In the evaluation of thyroid nodules, cytopathology of thyroid fine-needle aspiration specimens plays a central role. Established classification schemes should be used. In the case of indeterminate cytology, additional m...In the evaluation of thyroid nodules, cytopathology of thyroid fine-needle aspiration specimens plays a central role. Established classification schemes should be used. In the case of indeterminate cytology, additional molecular tests may be used. However, the stratification of indeterminate thyroid nodules into malignant and benign lesions based on molecular tests alone, apart from costly commercial assays from US vendors, has so far been clearly limited. Molecular testing of single genetic alterations that can confirm malignancy in papillary, poorly differentiated, and anaplastic thyroid carcinomas is helpful and relatively easy to perform. However, negative test results by no means exclude malignant neoplasia. Predictive markers for single entities (BRAF V600E, RET mutations and RET fusions) should be tested in all advanced thyroid carcinomas.
BACKGROUND: Body cavity fluids are among the most frequently examined samples in cytology. Cytomorphology is supplemented by additive testing. An international system of terminology and classification has been recently p...BACKGROUND: Body cavity fluids are among the most frequently examined samples in cytology. Cytomorphology is supplemented by additive testing. An international system of terminology and classification has been recently presented. OBJECTIVES: Cytopreparation and staining techniques as well as some exemplary morphological patterns are presented. "The International System for Serous Fluid Cytopathology" (TIS) is briefly presented. MATERIALS AND METHODS: Pleural effusion, pericardial effusion, and ascites: special technical issues, immunocytochemistry, molecular diagnostics, and reporting system issues are discussed. RESULTS: Body cavity fluids are important samples that provide significant information. Additive testing is established for routine use. The form and structure of reports is widely divergent in practical use. DISCUSSION: A reporting system for serous fluid cytopathology that is easily applied and recognized internationally is highly desirable. TIS is a valuable approach to this goal.
BACKGROUND: The cytology of lymph nodes is a cost-effective method with a short turnaround time and low risk to patients that delivers valuable information on the cause of the lymphadenopathies. OBJECTIVES: To discuss th...BACKGROUND: The cytology of lymph nodes is a cost-effective method with a short turnaround time and low risk to patients that delivers valuable information on the cause of the lymphadenopathies. OBJECTIVES: To discuss the value of lymph node cytology in the diagnosis of lymph node swellings. METHODS: Analysis of the causes of the controversially discussed aspects of lymph node cytology. Presentation of the diagnostic groups of lymph node cytology according to the Sydney system. RESULTS: The technical aspects of lymph node sampling during fine needle biopsy, as well as the subsequent preparation of the correctly fixed direct smears and the triage of the sample for the auxiliary studies, may pose a significant challenge for some puncturers. The whole spectrum of modern pathologic auxiliary studies can be applied to correctly triaged cytologic samples. The diagnoses of fine needle biopsies of the lymph nodes can be divided into five groups according to the recently proposed Sydney reporting system: insufficient/non-diagnostic, benign, atypical, suspicious, and malignant. Further details concerning the diagnosis as well as recommendations on how to proceed are additionally included in cytologic reports. CONCLUSIONS: The improvement of lymph node sampling as well as the technical aspects of the sample handling, including the application of auxiliary studies, considerably increase the diagnostic value of fine needle biopsy of the lymph nodes. Wide implementation of the usage of the diagnostic groups for reporting fine needle biopsies of the lymph nodes can standardize reporting and improve communication with other clinical specialists.
Hepatocellular carcinoma (HCC) represents the third leading cause of cancer-related mortality worldwide and has a well-defined etiology. It develops in a stepwise process with morphologically defined precursor lesions. T...Hepatocellular carcinoma (HCC) represents the third leading cause of cancer-related mortality worldwide and has a well-defined etiology. It develops in a stepwise process with morphologically defined precursor lesions. Typing of highly differentiated hepatocellular tumors is supported by immunohistological marker panel and the so-called matrix diagnosis. The recent World Health Organization (WHO) classification defined morpho-molecular HCC subtypes showing typical clinical and prognostic characteristics. If HCC subtyping is considered in future clinical studies of advanced HCC, this could help to introduce personalized HCC therapy. Currently, precision oncology is not available for HCC.
