American Journal of Surgical Pathology最新文献

{"title":"TRBC1 Immunohistochemistry Utilization in Formalin-fixed Paraffin-embedded Tissue as an Adjunct to T-cell Clonality Testing in the Assessment of Cutaneous Lymphoproliferative Disorders.","authors":"David G Grand, Jeffrey M Cloutier, Sarah R Palmer-DeClara, Jeremiah X Karrs, Shaofeng Yan, Shabnam Momtahen, Soma Jobbagy, Nicole Trepanowski, Joi B Carter, Frederick Lansigan, Robert E LeBlanc","doi":"10.1097/PAS.0000000000002572","DOIUrl":"10.1097/PAS.0000000000002572","url":null,"abstract":"<p><p>T-cell receptor β chain constant region 1 (TRBC1) immunohistochemistry (IHC) has emerged as a novel tool for identifying T-cell clonality in skin biopsies. Its performance in routine formalin-fixed, paraffin-embedded (FFPE) skin specimens across the spectrum of cutaneous T-cell lymphoma (CTCL), however, remains an area of active investigation. We evaluated TRBC1 IHC in 36 cases of cutaneous T-cell lymphoproliferative disorders and 31 polyclonal controls. TRBC1 was assessed relative to CD3 by blinded consensus interpretation followed by semiquantitative estimation of TRBC1-positive cells as a percentage of CD3-positive T-cells. Results were compared with molecular clonality test data, and subtype-specific analyses were performed. Overall concordance of TRBC1 consensus interpretation with clonality testing was 79% (sensitivity 64%, specificity 97%, positive predictive value 96%, negative predictive value 70%). Sensitivity was higher (72%) when analysis was restricted to cases of mycosis fungoides (MF) and controls, but sensitivity decreased (50%) when assessment was restricted to only the intraepithelial T-cells. Sensitivity was also lower (56%) with the assessment of non-MF CTCL. Thresholds of ≤20% or ≥80% and ≤30% or ≥70% TRBC1-positive cells permitted optimal discrimination between monoclonality and polyclonality. As anticipated, lymphoproliferative disorders composed of T-cells that did not express a β chain, including those composed of TCR-ɣ/δ T-cells, lacked TRBC1 expression. Overall, TRBC1 IHC demonstrated modest utility as an adjunctive marker of T-cell clonality in FFPE skin biopsies, with greatest diagnostic value in MF when evaluation is not restricted to intraepithelial lymphocytes.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"1007-1014"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052085","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":"Clinical Outcomes and Prognostication of CRTC1::TRIM11 Fusion Cutaneous Tumors.","authors":"Nithya S Trichy, Jonathan Braat, Lindsay J Holic, Shantel Olivares, Klaus J Busam, Alison Cheah, Jeffrey M Cloutier, Damian Collins, Pranav Dorwal, Arnaud de la Fouchardière, John Gross, Eleni Ieremia, Ivy John, Arivarasan Karunamurthy, Konstantinos Linos, Ata S Moshiri, José A Salinas, Sara Shalin, Campbell Stewart, Khin Thway, Gillian Weston, Pedram Gerami","doi":"10.1097/PAS.0000000000002575","DOIUrl":"10.1097/PAS.0000000000002575","url":null,"abstract":"<p><p>Since the original description of CRTC1::TRIM11 fusion cutaneous tumors (CTCT) in 2018, an increasing number of cases with metastatic behavior have been reported, yet there are limited studies analyzing prognostic parameters. This expanding data set presents an opportunity for reappraisal of clinical behavior. We present a series of 21 cases with detailed morphologic, molecular, clinical outcomes, and therapeutic response data. We utilize this data and a meta-analysis of all the cases in the literature to assess potential prognostic parameters to assist in clinical management. Primary tumors resulting in metastasis were larger ( P =0.038), had higher mitotic counts ( P <0.001), were more frequently ulcerated ( P =0.001), and exclusively harbored TERT promoter mutations ( P =0.005). A functional analysis of mixed data demonstrated a clear clustering pattern in which metastatic cases had larger diameters and were more mitotically active compared with nonmetastatic cases. Inclusion of TERT promoter mutational status further improved the model. There were no metastatic events among cases meeting all the following criteria: size <1.2 cm, <7 mitoses/mm 2 , and absent TERT promoter mutation. Metastatic events frequently involved regional lymph nodes, and all patients with distant metastasis had pulmonary involvement. Considering metastatic events in 23% of cases, sentinel lymph node biopsy and imaging studies may be considered in some cases, while, in cases with smaller size, low mitotic counts, and no evidence of a TERT promoter mutation, excision alone may be adequate. Given poor therapeutic responses in reported metastatic cases, more therapeutic options should be explored.