Archives of pathology & laboratory medicine最新文献

{"title":"Diagnostic Pitfalls in Breast Cancer Pathology With an Emphasis on Core Needle Biopsy Specimens.","authors":"Liza M Quintana,&nbsp;Laura C Collins","doi":"10.5858/arpa.2023-0007-RA","DOIUrl":"https://doi.org/10.5858/arpa.2023-0007-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Breast pathology has many mimics and diagnostic pitfalls. Evaluation of malignant breast lesions, particularly in the biopsy setting, can be especially challenging, with diagnostic errors having significant management implications.</p><p><strong>Objective.—: </strong>To discuss the pitfalls encountered when evaluating ductal carcinoma in situ and invasive breast carcinomas, providing histologic clues and guidance for appropriate use and interpretation of immunohistochemistry to aid in the correct diagnosis.</p><p><strong>Data sources.—: </strong>Data were obtained from review of pertinent literature of ductal carcinoma in situ and invasive breast carcinomas and from the experience of the authors as practicing breast pathologists.</p><p><strong>Conclusions.—: </strong>Awareness of the pitfalls in diagnosing breast cancers is important when creating a differential diagnosis for each breast lesion evaluated. This review will cover some of these scenarios to aid in the diagnostic process.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"1025-1038"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10150259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer.","authors":"Antonio C Wolff,&nbsp;Mark R Somerfield,&nbsp;Mitchell Dowsett,&nbsp;M Elizabeth H Hammond,&nbsp;Daniel F Hayes,&nbsp;Lisa M McShane,&nbsp;Thomas J Saphner,&nbsp;Patricia A Spears,&nbsp;Kimberly H Allison","doi":"10.5858/arpa.2023-0950-SA","DOIUrl":"https://doi.org/10.5858/arpa.2023-0950-SA","url":null,"abstract":"<p><strong>Purpose.—: </strong>To update the American Society of Clinical Oncology-College of American Pathologists (ASCO-CAP) recommendations for human epidermal growth factor receptor 2 (HER2) testing in breast cancer. An Update Panel is aware that a new generation of antibody-drug conjugates targeting the HER2 protein is active against breast cancers that lack protein overexpression or gene amplification.</p><p><strong>Methods.—: </strong>The Update Panel conducted a systematic literature review to identify signals for updating recommendations.</p><p><strong>Results.—: </strong>The search identified 173 abstracts. Of 5 potential publications reviewed, none constituted a signal for revising existing recommendations.</p><p><strong>Recommendations.—: </strong>The 2018 ASCO-CAP recommendations for HER2 testing are affirmed.</p><p><strong>Discussion.—: </strong>HER2 testing guidelines have focused on identifying HER2 protein overexpression or gene amplification in breast cancer to identify patients for therapies that disrupt HER2 signaling. This update acknowledges a new indication for trastuzumab deruxtecan when HER2 is not overexpressed or amplified but is immunohistochemistry (IHC) 1+ or 2+ without amplification by in situ hybridization. Clinical trial data on tumors that tested IHC 0 are limited (excluded from DESTINY-Breast04), and evidence is lacking that these cancers behave differently or do not respond similarly to newer HER2 antibody-drug conjugates. Although current data do not support a new IHC 0 versus 1+ prognostic or predictive threshold for response to trastuzumab deruxtecan, this threshold is now relevant because of the trial entry criteria that supported its new regulatory approval. Therefore, although it is premature to create new result categories of HER2 expression (eg, HER2-Low, HER2-Ultra-Low), best practices to distinguish IHC 0 from 1+ are now clinically relevant. This update affirms prior HER2 reporting recommendations and offers a new HER2 testing reporting comment to highlight the current relevance of IHC 0 versus 1+ results and best practice recommendations to distinguish these often subtle differences. Additional information is available at www.asco.org/breast-cancer-guidelines.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"993-1000"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Grade Desmoplastic Foamy Gland Prostatic Adenocarcinoma.","authors":"Guofeng Gao,&nbsp;Jonathan I Epstein","doi":"10.5858/arpa.2022-0165-OA","DOIUrl":"https://doi.org/10.5858/arpa.2022-0165-OA","url":null,"abstract":"<p><strong>Context.—: </strong>It is important to recognize high-grade foamy gland prostatic adenocarcinoma with desmoplastic stroma given its aggressive clinical course with frequent metastases and death.</p><p><strong>Objective.—: </strong>To review the morphology, immunohistochemistry, and prognosis for this rare subtype of prostate adenocarcinoma.</p><p><strong>Design.