Anaplastic lymphoma kinase-translocation renal cell carcinoma: clinical and pathological analysis / 中华病理学杂志

Objective: To investigate the clinicopathological features, molecular characteristics, differential diagnosis and prognosis of anaplastic lymphoma kinase (ALK)-translocation renal cell carcinoma. Methods: Two cases of ALK-translocation renal cell carcinoma diagnosed from January 2011 to December 2020 were retrospectively analyzed to characterize their morphological features, immunohistochemical expression and prognosis. Multiple molecular studies including fluorescence in situ hybridization (FISH), reverse transcriptase-polymerase chain reaction (RT-PCR), and next-generation sequencing were performed to characterize the genetic alterations. Results: Two patients included one male and one female, with 59 and 57 years old, respectively. Morphologically, case 1 resembled collecting duct carcinoma or renal medullary carcinoma, which demonstrated tubular, microcapsule and reticular structures, with a remarkable myxoid background and lymphocytes infiltration; case 2 resembled Xp11.2 translocation renal cell carcinoma or type 2 papillary renal cell carcinoma, which demonstrated tubular papillary and focal solid structures, with flocculent cytoplasm and many foamy histiocytes, but without myxoid background and lymphocytes infiltration. Immunohistochemistry showed strongly positive expression of ALK. CK7, E-cadherin, vimentin, PAX8 and CD10 showed various degrees of expression, and other antibodies were nonreactive. A variety of molecular assays showed definite ALK gene translocation, with rare VCL-ALK gene fusion (VCL exon and 16-ALK exon 20) in case 1, and EML4-ALK gene fusion (EML4 exon and 2-ALK exon 20) in case 2. Conclusions: ALK-translocation renal cell carcinoma is rare with various morphological features, and is easy to miss and misdiagnose. The characteristic ALK expression and molecular detection of ALK translocation are helpful for diagnosing this type of renal cell carcinoma.

Papillary renal neoplasm with reverse polarity: a clinicopathological analysis / 中华病理学杂志

Objective: To study the clinical pathological characteristics, immunophenotype, molecular changes and prognosis of the papillary renal neoplasm with reverse polarity (PRNRP). Methods: Nine cases of PRNRP, diagnosed from 2013 to 2019, were retrieved from the Department of Pathology of Nanjing Jinling Hospital, Nanjing University School of Medicine. Histomorphology, immunophenotype and molecular genetics were analyzed with review of the literatures. Results: There were five male and four female patients, aged from 49 to 70 years, with an average age of 60.1 years. During a mean follow-up of 29 months, one patient died for other cause, and the others survived without disease. Microscopically, the tumor cells arranged in papillary structure with a fibrovascular core, the surface of which was covered with a single layer of cuboidal or columnar cells. The most prominent feature was that the tumor nuclei located at the top of the cytoplasm far from the basement membrane, and they were monotonous in size and arranged neatly with no or few nucleoli. Immunohistochemically, all nine cases of PRNRP showed diffuse positive expression of CK7 and E-cadherin, various degrees of P504s expression, and no expression of CD10 and CD117, with a Ki-67 index of 1%-3%. Unlike other papillary renal cell carcinoma, the nine cases of PRNRP all showed characteristic positive expression of GATA3. The fluorescence in situ hybridization assay showed that the majority of PRNRPs (8/9) did not have triploids on chromosomes 7 and 17. The sequencing of the KRAS gene confirmed the presence of a nonsense KRAS mutation in 8 of the 9 cases. Conclusions: PRNRP is a subtype of papillary renal cell carcinoma with characteristic morphological, immunophenotypic and molecular features, and indolent behaviors. More data are needed to define PRNRP as "carcinoma", and a definitive diagnosis of PRNRP is of great significance for proper treatment choice and accurate prognostication.

Primary testicular diffuse large B-cell lymphoma: A clinicopathological analysis / 中华男科学杂志

Objective@#To investigate the clinicopathological features, immunophenotype and treatment of primary testicular diffuse large B-cell lymphoma (DLBCL).@*METHODS@#We retrospectively analyzed the pathomorphological characteristics and immunohistochemical markers of 23 cases of primary testicular DLBCL as well as their clinicopathological features with a review of the relevant literature. The patients were aged 48－76 (mean 61.4) years, 82.6% over 50 years, and all clinically presented with painless progressive unilateral testicular swelling, 9 cases in the left and the other 14 in the right testis.@*RESULTS@#Histologically, the lymphomas were composed of large atypical cells with prominent karyokinesis and diffusely infiltrated the testicular parenchyma. The neoplastic cells were positive for B-cell markers. Five of the patients were followed up for 2 to 32 months, of whom 4 survived and 1 died at 9 months.@*CONCLUSIONS@#Primary testicular DLBCL is a rare tumor with an invasive biological behavior, mostly found in elderly males and easily misdiagnosed or missed in diagnosis. Histopathology plays a key role and immunohistochemical markers are of high value in the definite diagnosis and differential diagnosis of the tumor.