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"1015-1028"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148157","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":"Urothelial Carcinoma in Children and Young Adults is Characterized by Higher Frequency of HRAS Mutations and Lower Prevalence of TERT Promoter and FGFR3 Mutations.","authors":"Liang Cheng, Hui Min Tan, Antonio Lopez-Beltran, Rodolfo Montironi, Adeboye O Osunkoya, Michael Cheng, Ali Amin, Alessia Cimadamore, Shaobo Zhang","doi":"10.1097/PAS.0000000000002566","DOIUrl":"10.1097/PAS.0000000000002566","url":null,"abstract":"<p><p>Urothelial carcinoma in young patients is exceedingly rare, and their molecular oncogenesis is not well understood. In this study, we investigated the frequencies of HRAS, TERT promoter, and FGFR3 mutations in a cohort of 31 urothelial neoplasms occurring in children and young adults, to understand their molecular characteristics and underpinnings. Thirty-one urothelial neoplasms were identified in patients less than 30 years of age. Genomic DNA was extracted from formalin-fixed paraffin-embedded (FFPE) tissue sections. Real-time polymerase chain reaction was used to detect HRAS, TERT promoter, and FGFR3 mutations, and the results were analyzed using high-resolution fluorescence melting curves. The cohort included 2 urothelial papillomas, 1 papillary urothelial neoplasm of low malignant potential (PUNLMP), 23 noninvasive low-grade papillary urothelial carcinomas, and 5 noninvasive high-grade papillary urothelial carcinomas. The patients' mean age was 18 years old, and the male-to-female ratio was 1.4:1. HRAS mutation was detected in 55.2% (16/29) of the premalignant/malignant cases and in 100% (2/2) of the urothelial papillomas, with an overall incidence of 58.1%. TERT promoter mutation was detected in 37.9% (11/29) of PUNLMP and malignant cases, and in none of the benign cases. FGFR3 mutation was not detected in any of the cases. Urothelial carcinomas occurring in children and young adults exhibit a distinct molecular profile compared with those in older patients, characterized by a higher frequency of HRAS mutations and a significantly lower prevalence of TERT promoter and FGFR3 alterations.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"999-1006"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947520","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 Analysis of 43 Surgically Resected Lactotroph Pituitary Neuroendocrine Tumors Stratified by Surgical Indication: A Pathologic Reappraisal of Apparent Male Aggressiveness.","authors":"Noriaki Tanabe, Naoko Inoshita, Eri Kasuga, Go Matsuoka, Atsushi Ishida, Masataka Kato, Haruko Yoshimoto, Hideki Shiramizu, Hidetaka Suga, Toru Tateno, Terushige Toyooka, Kenichi Ohashi, Masami Ono, Nobuhiro Miki, Koji Takano, Shozo Yamada","doi":"10.1097/PAS.0000000000002577","DOIUrl":"10.1097/PAS.0000000000002577","url":null,"abstract":"<p><p>Male lactotroph pituitary neuroendocrine tumors (PitNETs) are often considered more aggressive than those in women, but surgically treated cohorts are highly selected and may reflect differences in presentation and indication for surgery. We examined whether advanced clinical presentation in surgically treated lactotroph PitNETs is accompanied by distinct pathologic features. We reviewed 43 patients who underwent surgery for lactotroph PitNETs between 2018 and 2023 at a high-volume referral center. Cases were classified by surgical indication as preference for surgery/intolerance to dopamine agonists (P/I, n=26), resistance with hormonal symptoms (R/H, n=10), and resistance with mass effect (R/M, n=7). Clinical, radiologic, and pathologic parameters, including Ki-67, cytokeratin (CAM5.2), estrogen receptor, somatostatin receptor 2/5, and O6-methylguanine-DNA methyltransferase, were compared. Postoperative endocrinological remission was assessed at the last follow-up (median: 34 mo). All tumors were prolactin-immunoreactive, confirming lactotroph