Archives of pathology & laboratory medicine最新文献

{"title":"Challenges in Consistent Histologic Diagnosis of Superficially Invasive Anal Squamous Cell Carcinoma.","authors":"Faruk Erdem Kombak, Qingqing Liu, John D Paulsen, Xintong Wang, Fatemeh Ghazanfari Amlashi, Pei Hui, Wenxin Zheng, Alexandros D Polydorides, Yuxin Liu","doi":"10.5858/arpa.2024-0463-OA","DOIUrl":"https://doi.org/10.5858/arpa.2024-0463-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Superficially invasive squamous cell carcinoma of the anus (SISCCA) is defined as a minimally invasive cancer measuring less than 3 mm in depth and less than 7 mm in horizontal spread. Its subtle morphologic alterations pose a significant challenge for histologic diagnosis.</p><p><strong>Objective.—: </strong>To evaluate the diagnostic agreement among pathologists for SISCCA and to identify potential areas for improvement.</p><p><strong>Design.—: </strong>Four gastrointestinal (GI) and 4 gynecologic (GYN) pathologists independently reviewed digitized hematoxylin-eosin images of 20 anal high-grade squamous intraepithelial lesions with suspected early invasion. Participants classified each lesion as either invasive or noninvasive and selected features indicative of invasion from a list compiled from major textbooks. Cohen κ coefficient was calculated to assess interobserver agreement.</p><p><strong>Results.—: </strong>Of the 20 lesions, 8 (40%) received unanimous diagnoses, while 12 (60%) had discrepancies. Overall agreement was moderate (κ = 0.46; 95% CI, 0.29-0.48), with similar levels between the GI (κ = 0.53; 95% CI, 0.45-0.74) and GYN (κ = 0.46; 95% CI, 0.25-0.48) groups (P > .01). The GYN group diagnosed a higher number of lesions as invasive than did the GI group (median, 14.5 versus 10.5; P > .01). In consensus SISCCA diagnoses, the most commonly noted feature was the presence of small irregular tumor nests, followed by desmoplastic response and paradoxical maturation.</p><p><strong>Conclusions.—: </strong>Variability in recognizing histologic features indicative of early invasion contributed to the poor reproducibility in the diagnosis of SISCCA. Efforts should focus on refining diagnostic criteria and integrating features that have proved effective in identifying early invasive cancer at other anatomic sites.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting the Deceased, Their Families, and Their Communities Part 2: Practical Guidance for Building an Office of Decedent Affairs.","authors":"Meagan Chambers, Tanner Bartholow, Zachary T Parker, Kristina Peters, R Ross Reichard, Daniel J Luthringer, Charles Tigard, Jody E Hooper, Paul Benson, Ronnie Davis, Robert Cool, Ben Beglarian, Sharon Mount, Nicole R Jackson, Kathryn P Scherpelz, Desiree Marshall, John Sinard, Lisbeth Harcourt, LaTresa E Wiley, Sonja Chen, Jessica M Comstock, Courtney Hyland, Holly Harper, David Priemer, Amy Rapkiewicz, Amyn M Rojiani, Harold Sanchez","doi":"10.5858/arpa.2025-0094-OA","DOIUrl":"10.5858/arpa.2025-0094-OA","url":null,"abstract":"<p><strong>Context.—: </strong>After-death care can be complicated and time-consuming for clinical staff, and frustrating for bereaved families. Delays and errors can have damaging legal and reputational consequences for hospitals. Offices of Decedent Affairs (ODAs) have been proposed as a solution, and their potential benefits have been described in several single institution reports. The literature lacks a contemporary and comprehensive review of existing ODAs and their approaches.</p><p><strong>Objective.—: </strong>To describe the process of establishing a new ODA and to provide a snapshot of the spectrum of structure, function, and impact of existing ODAs in the United States.</p><p><strong>Design.—: </strong>A survey was administered to 11 established ODAs spread across the continental United States. Programs were identified through the College of American Pathologists Autopsy Committee and a Medical Autopsy Listserv.</p><p><strong>Results.—: </strong>Eleven ODAs returned the survey, representing more than 190 cumulative years of experience in decedent care in the hospital setting (median, 10 years). There was a wide range in staffing (both staff size and background) as well as scope of services offered. The median ratio of hospital deaths to full-time equivalent (FTE) staffing was 360 deaths per FTE. Respondents report that ODAs unburden clinical providers and facilitate decedent management. Some respondents report a quicker turnover of hospital beds and shorter intervals between pronouncement of death and autopsy. ODAs increased autopsy rates when the autopsy services were part of the ODA.