The influence of pathological network management system on pathological report process / 医学研究生学报

Objective The pathological network management system provides a good working platform for pathological diagnosis, but there are few related reports. In order to give full play to the influence of pathological network management system on the whole process of pathological report, optimize the process of pathological report, and improve the efficiency of process and the quality of pathological report, we statistical analyzed the 41535 pathological reports time in our hospital.Methods The 33696 pathological reports time from the pathology department of our hospital in 2012 and 41535 in 2017 were statistical analyzed, to investigate the influence of the system on the pathological reporting process, which was included pathological specimen reception, information input, technical production, pathological report writing, capture and so on. The failure rates of pathological reports by single-site working mode in 2012 with multi-site working mode in 2017 were compared.Results Among the 33696 pathological reports in 2012, 18482 were outpatients, of which 17779(96.2%) cases were reported in ≤3 days, and 15214 were inpatients, of which 14590 (95.9%) cases were reported in ≤5 days. Among the 41535 pathological reports in 2017, 22832 were outpatients, of which 22271(97.5%) cases were reported in ≤3 days, and 187037 were inpatients, of which 18347 (98.1%) cases were reported in ≤5 days. The failure rate of pathological reports in 2012 was 5.69%, while in 2017 was 1.93%. Pathological network management system was through the whole process of pathologic examination, from the specimen reception, production, diagnosis, application and pathology report card printing.Conclusion The operation process of pathological work is standardized, the labor time of the staff is shortened, the human error is reduced, the quality of the pathological report is improved, and the Objective basis for pathological quality control is provided by using the pathological network management system.

Primary mediastinal germ cell tumors: the clinicopathologic analysis of 56 cases / 临床与实验病理学杂志

Purpose To investigate the clinicopathologic features of primary mediastinal germ cell tumors and to improve the diagnosis and treatment guidance. Methods The clinical features, histologic findings, molecular detection and biological behaviors of 56 PMGCT cases were analyzed retrospectively. Results The age of patients ranged from 9 to 48 years (median age 29.1 years), and mature teratoma(76.8％, 43/56) were the most common type.3 cases of mature teratoma were prepubertal patients.53 cases of postpubertal patients included 40 cases of mature teratoma, 2 cases of nonmature teratoma, 2 cases of yolk sac tumor, 5 cases of seminoma, 4 cases of mixed germ cell tumor. All malignant PMGCTs were male, and mature teratoma was found in the female. Histopathologic morphology and immune phenotype of primary mediastinal germ cell tumors were consistent with those of sexual gland. The isochromosome 12p was detected in various component of malignant GCTs, not in mature teratoma. All patients underwent surgical resection, with additional chemotherapy for malignant germ cell tumor cases. The prognosis of mature teratoma regardless of prepubertal or postpubertal patients was benign, but PMGCTs (except mature teratoma) of postpubertal type were malignant. Conclusion Primary mediastinal germ cell tumors are rare and mature teratoma is most common. The malignant PMGCTs mostly occur in young men. The abnormal 12p detected by FISH is helpful to differential diagnosis and guide the treatment.

Diagnostic value of immunohistochemistry and FISH for chromosome 12p in type Ⅱ testicular germ cell tumors / 中华男科学杂志

<p><b>Objective</b>To study the pathological morphology, immunohistochemical characteristics, and molecular changes of type Ⅱ testicular germ cell tumors (TGCT) and investigate the possible value of immunohistochemistry and fluorescence in situ hybridization (FISH) in the diagnosis of TGCT.</p><p><b>METHODS</b>We collected for this study 97 cases of TGCT, including 75 cases of seminoma, 17 cases of embryonal carcinoma, 11 cases of yolk sac tumor, 16 cases of mature teratoma, 3 cases of immature teratoma, and 1 case of epidermoid cyst, in which normal testicular tissue was found in 20 and non-TGCT in 6. We detected the expressions of different antibodies in various subtypes of TGCT by immunohistochemistry and determined the rate of chromosome 12p abnormality using FISH.</p><p><b>RESULTS</b>The immunophenotypes varied with different subtypes of TGCT. SALL4 and PLAP exhibited high sensitivity in all histological subtypes. CD117 and OCT4 showed strongly positive expressions in invasive seminoma and germ cell neoplasia in situ (GCNIS) but not in normal seminiferous tubules. GPC3 was significantly expressed in the yolk sac tumor, superior to GATA3 and AFP in both range and intensity. CKpan, OCT4, and CD30 were extensively expressed in embryonal carcinoma, while HCG expressed in choriocarcinoma. The positivity rate of isochromosome 12p and 12p amplification in TGCT was 96.7% (29/30).</p><p><b>CONCLUSIONS</b>The majority of TGCT can be diagnosed by histological observation, but immunohistochemical staining is crucial for more accurate subtypes and valuable for selection of individualized treatment options and evaluation of prognosis. Chromosome 12p abnormality is a specific molecular alteration in type Ⅱ TGCT, which is useful for ruling out other lesions.</p>

