48.5 %) of the 33 patients with available survival data were alive and 17/33 (51.5 %) were dead of disease. There is a lack of unified criteria for the diagnosis of PGM, and future studies should aim to resolve this.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138631477","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":"Clinicopathological features of differentiated thyroid carcinoma as predictors of the effects of radioactive iodine therapy","authors":"Wen Liu ,&nbsp;Beibei Jiang ,&nbsp;Jingli Xue ,&nbsp;Ruijing Liu ,&nbsp;Yuqing Wei ,&nbsp;Peifeng Li","doi":"10.1016/j.anndiagpath.2023.152243","DOIUrl":"10.1016/j.anndiagpath.2023.152243","url":null,"abstract":"<div><h3>Background</h3><p>Patients with differentiated thyroid cancer<span> (DTC) usually have an excellent prognosis; however, 5 %–15 % develop radioactive iodine-refractory (RAIR) DTC (RAIR-DTC), which has a poor prognosis and limited treatment options. The aim of the present study was to investigate the clinicopathological characteristics of RAIR-DTC in order to provide clinical evidence for timely prediction of the effects of iodine therapy.</span></p></div><div><h3>Methods</h3><p>Clinicopathological data for 44 patients with RAIR-DTC and 50 patients with radioiodine-avid DTC (RAIA-DTC) were retrospectively analyzed. The risk factors for RAIR-DTC were evaluated and a RAIR-DTC prediction model was established.</p></div><div><h3>Results</h3><p><span>RAIR-DTC showed unique clinicopathological features that differed from those of RAIA-DTC; these included age &gt;55 years, a high-risk histological subtype, a large tumor size, a late TNM stage, calcification, distant metastasis, and more than six </span>metastatic lymph nodes<span>. Patients with RAIR-DTC also developed earlier tumor progression. Binary logistic regression analysis showed that distant metastasis, a high-risk histological subtype, and a maximum tumor diameter of ≥12.5 mm were independent risk factors for RAIR-DTC, and the specificity and sensitivity of a combination of these three parameters for the prediction of RAIR-DTC were 98.0 % and 56.8 %, respectively. Decision curve analysis and the calibration curve revealed that the combined prediction of these three parameters had good repeatability and accuracy.</span></p></div><div><h3>Conclusion</h3><p>The clinicopathological features of DTC can effectively predict the effects of iodine therapy. A combination of distant metastasis, a high-risk histological subtype, and a maximum tumor diameter of ≥12.5 mm showed significantly higher prediction accuracy.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572202","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":"SMARCB1/INI1-deficient epithelioid and myxoid neoplasms in paratesticular region: Expanding the clinicopathologic and molecular spectrum","authors":"Xiaona Yin ,&nbsp;Xiaoqun Yang ,&nbsp;Suying Wang ,&nbsp;Jue Zhou ,&nbsp;Ming Zhao","doi":"10.1016/j.anndiagpath.2023.152242","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2023.152242","url":null,"abstract":"<div><p><span><span>SMARCB1/INI1-deficient soft tissue tumors<span><span> with epithelioid and myxoid features are diverse and mainly include soft tissue myoepithelial tumor<span><span>, extraskeletal myxoid chondrosarcoma, and the recently described myoepithelioma-like tumor of the vulvar region and myxoepithelioid tumor with chordoid features. Because of their overlapping features, the accurate diagnosis and classification of these tumors are often challenging. Herein, we report two unique cases of SMARCB1/INI1-deficient soft tissue neoplasm with epithelioid and myxoid features occurring in male paratesticular region. The first case was a 52-year-old man presented with an intermittent painful left paratesticular mass for 1 year. The second case was a 41-year-old man presented with a painless paratesticular mass on the right side for 3 months. Both patients underwent an </span>orchiectomy. After 6 and 26 months of follow-up, both were alive with no evidence of recurrence or </span></span>metastasis. In both cases, the tumor was relatively well-demarcated and showed monomorphic round to </span></span>epithelioid cells<span><span> arranged in a nested, trabecular, reticular, and corded pattern, setting in a myxohyalinized and vascularized matrix. The tumor cells showed relatively uniform round nuclei with vesicular chromatin and variably prominent nucleoli. No rhabdoid cells were identified. Mitoses numbered 3 and 2 per 10 high-power fields. </span>Tumor necrosis<span><span> or lymphovascular invasion was absent. Immunohistochemically, both tumors expressed </span>epithelial membrane antigen<span><span> (focal), calponin (focal), and CD99. SMARCB1/INI1 