</p><p><strong>Conclusions.—: </strong>This survey provides practical information for hospitals considering establishing a new ODA and useful benchmarks for existing ODA programs.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infantile Pyknocytosis Revisited: Possible Familial Trend in a Study of 9 Patients.","authors":"Aileen Y Hu, Amy M Coffey, Jyotinder N Punia, Andrea N Marcogliese, Choladda V Curry, M Tarek Elghetany","doi":"10.5858/arpa.2024-0504-OA","DOIUrl":"https://doi.org/10.5858/arpa.2024-0504-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Infantile pyknocytosis (IP) is an uncommon cause of transient neonatal hemolytic anemia and hyperbilirubinemia occurring in approximately 10% of cases of unexplained neonatal hemolytic anemia.</p><p><strong>Objective.—: </strong>To study cases of IP with focus on long-term follow-up, perinatal events, and family history.</p><p><strong>Design.—: </strong>Cases were prospectively identified during review of peripheral blood smears for neonatal hyperbilirubinemia during an 11-year period. Clinical and laboratory parameters, follow-up data, and family history were recorded.</p><p><strong>Results.—: </strong>Nine cases of IP were identified from the morphologic recognition of pyknocytes and clinical and laboratory evidence of hemolysis, and included 6 males and 3 females. Age at diagnosis ranged from 1 to 18 days (median, 4 days), and gestational age at birth ranged from 29 to 38 weeks (median, 35 weeks). Hemoglobin nadir ranged from 4.9 to 8.1 g/dL (median, 6 g/dL), and maximum total bilirubin concentration ranged from 7.7 to 27.5 mg/dL (median, 22.0 mg/dL). All 9 patients required phototherapy and transfusions. Hemolysis spontaneously resolved without recurrence in all cases, with time to resolution ranging from 13 to 70 days (median, 33 days) and median follow-up of 7 years (range, 1-11 years). Six patients (67%) had a sibling with neonatal jaundice as well. A similar proportion had significant perinatal events.</p><p><strong>Conclusions.—: </strong>IP is associated with spontaneous resolution without long-term complications. The underlying etiology is unknown. Perinatal events may expose red blood cells to an overwhelming oxidative stress. Strong family history suggests familial predisposition causing transient red blood cell defect, making them more susceptible to hemolysis.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supporting the Deceased, Their Families, and Their Communities Part 1: Why Establish an Office of Decedent Affairs.","authors":"Meagan Chambers, Tanner Bartholow, Zachary T Parker, Kristina Peters, R Ross Reichard, Daniel J Luthringer, Charles Tigard, Jody E Hooper, Paul Benson, Ronnie Davis, Robert Cool, Ben Beglarian, Sharon Mount, Nicole R Jackson, Kathryn P Scherpelz, Desiree Marshall, John Sinard, Lisbeth Harcourt, LaTresa E Wiley, Sonja Chen, Jessica M Comstock, Courtney Hyland, Holly Harper, David Priemer, Amy Rapkiewicz, Amyn M Rojiani, Harold Sanchez","doi":"10.5858/arpa.2025-0090-OA","DOIUrl":"10.5858/arpa.2025-0090-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Decedent Affairs Offices and Programs can serve as an avenue to assist medical centers in facilitating efficient and comprehensive decedent management, despite a paucity of literature on their roles, establishment, and efficacy.</p><p><strong>Objective.—: </strong>To characterize the motivations and rationales for establishing Decedent Affairs Offices.</p><p><strong>Design.—: </strong>A survey was administered to 11 established Decedent Affairs Offices/Programs, identified through the College of American Pathologists Autopsy Committee and a Medical Autopsy Listserv. The questions comprehensively cover establishment, operations, and outcomes data available by institution.</p><p><strong>Results.—: </strong>Survey respondents report the rationale for starting their programs, and the benefits such offices can have.</p><p><strong>Conclusions.—: </strong>Decedent Affairs Offices and Programs provide a useful option to medical centers to navigate the increasingly complex task of comprehensive decedent management. The present survey helps to delineate the similarities and differences between these programs at 11 institutions, to aid nascent programs in their establishment and growth over time.