Primary testicular yolk sac tumor: clinicopathological study of 8 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological characteristics, diagnosis and treatment of primary testicular yolk sac tumor (YST).</p><p><b>METHODS</b>We studied 8 cases of primary testicular YST by microscopy and immunohistochemistry.</p><p><b>RESULTS</b>The 8 cases of primary testicular YST, including 2 consultation cases, were confirmed from 1998 to 2013, accounting for 10.7% (8/75) of all the testicular germ cell tumors diagnosed in our hospital. The patients ranged in age from 7 to 43 years, 23.9 years on average. The main clinical manifestation of the patients was painless unilateral testis swelling. Microscopically, reticular tissues, schiller-duvaI (S-D) bodies, and eosin-stain transparent bodies were seen in the tumors. One of the cases was confirmed to be simple YST, while the other 7 mixed YST. AFP was a characteristic immunophenotype marker of the tumors.</p><p><b>CONCLUSION</b>Primary testicular YST is a rare malignancyr with poor prognosis. Its diagnosis depends on preoperative AFP test and postoperative pathology. Comprehensive treatment, including orchiectomy, chemotherapy, and radiotherapy, can prolong the survival of the patients.</p>

Immunohistochemistry using epidermal growth factor receptor mutation-specific antibodies of delE746-A750 and L858R in lung adenocarcinomas / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the immunohistochemical detection of epidermal growth factor receptor(EGFR) mutations using two EGFR mutation-specific monoclonal antibodies: delE746-A750 and L858R.</p><p><b>METHODS</b>A total of 175 paraffin-embedded lung adenocarcinoma tissue samples previously genotyped by directive DNA sequencing were subject to immunostaining using delE746-A750 and L858R antibodies.</p><p><b>RESULTS</b>There was no significant difference of mutation detection between DNA sequence analysis and delE746-A750 and/or L858R immunostaining (33.7% vs 30.9%, P > 0.05). The overall sensitivity, specificity, positive predictive value and negative predictive value of immunostaining using these two EGFR mutation-specific antibodies were 83.1%, 95.7%, 90.7% and 90.9%, respectively.</p><p><b>CONCLUSION</b>With high sensitivity and good specificity, immunohistochemistry using EGFR mutation-specific monoclonal antibodies is an adequate, easy and cost-effective prescreening method to detect EGFR mutations using paraffin-embedded tissue specimens of lung adenocarcinomas.</p>

Immunohistochemical study of perivascular epithelioid cell neoplasms / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, immunophenotype and genetic changes of perivascular epithelioid cell neoplasms (PEComa).</p><p><b>METHODS</b>A total of 25 cases of PEComa located in various anatomic sites were selected for immunohistochemical staining (SP or EnVision method). TFE3 fluorescence in-situ hybridization was also performed to determine the TFE3 gene status.</p><p><b>RESULTS</b>The age of patient ranged from 21 to 61 years (mean = 43 years). The male-to-female ratio was 1: 1.3. Histologically, 22 cases represented conventional angiomyolipomas, composed of a mixture of adipose tissue, spindle element, epithelioid smooth muscle cells and abnormal thick-walled blood vessels in various proportions. Three cases involving lung, soft tissue and broad ligament had subtle but distinctive morphologic features. Nested or sheet-like architecture with epithelioid or spindle cells was observed. Immunohistochemical study showed that HMB 45, melan A, smooth muscle actin and cathepsin K were expressed in 80% (20/25), 88% (22/25), 88% (22/25) and 100% (25/25) of PEComa, respectively. Within positive cases, the average proportion of positive tumor cells was 36%, 41%, 35% and 90% respectively for HMB 45, melan A, smooth muscle actin and cathepsin K. TFE3 was negative in all of the 22 renal and hepatic PEComa studied, while it was positive in the 3 cases of extra-hepatorenal PEComa. None of the 25 cases exhibited evidence of TFE3 gene fusion or amplification.</p><p><b>CONCLUSIONS</b>Extra-hepatorenal PEComa have distinctive morphologic features and are associated with TFE3 overexpression. Cathepsin K immunostaining demonstrates high sensitivity and specificity in PEComa, better than other commonly employed immunomarkers. This marker is thus useful in diagnosis of PEComa and distinction with other neoplasms.</p>

