American Journal of Surgical Pathology最新文献

{"title":"Clinicopathologic and Genomic Features of Gastric-Type Intraductal Papillary Neoplasm of the Bile Duct: Potential Role of STK11 in Malignant Progression.","authors":"Yuki Shimada, Takeo Yamamoto, Koji Shindo, Yoshiyuki Nakanishi, Takashi Matsumoto, Shoko Noguchi, Shinichi Aishima, Masafumi Nakamura, Yoshinao Oda","doi":"10.1097/PAS.0000000000002451","DOIUrl":"10.1097/PAS.0000000000002451","url":null,"abstract":"<p><p>Gastric-type intraductal papillary neoplasm of the bile duct (G-type IPNB) remains an underexplored subtype of IPNBs, with limited molecular characterization. This study aimed to elucidate the clinicopathologic and genomic features of G-type IPNB to better understand its malignant potential and progression. Eighty-three IPNB cases, including 21 G-type IPNBs, were analyzed. The clinicopathologic features and prognosis of G-type IPNB were compared with those of other subtypes. Targeted sequencing was performed in 15 G-type cases, comprising 5 with high-grade dysplasia (HGD), 6 with invasive carcinoma (INV), and 4 with lymph node metastasis (LNM). The samples displayed varying histologic grades. The G-type frequently exhibited HGD; however, invasive G-type IPNBs showed significantly higher rates of lymph node metastasis compared with the other subtypes ( P =0.044). Recurrent mutations were detected in KRAS (60%), STK11 (40%), KMT2C (40%), APC (20%), CTNNB1 (13%), and TP53 (13%). Mutational profiles remained highly concordant across histologic grades, with no significant new mutations accumulating during tumor progression. KRAS mutations were predominantly found in preinvasive lesions, supporting their role in early tumorigenesis. STK11 mutations were exclusive to INV and LNM cases, but not detected in HGD cases. Notably, identical mutations were uniformly carried over from preinvasive lesions to invasive carcinoma and metastatic lymph node lesions. Immunohistochemically, aberrant STK11 expression was specific to the G-type compared with other subtypes ( P =0.030). These findings highlight the unique clinicopathologic and molecular features of G-type IPNB, including the association of STK11 mutations with invasive behavior and their potential as indicators of tumor progression.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"1004-1014"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased SOX10, p16, and Cyclin D1 Immunoreactivity Differentiates MAP Kinase-activated Low-grade Gliomas From Piloid Gliosis: Erratum.","authors":"Vivian Tang, Kevin Y Zhang, Kanish Mirchia, Rufei Lu, Ekin Guney, Merryl Terry, Azra H Ligon, Keith L Ligon, Charles G Eberhart, Arie Perry, Calixto-Hope G Lucas","doi":"10.1097/PAS.0000000000002462","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002462","url":null,"abstract":"","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":"49 10","pages":"e15"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncloaking the Fimbria Ovarica: Histologic Recognition of an Elusive Anatomic Structure.","authors":"Jeffrey D Seidman, Rebecca Stone, Vasiliki A Moragianni, Jayashree Krishnan, Russell Vang","doi":"10.1097/PAS.0000000000002414","DOIUrl":"10.1097/PAS.0000000000002414","url":null,"abstract":"<p><p>A portion of the fimbriated end of the fallopian tube known as the fimbria ovarica extends along the lateral edge of the mesosalpinx to the ovary to which it is attached at its lateral pole. Seventy-four examples of fimbrial plicae that were attached to the ovary or broad ligament and lacked features of adhesions were studied. The fimbrio-ovarian attachments were characterized by one or more of the following: continuity between the tubal epithelium and either the ovarian surface epithelium, peritoneum, or both, in 51 cases; direct continuity of the ovarian stroma into the stroma of the fimbria ovarica in 42 cases; and direct insertion of plicae into the ovarian surface or ovarian stroma in 18 cases. In 21 cases, there was a direct attachment of plicae to the broad ligament close to the ovary. The mean size of the