differentiation. Patients in the R/M group were older (median: 56 y), predominantly male (71.4%), and had larger tumors (median: 26 mm) with more frequent cavernous sinus invasion (Knosp grade 4, 85.7%) than those in the other groups. Long-term endocrinological remission differed significantly by indication (P/I, 88.5%; R/H, 80.0%; and R/M, 0%). In contrast, Ki-67 labeling index did not differ significantly across groups (P/I, 1.3%; R/H, 1.5%; and R/M, 2.6%; P =0.598), and no clear between-group differences were identified in CAM5.2 pattern, estrogen receptor, somatostatin receptor 2/5, or O6-methylguanine-DNA methyltransferase status. These findings suggest that the clinically most advanced surgical cases are not matched by distinct pathologic differences in the markers assessed and that the apparent aggressiveness of male-predominant mass-effect cases should not be interpreted solely as reflecting intrinsically aggressive tumor biology.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"1097-1105"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410194","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":"De Novo and Postradiation Adenocarcinoma of the Urethra: A Clinicopathologic and Radiologic Study of 55 Cases.","authors":"Miao Zhang, Raghu Vikram, Junhyoun Sung, Peng Wei, Kanishka Sircar, Patricia Troncoso, Curtis Pettaway, Pheroze Tamboli, Bogdan Czerniak","doi":"10.1097/PAS.0000000000002614","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002614","url":null,"abstract":"<p><p>Herein, we report the results of clinicopathologic and radiographic analyses of 55 patients with primary adenocarcinoma of the urethra. Their ages at diagnosis ranged from 42 to 88 years (mean: 66 y). Twenty-six patients were male and 29 were female (ratio: 1.0:1.1). We noted 2 distinct groups of cases: de novo urethral adenocarcinoma (n=45) and urethral adenocarcinoma in patients after radiation therapy for prostatic adenocarcinoma (n=10), defined as postradiation adenocarcinoma. Postradiation tumors developed 8 to 25 years (mean: 15.6 y) after radiation therapy. Eight patients underwent brachytherapy. Among the 45 patients with de novo adenocarcinoma, 29 were female, for a female-to-male ratio of 1.8 to 1.0. In 17 female patients with de novo urethral adenocarcinoma, tumors developed in a urethral diverticulum. Histologically, urethral adenocarcinomas exhibited adenocarcinoma not otherwise specified or clear cell, mucinous, enteric, and adenoid cystic carcinoma morphology. In 2 cases of de novo adenocarcinoma and 3 cases of postradiation adenocarcinoma, the tumors progressed to sarcomatoid carcinoma. The mean disease-specific survival time for the entire cohort was 100.35 months. As reflected by the Kaplan-Meier curves for these patients, the patterns of disease-specific survival were similar in the de novo and postradiation groups.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862897","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":"Toward Improved Classification of Vulvar Smooth Muscle Tumors: A Clinicopathologic Study of 35 Cases.","authors":"Krisztina Z Lengyel, G Petur Nielsen, Kyle M Devins, Lawrence Hsu Lin, Esther Oliva, Gulisa Turashvili","doi":"10.1097/PAS.0000000000002607","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002607","url":null,"abstract":"<p><p>Vulvar smooth muscle tumors have been evaluated using site-specific (1979 and 1996 Vulvar Criteria) or Uterine Criteria. We compared the performance of 3 classification systems for predicting clinical behavior in the largest series of 35 such tumors to date. Follow-up was available for 30 patients (median: 63 mo, 1 to 346). Most presented as a painless mass in premenopausal patients and showed spindled or myxoid morphology. Diagnoses were concordant across all 3 classification systems in most cases (80%, 28/35), including 22 leiomyomas and 6 leiomyosarcomas. Of the 7 discordant tumors, 3 with ≥5 cm, moderate to marked cytologic atypia, 5 mitoses per 10 high-power fields (HPF), and no tumor cell necrosis or infiltrative borders were diagnosed as smooth muscle tumors of uncertain malignant potential (STUMP) by the Uterine Criteria but as leiomyosarcoma/low-grade leiomyosarcoma by the site-specific criteria. Two tumors (≥5 cm, 8 to 9 mitoses per 10 HPF, no cytologic atypia or tumor cell necrosis, and unevaluable borders) were classified as mitotically active leiomyoma by the Uterine Criteria and the 1996 Vulvar Criteria but as low-grade leiomyosarcoma by the 1979 Vulvar Criteria. Two tumors with tumor cell necrosis, moderate atypia, 9 and 66 mitoses per 10 HPF, but <5 cm and well-circumscribed borders were categorized as leiomyosarcoma by the Uterine Criteria but as leiomyoma by both site-specific criteria. Our findings support the validity of the Uterine Criteria relative to the site-specific criteria for vulvar smooth muscle tumors, although the applicability of these criteria to the STUMP category warrants further study.