教学课程资源库 更多>>

关键词： aetiology   clinical pathology   paralysis   prognosis   rainbow lorikeet   temporal distribution  

摘要： Objective To report the temporal and spatial distribution of rainbow lorikeets presenting with lorikeet paralysis syndrome (LPS) and their clinicopathologic and pathologic findings, exposure to toxins, and response to treatment. Methods Records of lorikeets admitted in 2017 and 2018 to facilities in south-east Queensland (QLD) were reviewed and LPS and non-LPS cases were mapped and their distribution compared. Plasma biochemistries and complete blood counts were done on 20 representative lorikeets from south-east QLD and Grafton, New South Wales (NSW). Tissues from 28 lorikeets were examined histologically. Samples were tested for pesticides (n = 19), toxic elements (n = 23), botulism (n = 15) and alcohol (n = 5). Results LPS occurred in warmer months. Affected lorikeets were found across south-east QLD. Hotspots were identified in Brisbane and the Sunshine Coast. Lorikeets had a heterophilic leucocytosis, elevated muscle enzymes, uric acid and sodium and chloride. Specific lesions were not found. Exposure to cadmium was common in LPS and non-LPS lorikeets. Treated lorikeets had a 60-93% See Table 2 depending on severity of signs. Clinical significance The primary differential diagnosis for lorikeets presenting with lower motor neuron signs during spring, summer and autumn in northern NSW and south-east Queensland should be LPS. With supportive care, prognosis is fair to good.

关键词： combined positive score   head and neck squamous cell carcinoma   immunohistochemical assay   programmed death-ligand 1   review  

摘要： Background Programmed death-ligand 1 (PD-L1) expression with combined positive score (CPS) >= 1 is required for administration of checkpoint inhibitor therapy in recurrent/metastatic head and neck squamous cell carcinoma (HNSCC). The 22C3 pharmDx Dako immunohistochemical assay is the one approved as companion diagnostic for pembrolizumab, but many laboratories work on other platforms and/or with other clones, and studies exploring the potential interchangeability of assays have appeared. Evidence from the literature After review of the literature, it emerges that the concordance among assays ranges from fair to moderate, with a tendence of assay SP263 to yield a higher quota of positivity and of assay SP142 to stain better immune cells. Moreover, pathologists achieve very good concordance in assessing PD-L1 CPS, particularly with SP263. Conclusions Differences in terms of platforms, procedures, and study design still preclude a quantitative synthesis of evidence and clearly further work is needed to draw stronger conclusions on the interchangeability of PD-L1 assays in HNSCC.

关键词： Breast cancer   Multifocal breast cancer   Multiple invasive carcinomas   Interobserver variability   Staging  

摘要： Staging of multiple foci of invasive breast carcinoma may be challenging. We set out to evaluate the practice of local breast pathologists via a live voting survey. There was poor interobserver agreement with no consensus reached in any of the 6 scenarios, emphasizing the need for education and strict adherence to guidelines to ensure accurate staging and optimal clinical management. Background: The American Joint Committee on Cancer (AJCC) staging system is the reference standard for describing the extent of neoplastic disease on the basis of the size of primary tumor (T), and the presence of regional lymph node (N) involvement and distant metastasis (M). Multiple foci of invasive breast carcinoma may pose staging challenges to the reporting pathologist. We set out to evaluate the practice of local breast pathologists with regard to staging of multiple foci of invasive carcinoma. Patients and Methods: Breast pathologists were surveyed at a Community of Interest in Breast Pathology meeting. The live voting survey contained 6 case-based scenarios of multiple foci of invasive mammary carcinoma of the same or different histologic type and with unilateral or bilateral involvement. A supporting illustration was provided for each case. Results: There was poor interobserver agreement with no consensus reached among the respondents in any of the cases. Staging choices varied from staging tumors together irrespective of histology or procedure type to staging tumors of the same histologic type together, or staging each tumor focus separately. Confusion was particularly evident when tumor foci with different histologic types were present. Conclusion: Inconsistencies exist in the reporting of AJCC pathologic TNM stage for multiple foci of invasive carcinoma. The results serve as a reminder that education and strict adherence to the AJCC guidelines is essential for establishing standard practice in order to provide accurate cancer staging and ensure optimal clinical management.