—: </strong>Twenty-four cases received for consultation from 2010 to 2021 were analyzed including needle biopsy (n = 21), transurethral resection (n = 2), and a cystoprostatectomy (n = 1).</p><p><strong>Results.—: </strong>Patients ranged in age from 40 to 89 years (mean, 67 years). On average, 8 cores per case were involved (mean 67% core involvement). Extraprostatic extension and seminal vesicle invasion were observed in 6 of 21 (29%) and 3 of 21 (14%) needle biopsy cases, respectively. Twenty of the 24 cases (83%) were Grade Group (GG) 5 with 4 of 24 (17%) being GG4. Tumor necrosis as a component of Gleason pattern 5 was observed in 21 of 24 cases (88%). Associated intraductal adenocarcinoma (IDC) was observed in 22 of 24 cases (92%), with 4 of 24 cases (17%) demonstrating extensive IDC. Diagnostic challenges were as follows: (1) sparse isolated cancer glands embedded in the dense desmoplastic stroma; (2) fragmented glands; and (3) aberrant staining for high-molecular-weight cytokeratin in a nonbasal cell pattern in all cases. PTEN loss was observed in 9 cases, and p53 nuclear accumulation was observed in 8 cases. Three patients were lost to follow-up. Overall, of the 16 patients with meaningful follow-up, 12 (75%) either had metastases or died from prostate cancer.</p><p><strong>Conclusions.—: </strong>High-grade desmoplastic foamy gland adenocarcinoma is difficult to diagnose and grade and has a poor prognosis.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"1039-1049"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10147131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The American Society of Clinical Oncology-College of American Pathologists Guideline Update for Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer.","authors":"Stuart J Schnitt,&nbsp;Paolo Tarantino,&nbsp;Laura C Collins","doi":"10.5858/arpa.2023-0187-ED","DOIUrl":"https://doi.org/10.5858/arpa.2023-0187-ED","url":null,"abstract":"","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"991-992"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hot Topics in Breast Pathology.","authors":"Gulisa Turashvili,&nbsp;Xiaoxian Li","doi":"10.5858/arpa.2023-0194-ED","DOIUrl":"https://doi.org/10.5858/arpa.2023-0194-ED","url":null,"abstract":"","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"1001-1002"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10141739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Automated Classification of Diagnostic Entities in Dermatopathology Validated on Multisite Data Representing the Real-World Variability of Pathology Workload.","authors":"Victor Brodsky,&nbsp;Leah Levine,&nbsp;Enric P Solans,&nbsp;Samer Dola,&nbsp;Larisa Chervony,&nbsp;Simon Polak","doi":"10.5858/arpa.2021-0550-OA","DOIUrl":"https://doi.org/10.5858/arpa.2021-0550-OA","url":null,"abstract":"CONTEXT.— More people receive a diagnosis of skin cancer each year in the United States than all other cancers combined. Many patients around the globe do not have access to the highly trained dermatopathologists, whereas some biopsy diagnoses of patients who do have access result in disagreements between such specialists. Mechanomind has developed software based on a deep-learning algorithm to classify 40 different diagnostic dermatopathology entities to improve diagnostic accuracy and to enable improvements in turnaround times and effort allocation. OBJECTIVE.— To assess the value of machine learning for microscopic tissue evaluation in dermatopathology. DESIGN.— A retrospective study comparing diagnoses of hematoxylin and eosin-stained glass slides rendered by 2 senior board-certified pathologists not involved in algorithm creation with the machine learning algorithm's classification was conducted. A total of 300 glass slides (1 slide per patient's case) from 4 hospitals in the United States and Africa with common variations in tissue preparation, staining, and scanning methods were included in the study. RESULTS.— The automated algorithm demonstrated sensitivity of 89 of 91 (97.8%), 107 of 107 (100%), and 101 of 102 (99%), as well as specificity of 204 of 209 (97.6%), 189 of 193 (97.9%), and 198 of 198 (100%) while identifying melanoma, nevi, and basal cell carcinoma in whole slide images, respectively. CONCLUSIONS.— Appropriately trained deep learning image analysis algorithms demonstrate high specificity and high sensitivity sufficient for use in screening, quality assurance, and workload distribution in anatomic pathology.","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"1093-1098"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10148441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Values of Androgen Receptor in Breast Cancer.","authors":"Lun Li,&nbsp;Shuyue Zheng,&nbsp;Ming Chen,&nbsp;Weiru Chi,&nbsp;Jingyan Xue,&nbsp;Jiong Wu","doi":"10.5858/arpa.2021-0590-OA","DOIUrl":"https://doi.org/10.5858/arpa.2021-0590-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Whether androgen receptor (AR) expression can predict prognosis in breast cancer is under debate.