Archives of pathology & laboratory medicine最新文献

{"title":"Current Practices in Laboratories With Respiratory Nongynecologic Cytology Specimens: A Survey by the College of American Pathologists Cytopathology Committee.","authors":"Lananh N Nguyen, Ann King, Rhona J Souers, Christine N Booth, Eric Huang, Zaibo Li, Sinchita Roy-Chowdhuri, Donna Russell, Lisa Teot, Sana Tabbara","doi":"10.5858/arpa.2025-0225-CP","DOIUrl":"https://doi.org/10.5858/arpa.2025-0225-CP","url":null,"abstract":"<p><strong>Context.—: </strong>In 2013, the Cytopathology Committee of the College of American Pathologists conducted its first survey on the practice patterns of laboratories performing respiratory cytology.</p><p><strong>Objective.—: </strong>To capture current laboratory practices, recognize changes in respiratory cytopathology practices over the last decade, and provide insight into future directions for improvement.</p><p><strong>Design.—: </strong>The survey was mailed to 1979 laboratories.</p><p><strong>Results.—: </strong>The survey results show a high demand for respiratory cytology. There has been a shift regarding the preferred technique to endobronchial ultrasound-guided fine-needle aspirations as one of the most frequently processed and interpreted specimens, and the most commonly performed intraprocedural assessments. The pathologist alone mostly performed intraprocedural assessments, followed by the cytotechnologist alone. The immunostaining markers used to differentiate non-small carcinomas were most commonly the panel p63, CK5/6, and p40 for squamous cell carcinoma or TTF-1 and Napsin A for adenocarcinoma, compared with a single stain for either. Molecular testing for non-small cell lung carcinomas was commonly performed, with most molecular testing being sent to an outside laboratory. Immunohistochemical stains were validated in half of the institutions, with a high number responding that they were unsure of the validation performed in their laboratories.</p><p><strong>Conclusions.—: </strong>This follow-up study of our original study has shown significant advances in the field of respiratory cytology. The data also showed a few areas, specifically validation of cytology preparations for ancillary testing and molecular testing, which may benefit from guidelines to standardize cytopathology practice and ensure quality care.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671553","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":"Contemporary Updates on Subtypes of Prostate Cancer.","authors":"Liwei Jia, Ximing J Yang","doi":"10.5858/arpa.2025-0634-RA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0634-RA","url":null,"abstract":"<p><strong>Context.—: </strong>Prostatic acinar adenocarcinoma is the most common type of prostate cancer, while other types of cancer infrequently involve the prostate. In this review, we present an overview of contemporary updates on all types of cancers involving the prostate, with a focus on subtypes of prostatic adenocarcinoma. Unusual histological patterns and subtypes of acinar adenocarcinoma, and non-acinar forms of prostate cancers, and their prognostic and therapeutic relevance are discussed. The following summary of the contents presented in part at the 12th Princeton Integrated Pathology Symposium, Plainsboro, New Jersey, on May 10, 2025, supplemented with a relevant literature review, exemplifies the common diagnostic challenges and pitfalls for subtypes of prostate cancer, with emphasis on immunohistochemical and molecular updates when relevant.</p><p><strong>Objective.—: </strong>To describe the common lesions in the prostate, with emphasis on the diagnostic challenges and pitfalls that may arise in the pathologic assessment, and to highlight immunohistochemical workups and emerging molecular findings when relevant.</p><p><strong>Data sources.—: </strong>Published peer-reviewed literature and personal experience are the sources for this study and presented at the course.</p><p><strong>Conclusions.—: </strong>Although most prostate cancers are acinar adenocarcinoma, other types of prostate cancer infrequently occur, which may pose diagnostic challenges. Pitfalls that arise in the pathologic assessment of prostate cancer should raise awareness. We summarize the course content, supplement it with a relevant literature review, and hope to provide a diagnostic framework for evaluating these lesions in routine clinical practice.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671565","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":"A Stakeholder-Driven Workflow Management System for the Continuous Improvement of the College of American Pathologists Cancer Protocols.","authors":"Keren I Hulkower, Anna Patel, Edward Carithers, Eric Daley, Colleen Hébert, Sabrina Krejci, Samantha Lavery, Joni Young, Michael A Berman, Mary E Edgerton, Veronica E Klepeis","doi":"10.5858/arpa.2025-0524-CP","DOIUrl":"https://doi.org/10.5858/arpa.2025-0524-CP","url":null,"abstract":"<p><strong>Context.