关键词： Astroblastoma   HGNET   Meningioma-1   Metastatic mimicry  

摘要： Introduction Astroblastoma, MN1-altered (old name: high-grade neuroepithelial tumor/HGNET with MN1 alteration) is a recently described central nervous system tumor mostly affecting pediatric patients and profoundly young girls. Differential pathological diagnoses of these tumors include ependymoma, pleomorphic xanthoastrocytoma, embryonal tumor with multilayered rosettes, meningioma, and even glioblastoma. As the treatment approaches to these tumors differ, it is essential to increase the awareness about these tumors in the neurosurgical community. Clinical presentation A 7-year-old female patient admitted with a 7-day history of headache, nausea, and vomiting. A contrasted MRI scan revealed a left parietal 4 x 4 x 5 cm mass with central necrosis and peripheral contrast enhancement. The tumor's histopathological findings were suggestive of a metastatic carcinoma with unknown primary, yet further genetic analysis revealed MN1 alteration. Peculiarly, the tumor pathomorphological features were not compatible with astroblastomas and exerted features strongly indicating a metastatic cancer;however, systemic PET and whole-body MRI failed to detect a primary malignancy. Outcome and conclusions Eighteen months after gross-total tumor resection, an in-field and out-field multifocal recurrence developed which required a second surgery and subsequent chemo-radiotherapy. The patient is doing well for 1 year after the second treatment regimen at the time of this report. Despite the final cIMPACT6 classification in 2020 advised to define all MN1 altered brain tumors as astroblastomas, there exist prognostic differences in MN1-altered tumors with and without morphological features of astroblastoma. Rare morphological variants of MN1-altered tumors shall be recognized for their future prognostic and clinical classification. HGNET with MN1 alteration seems still be a more proper definition of such malignancies as an umbrella term.

关键词： Adrenal incidentaloma   Laparoscopic adrenalectomy   Extramedullary hematopoiesis  

摘要： Adrenal gland extramedullary hematopoiesis is extremely rare, and when present, imaging studies may mimic an incidentaloma suspicious of malignancy. We present a 55-year-old woman without a history of hematologic disorder or neoplasms. There was an incidental finding of a 3.2 x 2.4-cm heterogenous adrenal mass and enhanced by contrast abdominal CT scan. Suspicious of malignancy was established, and laparoscopic left adrenalectomy was performed. Histopathological examination and immunohistochemical staining exhibited myeloid and erythroid precursors, as well as megakaryocyte confirming the diagnosis of extramedullary hematopoiesis in the adrenal gland.

关键词： angiogenesis   intratumoral hemorrhage   PCNSL   PD-L1   perfusion MRI  

摘要： Primary central nervous system lymphomas (PCNSLs) rarely exhibit intratumoral hemorrhage. The differential diagnosis of hemorrhagic neoplasms of the central nervous system (CNS) currently includes metastatic carcinomas, melanomas, choriocarcinomas, oligodendrogliomas, and glioblastomas. Here we present the clinical, radiological, pathological, and molecular genetic features of six cases of PCNSL associated with intratumoral hemorrhage. The median age of patients was 75 years, with male predominance. While conventional PCNSLs were associated with low cerebral blood volume (CBV), perfusion magnetic resonance imaging (MRI) revealed elevated CBV in three cases, consistent with vascular proliferation. All six cases were diagnosed pathologically as having diffuse large B-cell lymphoma (DLBCL) with a non-germinal center B-cell-like (non-GCB) phenotype;marked histiocytic infiltrates and abundant non-neoplastic T-cells were observed in most cases. Expression of vascular endothelial growth factor and CD105 in the lymphoma cells and the small vessels, respectively, suggested angiogenesis within the neoplasms. Neoplastic cells were immunohistochemically negative for programmed cell death ligand 1 (PD-L1), while immune cells in the microenvironment were positive for PD-L1. Mutations in the MYD88 gene (MYD88) (L265P) and the CD79B gene (CD79B) were detected in five and one case, respectively. As therapeutic modalities used for PCNSLs differ from those that target conventional hemorrhagic neoplasms, full tissue diagnoses of all hemorrhagic CNS tumors are clearly warranted.