Relevance of molecular alterations in histopathologic subtyping of lung adenocarcinoma based on 2011 International Multidisciplinary Lung Adenocarcinoma Classification / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the relevance of molecular alterations and histopathological subtypes of lung adenocarcinoma according to 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Lung Adenocarcinoma Classification.</p><p><b>METHODS</b>Mutations of epidermal growth factor receptor (EGFR) 18-21 exons (E18-21), KRAS 12/13 codons and EML4-ALK fusion in 212 cases of lung adenocarcinoma which underwent complete tumor resection, were detected by immunohistochemistry, PCR-amplifying and gene sequencing. The relevance of the molecular alterations to histopathological subtypes based on the new classification and 2004 WHO classification were further characterized.</p><p><b>RESULTS</b>Mutations of EGFR were observed in 49.6% of lung adenocarcinomas, involving mainly E21 (52.4%, 55/105) and E19 (36.2%, 38/105). Mutations of KRAS were detected in 8% cases of adenocarcinoma, involving mainly codon 12 (15/17). EML4-ALK fusions were found in 6.1% of lung adenocarcinoma, the most common fusion mutation was type V1 (E13; A20) (7/13), followed by type V3a/b (E6a/b; A20) (4/13). Based on the new classification, 7/10 lepidic, 63.2% (48/76) papillary, and 5/8 micropapillary predominant adenocarcinomas harbored EGFR mutations. EGFR mutations showed significant difference among different histological subtypes (P = 0.008). KRAS mutations were most frequently found in invasive mucinous adenocarcinoma (1/2), followed by colloid predominant adenocarcinoma (3/7). There was significant difference of KRAS mutations among different histological subtypes (P = 0.003). EML4-ALK fusions were most frequently found in the solid predominant with mucin production subtype (15.4%, 6/39), followed by colloid predominant adenocarcinoma (1/7), and no significant difference of EML4-ALK fusions was found among different histological subtypes (P = 0.181). Significant TTF-1 overexpression was observed in adenocarcinomas harbored EGFR mutations (P = 0.008), and no or significantly lower level expression of TTF-1 was observed in adenocarcinomas harbored KRAS mutations (P = 0.000). However, there was no association between TTF-1 expression and EML4-ALK fusions (P = 0.274). Based on the 2004 WHO classification, mutations of KRAS (P = 0.002) and EML4-ALK (P = 0.000), rather than EGFR (P = 0.502), showed significant differences among different subtypes. According to both classification systems, the difference of "triple negative" adenocarcinomas was not significant among different subtypes (P = 0.684, P = 0.449, respectively).</p><p><b>CONCLUSIONS</b>The new classification, combined with TTF-1 immunomarker, can help to predict the molecular alterations of EGFR and KRAS genes, but can not indicate the EML4-ALK fusion in lung adenocarcinoma. Lepidic, papillary, and micropapillary predominant adenocarcinomas with TTF-1 expression are closely related to the presence of EGFR mutation, and invasive mucinous adenocarcinoma, while colloid predominant adenocarcinoma without TTF-1 expression is closely related to the presence of KRAS mutation.</p>

