-
BMC Oral Health Jun 2024Odontogenic carcinoma with dentinoid (OCD) is a rare and controversial entity, which has not yet been included in the current World Health Organization classification of... (Review)
Review
BACKGROUND
Odontogenic carcinoma with dentinoid (OCD) is a rare and controversial entity, which has not yet been included in the current World Health Organization classification of odontogenic lesions. Owing to the small number of reported cases, the clinicopathological characteristics, biological behavior, prognosis, and appropriate treatment strategies for OCD remain to be defined. Herein, we present an additional case of OCD with a focus on the differential diagnosis and review of the pertinent literature, in order to enable better recognition by oral clinicians and pathologists and further characterization of this entity.
CASE PRESENTATION
This paper reports a case of OCD in the posterior mandible of a 22-year-old female. Radiography showed a well-defined unilocular radiolucency with radiopaque materials. The intraoperative frozen section pathology gave a non-committed diagnosis of odontogenic neoplasm with uncertain malignant potential. Then a partial mandibulectomy with free iliac crest bone graft and titanium implants was performed. Microscopically, the tumor consisted of sheets, islands, and cords of round to polygonal epithelial cells associated with an abundant dentinoid matrix. Immunohistochemically, the tumor cells were diffusely positive for CK19, p63, and β-catenin (cytoplasmic and nuclear). No rearrangement of the EWSR1 gene was detected. The final diagnosis was OCD. There has been no evidence of recurrence or metastasis for 58 months after surgery. We also provide a literature review of OCD cases, including one case previously reported as ghost cell odontogenic carcinoma from our hospital.
CONCLUSIONS
OCD is a locally aggressive low grade malignancy without apparent metastatic potential. Wide surgical excision with clear margins and long-term period follow-up to identify any possible recurrence or metastases are recommended. Histopathological examination is essential to conclude the diagnosis. Special care must be taken to distinguish OCD from ghost cell odontogenic carcinoma and clear cell odontogenic carcinoma, as misdiagnosis might lead to unnecessary overtreatment. Study of additional cases is required to further characterize the clinicopathological features and clarify the nosologic status and biological behavior of this tumor.
Topics: Female; Humans; Young Adult; beta Catenin; Diagnosis, Differential; Keratin-19; Mandibular Neoplasms; Odontogenic Tumors; Transcription Factors; Tumor Suppressor Proteins
PubMed: 38890602
DOI: 10.1186/s12903-024-04471-8 -
International Journal of Surgery Case... Jul 2024Cystic lesions in the retrorectal space include developmental abnormality, inflammatory process, and tumor-relevant cysts. Among them, the tailgut cyst is the most...
INTRODUCTION AND IMPORTANCE
Cystic lesions in the retrorectal space include developmental abnormality, inflammatory process, and tumor-relevant cysts. Among them, the tailgut cyst is the most common lesion which is featured by the complex epithelium lining the wall. It is generally accepted that tailgut cysts are embryonic residues and are mostly benign, but there are also reports about malignant transformation and even metastasis.
CASE PRESENTATION
A 44-year-old female complained a sacrococcygeal discomfort more than one year. The imaging diagnosis was an infectious cyst. After surgery, a solid region was defined in a cyst. Morphologically, the region was composed of bland epithelia forming glandular or ribbon-like structure, with round nuclei and fine chromatin. Immunohistochemically, the cells were positive for CK7, CD56 and synaptophysin. The Ki-67-positive cells were about 1 %. The final diagnosis is a low-grade neuroendocrine tumor arising in a tailgut cyst. The patient was living without recurrence by the follow-up of 20 months after surgery.
CLINICAL DISCUSSION
By reviewing the previously reported NET arising from tailgut cysts, we summarized 29 cases of neuroendocrine neoplasms that reported detailed information, and the majority are women. We found that the higher-grade tumor presented a higher tendency of distant metastasis or recurrence after surgery. Complete resection and full evaluation by pathologists are necessary to get a correct diagnosis and avoid disease progression.