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gestational Choriocarcinoma: A Timely Review of Diagnostic Pathology.","authors":"Pei Hui","doi":"10.5858/arpa.2025-0156-RA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0156-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Gestational choriocarcinoma is the most common form of gestational trophoblastic neoplasm. It is characterized by aggressive, destructive growth and a marked tendency for hematogenous spread, leading to high mortality if left untreated. However, with the advent of effective clinical treatment for postmolar gestational trophoblastic neoplasms in recent decades, the clinicopathologic presentation of gestational choriocarcinoma has significantly changed. Today, it more frequently presents at extrauterine sites and/or in an unexpected manner, posing considerable diagnostic challenges for pathologists. Nonetheless, prompt and accurate pathologic diagnosis remains essential for effective clinical management and optimal patient outcomes.</p><p><strong>Objective.—: </strong>To review the clinical features and pathologic diagnosis of gestational choriocarcinoma, including its early manifestations.</p><p><strong>Data sources.—: </strong>This review is based on literature and the author's personal diagnostic experience.</p><p><strong>Conclusions.—: </strong>In the era of precision medicine, gestational choriocarcinoma has become a rare encounter, largely owing to the implementation of postmolar surveillance programs and timely initiation of chemotherapy. Diagnostic recognition of the tumor requires a high index of suspicion, familiarity with its histologic features and early forms, awareness of the unexpected extrauterine presentations, and appropriate use of immunohistochemical and molecular biomarkers. These tools are essential in distinguishing gestational choriocarcinoma from nongestational mimics of germ cell or somatic origin, which have a profound therapeutic and prognostic implications.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filling in the Gaps of Examining Human Epidermal Growth Factor Receptor 2 (HER2)-Low and HER2-Ultralow in Breast Cancer: Clone Choice, Sample Size, and Reevaluating Scores Made on Archived Samples.","authors":"Emad Alqassim, Sayeeda Yasmeen, John Etter, Thaer Khoury","doi":"10.5858/arpa.2024-0334-OA","DOIUrl":"https://doi.org/10.5858/arpa.2024-0334-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Human epidermal growth factor receptor 2 (HER2)-low breast carcinoma is a clinical entity that has targeted therapy.</p><p><strong>Objectives.—: </strong>To evaluate the effect of antibody clone/sample size on HER2 status and reinterpret archived HER2-stained slides following current guidelines.</p><p><strong>Design.—: </strong>We collected 86 estrogen-receptor+/HER2- breast carcinoma core needle biopsy (CNB) samples with archived slides stained with HER2 (HercepTest) and for Oncotype DX (ODX) assay. These slides were scored by 3 pathologists (consensus score) and then compared to the reported scores. The CNB and excisional biopsy (EB) samples were stained with 4B5. We performed a 3-way comparison between CNB-4B5, CNB-HercepTest, and EB-4B5. The mRNA values were abstracted from the ODX report. The mRNA values were compared with the EB-4B5 scores (semiquantitative [H-score] and categorical [zero, 1+, and 2+] system), the consensus score of CNB-HercepTest, and then with the consensus scores of CNB-4B5.</p><p><strong>Results.—: </strong>Upon rescoring the archived CNB-HercepTest slides, 45.3% were discordant; 12 of 19 (63.2%) reported as 1+ were HER2-zero. The discordance rate between CNB-4B5 and EB-4B5 was 24.4%; between CNB-4B5 and CNB-HercepTest, 59.3%; and between CNB-HercepTest and EB-4B5, 62.8%. The mRNA values correlated with EB-4B5 when using the H-score (P = .003) or the categorical system (zero, 1+, 2+) (P = .008), and with CNB-4B5 (P = .002), but did not correlate with CNB-HercepTest.</p><p><strong>Conclusions.—: </strong>The discordance of HER2 staining depended on the sample size and antibody clone. Tissue stained with 4B5 (CNB or EB), but not with CNB-HercepTest, correlated with mRNA values.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Pathology of Primary Intestinal Myopathy.","authors":"Raj P Kapur","doi":"10.5858/arpa.2025-0170-RA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0170-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Pathologic evaluation of intestinal biopsies or resection specimens is often part of the diagnostic workup for patients with pseudo-obstruction or other forms of severe intestinal dysmotility. Some of these patients have one of several types of primary intestinal myopathy, but the pathologic features that identify and/or distinguish these conditions have been incompletely defined and need to be readdressed in the context of newly recognized genetic etiologies.