High-grade endometrial carcinomas: Morphologic spectrum and molecular classification.

High-grade endometrial carcinoma (HGEC) is a heterogeneous group of tumors with various morphologic, genetic, and clinical characteristics. Morphologically, HGEC includes high-grade endometrioid carcinoma, serous carcinoma, clear cell carcinoma, undifferentiated/dedifferentiated carcinoma, and carcinosarcoma. The morphologic classification has been used for prognostication and treatment decisions. However, patient management based on morphologic classification is limited by suboptimal interobserver reproducibility, variable clinical outcomes observed within the same histotype, and frequent discordant histotyping/grading between biopsy and hysterectomy specimens. Recent studies from The Cancer Genome Atlas (TCGA) Research Network established four distinct molecular subtypes: POLE-ultramutated, microsatellite unstable, copy number high, and copy number low groups. Compared to histotyping, the TCGA molecular classification appears superior in risk stratification. The best prognosis is seen in the POLE-ultramutated group and the worst in copy number high group, while the prognosis in the microsatellite unstable and copy number low groups is in between. The TCGA subtyping is more reproducible and shows a better concordance between endometrial biopsy and resection specimens. It has now become apparent that the molecular classification can supplement histotyping in patient management. This article provides an overview of the pathologic diagnosis/differential diagnosis of HGEC and the TCGA classification of endometrial cancers, with the clinical significance and applications of TCGA classification briefly discussed when appropriate.

Monitoring and Morphologic Classification of Pediatric Cataract Using Slit-Lamp-Adapted Photography.

PURPOSE: To investigate the feasibility of pediatric cataract monitoring and morphologic classification using slit lamp-adapted anterior segmental photography in a large cohort that included uncooperative children. METHODS: Patients registered in the Childhood Cataract Program of the Chinese Ministry of Health were prospectively selected. Eligible patients underwent slit-lamp adapted anterior segmental photography to record and monitor the morphology of their cataractous lenses. A set of assistance techniques for slit lamp-adapted photography was developed to instruct the parents of uncooperative children how to help maintain the child's head position and keep the eyes open after sleep aid administration. RESULTS: Briefly, slit lamp-adapted photography was completed for all 438 children, including 260 (59.4%) uncooperative children with our assistance techniques. All 746 images of 438 patients successfully confirmed the diagnoses and classifications. Considering the lesion location, pediatric cataract morphologies could be objectively classified into the seven following types: total; nuclear; polar, including two subtypes (anterior and posterior); lamellar; nuclear combined with cortical, including three subtypes (coral-like, dust-like, and blue-dot); cortical; and Y suture. The top three types of unilateral cataracts were polar (55, 42.3%), total (42, 32.3%), and nuclear (23, 17.7%); and the top three types of bilateral cataracts were nuclear (110, 35.8%), total (102, 33.2%), and lamellar (34, 11.1%). CONCLUSIONS: Slit lamp-adapted anterior segmental photography is applicable for monitoring and classifying the morphologies of pediatric cataracts and is even safe and feasible for uncooperative children with assistance techniques and sleep aid administration. TRANSLATIONAL RELEVANCE: This study proposes a novel strategy for the preoperative evaluation and evidence-based management of pediatric ophthalmology (Clinical Trials.gov, NCT02748031).

Role of preoperative morphologic classification in solitary small hepatocellular carcinoma treated by RFA / 国际外科学杂志