Prognostic significance of a newly proposed grading and scoring system in stage I pulmonary adenocarcinoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic significance of a new grading and scoring system (based on the new IASLC/ATS/ERS classification) in stage I pulmonary adenocarcinoma, as compared with the WHO grading system.</p><p><b>METHODS</b>The clinicopathologic characteristics of 125 patients with stage I pulmonary adenocarcinoma primarily treated by surgical resection were reviewed retrospectively. All cases were classified according to the new IASLC/ATS/ERS classification and graded into three prognostic groups based on the new classification, the Sica scoring system and the WHO grading system, respectively. The differences in prognosis of the three groups were analyzed.</p><p><b>RESULTS</b>There was a statistically significant correlation between the new grading system and the WHO grading system (P = 0.000). Both of them showed negative correlation with overall survival. The new scoring system however better correlated with disease recurrence and/or metastasis (P = 0.855, P = 0.073 versus P = 0.011). According to univariate Log-rank test, the prognosis correlated with tumor size (P = 0.004), clinical stage (P = 0.000), the WHO grading (P = 0.020), the new grading system (P = 0.000), the new scoring system (P = 0.000), vascular invasion (P = 0.021), and recurrence and/or metastasis (P = 0.000). The Cox regression analysis demonstrated that clinical stage (P = 0.014), the new grading system (P = 0.047), the new scoring system (P = 0.043), and recurrence and/or metastasis (P = 0.018) were significantly independent poor prognostic factors.</p><p><b>CONCLUSIONS</b>The new grading and scoring system shows good correlation with the WHO grading system. Compared with the WHO grading system, the new scoring system based on the new IASLC/ATS/ERS classification provides valuable information in categorizing stage I pulmonary adenocarcinoma cases with different risks of disease recurrence, tumor metastasis and prognosis.</p>

Expression and clinical significance of kidney injury molecule-1 in renal epithelial neoplasms / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the expression and clinical significance of kidney injury molecule-1 (KIM-1) in primary and metastatic renal epithelial neoplasms.</p><p><b>METHODS</b>A total of 136 cases of kidney neoplasms were retrospectively reviewed including 63 primary clear cell renal cell carcinomas (RCCs), 22 papillary RCCs, 13 chromophobe RCCs, 7 oncocytomas, 7 RCCs associated with Xp11.2 translocation/TFE3 gene fusions and 24 metastatic clear cell RCCs. Immunostaining for KIM-1 and kidney-specific-protein (Ksp)-cadherin were performed and the relationship to tumor stage and grade in clear cell RCCs was investigated.</p><p><b>RESULTS</b>Expression of KIM-1 was detected in 77.8% (49/63) of clear cell RCCs, 90.9% (20/22) of papillary RCCs, 1/13 of chromophobe RCCs, 7/7 of RCCs associated with Xp11.2 translocation/TFE3 gene fusions and 87.5%(21/24) of the metastatic RCCs, but not detected in 7 cases of oncocytomas. A diffuse expression of KIM-1 was more frequently observed in Furhman nuclear grade III/IV clear cell RCCs (P = 0.010). Ksp-cadherin expression was mainly observed in chromophobe RCCs and oncocytomas.</p><p><b>CONCLUSIONS</b>KIM-1 is a specific biomarker for injuried kidney proximal tubules and the corresponding neoplasms, and has a high specificity and sensitivity for primary or metastatic clear cell RCCs, papillary RCCs and RCCs associated with Xp11.2 translocation/TFE3 gene fusions. Combination of KIM-1 and Ksp-cadherin immunostaining can lead to a more precise histological classification of primary kidney epithelial neoplasms and improve the diagnostic accuracy of metastatic RCCs.</p>

Clinicopathologic features of granulocytic sarcoma: a study of 38 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of granulocytic sarcoma.</p><p><b>METHODS</b>The clinical and pathologic findings of 38 cases of granulocytic sarcoma were retrospectively analyzed. Immunohistochemical study was performed and the literature was reviewed.</p><p><b>RESULTS</b>The age of patients ranged from 2 to 77 years (mean = 43.3 years). The male-to-female ratio was 1.5:1. Major clinical presentations included superficial lymph node enlargement and painful soft tissue mass. Follow-up data were available in 18 patients; and 14 of them died of tumor-related diseases. The average duration of survival of the patients was 16.9 months. Histologically, the tumor cells were relatively uniform in appearance and small to medium in size. The cytoplasm was scanty and pale in color. The nuclei were round or focally irregular, with fine chromatin and inconspicuous nucleoli. Mitosis figures were readily identified. Scattered immature eosinophilic myelocytes were seen. Immunohistochemical study showed that the tumor cells in all cases expressed MPO and CD43. Most cases were also positive for CD68, lysozyme, CD99 and TdT. The staining for CD3, CD20, CD79a, pan-cytokeratin and PLAP were negative.</p><p><b>CONCLUSIONS</b>Granulocytic sarcoma is a known histologic mimicker of non-Hodgkin lymphoma, Ewing sarcoma/PNET and embryonal rhabdomyosarcoma. Detailed morphologic examination, when coupled with immunohistochemical study, is useful in arriving at a correct diagnosis.</p>