</p><p><strong>Objective.—: </strong>To convey a practical approach to surgical pathology diagnosis of primary intestinal myopathy based on a comprehensive review of pathology findings in patients with primary intestinal myopathy, including data collected from patients with intestinal myopathy-related pathogenic gene variants.</p><p><strong>Data sources.—: </strong>A review of the literature as well as cases from multiple institutions that were examined by the author.</p><p><strong>Conclusions.—: </strong>Microscopic alterations indicative of primary intestinal myopathy must be distinguished from nonspecific findings associated with chronic distension, surgical procurement, or preanalytic tissue processing. Most histopathologically recognizable forms of primary intestinal myopathy can be grouped as either structural alterations of the muscularis propria or degenerative leiomyopathies. Some histopathologic findings correlate with specific types of primary intestinal myopathy, but biopsies or resections from many patients with pathogenic variants in genes that encode smooth muscle contractile proteins show no diagnostic alterations. In some situations, an invasive procedure to obtain tissue for histopathologic evaluation has limited utility and molecular genetic testing may be a superior initial diagnostic approach.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardization of Blood Product Orders Improves Patient Safety in Pediatric Transfusion Medicine: A Collaborative Project.","authors":"Margo Rollins, Sarah Thompson, Beverly B Rogers, Jennifer Andrews, Kyle Annen, Stella T Chou, Melkon DomBourian, Swaminathan Kandaswamy, Stephanie Kinney, Frank Nizzi, Daniel Noland, Evan Orenstein, Leon Su, Randy Winstead, Alexis B Carter","doi":"10.5858/arpa.2024-0074-OA","DOIUrl":"https://doi.org/10.5858/arpa.2024-0074-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Complexity of ordering and transfusing blood is particularly evident in the pediatric population. Simplification, clarification, and standardization of blood orders can decrease complexity and improve patient safety.</p><p><strong>Objective.—: </strong>To improve patient safety by optimizing electronic ordering of blood components in pediatrics through a collaborative process improvement initiative.</p><p><strong>Design.—: </strong>A multidisciplinary working group, formed as part of a value stream analysis to improve transfusion safety at Children's Healthcare of Atlanta (Atlanta, Georgia), focused on decreasing variability and providing clarity when ordering, preparing, and transfusing blood using the electronic health record. Through benchmarking with other pediatric institutions and a collaborative design process with multiple local stakeholders, an extensive redesign in the existing orders and order sets occurred. Metrics were collected to determine if a change was an improvement.</p><p><strong>Results.—: </strong>Nurse and laboratory informaticists, a pathology informaticist, and a transfusion medicine specialist built the new orders based on the design. The new orders focused on the following changes: standardization, introduction of logic, naming conventions, clarifying definitions, adding calculations, improving transparency of history and laboratory data, removing aliquots, clarifying communication, and implementing additional modules to inform the provider of necessary information about the patient. Metrics included a decrease in the number of orders changed within an hour, decreased calls from the blood bank to the provider to clarify the order, and an absence of overtransfusions and transfusion-related serious safety events for a year following implementation.</p><p><strong>Conclusions.—: </strong>This collaborative initiative, using standard process improvement tools, resulted in standardized blood orders improving transfusion safety.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical and Clinical Validity of Assessing Measurable Residual Disease by Multicolor Flow Cytometry in an Unselected Acute Myeloid Leukemia Patient Cohort.","authors":"Sa A Wang, Shaoying Li, Wei Wang, Jie Xu, Beenu Thakral, Shimin Hu, Chi Young Ok, Fuli Jia, Jeffrey L Jorgensen, L Jeffrey Medeiros, Farhad Ravandi, Nicholas J Short, Sanam Loghavi","doi":"10.5858/arpa.2025-0053-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0053-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Following the validation of a multicolor flow cytometry (MFC) assay for measurable residual disease (MRD) in acute myeloid leukemia (AML), this study examines its clinical applicability.