fimbria ovarica was 6.6 mm. The plicae were lined by normal tubal-type epithelium. The plical morphology was typically abnormal displaying one or more of the following features: short and blunted in 24 (32%), thickened in 18 (24%), elongated in 14 (19%), fusion in 13 (18%), edema in 13 (18%), and fibrosis in 11 (15%). Also noted were a mesothelial component in 69 cases (93%), the tubal-peritoneal junction in 53 cases (72%), transitional cell metaplasia/Walthard cell nests in 11 cases (15%), and foci resembling incipient fimbrial adenofibroma in 7 cases (9%). An understanding of the microanatomy and histology of the fimbria ovarica has important implications, particularly as: (a) portions may be left behind after prophylactic salpingectomy, providing a nidus for future development of high grade serous carcinoma (HGSC); (b) it constitutes an anatomic connection that may facilitate the spread of HGSC to the ovary, and (c) epithelial junctions are hotspots for carcinogenesis, and stem cells arising in such regions may be a source of HGSCs. In addition, understanding the fimbria ovarica has implications for the pathogenesis of ovarian surface epithelial inclusions, endosalpingiosis, and certain types of infertility. Its potential role as a site of origin of extrauterine HGSC, which typically arises in the fimbriae as serous tubal intraepithelial carcinoma, remains to be investigated.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"1042-1059"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a New Histopathologic Risk Model in Early Oral Tongue Cancer: A Combination of a Modified Worst Pattern of Invasion and a New Tumor Budding Score.","authors":"Alhadi Almangush, Tuula Salo, Caj Haglund, Luiz Paulo Kowalski, Jaana Hagström, Ricardo D Coletta, Antti A Mäkitie, Ilmo Leivo","doi":"10.1097/PAS.0000000000002433","DOIUrl":"10.1097/PAS.0000000000002433","url":null,"abstract":"<p><p>Oral tongue squamous cell carcinoma (OTSCC) is the most common cancer of the oral cavity. A new histopathologic risk assessment has been recently introduced and we sought to validate its prognostic value in a large multicenter cohort of early-stage OTSCC. A total of 310 cases treated for early-stage OTSCC were included in this study. The assessment of modified worst pattern of invasion and a recently developed tumor budding score were performed in hematoxylin and eosin-stained sections. A statistically significant association was observed in the multivariable analysis between high score of the new risk model and worse disease-specific survival (HR: 2.54, 95% CI: 1.48-4.37, P <0.001). Similarly, in disease-free survival, the high-risk group was significantly associated with poor survival (HR: 1.66, 95% CI: 1.07-2.58, P =0.024). In conclusion, the new histopathologic risk model is a powerful prognostic indicator and can be assessed as part of routine diagnostic practice. Early-stage OTSCC patients with a high-risk score have a poor prognosis and therefore require a multimodality treatment strategy with a close clinical follow-up.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"1036-1041"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12435260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depth of Liver Invasion as a Novel Predictor for Outcome of Perihilar Cholangiocarcinoma.","authors":"Tao Zhang, Li Li, Dong-Liang Yang, Nan Jiang, Hai-Jing Ge, Ming-Yu Lin, Chang-Zhen Yang, Si-Qiao Shan, Hua Sun, Zhe Yan, Xue-Li Yuan, Kai Sun, Jian-Ping Zeng, Can-Hong Xiang, Si-Yuan Wang, Shuo Jin","doi":"10.1097/PAS.0000000000002419","DOIUrl":"10.1097/PAS.0000000000002419","url":null,"abstract":"<p><p>The current American Joint Committee on Cancer (AJCC) pT classification was inaccurate in predicting prognosis for perihilar cholangiocarcinoma (pCCA). This study aimed to propose a novel classification based on the depth of liver invasion (DOLI) of pCCA. Patients who underwent major hepatectomy combined with caudate lobectomy for pCCA between January 2015 and June 2023 were reviewed retrospectively. The maximum straight-line distance