Clinicopathologic and molecular genetic study of renal cell carcinoma occurring in teenagers / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate clinicopathological features, molecular genetic characteristics, differential diagnoses and prognosis of renal cell carcinoma in teenagers.</p><p><b>METHODS</b>Microscopic and immunohistochemical features of 46 cases of renal cell carcinomas in teenagers were reviewed along with the clinical follow-up data. Loss of heterozygosity (LOH), analysis of von Hippel-Lindau (VHL) gene and screening for VHL gene mutations were performed in all of the tumors.</p><p><b>RESULTS</b>There were 19 Xp11.2 translocations/TFE3 gene fusions renal clear cell carcinomas (Xp11 RCCs), 9 chromophobe renal cell carcinomas (CCRCCs), 17 papillary renal cell carcinomas (PRCCs), and 1 unclassified renal cell carcinoma (RCC). All of the 19 Xp11.2 translocation RCCs showed a moderate to strong immunoreactivity for TFE, however, no TFEB expression was obtained. There were 4 histological patterns in the Xp11 RCC cases including: 8 tumors possessing a nested to papillary architecture resembling to the t(X;17) ASPL-TFE3 phenotype; 6 tumors possessing a morphologic feature like the t(X;1) PRCC-TFE3 phenotype; 4 cases morphologically resembling to clear cell RCC; and 1 Xp11 RCC case, with a special morphologic feature not searched yet in the literature, including a ground glass appearance of the nuclei accompanying occasionally with grooves on the nuclear surface; nucleoli inconspicuous with accumulation of abundant mucin-like substance in the stroma. VHL gene analysis revealed deletions at 3p25-26 in one clear cell RCC and one papillary type 2 RCC. The papillary type 2 RCC had also a family history of VHL disease, with a germline G→C mutation at a splicing site of position 553+5. There were no VHL mutations detected in the remaining 45 RCCs. Statistical analysis of tumor stage and outcome revealed that TFE+ RCCs of teen-agers were more frequently associated with a higher pT3/pT4 stage and a poorer outcome than that of the TFE-RCCs (P < 0.05).</p><p><b>CONCLUSIONS</b>RCCs of the teenagers have a different morphologic spectrum and genetic background from the RCCs seen in adults. Among RCCs of the teen-agers, Xp11.2 translocation tumors are the most common RCCs and have a poorer prognosis than that of the TFE-RCCs.</p>

Expression of CD20 in thymomas and its clinical implication / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the expression of CD20 in thymomas and its clinical significance.</p><p><b>METHODS</b>One hundred and seventy-nine cases of thymoma were enrolled into the study. The histologic diagnosis was reviewed by two experienced pathologists on the basis of the 2004 WHO classification. One hundred and two cases were selected for immunohistochemical study for CD20, pancytokeratin, TdT, CD3, CD43, CD99 and S-100 protein. The cases were further categorized into two groups, according to the association with clinical evidence of myasthenia gravis. The immunostaining pattern was then statistically analyzed.</p><p><b>RESULTS</b>Amongst the 102 cases studied, 7 cases belonged to type A thymoma, 32 cases type AB thymoma, 17 cases type B1 thymoma, 15 cases type B2 thymoma, 17 cases type B3 thymoma and 14 cases thymic carcinoma. The expression rates of CD20 in neoplastic epithelial cells of type A, type AB, type B1, type B2 and type B3 thymomas and thymic carcinomas were 3/7, 84.4% (27/32), 1/17, 2/15, 0/17, 0/14, respectively. The proportions of CD20-positive lymphocytes in the background were 3/7, 18.8% (6/32), 14/17, 11/15, 11/17, 6/14, respectively. The proportion of CD20-positive intra-tumoral B lymphocytes in the group of thymomas with myasthenia gravis was 67.5% (22/40), in contrast to 35.5% (22/62) in those without myasthenia gravis.</p><p><b>CONCLUSIONS</b>The neoplastic epithelial cells in cases of type A and type AB thymoma, as well as few cases of type B1 and B2 thymoma, express CD20. The immunostain highlights the presence of oval, stellate or spindly cells. Thymomas associated with myasthenia gravis contain a significant population of CD20-positive intra-tumoral B lymphocytes. Type AB thymomas may be originated from different populations of cells, rather than a simple admixture of type A and B thymoma cells.</p>