expression was deficient in both cases. In addition, case 1 diffusely expressed pan-cytokeratin, and case 2 diffusely expressed CD34 and </span>synaptophysin. Molecular genetically, case 1 showed </span></span></span></span><em>SMARCB1</em> homozygous deletion as detected by fluorescence <em>in-situ</em> hybridization (FISH), and case 2 demonstrated <em>SMARCB1</em> copy number deletions by next-generation sequencing and <em>SMARCB1</em> monoallelic deletion by FISH. Both cases lacked <em>EWSR1</em> rearrangements by FISH. The overall clinicopathologic profiles of the two cases made it difficult to classify them as one of the established categories of SMARCB1/INI1-deficient mesenchymal tumors. Our study further expands the clinicopathologic and molecular spectrum of SMARCB1/INI1-deficient epithelioid and myxoid neoplasms and highlights the challenges to diagnose these tumors.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138466477","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":"Granulomatous lobular mastitis co-existing with ductal carcinoma in situ: Report of three cases and review of the literature","authors":"Jianmin Zhu ,&nbsp;Xiuming Miao ,&nbsp;Xin Li ,&nbsp;Yang Zhang ,&nbsp;Yuan Lou ,&nbsp;Hanhan Chen ,&nbsp;Xiaofei Liu","doi":"10.1016/j.anndiagpath.2023.152241","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2023.152241","url":null,"abstract":"<div><p>Granulomatous lobular mastitis (GLM) is a benign and infrequent chronic breast ailment. Although this lesion can be clinically and radiographically mistaken for early-onset breast cancer, it is a rare occurrence for the two to coexist. This report describes three such cases. In all three patients, the primary signs and symptoms were related to the formation of diffuse breast masses or abscesses. Breast ultrasound and MRI revealed glandular edema and dilated breast ducts. The biopsies of all lesions exhibited both granulomatous inflammation confined to the lobules of the breast, abundant interstitial inflammatory cell infiltrates, and apparently cancerous cells located in dilated ducts with intact basement membranes. The surgically excised specimens confirmed the diagnosis of GLM and ductal carcinoma in situ (DCIS) in all three patients who underwent breast mass resection. By clinical imaging and clinical manifestations, GLM may obscure a concurrent DCIS, as highlighted by the cases reported herein.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1092913423001399/pdfft?md5=27d77dfe838e4105fef5122aae8e3db6&pid=1-s2.0-S1092913423001399-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138436918","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":"Prognostic implications of synaptophysin, CD56, thyroid transcription factor-1, and Ki-67 in pulmonary high-grade neuroendocrine carcinomas","authors":"Yulong He ,&nbsp;Lei Zhao ,&nbsp;Xiaorong Tang ,&nbsp;Qinling Jiang ,&nbsp;Xianling Zhao ,&nbsp;Yilin Cao","doi":"10.1016/j.anndiagpath.2023.152239","DOIUrl":"https://doi.org/10.1016/j.anndiagpath.2023.152239","url":null,"abstract":"<div><h3>Background</h3><p>The correlation between the expression of immunohistochemical markers and the clinicopathological characteristics of pulmonary high-grade neuroendocrine carcinomas (HGNEC) and its impact on the clinical outcomes of individuals with HGNEC has not yet been explored.</p></div><div><h3>Methods</h3><p>This study enrolled patients diagnosed with HGNEC between April 2015 and July 2023. Based on the expression levels of synaptophysin (Syn), the neural cell adhesion molecule (CD56), thyroid transcription factor-1 (TTF-1), and Ki-67, a comprehensive analysis was conducted. This involved a comparison of clinicopathological characteristics, chemosensitivity, overall survival (OS), and progression-free survival (PFS). Furthermore, the study identified prognostic factors associated with patient survival through univariate and multivariate analyses.</p></div><div><h3>Results</h3><p>Eighty-two patients were analyzed. Significant differences were identified in tumor stage (χ² = 5.473, <em>P</em> = 0.019), lymphatic invasion (χ² = 8.839, <em>P</em> = 0.003), and distant metastasis (χ² = 5.473, <em>P</em> = 0.019), respectively, between the CD56 positive and negative groups. A significant difference in lymphatic invasion was observed (χ² = 9.949, <em>P</em> = 0.002) between the CD56 positive and negative groups. A significant difference in vascular invasion was observed (χ² = 5.106, <em>P</em> = 0.024) between the low and high Ki-67 groups. Compared to the Syn negative group, the Syn positive group had significantly shorter PFS (<em>P</em> = 0.006). Compared to the Syn negative group, the Syn positive group had significantly shorter OS (<em>P</em> = 