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823914","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":"Histopathologic Grading of Residual Tumor Predicts Survival of Intrahepatic Cholangiocarcinoma Patients Treated With Neoadjuvant Therapy: Erratum.","authors":"Gaohua Wu, Xiufen Chen, Rongkui Luo, Ye Xin Koh, Tony Kiat Hon Lim, Valerie Chew, Jian Zhou, Jia Fan, Qiang Gao, Kai Zhu, Ruoyu Shi","doi":"10.1097/PAS.0000000000002597","DOIUrl":"https://doi.org/10.1097/PAS.0000000000002597","url":null,"abstract":"","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148807843","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":"Gynecologic Pathologist Agreement on Presence and Quantification of Lymphovascular Invasion in Low-stage, Low-grade Endometrial Endometrioid Adenocarcinoma.","authors":"Darrell Martin, Sakinah Thiryayi, Katherine Grondin, Sara Pakbaz, Kianoosh Keyhanian, David W Dodington, Lien Hoang, Mary Kinloch, Anjelica Hodgson","doi":"10.1097/PAS.0000000000002563","DOIUrl":"10.1097/PAS.0000000000002563","url":null,"abstract":"<p><p>Lymphovascular invasion (LVI) is a prognostic and treatment-driving parameter for low-stage, low-grade endometrial endometrioid adenocarcinoma (EEAC). There is lack of organizational recommendations/guideline consensus regarding the clinically significant cutoff and pathologist agreement on cutoff thresholds has not been extensively studied. Digitized unannotated tumor-containing slides from 52 low-grade/uterine corpus-confined EEAC of no specific molecular profile (NSMP) and mismatch repair-deficient (MMRd) molecular subgroups were reviewed by 6 gynecologic pathologists. The reviewers, blinded to the originally reported LVI status, independently evaluated for the presence of LVI and the maximum number of involved vessels in a single slide or slides, per case. To quantify inter-rater reliability, intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals were calculated (ICC<0.5=poor, 0.5 to 0.75=moderate, and 0.75 to 0.9=good and >0.9=excellent). A total of 280 slides were evaluated. The overall inter-rater reliability for the presence of LVI was moderate (ICC=0.53) and was slightly higher in the MMRd (ICC=0.56) compared with NSMP (ICC=0.52) group. For specific quantification of LVI, the overall inter-rater reliability was also moderate (ICC=0.71) and higher in the MMRd (ICC=0.76) compared with NSMP (ICC=0.69) group. Perfect agreement (6/6 reviewers with same assessment) only occurred for designations of no LVI or ≥5 involved vessels. There was a moderate level of inter-rater reliability that was not significantly affected by shifting the cutoff of involved vessels (from 3 to 4 to 5). Since a specific cutoff has no apparent bearing on the most reproducible cutoff for pathologists, future efforts should be directed towards obtaining clinical consensus for reporting purposes.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"964-971"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866383","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":"Papillary Squamous Intraepithelial Lesion Outside the Uterine Cervix: Clinicopathological Characterization and Immunohistochemical Study.","authors":"Gloria Zhang, Xuefeng Zhang, Robert A Soslow, John R Goldblum, Clifton G Fulmer, Shaomin Hu, Jacob R Sweeney, Bin Yang","doi":"10.1097/PAS.0000000000002559","DOIUrl":"10.1097/PAS.0000000000002559","url":null,"abstract":"<p><p>Papillary immature metaplasia, originally described in the uterine cervix, is increasingly recognized as a distinctive squamous intraepithelial lesion rather than a true metaplastic process. Accordingly, the term papillary squamous intraepithelial lesion (PSIL) has been proposed. PSIL occurring