CONCLUSION
We reported the rare case of NET G1 arising from a tailgut cyst and reviewed relevant reports, in order to broaden differential diagnoses when an isolated mass is identified in the retrorectal space.
PubMed: 38889516
DOI: 10.1016/j.ijscr.2024.109912 -
Annals of Surgery Open : Perspectives... Mar 2024High-volume pancreatic surgery centers require a significant investment in expertise, time, and resources to achieve optimal patient outcomes. A detailed understanding...
BACKGROUND
High-volume pancreatic surgery centers require a significant investment in expertise, time, and resources to achieve optimal patient outcomes. A detailed understanding of the economics of major pancreatic surgery is limited among many clinicians and hospital administrators. A greater consideration of these financial aspects may in fact have implications for enhancing clinical care and for a broader sustainability of high-volume pancreatic surgery programs.
METHODS
In this retrospective observational study, patients who underwent pancreaticoduodenectomy (PD), total pancreatectomy, or distal pancreatectomy at one academic medical center during the fiscal year 2021 were evaluated. Detailed hospital charges and professional fees were obtained for patients using the Qlik perioperative database. Clinical data for the study cohort were gathered from a prospectively maintained, IRB-approved pancreatic surgery database. Charges for the 91-day perioperative period were included. A < 0.05 was considered significant.
RESULTS
During the study period, 159 evaluable patients underwent 1 of 3 designated pancreatic resections included in the analysis. Ninety-seven patients (61%) were diagnosed with adenocarcinoma and 70% (n = 110) underwent PD. The total charges (combined professional and hospital charges) for the cohort encompassing the entire perioperative period were $20,661,759. The median charge per patient was $130,306 (interquartile range [IQR], $34,534). The median direct cost of care was $23,219 (IQR, $6321) and the median contribution margin per case was $10,092 (IQR, $22,949). The median surgeon professional fee charges were $7700 per patient (IQR, $1296) as compared to $3453 (IQR, $1,144) for professional fee receipts (45% of the surgeon charge). The differences between the professional fee charges and receipts per patient were also considerable for other health care professionals such as anesthesiologists ($4945 charges vs $1406 receipts [28%]) and pathologists ($3035 charges vs $680 receipts [22%]). The surgeon professional fees were only 6% of the total charges, while the professional fees for anesthesiology and pathology were 4% and 2% of the total charges, respectively. Supply charges were 3% of the total charges. Longer operative time was correlated with increased hospital and anesthesia charges, without a significant increase in surgeon charges ( < 0.001, < 0.001, and = 0.2, respectively). Male sex, diabetes, and low serum albumin correlated with greater total hospital charges ( = 0.01, = 0.01, and = 0.03, respectively).
CONCLUSIONS
The role of the surgeon in the perioperative clinical care of major pancreatic resection patients is crucial and important and is by no means limited to the operative day. Nevertheless, in the context of the current US health care system, the reimbursement to the surgeon in the form of professional fees is a relatively small fraction of the total health care receipts for these patients. This imbalance necessitates a substantial financial partnership between hospitals and their pancreatic surgery units to ensure the long-term viability of these programs.
PubMed: 38883966
DOI: 10.1097/AS9.0000000000000362 -
Cureus May 2024Oncocytes are frequently encountered in routine thyroidectomies. The distinction between oncocytic hyperplastic nodules and oncocytic adenomas (OAs) may be challenging....