—: </strong>The College of American Pathologists (CAP) Cancer Protocols are standardized pathology reporting tools that support accurate, complete, and interoperable cancer diagnoses. Available in electronic, downloadable, and mobile formats, they are used by more than 9500 licensed users. CAP has developed a quality management system specifically for the cancer protocols with a focus on stakeholder feedback. It also maintains alignment with multiple international regulatory standards, enabling compliance with accreditation requirements.</p><p><strong>Objective.—: </strong>To describe the process for tracking, triaging, and resolving inquiries to increase transparency of the creation and maintenance of the CAP protocols. This process ensures that stakeholder feedback is fully considered and systematically incorporated into protocol updates.</p><p><strong>Design.—: </strong>Inquiries submitted in 2023-2024 were logged into 2 databases for triage within a customized task management system. For each inquiry, data were captured on volume, source, submission platform, protocol group, issue type, and resolution time.</p><p><strong>Results.—: </strong>Of 507 inquiries, 156 (31%) resulted in protocol updates. Despite 278 inquiries (55%) requiring committee input, 446 (88%) were resolved within 7 days. Most inquiries involved content (283; 56%), and technical issues were minimal (61; 12%). Submission via the preferred route (cancerprotocols@cap.org) was used for 395 inquiries (78%). Breast, gastrointestinal, genitourinary, and gynecologic protocols generated the most inquiries.</p><p><strong>Conclusions.—: </strong>Stakeholder input is used in a quality management system to create and maintain the CAP Cancer Protocols. Use of this system ensures the ongoing accuracy, usability, and interoperability of the CAP Cancer Protocols, supporting precision oncology and excellence in patient care.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671578","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":"Obstetrical Clinical Feedback to a Novel Placenta Diagnostic Template.","authors":"Philip J Katzman, Heather B Florescue, Rachelle P Mendoza, Leon A Metlay","doi":"10.5858/arpa.2025-0400-OA","DOIUrl":"10.5858/arpa.2025-0400-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Two recurring themes in placental pathology include (1) the difficulty clinicians have in reading placenta pathology reports; and (2) the irrelevance that many diagnoses have in clinical practice.</p><p><strong>Objective.—: </strong>To create and distribute surveys to local obstetric clinicians, soliciting their opinions of a novel placental pathology report template that is annotated with comments.</p><p><strong>Design.—: </strong>We composed and sent initial and 2 follow-up surveys (10 months and 28 months after the initial survey) to our community obstetric clinicians to screen their impressions of current and revised placental pathology reports based on Amsterdam criteria categories. After survey feedback, the template was revised and used prior to a follow-up survey.</p><p><strong>Results.—: </strong>Initial and 2 separate follow-up surveys included 69, 94, and 21 clinicians. Prior to the revision, most clinicians (45; 65%) found placental reports not useful; however, a majority (58; 84%) would modify care of the patient's next pregnancy if they were told that a placental finding predicted future pregnancy risk. In each of 2 follow-up surveys, clinicians were divided on the usefulness of the new reports: 70 (74%) and 8 (53%), respectively, thought that the new format was either a great, or somewhat of an, improvement.</p><p><strong>Conclusions.—: </strong>Pathologists need to provide placental diagnoses and explanatory comments that provide value-added information related to poor outcomes and recurrence. Follow-up surveys of clinicians suggest that, despite providing more and better organized diagnoses in revised reports, their clinical utility was limited by anxiety caused by distribution to patients and the absence of patient-specific comments. The new template will require additional refinements to provide more focused diagnoses.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"645-651"},"PeriodicalIF":3.