outside the uterine cervix is exceedingly rare. In this study, we characterize the clinicopathologic, immunophenotypic, and virologic features of 25 cases of PSIL involving non-cervical sites (vagina, vulva, anus, and endometrium). All lesions demonstrated exophytic papillary architecture lined by uniform immature squamous cells with limited surface maturation. Mitotic figures were frequently identified in the lower half of the epithelium. Low-risk HPV E6/E7 mRNA was detected in 76% of cases, whereas none harbored high-risk HPV. HPV transcripts exhibited a distinctive punctate distribution throughout the epithelium, contrasting with the superficial clustered pattern seen in condyloma/LSIL. Non-block p16 immunostaining pattern was seen in all PSILs, while Ki-67 labeling indices were increased (median 50%), predominantly involving the lower half to two-thirds of the epithelium. Clinical follow-up (median 32 months) demonstrated recurrence in 43% of cases, most commonly with incomplete excision. Our study shows that non-cervical PSIL shares morphologic, immunophenotypic, and virologic features with cervical PSIL. Despite the absence of block-type p16 expression, PSIL demonstrates high proliferative activity, frequently leading to diagnostic confusion with HSIL. Given its distinctive papillary architecture, unusual HPV distribution pattern, and tendency for recurrence, PSIL represents a unique low-risk HPV-associated intraepithelial lesion distinct from conventional LSIL and HSIL. Adoption of the term papillary squamous intraepithelial lesion is recommended in accordance with LAST terminology.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"934-942"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809654","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":"Discontinuous Involvement of the Spermatic Cord by Germ Cell Tumors Should Not Be Considered Pathologic Stage M1: An International Multi-Institutional Study.","authors":"João Lobo, Dheeraj Chinnam, Kvetoslava Michalova, Maurizio Colecchia, Ankur R Sangoi, Douglas J Wu, Pilar G Peramato, Mariana A Morini, Costantino Ricci, Gabriela Quiroga-Garza, Adeboye O Osunkoya, Jennifer B Gordetsky, Trevor Flood, Muhammad T Idrees, Timothy A Masterson, Lawrence Einhorn, Thomas M Ulbright, Andres M Acosta","doi":"10.1097/PAS.0000000000002552","DOIUrl":"10.1097/PAS.0000000000002552","url":null,"abstract":"<p><p>In testicular germ cell tumors (TGCTs), staging is a major determinant of disease-specific outcomes and dictates clinical management. The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual recommends that tumor deposits in the spermatic cord that are discontinuous with the primary tumor be considered pathologic stage M1 (clinical stage [CS] III). This recommendation is controversial because, if patients do not show other metastases, it results in upstaging from CS I to III. This is relevant because CSI patients are candidates for active surveillance, whereas chemotherapy represents the standard treatment of CSIII patients. In this study, we describe the clinicopathologic findings and disease outcomes of TGCT patients presenting with discontinuous cord involvement no other concurrent metastases (ie, otherwise CS I). A total of 19 patients were assessed: 16 nonseminomas and 3 seminomas. When the focus of discontinuous spermatic cord invasion was excluded from staging, 10 tumors were pT3, 8 were pT2, and 1 was pT1. Adjuvant chemotherapy was given to 15 patients, 10 of whom developed disease recurrence (8 of them showing metastases in the retroperitoneum). None of the 4 patients kept on active surveillance showed evidence of recurrence at last follow-up, which is incompatible with the natural history of untreated CS III TGCTs. If the focus of discontinuous cord involvement was excluded from staging, these 4 cases were all pT2. Our data support that discontinuous cord invasion should not be considered pM1, since this practice may result in overtreatment of patients that could be kept on surveillance. We suggest staging these tumors as pT3(disc), considering this finding a risk factor for recurrence.</p>","PeriodicalId":7772,"journal":{"name":"American Journal of Surgical Pathology","volume":" ","pages":"906-911"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759755","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}