Objective To invcstigate the value of preoperative imaging morphologic classification in solitary small hepatocellular carcinoma treated by RFA.Methods The clinical data of 73 patients with small hepatocellular carcinoma who rcccivcd radiofrequency ablation at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to December 2012 were analyzed retrospectively.The lesions were classified into three types according to gross appearance in preoperative contrast-enhanced computed tomography (CT):single nodular type (type 1);single nodular with extranodular growth type or confluent multinodular type (type 2);infiltrating type (type 3).Thc clinicopathological features of patients with 3 types of tumors were compared by statistical methods.Patients were followed up via outpatient examination and telephone interview up to August 2014 or death.Results There were 24 cases of type 1,35 cases of type 2,14 cases of type 3,and the proportion were 20.2％,32.9％,47.9％,19.2％,respectively.The preoperative alpha-fetoprotein of type 3 was significantly higher than othcr types.The disease-free survival time of the three types were (37.2 ± 3.3) months,(20.9 ± 4.0) months,(14.4 ±4.9) months.The prognosis of the irregular types (type 2,type 3) is poor than the regular types (type 1).The overall survival time were (72.5 ± 4.7) months,(66.2 ± 7.3) months,(31.2 ± 5.3) months.The type 3 was the worst.The results of univariate analysis showed that morphologic classification,preoperative AFP,tumor size were related factors affecting the prognosis of patients (P ＜ 0.05).The results of multivariate analysis showed that morphologic classification was the independent risk factors affecting the prognosis of patients (P ＜ 0.05).Conclusion The preoperative imaging morphologic classification is the independent risk factors affecting the prognoses of patients with small HCC,which is help to choose the best treatment for patients with small hepatocellular.

Morphologic variants of focal segmental glomerulosclerosis and their significance.

Focal segmental glomerulosclerosis (FSGS) comprises a group of clinical-pathologic syndromes characterized by heavy proteinuria and segmental obliteration of glomerular capillaries by extracellular matrix. FSGS lesions display morphologic heterogeneity with respect to their relationship to the glomerular vascular and tubular poles, the presence of capillary collapse, and endocapillary and extracapillary hypercellularity. A working proposal, commonly referred to as the Columbia Classification, distinguishes 5 mutually exclusive morphologic variants: collapsing, tip, cellular, perihilar, and not otherwise specified (NOS), which can be applied to primary and secondary forms of FSGS. Several studies have documented significant differences in baseline clinical characteristics and outcomes between morphologic variants of primary FSGS, supporting that this classification may provide useful prognostic information. The association of certain variants with particular secondary causes of FSGS suggests pathogenetic relevance.

Endoscopic mucosal resection and endoscopic submucosal dissection of epithelial neoplasia of the colon.

Endoscopic mucosal resection (EMR) with curative intent has evolved into a safe and effective technique and is currently the gold standard for management of large colonic epithelial neoplasms. Piecemeal EMR is associated with a high risk of local recurrence requiring vigilant surveillance and repeat interventions. Endoscopic submucosal dissection (ESD) was introduced in Japan for the management of early gastric cancer, and has recently been described for en bloc resection of colonic lesions greater than 20 mm. En bloc resection allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps determine additional therapy. Morphologic classification of lesions prior to resection allows prediction of depth of invasion and risk of nodal metastasis, allowing selection of the appropriate intervention. This review provides an overview of the assessment of epithelial neoplasms of the colon and the application of EMR and ESD techniques in their management.

Characteristics of Laterally Spreading Colorectal Tumors according to Morphologic Classifications / 대한소화기내시경학회지

BACKGROUND/AIMS: Laterally spreading tumors (LSTs) are similar in color to the adjacent mucosa, so they are difficult to recognize. This study aimed to investigate the features of LSTs by morphologic classification and find effective diagnoses and treatments. METHODS: This retrospective study was done between March 2006 and August 2008. We reviewed patients' medical records, endoscopic findings, and histological findings. RESULTS: A total of 151 patients met criteria for LSTs. Eighty-seven lesions (57.6%) were of the granular type. The most frequent location was ascending colon (37.1%), followed by rectum and sigmoid colon (36.4%). The cecum is a common site in the granular type, but the transverse colon is common in the nongranular type. The overall malignancy rate was 21.2%, and the malignant rate increased in proportion to size. Malignant rates were higher for the mixed nodular type (25.9%) and pseudo-depressed type (41.2%) than for the homogeneous granular type (3.0%) or flat elevated type (10.0%). CONCLUSIONS: LSTs showed different clinicopathologic characteristics according to their morphologic classification. The homogenous type has a lower malignant potential. Piecemeal resection for those with a large diameter is possible, while the pseudo-depressed and mixed nodular types have a higher malignant potential and should receive en-bloc resection as soon as possible.