Journal Club #10: Calretinin immunohistochemistry as a tool to diagnose Hirschsprung disease

Diagnosis of Hirschsprung disease (HD) is quite entirely based on the histopathological analysis of suction rectal biopsies.This hematoxylin and eosin approach has some limitations, despite the help of acetylcholinesterase staining. pathologist.  [...] Calretinin immunohistochemistry overcomes most of the difficulties encountered using the combination of histology and acetylcholinesterase staining, and detects almost all cases of HD with confidence, with no false positives.

Guinard-Samuel V, et al. Calretinin immunohistochemistry: a simple and efficient tool to diagnose Hirschsprung disease. Mod Pathol. 2009 Oct;22(10):1379-84.

Bibliography.

Barshack I, et al. The loss of calretinin expression indicates aganglionosis in Hirschsprung's disease. J Clin Pathol. 2004 Jul;57(7):712-6.

Kapur RP. Calretinin-immunoreactive mucosal innervation in very short-segment Hirschsprung disease: a potentially misleading observation. Pediatr Dev Pathol.2014 Jan-Feb;17(1):28-35.

Szylberg L, Marszałek A. Diagnosis of Hirschsprung's disease with particular emphasis on histopathology. A systematic review of current literature. Prz Gastroenterol. 2014;9(5):264-9.

Journal Club #9: Focal myositis, an intramuscular mass-like reactive process.

Focal myositis is an uncommon inflammatory pseudotumor of skeletal muscle that can be confused with a variety of neoplastic and inflammatory diseases. It is often misunderstood because it presents as a tumor-like mass, but histologically resembles a skeletal muscle myopathy or dystrophy. [...] Histologically, these were solitary intramuscular processes composed of variable myopathic and focal neurogenic changes, fibrosis, and inflammation, occasionally accompanied by prominent eosinophils.[...] Clinical diagnostic considerations ranged from benign entities such as rhabdomyoma, intramuscular lipoma, fibromatosis, myositis ossificans, proliferative myositis, inflammatory myofibroblastic tumor, and inflammatory myopathy to malignant entities such as rhabdomyosarcoma, leiomyosarcoma, liposarcoma, and lymphoma. Available follow-up revealed spontaneous regression.[...] Careful attention to reproducible clinicopathologic features can aid diagnosis and spare patients from excessive surgery or adverse therapy.

Auerbach A, et al. Focal myositis: a clinicopathologic study of 115 cases of an intramuscular mass-like reactive process. Am J Surg Pathol. 2009 Jul;33(7):1016-24.

Bibliography.

Layfield LJ, Crim J, Gupta D. Fine-needle aspiration findings in nodular myositis: a case report. Diagn Cytopathol. 2000 Nov;23(5):343-7

Lost in Pathology

Lo so. Il blog langue da un bel po (l' ultimo post risale al 22 aprile!). Qualcuno l' ha sicuramente dato per morto, altri avranno detto: ecco, la solita iniziativa che comincia bene e poi....

Francesco Merolla mi ha dato l' occasione per un post estivo, segnalandomi un interessante numero della rivista Nature sulle Key Advances in Medicine, in cui si riassumono gli hot topics della ricerca medica, corredati da una selezione di paper pubblicati sulle riviste del gruppo Nature nel 2013. Una interessante ma agile lettura estiva! 

Dopo il (meritato) riposo, i post sul blog riprenderanno, con una auspicabile partecipazione di specializzandi, dottorandi e docenti. Da fine settembre riprenderanno inoltre gli incontri del Journal Club, che hanno riscosso un buon successo in termini di partecipazione. E poi i Seminari, il Cineforum e numerose altre iniziative per vivacizzare la formazione degli specializzandi e non.

Perché, nel nostro (meraviglioso) mestiere, non si finisce mai di imparare!

Buone vacanze,

Pathfinder.

Key Advances in Medicine, January 2014, Nature Reviews.

Journal Club #3: H. pylori detected by PCR-based technique.

PCR-based techniques may substitute the hystochemical and immunohistochemical stainings in the detection of H. pylori in gastric biopsy. Moreover, these new assays can identify mutations that predict antibiotic resistance, avoiding the time-consuming coltures.

Bibliography.

Schmitt BH, Regner M, Mangold KA, Thomson RB Jr, Kaul KL. PCR detection of clarithromycin-susceptible and -resistant Helicobacter pylori from formalin-fixed, paraffin-embedded gastric biopsies. Mod Pathol. 2013 Sep;26(9):1222-7.

Weiss J, Tsang TK, Meng X, Zhang H, Kilner E, Wang E, Watkin W. Detection of Helicobacter pylori gastritis by PCR: correlation with inflammation scores and immunohistochemical and CLOtest findings. Am J Clin Pathol. 2008 Jan;129(1):89-96.

Yantiss RK, Lamps LW. To stain or not to stain...That remains the question. Am J Clin Pathol. 2012 Mar;137(3):343-5. 

Comment on

Hartman DJ, Owens SR. Are routine ancillary stains required to diagnose Helicobacter infection in gastric biopsy specimens? An institutional quality assurance review. Am J Clin Pathol. 2012 Feb;137(2):255-60.