from the hepatic hilar plate to the infiltrated liver parenchyma was measured as DOLI. Log-rank statistics were used to determine the cutoff points. Among 167 patients, liver invasion was observed in 100 patients (59.9%). The cutoff points of DOLI for prognosis were 0 mm and 2.5 mm. DOLI was stratified into grade 1 (DOLI=0 mm; 67/167, 40.1%), grade 2 (0 mm<DOLI ≤ 2.5 mm; 63/167, 37.7%), and grade 3 (DOLI >2.5 mm; 37/167, 22.2%). The DOLI grade was associated with CA19-9 levels, tumor size, lymph node metastasis, perineural invasion, and portal vein invasion. The DOLI grade was an independent prognostic factor for both overall survival (OS) and recurrence-free survival (RFS) (both P <0.001), and demonstrated superior prognostic discrimination compared with the pT classification (C-indexes for OS and RFS: 0.67 vs. 0.63; 0.64 vs. 0.61). In conclusion, DOLI was an accurate prognostic indicator for pCCA. The 3-tier DOLI grades with cutoff points of 0 and 2.5 mm may serve as a potential alternative to the current pT classification.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"1060-1067"},"PeriodicalIF":4.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144118550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aberrant Cytoplasmic p53 Staining in Oral Squamous Cell Carcinoma and Dysplasia: A Clinicopathologic and Molecular Study.","authors":"Lingxin Zhang, Tony Ng, Lien Hoang, Yen Chen Kevin Ko","doi":"10.1097/PAS.0000000000002471","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002471","url":null,"abstract":"<p><p>p53 cytoplasmic sequestration has been shown to be a mechanism of carcinogenesis. However, until recently, an aberrant p53 cytoplasmic staining pattern by immunohistochemistry (IHC) was under-reported in oral squamous cell carcinoma (OSCC) and oral epithelial dysplasia (OED). Following the identification of a pilot case, the authors studied the clinicopathologic features of 4 OSCCs and 10 OEDs with p53 cytoplasmic staining pattern, 4 of which exhibited co-occurrence of nuclear null/overexpression patterns. Using next-generation sequencing (NGS), we demonstrate that this cytoplasmic staining pattern correlates with TP53 mutations that disrupt or truncate the C-terminal nuclear localization sequence (NLS) or nuclear exclusion sequence (NES). High-impact NLS-altering mutations in the same region are identified in 8.7% to 11.0% of TP53-mutant samples in the TCGA-HNSC cohort. Our study provides a practical definition for aberrant p53 cytoplasmic staining in HNSCC and OED, a diagnostic pitfall with potential biological implication. This study proposes an updated p53 IHC interpretation algorithm to facilitate further data accrual.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic and Prognostic Features of Sarcomatoid Urothelial Carcinoma: A Retrospective Study of 136 Patients With Emphasis on Early-Stage (pT1) Disease.","authors":"Huili Li, Vamsi Parimi, Burles Johnson, Sonia Kamanda, Ezra Baraban, Jean Hoffman-Censits, Max Kates, David J McConkey, Noah M Hahn, Andres Matoso","doi":"10.1097/PAS.0000000000002468","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002468","url":null,"abstract":"<p><p>Sarcomatoid urothelial carcinoma (SUC) is a rare and aggressive subtype of bladder cancer. We retrospectively analyzed 136 patients diagnosed between 1993 and 2025. Clinicopathologic features, immunophenotype, PD-L1 expression, molecular alterations, and survival outcomes were assessed, with a focus on patients presenting with local low-stage (pT1) disease. The cohort included 96 males and 40 females (median age: 72). Most tumors (77%) were mixed with conventional urothelial carcinoma (UC), and 10% demonstrated heterologous differentiation. Tumor stage, lymphovascular invasion (LVI), and nodal metastasis were significantly associated with poor overall survival (OS; P<0.05). Fifty-four cases had CK5/6 and GATA3 immunohistochemical stains available; a mixed basal-luminal phenotype (CK5/6+/GATA3+) was most common (43%), though immunophenotypic grouping did not significantly impact