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522927","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":"Risk Assessment and Mitigation of Preanalytical Errors: A Quality Improvement Initiative at a National Accreditation Board for Testing and Calibration Laboratories-Accredited Diagnostic Laboratory.","authors":"Jagdish Chandarana, Kinjal Butani","doi":"10.5858/arpa.2026-0093-OA","DOIUrl":"https://doi.org/10.5858/arpa.2026-0093-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Preanalytical errors account for 60% to 70% of total laboratory errors and represent a significant threat to laboratory quality and patient safety. Despite their impact, systematic risk assessment approaches remain underutilized in clinical laboratories, particularly in resource-limited settings.</p><p><strong>Objective.—: </strong>To implement a structured risk assessment framework for identifying, evaluating, and mitigating preanalytical process vulnerabilities in a stand-alone diagnostic laboratory, and to measure the impact of targeted interventions on error reduction.</p><p><strong>Design.—: </strong>A quality improvement initiative was conducted at Vedant Diagnostic Center, a National Accreditation Board for Testing and Calibration Laboratories (NABL)-accredited stand-alone diagnostic laboratory in Rajkot, Gujarat, India, processing approximately 4000 tests monthly. Nine critical preanalytical processes were systematically evaluated with a Severity × Probability risk matrix. Processes were classified as low (1-4), medium (5-9), high (10-15), or extreme risk (16-25). Corrective and preventive actions (CAPAs) were implemented.</p><p><strong>Results.—: </strong>One process (11%) was classified as extreme risk, 2 (22%) as high risk, and 6 (67%) as medium risk. Baseline error rate was 1.0% (40 errors per 4000 tests monthly). Following CAPA implementation-including phlebotomist training, expiry verification, and temperature monitoring-error rate decreased to 0.3% (12 errors monthly), representing a statistically significant 70% reduction (χ2 = 21.8; P < .001).</p><p><strong>Conclusions.—: </strong>Systematic risk assessment combined with targeted corrective actions achieved substantial reduction in preanalytical errors. This reproducible, resource-appropriate methodology enables laboratories to enhance preanalytical quality and patient safety, particularly where NABL or other laboratory accreditation requirements drive continuous improvement.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551698","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":"Fluorescence In Situ Hybridization Analysis of Hematologic Neoplasms: A 20-Year Review of Proficiency Testing Results From the College of American Pathologists/American College of Medical Genetics Cytogenetics Committee.","authors":"Jess F Peterson, Guilin Tang, Christopher Mixon, Cinthya J Zepeda-Mendoza, William R Sukov, Ying S Zou, Rangsinee Nusapan, Julian Tan, James Dvorak, Gopalrao V Velagaleti, Min Fang, Brynn Levy, Patricia M Miron, Yang Cao, Caroline Astbury, Juli-Anne Gardner","doi":"10.5858/arpa.2026-0083-CP","DOIUrl":"https://doi.org/10.5858/arpa.2026-0083-CP","url":null,"abstract":"<p><strong>Context.—: </strong>One objective of the College of American Pathologists/American College of Medical Genetics Cytogenetics Committee is to ensure the accurate detection and clinical interpretation of abnormalities observed by fluorescence in situ hybridization (FISH) analysis when evaluating hematologic neoplasms.</p><p><strong>Objective.—: </strong>To report a 20-year performance summary (2005-2024) of FISH challenges focusing on hematologic neoplasms.</p><p><strong>Design.—: </strong>A retrospective review was performed from 2005 through 2024 to identify FISH challenges specifically addressing hematologic neoplasms. The overall performance of participants was evaluated to identify potential recurring errors of clinical relevance.</p><p><strong>Results.—: </strong>A total of 124 hematologic neoplasm FISH challenges from 2005 to 2024 were provided to participating laboratories, including 45 paper challenges (results and/or images were provided for interpretation purposes), 43 liquid challenges (bone marrow aspirate or peripheral blood), and 36 formalin-fixed paraffin-embedded (FFPE) tissue challenges. Of the 124 challenges, 120 (97%) exceeded the required 80% consensus for grading purposes. Of the 4 failed challenges (3%), 2 (1 liquid, 1 paper) involved the interpretation of atypical FISH signal patterns; 1 (paper) involved the interpretation of FISH signal patterns correlating involvement by myeloid versus lymphoid interphase nuclei; and 1 (liquid) likely involved a specimen processing or handling error that resulted in discordant participant responses. All 36 FFPE tissue challenges exceeded the 80% consensus for grading purposes.</p><p><strong>Conclusions.—: </strong>This 20-year retrospective review demonstrates that clinical cytogenomic laboratories have been and continue to be highly proficient in the detection and interpretation of FISH abnormalities associated with hematologic neoplasms.