Prognostic significance and grading of stromal invasion in pT1 adenocarcinoma of lung / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the prognostic significance of grading system for stromal invasion in pathologic tumor stage T1 (pT1) adenocarcinoma of lung.</p><p><b>METHODS</b>Eighty-five cases of surgically resected pT1 lung adenocarcinoma with clinicopathologic and follow-up data were retrospectively reviewed. The degree of invasive growth was classified into three grades according to its location in the tumor. The clinicopathologic characteristics and prognostic significance were analyzed.</p><p><b>RESULTS</b>Amongst the 85 cases studied, 17 cases (20%) were in grade 1, 12 (14%) in grade 2 and 56 (66%) in grade 3. The tumor size was smaller and lymphovascular permeation was less frequently encountered in cases with grade 1 stromal invasion than in those with grade 3 (P=0.005 for tumor size and P=0.018 for occurrence of lymphovascular permeation). The rate of lymph node metastasis and pathologic staging in cases with grade 1 and grade 2 were similar and were significantly lower than those with grade 3 (P=0.007 for rate of lymph node metastasis in grade 1 versus grade 3 tumors, P=0.002 for pathologic stage in grade 1 versus grade 3 tumors, P=0.027 for rate of lymph node metastasis in grade 2 versus grade 3 tumors and P=0.021 for pathologic stage in grade 2 versus grade 3 tumors). There was no statistically significant difference with respect to age, gender and smoking history of the patients, amongst cases in different grades. The overall five-year survival rate was 63%. The five-year survival rates for cases with grade 1, grade 2 and grade 3 were 100%, 83.3% and 46.6%, respectively. The difference between cases with grade 2 and grade 3 was statistically significant (P=0.027). The death rate during follow-up for cases with grade 1, grade 2 and grade 3 were 0, 16.7% and 42.9%, respectively. The difference between cases with grade 1 and grade 3 was statistically significant (P=0.001). Univariate analysis showed that grade of stromal invasion (P=0.001), pathologic stage (P<0.001), presence of lymphovascular permeation (P<0.001) and lymph node involvement (P<0.001) represented important prognostic factors. Multivariate analysis also showed that pathologic stage (P<0.001) was an independent prognostic factor.</p><p><b>CONCLUSIONS</b>The grading system of stromal invasion in pulmonary adenocarcinoma correlates with tumor prognosis and other prognostic factors. It represents a useful criterion in prognostic categorization of pT1 adenocarcinoma of lung.</p>

Primary Burkitt lymphoma of the seminal vesicle: a case report and review of the literature / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features of primary Burkitt lymphoma of the seminal vesicle.</p><p><b>METHODS</b>We reported the clinical characteristics, histological changes and the results of immunohistochemical staining and molecular in situ hybridization of 1 case of primary Burkitt lymphoma of the seminal vesicle. We also reviewed the related literature and studied the pathomorphological characteristics and differential diagnosis of the tumor.</p><p><b>RESULTS</b>The characteristic manifestations of the patient were frequent micturition with dysuria, followed by inguinal lymphadenectasis 2 months later. Medical imaging showed a diffuse and monotonous infiltration of neoplastic cells with scanty cytoplasm and a few mitosis images. Microscopy displayed a starry sky pattern. The tumor cells were positive for CD10, CD20, CD79alpha, Bcl-6 and EBER in situ hybridization, but negative for CD3, CD6 and Cyclin D1. The Ki-67 index was > 95%.</p><p><b>CONCLUSION</b>Primary Burkitt lymphoma of the seminal vesicle is a very rare tumor with aggressive behavior. The pathological diagnosis of the tumor depends on histopathological examination and immunohistochemical techniques. However it should be differentiated from diffuse large B-cell lymphoma, lymphoblastic lymphoma and small cell carcinoma of the seminal vesicle or prostate gland.</p>

Analysis of 12 206 cases of external pathology consultation / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the concordance rate of external pathology consultation referred by hospitals of various scales and to evaluate the value of such practice.</p><p><b>METHODS</b>A total of 12 206 external pathology consultation cases referred by outside institutions were encountered during a 5-year period. The final pathologic diagnoses in 3289 cases were compared with the original interpretations. Each case was reviewed by at least two experienced pathologists. Immunohistochemical study was carried in selected examples. The pathologic findings were categorized as follows: (1) no diagnostic discrepancy, (2) minor diagnostic discrepancy and (3) major diagnostic discrepancy.</p><p><b>RESULTS</b>Amongst the 12 206 cases studied, 7198 cases (59.0%) were sampled from the digestive tract, hematolymphoid system, soft tissue or breast. Seven thousand eight hundred and sixty-five cases (64.4%) were referred by small and medium-sized hospitals, while only 948 cases (7.8%) were referred by large hospitals (ranked IIIA). The diagnoses in 1842 cases (15.1%) were confirmed upon examination of the original paraffin sections, while the diagnoses in 2569 cases (21.1%) were made with cutting of additional sections from the paraffin blocks. On the other hand, the diagnoses in 7795 cases (63.8%) were arrived with the application of ancillary studies, including histochemistry and immunohistochemistry. Amongst the 3289 cases reviewed, diagnostic agreement was noted in 582 cases (17.7%), while major diagnostic discrepancy was observed in 113 cases (3.4%), including a change in diagnosis from "benign" to "malignant" in 31 cases (0.9%) and from "malignant" to "benign" in 38 cases (1.1%). The pathologic classification of the original diagnoses was modified in 44 cases (1.3%).</p><p><b>CONCLUSIONS</b>External pathology consultation is useful for patient management in small and medium-sized hospitals, especially in resolving difficult and controversial pathologic diagnoses. Application of ancillary techniques, including immunohistochemistry, further helps to clear up the potential diagnostic dilemma.</p>