0.004). The CD56 positive group also had significantly shorter OS than the CD56 negative group (<em>P</em> = 0.027). Univariate analysis revealed that tumor stage and Syn expression were associated with OS and PFS. Lymphatic invasion and CD56 expression were associated with OS. Multivariate analysis revealed that tumor stage was the strongest predictor of poor prognosis for OS (hazard ratio [HR] 0.551, 95 % confidence interval [CI] 0.328–0.927, <em>P</em> = 0.025) and PFS (HR 0.409, 95 % CI 0.247–0.676, <em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>Positive expression of Syn was associated with reduced PFS and OS, while positive CD56 expression was correlated with a shorter OS in HGNEC. The TNM stage was an independent risk factor that significantly influenced PFS and OS in patients with HGNEC. More studies are needed to make further progress in future treatment.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1092913423001375/pdfft?md5=44799c14c4a670ac2834f6d631f7fcad&pid=1-s2.0-S1092913423001375-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138413721","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":"A case-control autopsy series of liver pathology associated with novel coronavirus disease (COVID-19)","authors":"Fabiola A. Righi ,&nbsp;Richard S. Vander Heide ,&nbsp;Rondell P. Graham ,&nbsp;Marie Christine Aubry ,&nbsp;Jorge A. Trejo-Lopez ,&nbsp;Melanie C. Bois ,&nbsp;Anja C. Roden ,&nbsp;Ross Reichard ,&nbsp;Joseph J. Maleszewski ,&nbsp;Mariam P. Alexander ,&nbsp;Reade A. Quinton ,&nbsp;Sarah M. Jenkins ,&nbsp;Christopher P. Hartley ,&nbsp;Catherine E. Hagen","doi":"10.1016/j.anndiagpath.2023.152240","DOIUrl":"10.1016/j.anndiagpath.2023.152240","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for </span>coronavirus disease 2019 (COVID-19) is most well-known for causing pulmonary injury, a significant proportion of patients experience </span>hepatic dysfunction<span>. The mechanism by which SARS-CoV2 causes liver injury is not fully understood. The goal of this study was to describe the hepatic pathology in a large cohort of deceased patients with COVID-19 as compared to a control group of deceased patients without COVID-19.</span></p></div><div><h3>Methods</h3><p><span>Consented autopsy cases at two institutions were searched for documentation of COVID-19 as a contributing cause of death. A group of consecutive consented autopsy cases during the same period, negative for SARS-CoV-2 infection, was used as a control group. The autopsy report and electronic medical records were reviewed for relevant clinicopathologic information. H&amp;</span><em>E</em><span><span>-stained liver sections from both groups were examined for pertinent histologic features. Select cases underwent immunohistochemical staining for CD 68 and ACE2 and </span>droplet digital polymerase chain reaction (ddPCR) assay for evaluation of SARS-CoV2 RNA.</span></p></div><div><h3>Results</h3><p><span>48 COVID-19 positive patients (median age 73, M:F 3:1) and 40 COVID-19 negative control patients (median age 67.5, M:F 1.4:1) were included in the study. The COVID-19 positive group was significantly older and had a lower rate of alcoholism and malignancy, but there was no difference in other comorbidities. The COVID-19 positive group was more likely to have received steroids (75.6 % vs. 36.1 %, </span><em>p</em><span> &lt; 0.001). Hepatic vascular changes were seen in a minority (10.6 %) of COVID-19 positive cases. When all patients were included, there were no significant histopathologic differences between groups, but when patients with chronic alcoholism were excluded, the COVID-19 positive group was significantly more likely to have steatosis (80.9 % vs. 50.0 %, </span><em>p</em> = 0.004) and lobular inflammation (45.7 % vs. 20.7 %, <em>p</em><span><span> = 0.03). Testing for viral RNA by ddPCR identified 2 of the 18 (11.1 %) COVID-19 positive cases to have SARS-CoV-2 RNA detected within the liver </span>FFPE tissue.</span></p></div><div><h3>Conclusions</h3><p>The most significant findings in the liver of COVID-19 positive patients were mild lobular inflammation and steatosis. The high rate of steroid therapy in this population may be a possible source of steatosis. Hepatic vascular alterations were only identified in a minority of patients and did not appear to play a predominant role in COVID-19 mediated hepatic injury. Low incidence of SARS-CoV-2 RNA positivity in liver tissue in our cohort suggests hepatic injury in the setting of COVID-19 may be secondary in nature.</p></div>","PeriodicalId":50768,"journal":{"name":"Annals of Diagnostic Pathology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300555","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}