Pre- or perioperative chemo- or radiochemotherapy and subsequent resection is the standard therapy for locally advanced esophageal, gastric, and rectal cancer. A tumor regression grading (TRG; also tumor regression grade...Pre- or perioperative chemo- or radiochemotherapy and subsequent resection is the standard therapy for locally advanced esophageal, gastric, and rectal cancer. A tumor regression grading (TRG; also tumor regression grade) categorizes the extent of the regressive changes after a neoadjuvant treatment. There are several TRG systems for gastrointestinal carcinomas that relate either to the extent of the therapy-induced fibrosis in relation to the residual tumor or the estimated proportion of the residual tumor in the area of the former tumor area. An ideal TRG system shows significant interobserver agreement and offers relevant prognostic information - in most cases a complete or almost complete regression after neoadjuvant therapy is associated with an improved prognosis. In this review, the most commonly used TRG systems for gastrointestinal carcinomas are presented and discussed. In addition, current issues such as the standardization of TRG and the subject of regression in lymph node metastases in the context of a TRG system are discussed.
Applications of deep learning and other artificial intelligence techniques play an increasing role in pathological research. In contrast to research, applications in clinical routine are rare so far, although the first c...Applications of deep learning and other artificial intelligence techniques play an increasing role in pathological research. In contrast to research, applications in clinical routine are rare so far, although the first certified solutions have already been established (analysis of prostate sections, ER, PR, and Her2 in breast cancer). Besides the still low use of virtual microscopy in practice, there are a number of hurdles that stand in the way of a rapid diffusion of AI applications. The EMPAIA project has a goal of removing these hurdles. The path taken to build an ecosystem for this purpose is intended to exemplify that the introduction of AI applications in image-based diagnostics is possible on a broad basis if the existing hurdles are removed in a joint, moderated process. The components of the EMPAIA ecosystem and its strategy will be described, and reference will be made to the technical solution approaches.
Mesenchymal tumors and tumor-like lesions of the gastrointestinal (GI) tract are uncommon. They vary from reactive tumefactive lesions and benign neoplasms to highly aggressive sarcomas. Among them, GI stromal tumors (GI...Mesenchymal tumors and tumor-like lesions of the gastrointestinal (GI) tract are uncommon. They vary from reactive tumefactive lesions and benign neoplasms to highly aggressive sarcomas. Among them, GI stromal tumors (GISTs) are most common, followed, with less frequency, by smooth muscle and neurogenic tumors. The major challenge resides in correctly identifying GISTs and providing a comprehensive report (including risk assessment and genotyping) that represents the basis for an optimized surgical-oncological treatment and/or adjuvant therapy. On the other hand, the challenge of benign lesions is to find a good name (well understandable and reproducible diagnostic term) that helps avoid diagnostic ambiguity and prognostic uncertainty so that overprognostication and overtreatment can be prevented. Moreover, several recently described genetically defined benign and malignant entities need be correctly diagnosed due to their special "targeted" therapeutic options and to further characterize their clinicopathological and biological properties in the future. These recent entities include aggressive epithelioid inflammatory myofibroblastic sarcoma (ALK-RANBP2-driven), malignant gastrointestinal neuroectodermal tumor (EWSR1-ATF1/CREB-related), NTRK-rearranged neoplasms, and, most recently, colorectal NUTM1-rearranged sarcomas. This review highlights the major clinicopathological features of gastrointestinal mesenchymal lesions in light of recent developments.