survival. Twenty-two patients had PD-L1 immunostain performed at diagnosis, and most patients (82%) were PD-L1(+) with a CPS ≥10. Patients with CPS ≥50 trended toward improved OS. Panel-based sequencing was available for 6 patients and revealed heterogeneous mutations with few recurrent alterations. In our cohort, 10 patients had local low-stage (LLS/pT1) SUC, which is rare in SUC. The metastatic rate was 30%, and mortality was 40%. Findings in LLS patients with poor outcomes included large tumor, extensive invasion, tumor necrosis, and heterologous elements. LLS patients who underwent radical cystectomy (RC) had longer OS compared with those treated with transurethral resection of bladder tumor (TURBT) alone (P=0.0269). 3/6 survival LLS patients had no residual tumor at RC. Our findings highlight the variable clinical courses of SUC, and call for more attention on this unique group of patients. The absence of residual disease in several pT1 patients following RC suggests that timely RC can have a favorable outcome in a subset of patients.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SOX2 Is the Most Sensitive Biomarker in Testicular and Gynecologic Embryonic-type Neuroectodermal Tumors (ENT) Based on a Comprehensive Evaluation of Biomarker Expression.","authors":"Jessica F Williams, Krzysztof Glomski, Thomas M Ulbright, Krisztina Z Hanley, Kenneth A Iczkowski, Andres M Acosta, Marisa R Nucci, Esther Oliva, Michelle S Hirsch","doi":"10.1097/PAS.0000000000002466","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002466","url":null,"abstract":"<p><p>Embryonic-type neuroectodermal tumor (ENT; previously referred to as primitive neuroectodermal tumor, PNET) of the testis and gynecologic tract share morphologic features with small round blue cell tumors, including Ewing sarcoma (ES), yet are biologically, therapeutically, and prognostically distinct. The diagnosis of ENT can be challenging, and it is unclear if there are reliable biomarkers that can be used to confirm this diagnosis. This study characterized 50 ENTs arising from the testis (n=38) and gynecologic tract (n=12; 7 ovary/5 uterus) with 27 biomarkers (AE1/AE3, ATRX, CD99, chromogranin-A, Cyclin D1, Fli-1, GFAP, GLUT-1, IDH1/2, INSM1, MTAP, NANOG, Nestin, neurofilament, NKX2.2, NSE, OCT3/4, OLIG2, p16, PAX6, PHOX2B, S100, SALL4, SOX2, SOX10, SOX17, synaptophysin). Expression was evaluated for extent (0, negative; 1, ≤10% positive; 2, 11% to 50% positive; 3, >50% positive) and intensity (1, weak; 2, moderate; 3, strong) of staining to obtain a combined score (CS) of 0-9; a CS ≥4 was considered \"significant staining.\" SOX2 was the most sensitive biomarker for ENT, as 85% of the tumors demonstrated CS=9. GLUT-1, Fli-1, SALL4, and Cyclin D1 also showed CS ≥4 in more than half of the ENTs; however, only a minority demonstrated CS=9. All other biomarkers showed CS ≥4 in fewer than half of the ENTs, including synaptophysin (38%), GFAP (15%), S100 (15%), and chromogranin-A (14%). NKX2.2, CD99, and SOX17 showed CS ≥4 in 7%, 0%, and 3% of tumors, respectively. Overall, we found that in the appropriate clinicopathologic context, utilizing a panel of SOX2, OCT3/4 (to exclude embryonal carcinoma), AE1/AE3, NKX2.2, CD99, and SOX17 could be helpful in the diagnosis of ENT; many other traditional diagnostic biomarkers show limited utility.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinephric Myxoid Pseudotumor of Fat: A Series of 29 Cases Demonstrating Inconsistent Associations With Underlying Kidney Disease.","authors":"Azfar Neyaz, John S A Chrisinger, Dimitrios Korentzelos, Gayathri Devi Jalluri, Rana Naous, Abigail I Wald, Veronica Ulici, Sintawat Wangsiricharoen, Ali Alani, Douglas Rottmann, Carina A Dehner, Josephine K Dermawan, Kyle Perry, Ivy John","doi":"10.1097/PAS.0000000000002467","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002467","url":null,"abstract":"<p><p>Perinephric myxoid pseudotumor of fat (PMPTF) is a recently characterized lesion typically associated with non-neoplastic renal disease. Its pathogenesis is thought