关键词： Multiparametric magnetic resonance imaging   Prostate   Diffusion magnetic resonance imaging   Prostatic neoplasm   Diffusion magnetic resonance imaging  

摘要： Objectives To evaluate the prevalence of prostate cancer (PCa) of two PI-RADS version (v) 2.1 transition zone (TZ) features (PI-RADS 1 ['nodule in nodule'] and 2 ['homogeneous mildly hypointense area between nodules']). Methods With an institutional review board approval, from a 5-year cohort between 2012 and 2017, we retrospectively identified 53 consecutive men with radical prostatectomy (RP) confirmed TZ tumors and MRI. Three blinded radiologists (R1/2/3) independently evaluated T2-weighted and diffusion-weighted imaging (DWI) using PI-RADS v2.1 for the presence of (1) 'nodule in nodule' (recording 'cystic change', inner nodule encapsulation, size, and DWI score) and (2) 'homogeneous mildly hypointense area between nodules' (also recording size and DWI score). MRI-RP maps established ground truth. Primary tumor was evaluated assessing PI-RADS v2.1 category, size, and presence of imaging variants. Results R1/2/3 identified 26/18/22 'nodule in nodule' respectively with 7.7% (2/26;95% confidence interval [95% CI]: 0.1-17.9%), 5.6% (1/18;95% CI: 0.01-16.1%), and 4.5% (1/22;95% CI: 0.01-13.3%) PCa (both Gleason score 3 + 4 = 7). Agreement was fair-to-substantial, kappa = 0.222-0.696. 'Cystic change', inner nodule absent/incomplete encapsulation and DWI score >= 4 for R1/R2/R2 were present in 80.8% (21/26), 46.2% (12/26), 7.7% (2/26);94.4% (17/18), 33.3% (6/18), 5.6% (1/18);and 59.1% (13/22), 63.6% (14/22), 9.1% (2/22). Both PCa had inner nodule absent/incomplete encapsulation and DWI score >= 4. No other TZ tumors demonstrated 'nodule in nodule', nodule 'cystic change', or 'homogeneous mildly hypointense area between nodules'. R1/2/3 identified 5/6/13 'homogeneous mildly hypointense area between nodules' with zero PCa for any reader (upper bound 95% CI: 24.7-52.2%). Interobserver agreement was fair-to-substantial, kappa = 0.104-0.779. Conclusion The proportion of cancers in PI-RADS v2.1 'nodule in nodule' was low (similar to 5-8%) with zero cancers detected in 'homoge

摘要： [...]the absence of reduction of pre-existing intracellular tau pathology is not unexpected, in line with the other neuropathological study of patients after anti-tau treatment.5 Of note, progressive supranuclear palsy diagnosis was confirmed at autopsy in both participants. [...]one patient was treated with only one dose, which might not be sufficient to induce morphological alteration of astrocytic tau pathology. [...]we did not do statistical analyses, owing to the small number of patients.

关键词： characteristics   HGEC   type  

摘要： Objective The molecular features of high-grade endometrioid carcinoma (HGEC) are more akin to nonendometrioid high-grade carcinoma (NEHC). This study aims to explore whether HGEC also has similar clinical pathology and prognosis similar to NEHC. Methods Using the SEER database (Surveillance, Epidemiology, and End Results), a retrospective study of the clinical-pathological data and prognosis was carried out. Result (1) Compared with LGEC (low-grade endometrioid carcinoma), HGEC patients were older with larger tumor size and a higher proportion of stage III-IV disease. However, the young had a lower proportion of stage III-IV disease than NEHC. (2) Postoperative pathological examination revealed that the positive rate of peritoneal cytology, pelvic lymph nodes and para-aortic lymph nodes in HGEC were significantly higher than LGEC, but lower than NEHC. LGEC, HGEC, and NEHC, all showed distant organ metastases such as brain metastases, bone metastases, liver metastases, and lung metastases. Notably, the metastasis rates between HGEC and NEHC were not significantly different but were higher than LGEC. (3) The five-overall survival rates of LGEC, HGEC, and NEHC were 95.1%, 73.2%, and 54.8%, respectively. Notably, the survival rates decreased significantly in stage IV. There were no significant differences between HGEC and NEHC in stage IV (p = 0.665) and both were associated with worsened survival. Also, HGEC survival prognosis was similar to NEHC. Conclusion HGEC presents mixed or overlapping clinical-pathological features of NEHC. Therefore, based on the unique pathological and prognostic features, HGEC could be classified as an intermediate between LGEC and NEHC.