Interpretation of needle biopsies of the kidney for investigation of renal masses

The development of new therapeutic options for renal tumors has lead to the need of a pretherapeutic diagnosis for an increasing proportion of patients presenting with a renal mass. This need is particularly important for a small, incidentally discovered renal mass (less than 4cm) as it can be a benign lesion in a significant percentage of cases. Recent studies have shown that needle biopsy is an accurate and safe method allowing for a precise histopathological diagnosis of the mass in most cases. The aims of the biopsy are (1) to assess the benign or malignant nature of the lesion, (2) to assess the primary or secondary nature of the lesion, and (3), in case of a primary malignancy, to determine histological prognostic factors, such as the tumor type. This review, based on the most recent literature and our own experience, is intended to provide a practical approach to the diagnosis, relying on appropriate morphologic assessment and the use of immunohistochemistr

Analysis of the clinical relevance of histological classification of benign epithelial salivary gland tumours

IntroductionA vast increase in knowledge of numerous aspects of malignant salivary gland tumours has emerged during the last decade and, forseveral reasons, thishas not been the case in benign epithelial salivary gland tumours. We have performed a literature review to investigate whether an accurate histological diagnosis of the 11 different types of benign epithelial salivary gland tumours is correlated to any differences in their clinical behaviour.MethodsA search was performed for histological classifications, recurrence rates and risks for malignant transformation, treatment modalities, and prognosis of these tumours. The search was performed primarily through PubMed, Google Scholar, and all versions of WHO classifications since 1972, as well as numerous textbooks on salivary gland tumours/head and neck/pathology/oncology. A large number of archival salivary tumours were also reviewed histologically.ResultsPleomorphic adenomas carry a considerable risk (5-15%) for malignant transformation but, albeit to a much lesser degree, so do basal cell adenomas and Warthin tumours, while the other eight types virtually never develop into malignancy. Pleomorphic adenoma has a rather high risk for recurrence while recurrence occurs only occasionally in sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and the membranous type of basal cell adenoma. Papillomas, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (solid, trabecular and tubular subtypes) very rarely, if ever, recur.ConclusionsA correct histopathological diagnosis of these tumours is necessary due to (1) preventing confusion with malignant salivary gland tumours; (2) only one (pleomorphic adenoma) has a considerable risk for malignant transformation, but all four histological types ofbasal cell adenoma canoccasionally develop into malignancy, as does Warthin tumour; (3) sialadenoma papilliferum, oncocytoma, canalicular adenoma, myoepithelioma and Warthin tumour only occasionally recur; while (4) intraductal and inverted papilloma, lymphadenoma, sebaceous adenoma, cystadenoma, basal cell adenoma (apart from the membranous type) virtually never recur. No biomarker was found to be relevant for predicting recurrence or potential malignant development. Guidelines for appropriate treatment strategies are given.info:eu-repo/semantics/publishedVersio

Oncocytoma of the Parotid Gland and its Mimickers: A Comprehensive Review

Oncocytomas are benign neoplasms composed of oncocytes; the large eosinophilic      cuboidal to columnar cells with more than 60% of their cytoplasm occupied by mitochondria. Oncocytomas represent less than 1% of the salivary gland neoplasms and 82% to 90% of them occur in the parotid gland. Salivary gland oncocytomas constitute 2.5% of the parotid gland tumors. Despite the well-recognized morphology of this tumor, there is a wide range of neoplasms that may mimic oncocytoma and hence need to be considered in its differentialdiagnosis. A predominantly clear cell variant of oncocytoma may resemble a number of salivary gland neoplasms where clear  cells   may   be  prominent.   In  addition,  oncocytic metaplasia may be a focal or an extensive component of other distinct salivary gland neoplasms. An awareness of all the possible “mimickers” of clear cell oncocytoma becomes more significant in view of the fact that most are malignant neoplasms with a poor prognosis

Correlation between periacinar retraction clefting and the expression of E-cadherin and Beta-catenin proteins in prostatic adenocarcinoma