to result from chronic renal \"irritation,\" either due to mass effect from renal carcinoma or inflammation related to benign renal conditions. Prompted by several cases arising in the absence of underlying renal pathology, we conducted a multi-institutional study of 29 mass-forming cases with detailed clinical, histologic, and molecular characterization. We also reviewed 79 published cases to place our findings in a broader context. Histologic slides were reviewed for morphologic and immunohistochemical features. Clinical and follow-up data were obtained through retrospective chart review. The mean age was 67 years (range: 35 to 82), with a strong male predominance (M:F=13.5:1). The average tumor size was 10.3 cm. Liposarcoma was the most common initial diagnosis (n=20). Twelve patients (42%) had non-neoplastic renal disease, 7 (24%) had both non-neoplastic disease and renal cell carcinoma, one (3%) had renal cell carcinoma only, and 9 (31%) had no renal pathology. Histologically, lesions showed mature fat with scattered bland spindle to stellate cells, chronic inflammation, lymphoid aggregates, myxoid change, fat necrosis, hemosiderin, and prominent vasculature; extramedullary hematopoiesis was rare. All tested 28 cases were negative for MDM2 amplification by FISH. Comprehensive targeted NGS (Oncomine) and whole transcriptome sequencing (n=4) did not reveal any pathogenic alterations. Follow-up (n=28; mean, 20 months) showed stable or no disease in 24 cases; 3 patients died of unrelated causes, and one from postoperative complications. PMPTF is a benign, mass-forming lesion that mimics malignancy, particularly well-differentiated liposarcoma. Its occurrence in patients without identifiable renal pathology suggests alternative etiologies. Lack of genomic alterations supports its non-neoplastic nature. Accurate recognition is critical to prevent overtreatment. PMPTF may represent an early-stage reactive process within a broader spectrum of adipose tissue remodeling that includes renal replacement lipomatosis.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postneoadjuvant Whipple Resections Show Significant Residual Microscopic Tumor Beyond Grossly Identified Tumor Bed: Implications for Accurate Tumor Staging.","authors":"Komson Wannasai, Anthony R Russo, Stuti G Shroff, Jonathan N Glickman, Anthony Mattia, M Lisa Zhang, Maria L Ganci, Anna Rider, Fernandez-Del Castillo Carlos, Mari Mino-Kenudson, Angela R Shih","doi":"10.1097/PAS.0000000000002465","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002465","url":null,"abstract":"<p><p>Neoadjuvant chemotherapy plays a vital role in the treatment of pancreatic ductal adenocarcinoma (PDAC), but treatment effect complicates pathologic examination of postneoadjuvant Whipple resections. Institutional practice is variable but current Pancreatobiliary Pathology Society (PBPS) guidelines suggest extensive microscopic examination of the tumor bed (TB). In practice, gross identification of TB is challenging and may lead to an inaccurate assessment of tumor size. The purpose of this study is to evaluate the adequacy of current practice in postneoadjuvant Whipple resections for pathologic staging. A single institutional prospective cohort was assessed, including 29 entirely submitted (ES) specimens and 10 current PBPS guideline-based (CG) specimens. Cases were evaluated for TB gross measurement, TB microscopic tumor, nontumor bed (N-TB) microscopic tumor, overall size assessment by microscopic evaluation, and presence of lymph nodes with metastases. ES and CG specimens showed similar overall residual tumor size measurements under the current PBPS guidelines protocol, but with the entire submission, tumor size increased by an average of 0.5 cm (range: 0.0 to 2.1 cm). Twenty-eight percent had an upstaged ypT due to a significant N-TB tumor. These findings delineate the limitations of gross TB assessment in postneoadjuvant Whipple resections for adequate pathologic staging and appropriate prognostication.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}