Lung Squamous Cell Carcinoma with EML4-ALK Fusion and TP53 Co-mutation Treated with Ensartinib: A Case Report and Literature Review / 中国肺癌杂志

Lung squamous cell carcinoma (LSCC) accounts for approximately 30% of non-small cell lung cancer (NSCLC) cases and is the second most common histological type of lung cancer. Anaplastic lymphoma kinase (ALK)-positive NSCLC accounts for only 2%-5% of all NSCLC cases, and is almost exclusively detected in patients with lung adenocarcinoma. Thus, ALK testing is not routinely performed in the LSCC population, and the efficacy of such treatment for ALK-rearranged LSCC remains unknown. Echinoderm microtubule associated protein like 4 (EML4)-ALK (V1) and TP53 co-mutations were identified by next generation sequencing (NGS) in this patient with advanced LSCC. On December 3, 2020, Ensatinib was taken orally and the efficacy was evaluated as partial response (PR). The progression-free survival (PFS) was 19 months. When the disease progressed, the medication was changed to Loratinib. To our knowledge, Enshatinib created the longest PFS of ALK-mutant LSCC patients treated with targeted therapy since literature review. Herein, we described one case treated by Enshatinib involving a patient with both EML4-ALK and TP53 positive LSCC, and the relevant literatures were reviewed for discussing the treatment of this rare disease.
.

Clinicopathologic features and expression of OCT4 protein in testicular diffuse large B cell lymphoma / 中华病理学杂志

Objective@#To evaluate the expression of OCT4 and SALL4 in testicular diffuse large B-cell lymphoma (DLBCL), and the utility of an immunohistochemical (IHC) panel of OCT4, SALL4 and CD20 in the differential diagnosis of DLBCL and GCT of the testis.@*Methods@#Eighteen cases of testicular DLBCL were selected.IHC method was used to detect the protein expression of CD20, CD3, CD5, CD10, bcl-6, MUM1, Ki-67, bcl-2, c-MYC, OCT4 and SALL4.@*Results@#Among the 18 cases, CD20 and PAX5 were strongly and diffusely expressed in all cases, while CD21, CD3, cyclinD1, SALL4, CD117 and PLAP were all negative. CD5, bcl-2 and c-myc were expressed in 3, 16 and 8 cases, respectively. Ki-67 proliferation index ranged from 40%-95%. Bcl-2 and c-MYC were co-expressed in seven cases. Four cases were GCB-DLBCL and the remaining 14 cases were non-GCB-DLBCL, according to Hans algorithm. Nuclear OCT4 expression was present in two cases, which demonstrated moderate expression in >50% of neoplastic cells. Univariate analysis showed that clinical stage, CD5 and OCT4 expression were relevant to prognosis. Multivariate Cox regression analysis further confirmed that clinical stage, CD5 and OCT4 were independent prognostic factors in patients with testicular DLBCL.@*Conclusions@#Care should be exercised in using OCT4 as the sole marker of germ cell differentiation in the testis. The association of OCT4 and CD5, bcl-2 co-expression raises the question of whether OCT4 expression in DLBCL may reflect more aggressive biology.

Clinicopathologic analysis of solid papillary carcinoma of breast / 临床与实验病理学杂志

Purpose To investigate the clinical pathological features, histologic features, and prognosis of solid papillary carcinoma ( SPC) of breast. Methods Nine cases of SPC of breast were analyzed by morphological observation, AB-PAS staining and immuno-histochemical MaxVision staining. The follow-up and analysis of the clinical datas of these nine cases were performed and relevant liter-atures were also reviewed. Results The age of 9 cases of SPC of breast ranged from 32 to 83 years old (mean age is 69. 2 years old). Three cases presented with nipple discharge. Nuclear levels of 9 cases were between low to mid-level. Seven cases were associated with intracellular and extracellular mucus secretion, two cases with calcification, and 3 cases with comedonecrosis. All of these nine cases were ER, PR positive and the positive rates were high ( >70%) , HER-2 was all negative. Syn expression in these nine cases were diffused positive except for one case showing focal positive, 4 with CgA diffused positive, 1 with partial positive and 4 were negative of CgA. Six patients had partial loss of the expression of myoepithelial markers, and 3 cases with complete myoepithelial expression. Ki-67 proliferation index was between 3% and 20%. Except for only one case with small area of invasive ductal carcinoma (IDC) (2 mm in great diameter) , all other cases were not associated with other types of breast cancer, sentinel lymph nodes and/or axillary/supracla-vicular lymph nodes metastasis. 8 patients accepted breast-conserving surgey, one case did not undergo radical mastectomy for small le-sion. All of these cases were accepted further endocrine drugs treatment and only one case accepted chemical therapy simultaneously because of the accompanied IDC. None of them was found to relapse for 3 to 61 months (mean 19. 6 months) of follow-up. Conclusion Nine cases of SPC of breast showed some characteristics such as relatively low nuclear level, often accompanied by intracellular and extracellular mucus secretion, positive for neuroendocrine marker, low lymph node metastasis rate, and no recurrence, which suggest that SPC may have a better clinical prognosis.