Periacinar retraction clefting represents a criteria favoring prostatic adenocarcinoma diagnosis. In the present study, tissues from 53 cases of prostate morphologically diagnosed as prostatic adenocarcinoma and the adjacent nonneoplastic prostatic tissue were evaluated for the presence and the extent of periacinar retraction clefting. Immunohistochemistry (IHC) was used to evaluate the expression of E-cadherin and β-catenin, and this expression was compared with GSC, sPSA, positive surgical margins, BCR, TNM stage, and periacinar retraction clefting. Our study confirmed that periacinar retraction clefting is significantly more extensive in prostatic adenocarcinoma than in nonneoplastic prostatic tissue (P<0.001).We found a decreased expression of E-cadherin and β-catenin in prostatic adenocarcinoma and a negative correlation with GSC, positive surgical margins, BCR, and T stage. Periacinar clefting was positively correlated with the intensity of E-cadherin staining (rho=0.398; P=0.003), the percentage of E-cadherin staining (rho=0.367; P=0.007), the intensity of β-catenin staining (rho= 0.374; P=0.006) and the percentage of β-catenin staining (rho=0.347; P=0.011) in prostatic adenocarcinoma. However, in 4 (7.54%) samples with Gleason score (GSC) 7 (4+3) and with a mixed population of positive and negative cells, E-cadherin staining was weak to negative in the cells of tumor glands with periacinar clefts and positive in tumor glands with no periacinar clefts. This suggests that E-cadherin might play a role in the origin of periacinar clefting in higher grade tumors

A Correlative Cytological and Histopathological Study on Lesions of Salivary Gland.

Salivary Glands Are Unique Amongst The Secretory Glands, With Most Heterogenous Group Of Tumors, Exhibiting Greatest Histological Diversity. Bland Sutton Aptly Said “Tumors Of The Salivary Gland Are A Pathological Puzzle And A Source Of Unsatisfactory Speculation”. A Swelling Involving The Salivary Gland May Be As A Result Of Inflammation, Cyst Or Neoplasm. 30% Of Parotid Masses And 85% Of Submandibular Masses Are Non-Neoplastic. Tumors Of Salivary Glands Are Uncommon And Comprise Less Than 3% Of All Tumors Of Head And Neck. The Nature Of The Lesion Cannot Be Determined On Clinical Examination And Therefore Pathological Examination Is Required For Definite Diagnosis In Suspected Cases Of Neoplastic Disease. Nowadays Fine Needle Aspiration Cytology Has Emerged As An Effective And Sensitive Technique In The Diagnosis Of Lesions Of Major Or Minor Salivary Glands. Fna Is Virtually Risk Free, Simple, Rapid, Inexpensive Technique And Provides The Clinician A Definite Preoperative Diagnosis And Thus Can Facilitate Further Management. The Usefulness Of Fna In Salivary Gland Lesions Was First Observed By Karolinska Group Nearly 30 Years Ago Who Documented The Diagnostic Accuracy Of Fna In A Large Series Of Cases. Salivary Glands Are Generally Not Subjected To Incisional Or Core Biopsy Because Of The Possible Risk Of Fistula, Facial Nerve Injury And Tumor Implantation In The Cases Of Neoplasms. In The Present Study, The Utility Of Fna Cytology In The Diagnosis Of Salivary Gland Enlargement Was Studied By Correlating The Cytological Findings With The Histopathological Features. Diagnostic Accuracy, Specificity And Sensitivity Were Evaluated. The Diagnostic Pitfalls Of Fna Of Salivary Lesions Were Identified And The Possible Ways To Rectify The Misdiagnosis Were Proposed. In Addition, The Recent Literature Regarding Epidemiology, Clinical Features, Cytopathology And Histomorphology Of Salivary Gland Lesions Were Reviewed