Histologic subtyping and prognosis of thymoma: a study of 108 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the prognostic and clinical relevance of histologic subtyping of thymoma according to the World Health Organization (WHO) classification.</p><p><b>METHODS</b>The clinicopathologic features of 108 patients with thymoma removed surgically were retrospectively reviewed. The histologic diagnosis of the tumors was made on the basis of 2004 WHO classification by two experienced pathologists. The correlation between Masaoka tumor stage, WHO histologic subtype, completeness of resection, presence of myasthenia gravis, other clinical parameters (including age, gender and tumor size) and survival was studied.</p><p><b>RESULTS</b>According to WHO classification, there were 7 cases (6.5%) of type A thymoma, 19 cases (17.6%) of type AB thymoma, 23 cases (21.3%) of type B1 thymoma, 19 cases (17.6%) of type B2 thymoma, 27 cases (25.0%) of type B3 thymoma and 13 cases (12.0%) of type C thymoma. According to Masaoka tumor staging, 36 cases (33.3%) were in stage I, 34 cases (31.5%) in stage II, 27 cases (25.0%) in stage III and 11 cases (10.2%) in stage IV(a). The association between histologic subtype and Masaoka tumor stage was statistically significant (P = 0.000). The 5-year survival rates of type A, AB, B1, B2 and B3 thymoma cases were 100%, 100%, 93%, 83% and 43%, respectively; while the 10-year survival rates were 100%, 100%, 81%, 70% and 33%, respectively. The median survival time of type C thymoma was 62.5 months. Type B2 and B3 thymoma cases had an intermediate prognostic ranking in comparison with type C thymoma and other groups (P = 0.000). The 5-year survival rates of tumors in stage I, II and III were 100%, 77% and 54%, respectively; while the 10-year survival rates were 100%, 70% and 27%, respectively. The median survival time of patients in stage IV(a) was 14.0 months. Masaoka tumor stage was highly significant in predicting survival of patients (P = 0.000). On multivariate analysis, Masaoka tumor stage was an independent predictive factor for survival (P = 0.027). On the other hand, the WHO subtype (type A to B1 versus type B2 to B3 versus type C) and completeness of resection could predict the tumor-related survival.</p><p><b>CONCLUSIONS</b>The Masaoka tumor stage is the single most important prognostic factor of thymoma. The WHO histologic subtype and completeness of resection affect mainly the post-operative survival. The classification of thymoma may also reflect the clinical behavior of the tumor. Type A, AB and B1 thymomas belong to the low-risk group, while type B2 and B3 thymomas have an intermediate prognostic ranking. Type C thymoma carries the worst prognosis.</p>

Clinicopathological analysis of Paget's disease of the scrotum and penis / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinical pathological characteristics, diagnosis and differential diagnosis of Paget's disease of the scrotum and penis.</p><p><b>METHODS</b>Thirteen cases of Paget's disease of the scrotum and penis were analyzed by light microscopy, alcian-blue (AB)/periodic-acid-Schiff (PAS) and immunohistochemical staining.</p><p><b>RESULTS</b>Paget's disease of the scrotum and penis mainly affected old individuals aged 55-84 (mean 71) years. Macroscopically, typical presentations of Paget's disease of the scrotum and penis were eczematoid lesions. Microscopically, Paget cells were distributed singly or in groups (as strands, nests or glandular patterns) within the epidermis. Paget cells were typically stained for AB/PAS, positive for CK7, CEA and EMA, and negative for CK5/6, S-100 and P63. The positive rates of GCDFP-15 and CK20 expressions were 76.92% (10/13)and 53.85% (7/13) respectively.</p><p><b>CONCLUSION</b>Paget's disease of the scrotum and penis is a low-malignancy cutaneous tumor with typical clinical and pathological features. Pathologic diagnosis is based on immunohistochemical findings.</p>