BACKGROUND: Due to the corona pandemic, digital teaching has become especially important in education and has led to a restructuring of teaching, not only in the subject of surgical pathology. OBJECTIVES: In this article...BACKGROUND: Due to the corona pandemic, digital teaching has become especially important in education and has led to a restructuring of teaching, not only in the subject of surgical pathology. OBJECTIVES: In this article, different forms of e‑learning are presented and illustrated using the example of teaching surgical pathology and neuropathology at the University Medical Center Mainz. RESULTS: Before the onset of the corona pandemic in spring 2020, digitization had already assumed great importance for teaching in the technology- and method-oriented subject of surgical pathology. In particular, the possibility of virtual microscopy via scanned slides with a digital slide server has been used in many pathology institutes. Virtual microscopy often partially or completely replaced conventional microscopy of histologic slide collections. Complementary virtual learning offers are becoming more and more important. These include asynchronously provided lectures or macroscopy videos, video conferences, scripts and communication via learning platforms. In addition, electronic exams have become an indispensable part of teaching. Nevertheless, the corona pandemic revealed how important personal contact with students is to achieve optimal learning success; learning forms with a combination of face-to-face teaching and e‑learning in the sense of blended learning are of particular importance. CONCLUSIONS: As part of blended learning, digital teaching is an ideal complement to face-to-face teaching and is changing teaching in the longer term, not only in the field of surgical pathology. Digital learning formats will remain in the future and will at least partially replace classroom formats such as lectures.
Round robin testing is an important instrument for quality assurance. Increasingly, this also applies to the results of molecular diagnostics in pathology, which directly influence therapy decisions in precision oncology...Round robin testing is an important instrument for quality assurance. Increasingly, this also applies to the results of molecular diagnostics in pathology, which directly influence therapy decisions in precision oncology. In metastatic colorectal carcinoma (mCRC), the focus has been on detecting KRAS and NRAS mutations, whose absence allows therapy with EGFR blocking antibodies. Recently, BRAF has been added as another predictive marker, since mCRC patients with BRAF V600E mutation benefit significantly from treatment with encorafenib (a BRAF inhibitor) in combination with cetuximab (anti-EGFR antibody) after systemic therapy. Due to the approval of this treatment in 2020, it is a pre-requisite that BRAF V600E mutation detection in diagnostic pathologies is reliably performed. Therefore, this round robin test with BRAF V600E testing either by immunohistochemistry or molecular methods was performed. The round robin test results demonstrate that molecular BRAF V600E detection is currently clearly superior to immunohistochemical detection.
The fifth edition of the World Health Organization (WHO) classification of digestive system tumours was published in 2019. The classification of invasive carcinoma is basically the same as in the fourth edition, but the...The fifth edition of the World Health Organization (WHO) classification of digestive system tumours was published in 2019. The classification of invasive carcinoma is basically the same as in the fourth edition, but the description of each histological type has been updated, and some rare subtypes such as micropapillary carcinoma, gastric adenocarcinoma of the fundic gland type and undifferentiated carcinoma have been added and explained. Although this classification did not provide specific numerical criteria for the diagnosis of signet-ring cell carcinoma in poorly cohesive carcinoma, an additional study defined signet-ring cell carcinoma as having more than 90% signet-ring cells. The molecular classification of gastric cancer (Epstein-Barr virus-positive type, microsatellite instability type, genomically stable type, chromosomally unstable type) was additionally introduced. Many pages in the present classification have been devoted to precancerous lesions, and this article focuses on foveolar-type adenoma/dysplasia.
BACKGROUND: The histopathologic diagnosis of infectious colitis remains relevant despite recent advances in microbiologic techniques. OBJECTIVE: This article aims to describe the histologic features of selected infectiou...BACKGROUND: The histopathologic diagnosis of infectious colitis remains relevant despite recent advances in microbiologic techniques. OBJECTIVE: This article aims to describe the histologic features of selected infectious diseases of the colon. MATERIALS AND METHODS: Existing reports on histopathologic and clinical aspects of colonic infectious agents were reviewed. RESULTS: While histology alone may not be as sensitive as current microbiologic methods, tissue identification of infectious agents still plays an important role in patient care. Infectious colitis can have a variety of clinical manifestations, ranging from strongyloidiasis, which can cause a smoldering, subclinical infection for decades, to syphilis, which can clinically mimic cancer or inflammatory bowel disease. Therefore, the histopathologic identification of infection as the cause of a patient's colitis has a considerable impact on treatment decisions. Morphologic overlap can occur between infection and other diseases, however. Moreover, some infections can elicit various tissue responses beyond acute colitis. Immunosuppressed patients may not mount an inflammatory response to pathogens such as cytomegalovirus or adenovirus. Sexually transmitted proctocolitis can cause plasma-cell-rich inflammation. Gastrointestinal histoplasmosis is more likely to cause diffuse histiocyte infiltration rather than the expected granuloma formation. In some cases, ancillary tests are useful, but equivocal results can cause diagnostic dilemmas. CONCLUSION: Given the range with which colonic infectious disorders can manifest, pathologists should be aware of the typical features of infectious colitis, as well as findings beyond the classic morphologies.
In the fifth edition of the World Health Organization (WHO) classification of tumors of the breast, the histological features of the lesions continue to form the basis of the classification; however, molecular pathology...In the fifth edition of the World Health Organization (WHO) classification of tumors of the breast, the histological features of the lesions continue to form the basis of the classification; however, molecular pathology nowadays provides approaches for improved diagnostics and prediction of prognosis and treatment response, which have been incorporated into the update of the classification. The most important changes are presented, which include changes in the histological classification of invasive carcinomas, the subtyping of lobular carcinoma in situ (LCIS) and the dignity criteria of phyllodes tumors.