Oncocytes are frequently encountered in routine thyroidectomies. The distinction between oncocytic hyperplastic nodules and oncocytic adenomas (OAs) may be challenging. Although both entities are benign, a precise diagnosis is essential. We present two cases of solitary oncocytic lesions carrying pathogenic mutations in the p53 and NRAS genes, respectively, leading to a histological diagnosis of oncocytic hyperplastic nodules. Additionally, similar oncocytic nodules from two cases of autoimmune thyroiditis did not show any significant findings on molecular analysis (next-generation sequencing, NGS). Hence, this brief investigative series study is of particular diagnostic interest because it prompts pathologists to use the term adenoma when a solitary oncocytic nodule is encountered, regardless of the established criteria for the diagnosis of adenoma. This viewpoint leads to the possible need for the reevaluation of the histological criteria of adenomas when it comes to oncocytic lesions in order to gain a common diagnostic approach and nomenclature among pathologists and overcome any controversies in such cases.
PubMed: 38882980
DOI: 10.7759/cureus.60361 -
Journal of Pharmacy & Bioallied Sciences Apr 2024AI in healthcare services is advancing every day, with a focus on uprising cognitive capabilities. Higher cognitive functions in AI entail performing intricate processes...
Utilizing Artificial Intelligence Application for Diagnosis of Oral Lesions and Assisting Young Oral Histopathologist in Deriving Diagnosis from Provided Features - A Pilot study.
BACKGROUND
AI in healthcare services is advancing every day, with a focus on uprising cognitive capabilities. Higher cognitive functions in AI entail performing intricate processes like decision-making, problem-solving, perception, and reasoning. This advanced cognition surpasses basic data handling, encompassing skills to grasp ideas, understand and apply information contextually, and derive novel insights from previous experiences and acquired knowledge. ChatGPT, a natural language processing model, exemplifies this evolution by engaging in conversations with humans, furnishing responses to inquiries.
OBJECTIVE
We aimed to understand the capability of ChatGPT in solving doubts pertaining to symptoms and histological features related to subject of oral pathology. The study's objective is to evaluate ChatGPT's effectiveness in answering questions pertaining to diagnoses.
METHODS
This cross-sectional study was done using an AI-based ChatGPT application that provides free service for research and learning purposes. The current version of ChatGPT3.5 was used to obtain responses for a total of 25 queries. These randomly asked questions were based on basic queries from patient aspect and early oral histopathologists. These responses were obtained and stored for further processing. The responses were evaluated by five experienced pathologists on a four point liekart scale. The score were further subjected for deducing kappa values for reliability.
RESULT & STATISTICAL ANALYSIS
A total of 25 queries were solved by the program in the shortest possible time for an answer. The sensitivity and specificity of the methods and the responses were represented using frequency and percentages. Both the responses were analysed and were statistically significant based on the measurement of kappa values.
CONCLUSION
The proficiency of ChatGPT in handling intricate reasoning queries within pathology demonstrated a noteworthy level of relational accuracy. Consequently, its text output created coherent links between elements, producing meaningful responses. This suggests that scholars or students can rely on this program to address reasoning-based inquiries. Nevertheless, considering the continual advancements in the program's development, further research is essential to determine its accuracy levels in future versions.
PubMed: 38882904
DOI: 10.4103/jpbs.jpbs_1287_23 -
Journal of Pharmacy & Bioallied Sciences Apr 2024histopathology plays a pivotal role in clinical diagnosis, research, and medical education. In recent years, whole slide imaging (wsi) has emerged as a potential...
BACKGROUND
histopathology plays a pivotal role in clinical diagnosis, research, and medical education. In recent years, whole slide imaging (wsi) has emerged as a potential alternative to traditional microscopy for pathological examination. This study aims to provide a comprehensive comparison of wsi and traditional microscopy(tm) in various aspects of histopathology practice.
MATERIALS AND METHODS
In this study, total of 30 cases comprising of oral premalignant and malignant cases which were diagnostically challenging was considered from the archives of the institute for validation. The slides were scanned with slide scanner and were evaluated by histopathologists. The comparative parameters which were noted were diagnostic discordances, number of fields observed to reach the diagnosis and time taken.
RESULTS
The mean time taken by the pathologists to reach the diagnosis was significantly less in whole slide imaging technique. The average number of fields observed was higher by using wsi that too in a lesser time compared to tm, the results were found to be statistically significant with p=0.001.however the diagnostic disparity were seen to be maximum for verrucous lesions both in wsi and tm.