Journal Club #2 - Tumor budding as prognostic marker in colorectal cancer

Tumor budding (defined as single neoplastic cells or clusters up to five cells at the invasive front of CRC) may represent a new prognostic marker in colorectal cancer. In particular, it could be useful to indentify those pT3N0M0 "high risk" patients who may benefit of additional therapeutic regimen.

Interestingly, tumor budding can be assessed also in pre-operative biopsy and in cancers other than CRCs. 

Overview of the histomorphological and molecular features of the tumour centre, invasive front and tumour buds in CRC. Reproduced from Zlobec and Lugli, 2010.

Bibliography.

Wang LM, Kevans D, Mulcahy H, O'Sullivan J, Fennelly D, Hyland J, O'Donoghue D, Sheahan K. Tumor budding is a strong and reproducible prognostic marker in T3N0 colorectal cancer. Am J Surg Pathol. 2009 Jan;33(1):134-41.

Lugli A, Karamitopoulou E, Zlobec I. Tumour budding: a promising parameter in colorectal cancer. Br J Cancer. 2012 May 22;106(11):1713-7. doi: 10.1038/bjc.2012.127. Epub 2012 Apr 24. Review. 

Rogers AC, Gibbons D, Hanly AM, Hyland JM, O'Connell PR, Winter DC, Sheahan K. Prognostic significance of tumor budding in rectal cancer biopsies before neoadjuvant therapy. Mod Pathol. 2014 Jan;27(1):156-62.

Giger OT, Comtesse SC, Lugli A, Zlobec I, Kurrer MO. Intra-tumoral budding in preoperative biopsy specimens predicts lymph node and distant metastasis in patients with colorectal cancer. Mod Pathol. 2012 Jul;25(7):1048-53.

Sarioglu S, Acara C, Akman FC, Dag N, Ecevit C, Ikiz AO, Cetinayak OH, Ada E; for Dokuz Eylül Head and Neck Tumour Group (DEHNTG). Tumor budding as a prognostic marker in laryngeal carcinoma. Pathol Res Pract. 2010 Feb 15;206(2):88-92.

Liang F, Cao W, Wang Y, Li L, Zhang G, Wang Z. The prognostic value of tumor budding in invasive breast cancer. Pathol Res Pract. 2013 May;209(5):269-75.

FNA is the ideal tool to study and analyze tumor heterogeneity at metastatic sites

In routine practice, suspected metastases in patients with cancer are only occasionally biopsied, primarily because of the cost and invasiveness of the procedure. However, biopsies of metastatic lesions can be valuable, not only in confirming the presence of metastatic disease, but also in revealing unsuspected benign disease or secondary malignancies. In addition, such biopsies also allow the assessment of biomarkers that might differ from those on primary tumor cells, and can thereby facilitate selection of the optimal treatment. Because of the increasing recognition of clonal and phenotypic heterogeneity of tumors, we anticipate that in the near future, biopsying of metastatic lesions will constitute a standard-of-care practice, allowing assessment of molecular differences between the primary tumor and metastatic lesions. In our opinion, fine-needle aspiration is currently the best method for making repeated biopsies to monitor the tumor: it is minimally invasive, safe, and cost effective and can be coupled with modern ancillary techniques. Here we provide an up-to-date review of the clinical implications of tumor heterogeneity in metastatic disease and the ancillary molecular techniques used in cytology; we also discuss the role of modern cytology in contemporary diagnosis and management of metastatic cancer.

Beca F, Schmitt F. Growing indication for FNA to study and analyze tumor heterogeneity at metastatic sites. Cancer Cytopathol. 2014 Jan 29.

Getting Out From Behind the Paraffin Curtain

A must-to-read Editorial on pathologist's career with a focus on the political efforts needed  to achieve a good work quality and the consideration deserved among clinician colleagues and hospital administrators. To get out from behind the paraffin curtain.

Many pathologists, especially those who maintain contracts with hospitals and other providers, possess keen political skills. They have learned how to keep clinicians happy with the accuracy and alacrity of laboratory services, administrators satisfied with efficiency and financial performance, and technical personnel content with working conditions. [...] As pathologists' careers develop, they are often called on to be leaders. Some are uncomfortable in leadership positions, their careers to date having been founded mostly on individual achievement. The reluctant leader should not be dissuaded by lack of leadership experience. Often the best leaders are those who did not seek out the position but developed their own style as they adapted to the demands of the position. [...] Other challenges include learning to delegate (and follow up on delegated tasks), providing encouragement and inspiration to team members (some of whom may be quite hard-boiled and cynical), and occasionally standing up for the team when it is under assault by powerful factions, including clinicians and other clients. This last challenge takes no small measure of courage and equanimity. [...] The pathologist/politician/leader is commonly confronted by ethical issues. We typically serve multiple masters, including patients, administrators, clinicians, and regulatory agencies. We need to be sensitive to their conflicting agendas. Medical ethics is a complex field [...]  Nevertheless, building a reputation for incorruptibility does foster trust, and trust is fertile ground for opportunity.

Edward O. Uthman (2014) Getting Out From Behind the Paraffin Curtain. Archives of Pathology & Laboratory Medicine: January 2014, Vol. 138, No. 1, pp. 12-13.

Happy New Year 2014.