Clinicopathologic analyses of Castleman′s disease and review of the literature / 临床与实验病理学杂志

Purpose To describe clinicopathological features, diagnosis and differential diagnosis of Castleman′s disease. Methods Retrospective analyses of the clinical data, clinicopathology and immunohistochemistry were conducted in ten cases of Castleman dis-ease and reviewed of literature. Results There were 8 cases of unicenrtic Castleman′s disease and 2 cases of multicentric Castleman′s disease. Pathologically, there were 6 cases of hayline vascular types, one case of plasmatcyic type and 3 cases of mixed type in all Castleman′s disease. Immunohistochemically, all cases were negative for BCL-6 and CD10, and Ki-67 expression was less than or e-qual to 30%. There were 4 cases with complete follow-up data, including one case of intermediate type, 3 cases of hyaline vascular type which were healed by surgical resection without recurrence. Conclusions Castleman′s disease is a rare and lymphoproliferative disorders with unknown cause, it is not easy to diagnose before the operation. Whether immunohistochemical features reflect abnormal immune function or play unknown role in the pathogenesis of Castleman′s disease is also demanded further study.

Clinicopathologic features of inflammatory fibroid polyp in gastrointestinal tract / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic characteristics, immunophenotypes, pathologic diagnosis and differential diagnosis of gastrointestinal inflammatory fibroid polyp (IFP).</p><p><b>METHODS</b>The clinical data, histologic features and immunohistochemical results of 6 cases of gastrointestinal inflammatory fibroid polyp were analyzed, with review of literature.</p><p><b>RESULTS</b>There were altogether 5 women and a man. The age of patients ranged from 44 to 87 years (median age = 61 years and mean age = 62 years). The sites of involvement included stomach (number = 2), jejunum (number = 2), distal ileum (number = 1) and rectum (number = 1). The patients often presented with abdominal pain or discomfort and tarry stool. All the cases studied showed similar morphology, were submucosa-based and composed of bland spindle cells associated with loose collagenous stroma and perivascular edema. Prominent concentric fibroblastic proliferation ("onion-skin" appearance) and eosinophilic infiltrate were characteristics. Three of the patients underwent surgical resection. The remaining patients had the lesions removed with endoscopy. Follow-up data were available in 5 patients and none of them had disease recurrence or metastasis.</p><p><b>CONCLUSIONS</b>IFP is a rare benign tumor of gastrointestinal tract. Correct diagnosis primarily relies on pathologic examination. It needs to be distinguished from gastrointestinal stromal tumors or inflammatory myofibroblastic tumor.</p>

Wif-1 methylation and β-catenin expression in colorectal serrated lesions / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate methylation status of Wif-1 and β-catenin expression in colorectal serrated lesions.</p><p><b>METHODS</b>Various colorectal lesions were collected including 52 cases of hyperplastic polyps, 41 cases of sessile serrated adenoma, 23 cases of traditional serrated adenoma, 24 cases of colorectal cancer and 24 cases of normal mucosa. All specimens were subject to immunohistochemical staining of β-catenin.SYBR Green PCR analysis of Wif-1 promoter methylation was performed in 29 cases of hyperplastic polyps, 29 cases of sessile serrated adenoma, 19 cases of traditional serrated adenoma, 14 cases of colorectal cancer and 16 cases of normal mucosa.</p><p><b>RESULTS</b>Abnormal expression rates of β-catenin in normal mucosa, hyperplastic polyps, sessile serrated adenoma, traditional serrated adenoma and colorectal cancer were 12.5% (3/24), 59.6% (31/52), 63.4% (26/41), 73.9% (17/23) and 100.0% (24/24), respectively. The corresponding methylation rates of Wif-1 promoter were 2/16, 10/29 (34.5%), 16/29 (55.2%), 15/19 and 13/14 (P < 0.05), respectively. Abnormal β-catenin expression was positively correlated with Wif-1 promoter methylation in traditional serrated adenomas (r = 0.536, P < 0.05).</p><p><b>CONCLUSIONS</b>Abnormal β-catenin expression and methylation rate of Wif-1 promoter are significantly higher in colorectal serrated lesions. Methylation of Wif-1 promoter may be related to the abnormal expression of β-catenin through activation of Wnt/β-catenin signaling pathway, which may contribute to the development of colorectal serrated lesions.</p>