We report a case of a placenta with extensive maternal vascular malperfusion and chronic histiocytic intervillositis corresponding to SARS-CoV‑2 placentitis in the context of fetal demise at 31 weeks of gestation. Placen...We report a case of a placenta with extensive maternal vascular malperfusion and chronic histiocytic intervillositis corresponding to SARS-CoV‑2 placentitis in the context of fetal demise at 31 weeks of gestation. Placental swamp and PCR of the placental parenchyma, umbilical cord and amnion-chorion membrane showed SARS-CoV-2- and B‑betacoronavirus-specific RNA. Maternal vascular malperfusion has been described in cases of SARS-CoV‑2 infection; however, the manifested severity of this case in the setting of a severe SARS-CoV‑2 placentitis is rare. It emphasizes the need of a maternal prophylactic anticoagulation.
Paediatric acute liver failure (PALF; also fulminant hepatic failure, fulminant hepatitis) is a critical clinical syndrome that is characterised by a sudden, rapid deterioration and disease progression in a usually previ...Paediatric acute liver failure (PALF; also fulminant hepatic failure, fulminant hepatitis) is a critical clinical syndrome that is characterised by a sudden, rapid deterioration and disease progression in a usually previously healthy child. The pathogenesis is an advanced degree of hepatocellular necrosis that exceeds the rate of hepatocyte regeneration. The diagnostic criteria of PALF (modelled on adult criteria) were developed by the "Pediatric Acute Liver Failure (PALF) Study Group" (NIH). The rule of the liver biopsy in PALF is controversial and in some cases contraindicated (coagulopathic state). In addition, extensive necrosis is a common finding in PALFs but may not be predictive of the overall outcome (transplantation versus continuous treatment) due to sampling issues. There are, however, some histological patterns that offer a degree of specificity that can be carefully considered in the overall clinical picture. The histopathologists will be part of a multidisciplinary team and can contribute to the diagnostic and prognostic pathway.The aetiologies of PALF are numerous and depend on age and geographical region. For all age groups the main causes can be divided into infectious, immunological, metabolic and toxin drug related. Rarer causes include circulatory disorders and malignancies. In the paediatric group, up to 30-50% of causes leading to PALF remain unknown.
BACKGROUND: About 10% of patients develop persistent symptoms after mild/moderate COVID-19. We have previously reported detection of antinuclear autoantibodies/extractable nuclear antigens (ANA/ENA) in patients with seve...BACKGROUND: About 10% of patients develop persistent symptoms after mild/moderate COVID-19. We have previously reported detection of antinuclear autoantibodies/extractable nuclear antigens (ANA/ENA) in patients with severe COVID-19. OBJECTIVES: The aim of this small pilot study was to characterize long-/post-COVID and to evaluate possible similarities between lung involvement in long-/post-COVID and connective tissue disease (CTD). METHODS: We prospectively enrolled 33 previously healthy patients with persistent pulmonal symptoms after mild/moderate COVID-19 without hospitalization (median age, 39 years). We performed clinical evaluation including pulmonary function tests, computed tomography (CT), and serology for ANA/ENA. In 29 of 33 patients, transbronchial biopsies (TBBs) were taken for histopathological assessment. RESULTS: Most patients presented with disturbed oxygen pulse in spiroergometry and slight lymphocytosis in bronchoalveolar lavage (BAL) fluid. The CT pattern showed bronchial wall thickening and increased low-attenuation volume. Autoantibodies were detected in 13 of 33 patients (39.4%). Histopathological assessment showed interstitial lymphocytosis with alveolar fibrin and organizing pneumonia. Ultrastructural analyses revealed interstitial collagen deposition. CONCLUSION: While histopathology of pulmonary long-/post-COVID alone is unspecific, the combination with clinical and radiological features together with detection of autoantibodies would allow for a diagnosis of interstitial pneumonia with autoimmune features (IPAF). Since we observe interstitial collagen deposition and since IPAF/CTD-ILD might progress to fibrosis, the persistence of autoantibodies and possible fibrotic change should be closely monitored in autoantibody-positive long-/post-COVID patients.