BACKGROUND: Some patients with high-risk colorectal cancer show a worse prognosis within the same UICC stage. Therefore, the identification of additional risk factors is necessary to find the best treatment for these pat...BACKGROUND: Some patients with high-risk colorectal cancer show a worse prognosis within the same UICC stage. Therefore, the identification of additional risk factors is necessary to find the best treatment for these patients. OBJECTIVE: In which settings can tumor budding help the clinical decision-making process for treatment planning and how should scoring be performed? MATERIAL AND METHODS: Evaluation of current publications on tumor budding with an emphasis on practical grading and potential problems in the determination of tumor budding. RESULTS: Tumor budding is a significant risk factor for worse clinical outcome of colorectal cancer and can influence clinical decision-making in pT1 and stage II colorectal cancer. A scoring method was standardized by the ITBCC 2016 and is feasible in everyday practice. Challenges in assessment can be addressed by increasing awareness of potential problem cases.
BACKGROUND: Autopsies are an important tool for understanding novel diseases, including COVID-19. MATERIALS AND METHODS: The German Registry of COVID-19 Autopsies (DeRegCOVID) was established and launched in April 2020....BACKGROUND: Autopsies are an important tool for understanding novel diseases, including COVID-19. MATERIALS AND METHODS: The German Registry of COVID-19 Autopsies (DeRegCOVID) was established and launched in April 2020. DeRegCOVID acts as the electronic backbone of the German Network for Autopsies in Pandemics (DEFEAT PANDEMIcs), which started in September 2020. RESULTS: The results of DeRegCOVID and DEFEAT PANDEMIcs are characterized by an unprecedented collaboration of more than 35 university and non-university autopsy centers linking pathological, neuropathological, and forensic medicine institutes. DeRegCOVID has evolved, adapted to new challenges, and currently contains the largest international autopsy dataset. After only a short period of operation, more than 80 publications have been produced, which have contributed to the understanding of the pathogenesis of COVID-19, e.g., through the discovery of thromboembolic events, multiorgan tropism, and NeuroCovid-19. The autopsy centers have carried out extensive educational work and, beyond the scientific gain in knowledge, have explained to politicians and the general public the essential role of autopsies in pandemic management. To further develop autopsy-driven research, a continuation of DEFEAT PANDEMIcs was conceived, the National Autopsy Network (NATON). CONCLUSIONS: The registry and network, in which all interested centers can participate, have demonstrated the value of networked medical research and the high value of autopsy for medicine.
BACKGROUND: In situ follicular neoplasia (ISFN) is a t(14;18)(q32;q21) precursor lesion of follicular lymphoma (FL), which in turn can transform into diffuse large B‑cell lymphoma (DLBCL). For DLBCL that arise de novo, n...BACKGROUND: In situ follicular neoplasia (ISFN) is a t(14;18)(q32;q21) precursor lesion of follicular lymphoma (FL), which in turn can transform into diffuse large B‑cell lymphoma (DLBCL). For DLBCL that arise de novo, no precursor lesion is known. Given the high frequency of the t(14;18) translocation in de novo DLBCL as well, we investigated whether they can also arise from ISFN without FL as an intermediate step. OBJECTIVES: To investigate the clonal evolution of ISFN to DLBCL - transformed from FL and de novo. MATERIALS AND METHODS: Identification of ISFN lesions in patients with DLBCL was performed by BCL2 staining of reactive lymphoid tissues. ISFN and DLBCL were subsequently analyzed by fluorescence in situ hybridization, clonality analyses, sequencing of the t(14;18) breakpoint, and targeted next-generation sequencing. RESULTS: 10 cases with paired ISFN and DLBCL samples were identified, 6 of which were de novo DLBCL and 4 transformed from FL. 3 DLBCL carried MYC-rearrangements in addition to the t(14;18) and were classified as high-grade B‑cell lymphoma (HGBL). The clonal relationship of ISFN and DLBCL/HGBL was confirmed for all cases. CREBBP, KMT2D, EZH2, TNFRSF14, and BCL2 were the genes most frequently mutated, with the distribution of private and shared mutations pointing to 2 different scenarios of clonal evolution. In most cases, DLBCL/HGBL, ISFN, and, if also present, FL had evolved divergently from a common progenitor, whereas linear evolution was less frequent. CONCLUSION: We show for the first time that t(14;18) DLBCL/HGBL can arise directly from ISFN without FL as an intermediate step and that during this progression, divergent evolution is common.
Prostate cancer is the most prevalent noncutaneous cancer in men. The Gleason grading is considered to be the strongest prognostic parameter regarding progression-free survival and overall survival. The original grading...Prostate cancer is the most prevalent noncutaneous cancer in men. The Gleason grading is considered to be the strongest prognostic parameter regarding progression-free survival and overall survival. The original grading system has been modified during the last decade resulting in a more precise prognostic tool. The pretreatment Gleason score guides clinical management and is a key component in S3 guidelines for prostate cancer. In addition to Gleason score several other histologic findings in prostate needle biopsy influence patient management. In this second part of our CME series about prostate cancer, we will discuss the diagnosis of prostate cancer and current guidelines for reporting prostate cancer. In addition, we will highlight prostate lesions of urothelial origin and neuroendocrine prostate cancer as well as prognostic biomarkers.