A Five Year Retrospective Histopathologic Study on Salaivary Gland Lesions

This study analyzed the incidence and distribution of salivary gland lesions over a period of 5 years from the specimen submitted to the pathology department of Tirunelveli Medical College during the period between 2006 to 2010. Distribution of lesions recorded were neoplasm 78.75%, sialadenitis 20% and sialolithasis 1.25%. Lesions occurred from 10 years to 80 years of age with the mean age of 41.19. There is predominance of lesions in females than males was seen. Parotid gland was mostly affected followed by submandibular gland. Tumour was recorded from 10 to 80 years of age and 76.19% of tumours occurred at the age group of 20 to 60 years. Most of the benign tumour was seen in the second and third decades while malignant was in fifth decade of life. Females were mostly affected then males. Most tumours were in the parotid gland followed by submandibular gland. Most common benign tumour was pleomorphic adenoma while malignant tumour was mucoepidermoid carcinoma and acinic cell carcinoma. Sialadenitis was most common non neoplastic lesion and seen between 15 to 56 years of age. It was seen mostly in females then males. Submandibular gland was mostly affected followed by parotid gland. Analysis of the lesions showed statistically significant difference in age, sex, site distribution except submandibular sialadenitis and age distribution of malignant tumour

Morphological, immunohistochemical and genetic aspects of acinar and ductal adenocarcinoma of the prostate

Prostate cancer is one of the most common causes of cancer-related death in developed countries. Acinar adenocarcinoma is by far the most common subtype of prostate cancer, with ductal adenocarcinoma being the second most common subtype. Biobanking of prostate cancer tissue is important for basic research, development of new biomarkers and a move towards personalized medicine. Various biobanking techniques have been described but harvesting of tissue is still often based on macroscopic identification of cancer in radical prostatectomy specimens. In the literature, the macroscopic features of prostate cancer in unfixed prostatectomy specimens are incompletely described. In our first study, we investigated the macroscopic features of identifiable tumors and their zonal distribution in 514 radical prostatectomy specimens. Grossly detected findings conclusive for cancer were seen in 52% of cases and suspicious for cancer in 24%. Macroscopic findings conclusive for cancer predicted microscopic identification of prostate cancer on microscopic examination in most cases. Cancers ≥2 mm were present somewhere on the cut surface in the majority of cases even when no suspicious or conclusive cancers had been identified macroscopically. Tumors in the transition zone of the prostate were more difficult to identify macroscopically. In our second study, we report a novel biobanking protocol for harvesting a full horizontal slice of unfixed prostate tissue from 20 radical prostatectomy specimens. In 18 of 20 cases, cancer was found in the biobanked tissue material. The biobanking protocol facilitated harvesting of a large slice of prostatic tissue, allowing studies of multifocal tumors and tumor heterogeneity. Clinical histopathological parameters could be reported from frozen sections of the biobanked material. The morphological quality, using cryogel, and the RNA quality, measured by RNA integrity number (RIN), were excellent. Ductal adenocarcinoma is a high-grade neoplasm with an adverse prognosis compared to acinar adenocarcinoma. The definition of ductal adenocarcinoma is based on histological features. Ductal adenocarcinoma usually presents in mixed tumors together with acinar adenocarcinoma. For a long time, the histogenesis and definition of ductal adenocarcinoma has been controversial. Some studies have suggested that acinar and ductal adenocarcinoma components may have a common clonal background. Expression of Programmed Death Ligand-1 (PD-L1) is a predictive biomarker for a new group of oncological drugs, immune checkpoint inhibitors. The frequency of PD-L1 expression in ductal adenocarcinoma is not well described. Deficient mismatch repair (dMMR) results in an accumulation of mutations in cancer cells. dMMR has been reported to be uncommon in prostate cancer. In our third study, we investigated the expression of PD-L1, dMMR and tumor infiltrating immune cells in acinar and ductal adenocarcinoma using a tissue microarray (TMA). PD-L1 expression in tumor cells was rare but more common in tumor infiltrating immune cells. PD-L1 expression was identified in tumor infiltrating immune cells in 29% of ductal adenocarcinomas. dMMR was rare, identified in only 5% of cases. There was a statistically significant increase in the number of CD8+ lymphocytes in ductal adenocarcinoma compared to acinar adenocarcinoma. In our final study, we investigated the clonal relationship between acinar and ductal adenocarcinoma components in mixed prostate cancers. Targeted sequencing was performed in 15 cases, followed by bioinformatic processing and manual curation of data. A common somatic denominator for both tumor components could be identified in 12 out of 15 cases indicating a common clonal origin. Increased ploidy, which is associated with advanced prostate cancer, was seen in more than half (53%) of ductal adenocarcinomas but not in any acinar adenocarcinoma. PTEN and CTNNB1 mutations were common in ductal adenocarcinoma (40%) but not seen in any acinar adenocarcinoma. In both acinar and ductal adenocarcinomas, ERG gene fusions were detected in 47%. No cases showed microsatellite instability or high tumor mutation burden. The genetic signature of ductal adenocarcinoma was consistent with its characterization of ductal adenocarcinoma as an aggressive form of prostate cance