CONCLUSION
wsi has facilitated the specialty with rapid mode of diagnosis in a more efficient and error less manner. It has also aided in case banking as well as research possibilities. Hence with the advent of telepathology it is very much necessary to get trained with wsi as early as possible so that the professionals can render correct diagnosis.
PubMed: 38882897
DOI: 10.4103/jpbs.jpbs_1042_23 -
Journal of Pharmacy & Bioallied Sciences Apr 2024Tumor budding is a distinctive phenomenon which involves the presence of small clusters or individual cancer cells at the invasive front of tumors. Tumor budding has...
INTRODUCTION AND AIM
Tumor budding is a distinctive phenomenon which involves the presence of small clusters or individual cancer cells at the invasive front of tumors. Tumor budding has garnered attention due to its potential implications for prognosis, treatment strategies, and our understanding of cancer progression. Our aim is to study the distribution of tumor buds and its scoring in patients with infiltrating breast carcinoma and to associate with other histopathological parameters like the size of the tumor, its grade, lymphovascular invasion, and lymph node metastasis.
MATERIALS AND METHODS
This was a study analyzing the data of 70 resected specimens of primary breast carcinomas and providing a descriptive overview. Tumor budding was recognized, counted, and graded in hematoxylin and eosin slides. The cases were classified as low (0-4), intermediate (5-9), and high (≥10 buds) based on the count of tumor buds. Tumor budding has significant correlation with tumor grade and tumor size.
RESULTS
Of the 70 cases, 60 cases (85.71%) were diagnosed as invasive ductal carcinoma NOS. The majority [38 (54.28%)] of the cases showed an intermediate tumor budding score of 5-9/10 HPF.
CONCLUSION
Evaluation of tumor budding allows pathologists and oncologists to gather valuable information about the tumor's biological aggressiveness and potential for metastasis. It also helps in better risk stratification of patients, enabling a more personalized and tailored approach to treatment planning. In conclusion, assessing tumor budding in breast carcinoma holds significant clinical importance in the management and prognosis of this disease.
PubMed: 38882784
DOI: 10.4103/jpbs.jpbs_910_23 -
Ocular Oncology and Pathology Jun 2024Eugene Wolff (1896-1954) and Jonas S. Friedenwald (1897-1955) were life-long students and educators of anatomic pathology and ophthalmology. Both contributed toward... (Review)
Review
BACKGROUND
Eugene Wolff (1896-1954) and Jonas S. Friedenwald (1897-1955) were life-long students and educators of anatomic pathology and ophthalmology. Both contributed toward narrowing the gap between the two rapidly diverging specialties of pathology and ophthalmology. Friedenwald in 1929 and Wolff in 1934 each published textbooks of ophthalmic pathology that influenced medical education for decades to come.
SUMMARY
Friedenwald's and Wolff's introduced ophthalmologists in training and practice to anatomic pathology, while familiarizing pathologists with the nature of ocular disease. Both books appeared at the time when anatomic pathology was departing from its mostly academic roles in education and research to assume more active participation in clinical care by establishing diagnoses through biopsy.
KEY MESSAGES
Wolff and Friedenwald dedicated their careers to teaching the art and science of anatomic pathology to clinical ophthalmologists. Their efforts helped anchor ophthalmology to the traditions of mainstream medicine.
PubMed: 38882023
DOI: 10.1159/000537784 -
Translational Cancer Research May 2024In lung cancer, molecular testing and next-generation sequencing (NGS) are needed to identify therapeutic targets and are increasingly being used in earlier stages of...
BACKGROUND
In lung cancer, molecular testing and next-generation sequencing (NGS) are needed to identify therapeutic targets and are increasingly being used in earlier stages of the disease. Despite its longstanding use, it remains unclear whether transbronchial needle aspiration (TBNA) of peripheral lung lesions provides as adequate material for genetic testing as transbronchial forceps biopsies (TBFBs). In this study, we aim to analyze the use of TBNA using median viable cell area (MVCA) as a surrogate parameter to analyze sample quality.