</p><p><strong>Objective.—: </strong>To analyze, retrospectively, the prognostic and treatment-predictive ability of AR status in breast cancer.</p><p><strong>Design.—: </strong>A total of 5765 patients diagnosed with primary invasive breast cancer without distant metastasis in the adjuvant setting were analyzed. The propensity score-matching method was used to develop a new cohort of 3978 patients (1989 patients each) in which important prognostic factors were balanced.</p><p><strong>Results.—: </strong>Positive AR expression is an independent prognostic factor for disease-free survival and overall survival. Estrogen receptor (ER)+ and progesterone receptor (PR)+ AR+ breast cancer patients had the longest survival, whereas ER-PR-AR- breast cancer patients had the shortest survival. The ER/PR/AR combinations could not predict the treatment effects for adjuvant trastuzumab but could be used for adjuvant chemotherapy and endocrine therapy selection. The worst survival was found in ER+PR-AR- patients receiving toremifene, ER+PR-AR+ patients receiving exemestane, ER+PR+AR- patients receiving anthracycline, and ER-PR-AR+ patients receiving taxanes. ER+PR-AR-, ER-PR-AR+, and ER-PR-AR- patients were associated with the worst survival among those who received radiotherapy and anthracycline plus taxanes.</p><p><strong>Conclusions.—: </strong>AR in combination with ER and PR could predict the prognosis and treatment effects of chemotherapy, endocrine therapy, and radiotherapy in the adjuvant setting.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"1075-1085"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10148446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression and Suicidality in Pathology and Laboratory Medicine: We Should Be Concerned.","authors":"Vinita Parkash,&nbsp;Stephen M Smith","doi":"10.5858/arpa.2022-0272-LE","DOIUrl":"https://doi.org/10.5858/arpa.2022-0272-LE","url":null,"abstract":"","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"987-988"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10150256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Epidermal Growth Factor Receptor 2 \"Low\" in Breast Cancer in 2023.","authors":"Shabnam Jaffer","doi":"10.5858/arpa.2023-0176-ED","DOIUrl":"https://doi.org/10.5858/arpa.2023-0176-ED","url":null,"abstract":"","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"989-990"},"PeriodicalIF":4.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinicopathologic and Molecular Features of Pancreatic Ductal Adenocarcinomas Harboring Alterations in COMPASS-like Complex Genes.","authors":"Erika Hissong, Lili Zhao, Jiaqi Shi","doi":"10.5858/arpa.2022-0103-OA","DOIUrl":"10.5858/arpa.2022-0103-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Recent genome-wide sequencing studies have identified a subset of pancreatic ductal adenocarcinomas (PDACs) harboring significant alterations in epigenetic regulation genes, including the COMPASS-like complex genes. Whether this subset of PDACs has specific histologic characteristics or carries prognostic or therapeutic implications is unknown.</p><p><strong>Objective.—: </strong>To determine the specific clinicopathologic and molecular features of PDACs carrying mutations in COMPASS-like complex genes.</p><p><strong>Design.—: </strong>We analyzed a series of 103 primary and metastatic PDACs with comprehensive molecular profiling, including 13 PDACs carrying loss-of-function COMPASS-like complex gene alterations (study cohort). Another 45 patients carrying PDACs with wild-type COMPASS-like complex genes were used as the control group.</p><p><strong>Results.—: </strong>PDACs within the study cohort were smaller, harboring frequent areas of poor differentiation and concurrent alterations in KRAS, TP53, SMAD4, and CDKN2A. A subset of metastatic PDACs from the study cohort showed squamous differentiation. There was a trend toward decreased survival in the study group. We further interrogated 2 public data sets and found that PDACs with COMPASS-like complex gene alterations have increased rates of TP53 mutation, body-tail location, poor differentiation or undifferentiated histology, and a higher death rate.</p><p><strong>Conclusions.—: </strong>COMPASS-like complex gene alterations likely represent a subset of more aggressive PDACs with poor or squamous differentiation histologically and increased concurrent TP53 mutations. These findings may have potential prognostic and therapeutic implications.</p>","PeriodicalId":8305,"journal":{"name":"Archives of pathology & laboratory medicine","volume":"147 9","pages":"1050-1059"},"PeriodicalIF":3.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10261500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10150479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}