Histopathological Analysis of Salivary Gland Lesions and Role of Immunohistochemistry in Differential Diagnosis

BACKGROUND: Tumors of salivary gland have diverse histological forms and unpredictable clinical behavior. The diverse site of origin and complexity of classification further compound the difficulties in diagnosis. The main application of immunohistochemistry in salivary gland tumors is to demonstrate the existence of myoepithelial/basal cells or luminal cells. OBJECTIVES: 1. To determine the incidence, age, sex, site distribution of lesions in various salivary glands and to study the histomorphological appearance of these lesions. 2. To study the expression of various Immunohistochemical markers in salivary gland tumors. METHODS: Surgically resected specimens received at Department of pathology, Thanjavur Medical College were subjected to histopathological examination. Specimen were fixed in 10% formalin, processed and embedded in paraffin blocks. Serially cut to get sections of 3-5microns thickness, stained with Hemotoxylin and Eosin, Histochemistry and Immunohistochemistry were done wherever necessary. RESULTS: The total number of specimens was 92, of which 41were neoplastic (benign44.56% and malignant 25%) 28 were nonneoplastic. Pleomorphic adenoma was the commonest benign tumor accounting for73.17% of benign tumors. Mucoepidermoid carcinoma was the most common malignant tumor accounting for 52.18% of malignant tumors. Parotid is the common salivary gland involved followed by minor salivary and submandibular gland.salivary gland tumors shows slight female preponderance with male female ratio of 1:1.7. Expression of p63 in pleomorphic adenoma has confirmed the role of myoepithelial cells in the histiogenesis of this tumor. Lack or minimal expression of p63 in Mucoepidermoid indicates minimal myoepithelial cell differentiation in these tumors. CONCLUSION: Histopathology is still the goldern standard for diagnosis of salivary gland tumor. IHC do not directly indicate a def inite diagnosis. It can enhance the accuracy and be a helpful tool when the diagnosis cannot be assessed by histological examination such as cell of origin, cell proliferation and tumor protein expression

Cytologic Spectrum of Salivary Gland Lesions with Histopathological Correlation

BACKGROUND: FNAC offers an invaluable and accurate initial diagnostic tool for the evaluation of salivary gland lesions .Keeping Histopathological diagnosis as gold standard sensitivity, specificity and diagnostic accuracy of FNAC was calculated. OBJECTIVES: 1. To analyse the clinical ,histological and cytological features of salivary gland lesions with Histological diagnosis. 2. To analyse the reasons for diagnostic pitfalls in cases that have cytohistological discrepancy. MATERIALS AND METHODS: This was a prospective study of FNAC and subsequent histopathology of major salivary gland lesions performed in the Department of Pathology Coimbatore medical college from August 2018-July 2019. RESULTS: Out of 45 cases, Histopathological confirmation showed 9 cases as non neoplastic, 28 cases as benign and 8 cases as malignant. We found a good concordance between FNAC and Histology. There was a significant relationship between consistency, site and cellularity of lesion and benign vs malignant. CONCLUSION: FNAC is a safe initial diagnostic tool in distinguishing benign and malignant lesions. In the present study FNAC and Histopathology complemented each other for diagnosis