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458080","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":"Centenary of Archives of Pathology & Laboratory Medicine: Its Conception, Gestation, Birth, Childhood, and Maturation.","authors":"James R Wright","doi":"10.5858/arpa.2026-0085-HP","DOIUrl":"10.5858/arpa.2026-0085-HP","url":null,"abstract":"<p><p>Archives of Pathology & Laboratory Medicine is 100 years old this year. In this article, I describe the milieu into which Archives was conceived, then recount details of its gestation and birth, compare and contrast it with its siblings and cousins, and finally describe its growth and maturation. Throughout the 19th century, pathology was exclusively an academic discipline. During the first 2 decades of the 20th century, the opportunity for laboratorians to provide \"clinical pathology\" services directed at improving patient care appeared. In 1901, during the heyday of medical specialization, the American Medical Association created a Section on Pathology and Physiology, and in 1925 this section recommended that the American Medical Association establish a specialty journal. In January 1926, Archives was established with Ludvig Hektoen, MD, as editor. At about the same time, several other American pathology journals appeared on the horizon, with each filling different niches. Archives' publication mix was roughly half observational pathologic morphology and half experimental pathology. During the 1920s, America became the world leader in both surgical pathology and clinical pathology, allowing the journal to thrive. In 1984, the College of American Pathologists (CAP) became the journal's co-sponsor and in 1995 CAP assumed its full fiscal, editorial, and operational responsibility. In 2009, Archives was voted the only pathology journal among the top 100 most influential journals of biology and medicine in the past 100 years by the Biomedical and Life Sciences Division of the Special Libraries Association. It is currently the most widely read journal among practicing American pathologists.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":"678-688"},"PeriodicalIF":3.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407450","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":"Assessing Human Epidermal Growth Factor Receptor 2 in Urothelial Carcinoma: Insights From Clinical Practice Into Scoring Criteria, Histologic Subtypes, and Genomic Characteristics Across Disease Sites.","authors":"Swati Bhardwaj, Eli Morris, Aditya Halthore, Sunil Patel, Max Kates, Armine Smith, Noah Hahn, Andres Matoso, Jean Hoffman-Censits, Burles A Johnson, Ezra Baraban","doi":"10.5858/arpa.2025-0386-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0386-OA","url":null,"abstract":"<p><strong>Context.—: </strong>Human epidermal growth factor receptor 2 (HER2) alterations occur in several solid tumors, including urothelial carcinoma. Although HER2-targeted therapies, such as trastuzumab deruxtecan, have shown promising results in HER2-positive bladder cancer, optimal immunohistochemistry (IHC) scoring criteria for urothelial carcinoma remain unclear.</p><p><strong>Objective.—: </strong>To compare American Society of Clinical Oncology (ASCO) and College of American Pathologists (CAP) HER2 IHC scoring criteria for breast and upper gastrointestinal (GI) cancers in urothelial carcinoma and to correlate HER2 expression with histologic subtypes, metastatic sites, temporal heterogeneity, and next-generation sequencing (NGS) findings.</p><p><strong>Design.—: </strong>A total of 139 specimens from 129 patients with urothelial carcinoma were evaluated. HER2 IHC was scored using both breast and upper GI CAP criteria across histologic subtypes and metastatic sites. Temporal heterogeneity was assessed in paired primary and metastatic specimens (n = 11).</p><p><strong>Results.—: </strong>Using upper GI criteria, 43 of 105 cases (41%) were HER2 3+ compared with 35 of 105 (34%) HER2 3+ with breast criteria, with 12 of 139 cases (9%) showing higher scores using upper GI criteria. ERBB2 mutations were found in 15 of 96 (16%) and amplification in 4 of 96 (4%) of sequenced cases. HER2 3+ staining was enriched in micropapillary (11 of 14; 79%) and plasmacytoid (3 of 5; 60%) subtypes. Brain metastases had the highest proportion (6 of 15; 40%) of HER2 3+ cases. In paired samples, HER2 scores in metastases were the same (9 of 12; 75%) or higher (3 of 12; 25%) than primaries.</p><p><strong>Conclusions.—: </strong>Upper GI and breast scoring criteria yield divergent scores in a significant subset of urothelial carcinomas, potentially affecting eligibility for targeted therapy. Associations with histologic subtype and metastatic site support disease-specific diagnostic and therapeutic strategies.