</p><p><strong>Objective.—: </strong>To evaluate the practicality and performance of MFC-based MRD detection in AML.</p><p><strong>Design.—: </strong>Prospectively assessed AML MRD MFC in unselected AML patients achieving morphologic remission with follow-up studies, molecular genetics, and survival data.</p><p><strong>Results.—: </strong>Among 379 patient bone marrow samples in this cohort, an interpretable result was obtained in 359 (95%). A total of 57 of the 359 cases (16%) were positive for MRD, and the most frequently observed immunophenotype was CD34+CD117+ myeloid (n = 46; 81%), followed by CD34-/CD117+ myeloid (n = 8; 14%) and monocytic (n = 3; 5%). Of 57 MRD+ cases, 6 (11%) had no leukemia-associated immunophenotypes available, and 16 of 51 (31%) with leukemia-associated immunophenotype for comparison exhibited significant immunophenotypic drift/switch, highlighting the importance of the \"deviation from normal\" approach. The remaining 302 cases were MRD negative; among these, 21 (6%) displayed a preleukemic immunophenotype that was associated with persistent clonal hematopoiesis in 18 patients (86%). A positive MFC result was strongly associated with subsequent follow-up positive MRD (41 of 45 [91%] versus 14 of 240 [6%], P < .01), morphologic relapse (42 of 55 [76%] versus 48 of 301 [16%], P < .01), an inferior overall survival (12.5 months versus not reached, P < .01), and leukemia-free survival (6.5 months versus not reached, P < .01). Among MRD-negative patients, a preleukemic phenotype was associated with a shorter overall survival (P = .03), but not leukemia-free survival (P = .16).</p><p><strong>Conclusions.—: </strong>Our study provides data-driven technical insights for laboratories considering MFC AML MRD implementation and offers strong evidence supporting the utility of MRD assessment by MFC in patients with AML undergoing various stages of treatment and surveillance.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonclassic Histologic Variants of Kaposi Sarcoma With Nonspecific Endoscopic Inflammatory Patterns: A Near-Miss Diagnosis Lookout in Gastrointestinal Tract Biopsies.","authors":"James Michael Mitchell, Karen T Shore, Dipti M Karamchandani","doi":"10.5858/arpa.2025-0085-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0085-OA","url":null,"abstract":"<p><strong>Context.—: </strong>The gastrointestinal (GI) tract is the most frequent extracutaneous site for Kaposi sarcoma (KS). However, GI-KS often displays nonspecific endoscopic findings with nonclassic histology in biopsies with a serious potential for a missed diagnosis. There is a paucity of studies discussing the histologic variants of GI-KS, coupled with reportedly high false-negative rates of GI-KS on endoscopic biopsies.</p><p><strong>Objective.—: </strong>To present our single-institution large case analysis to further elucidate nonclassic histologic variants of GI-KS, with pathologic-endoscopic correlation.</p><p><strong>Design.—: </strong>A retrospective pathology database search was performed to retrieve 44 GI-KS biopsies from 28 immunocompromised patients.</p><p><strong>Results.—: </strong>We found that 64% (28 of 44) showed exclusive nonclassic histology mimicking varied inflammatory patterns, namely mucosal hemorrhage-like (n = 10; 23%), mucosal prolapse-like (n = 6; 14%), mucosal inflammation-like (n = 5; 11%), granulation tissue-like (n = 5; 11%), and dilated vascular- or lymphatic-like (n = 2; 5%) patterns. Classic morphology was seen in 16 biopsies (36%), with 11 (25%) also showing concomitant nonclassic histologic patterns. Endoscopically, most cases presented as nodules (n = 16; 36%), or inflammatory patterns (n = 11; 25%). Interestingly, 91% (10 of 11) presenting endoscopically as a nonspecific inflammatory pattern showed nonclassic histology. GI-KS preceded cutaneous diagnosis in 54% (15 of 28) of patients. Coexisting infectious or drug-associated pathology was seen in 18% (8 of 44) of biopsies, further confounding histologic assessment.</p><p><strong>Conclusions.—: </strong>GI-KS often presents with nonspecific endoscopic and histologic findings, frequently mimicking benign reactive and inflammatory conditions. Awareness of the morphologic diversity of KS on limited biopsy material in the setting of immunosuppression is crucial for pathologists to actively consider this diagnosis even in the absence of known cutaneous KS or an endoscopic masslike lesion.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}