METHODS
This prospective single-center study analyzed biopsy specimens or aspirates of patients who underwent bronchoscopy with transbronchial biopsy. Patients underwent bronchoscopy with TBFB and TBNA for suspected lung cancer in peripheral lung lesions. Patients were randomized 1:1 to receive either TBFB or TBNA as the first biopsy technique and then switched to the other. After routine workup, sample slides were digitally scanned, and MVCA was calculated by a pathologist blinded to the biopsy technique used. The primary endpoint was MVCA of TBNA versus TBFB. Secondary endpoints were complications categorized as bleeding, pneumothorax, and other.
RESULTS
Between August 2021 and April 2022, 15 patients were included in the per-protocol analysis. Six patients were included in cohort 1 and nine patients in cohort 2. A malignant diagnosis was confirmed in 11/15 (73.3%) cases, of which nine were primary lung malignancies. Overall, MVCA in samples obtained by TBFB was significantly larger than TBNA samples {TBFB-MVCA 9.80 mm [interquartile range (IQR), 2.70-10.39 mm] . TBNA-MVCA 2.70 mm (IQR, 0.14-8.21 mm), P=0.008}. Despite this difference, molecular testing was feasible in both TBNA and TBFB samples. No major complications were observed.
CONCLUSIONS
Despite a significantly smaller MVCA provided by TBNA, samples were still considered feasible for NGS, indicating that TBNA represents an alternative method to obtain sufficient tumor tissue in peripheral nodules as part of the diagnosis of suspected lung cancer.
PubMed: 38881945
DOI: 10.21037/tcr-23-2320 -
Translational Cancer Research May 2024Cancer is a leading cause of morbidity and mortality worldwide. The emergence of digital pathology and deep learning technologies signifies a transformative era in... (Review)
Review
BACKGROUND AND OBJECTIVE
Cancer is a leading cause of morbidity and mortality worldwide. The emergence of digital pathology and deep learning technologies signifies a transformative era in healthcare. These technologies can enhance cancer detection, streamline operations, and bolster patient care. A substantial gap exists between the development phase of deep learning models in controlled laboratory environments and their translations into clinical practice. This narrative review evaluates the current landscape of deep learning and digital pathology, analyzing the factors influencing model development and implementation into clinical practice.
METHODS
We searched multiple databases, including Web of Science, Arxiv, MedRxiv, BioRxiv, Embase, PubMed, DBLP, Google Scholar, IEEE Xplore, Semantic Scholar, and Cochrane, targeting articles on whole slide imaging and deep learning published from 2014 and 2023. Out of 776 articles identified based on inclusion criteria, we selected 36 papers for the analysis.
KEY CONTENT AND FINDINGS
Most articles in this review focus on the in-laboratory phase of deep learning model development, a critical stage in the deep learning lifecycle. Challenges arise during model development and their integration into clinical practice. Notably, lab performance metrics may not always match real-world clinical outcomes. As technology advances and regulations evolve, we expect more clinical trials to bridge this performance gap and validate deep learning models' effectiveness in clinical care. High clinical accuracy is vital for informed decision-making throughout a patient's cancer care.
CONCLUSIONS
Deep learning technology can enhance cancer detection, clinical workflows, and patient care. Challenges may arise during model development. The deep learning lifecycle involves data preprocessing, model development, and clinical implementation. Achieving health equity requires including diverse patient groups and eliminating bias during implementation. While model development is integral, most articles focus on the pre-deployment phase. Future longitudinal studies are crucial for validating models in real-world settings post-deployment. A collaborative approach among computational pathologists, technologists, industry, and healthcare providers is essential for driving adoption in clinical settings.
PubMed: 38881914
DOI: 10.21037/tcr-23-964