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371333","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":"Cross-Reactivity of TPIT Antibody Clone OTI2G1 in Chordoma: Structural Mechanisms and Diagnostic Implications.","authors":"Bo Hong, Hui Zhang, Yun Qian","doi":"10.5858/arpa.2025-0644-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0644-OA","url":null,"abstract":"<p><strong>Context.—: </strong>TPIT (TBX19 [T-box transcription factor 19]) immunohistochemistry is widely used to classify corticotroph tumors, yet unexpected nuclear staining has been observed in chordoma with certain commercial clones, raising concerns about diagnostic cross-reactivity.</p><p><strong>Objective.—: </strong>To investigate the molecular basis of cross-reactivity of the TPIT antibody clone OTI2G1 in chordoma and assess the potential diagnostic pitfall in tumors of the sellar region.</p><p><strong>Design.—: </strong>We compared TBX19 and TBXT (Brachyury [T-box transcription factor T]) by T-box domain sequence alignment and structural modeling/superposition. Immunohistochemistry for TPIT (OTI2G1, CL6251) and Brachyury was performed on pituitary tissues, corticotroph tumors, and chordomas. Colocalization of OTI2G1 and Brachyury was quantified by multiplex immunofluorescence.</p><p><strong>Results.—: </strong>TBX19 and Brachyury T-box domains showed marked structural similarity (Cα root mean square deviation, 0.071 Å), and the OTI2G1 immunogen (TBX19 amino acids [aa] 1-238) overlapped the Brachyury T-box. OTI2G1 showed diffuse nuclear staining in chordomas, whereas CL6251 showed negativity. Multiplex immunofluorescence demonstrated OTI2G1 signal in 77.6% of Brachyury-positive chordoma cells (95% CI, 77.5%-77.6%; P < .001).</p><p><strong>Conclusions.—: </strong>Diffuse nuclear \"TPIT\" staining with OTI2G1 in chordoma reflects cross-reactivity driven by conserved T-box structure rather than true TBX19 expression. For the differential diagnosis of sellar lesions, especially poorly differentiated chordoma versus pituitary neuroendocrine tumor, use of more specific clones (eg, CL6251) is recommended.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371254","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":"Paracoccidioidomycosis at Autopsy: A Case Series and Literature Review.","authors":"Márcio Ketner Sguassábia, Moabe Miguel, Pedro Stringelli-Brandão, Marília Prior Fuga, Adilha Misson Rua Micheletti, Renata Margarida Etchebehere, Lucinda Calheiros Guimarães, Ivonete Helena Rocha, Mario León Silva-Vergara","doi":"10.5858/arpa.2025-0342-OA","DOIUrl":"https://doi.org/10.5858/arpa.2025-0342-OA","url":null,"abstract":"<p><strong>Context.—: </strong>The prevalence of paracoccidioidomycosis remains unknown; current estimates rely primarily on hospital-based records from Brazil, where approximately 80% of reported cases occur. In Brazil, paracoccidioidomycosis ranks as the eighth leading cause of death among chronic infectious diseases.</p><p><strong>Objective.—: </strong>To present data on cases of paracoccidioidomycosis identified at autopsy in a teaching hospital and to compare these findings with previously published autopsy case series.</p><p><strong>Design.—: </strong>Autopsy records from 1989 to 2024 were reviewed to identify paracoccidioidomycosis cases. Demographic, epidemiologic, and clinical data were extracted from the corresponding medical charts.</p><p><strong>Results.—: </strong>Among 2397 autopsies, 17 cases of paracoccidioidomycosis (0.71%) were confirmed. Twelve patients (70.5%) were male, with a median age of 44.6 years. Nine patients (52.9%) were HIV (human immunodeficiency virus)-positive, 5 of whom (55.5%) received both diagnoses within the same year. Including the present study, 12 published autopsy case series of paracoccidioidomycosis have summarized the findings from 325 cases. Most cases demonstrated disseminated fungal disease involving multiple organs, with frequencies ranging from 42.8% to 100% for the lungs; 28.5% to 100% for lymph nodes; 17.6% to 83.3% for mucosal sites; 11.8% to 80.5% for the adrenal glands; and 2.8% to 64.3% for the skin.</p><p><strong>Conclusions.—: </strong>This study, consistent with other autopsy series, confirms the systemic nature of this mycosis, particularly in HIV-infected patients. HIV infection appears to alter the natural history of paracoccidioidomycosis, resulting in a more acute, severe, and disseminated clinical course. All non-HIV-infected patients were diagnosed post mortem and had less extensive systemic organ involvement. The HIV-infected cases herein included represent the largest autopsy cohort of HIV-paracoccidioidomycosis coinfection reported to date.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371276","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}