DSDM (Digital Slide Dynamic Morphometry): targeting tumor budding in colorectal cancer.

Background: In histopathology, quantitative assessment of various morphologic features is based on published methods that were conceived on specific areas observed through the microscope and microscopical objective used. Failure to reproduce the same reference field size if using a different microscope may change the score assessed. When visualizing a digital slide on a computer screen, through a dedicated viewer, it is possible to select the adequate objective-magnification (zoom toolbar). However, the field of view is rectangular, different from the circular field area viewed by optical microscopy. In addition, the evaluation of the size of the selected area of the digital slide is not immediately evident and must be estimated with the draw functions of the viewer or the scale/axes grid. Methods: Using the tools offered by ImageScope, the virtual slide viewer of Aperio Technologies (Vista, USA), a system was conceived to reproduce the various methods published for assessing tumor budding, an important prognostic factor in colorectal cancer. Each method, based on counting tumor budding within a specific area, was reproduced as a colored circle, corresponding to a graphic overlay layer. The various circles were grouped in a target-like shape and then exported and saved as an .xml file. A web page was created giving access to 100 whole-slide digital scans. When each digital slide was opened the file containing the target-like area had to be imported in order to move it onto a tumor budding \u201chot spot\u201d and to perform the measurements. Eighteen international experts in gastrointestinal pathology were invited to participate. Results: Twelve investigators completed the task, the majority of them performing the multiple assessments of each case in less than 12 minutes. Conclusions: The assessing system proposed appeared to be feasible for pathologists. It allows precise application of methods originally conceived for optical microscopy. The graphical layers that make the tool are freely moved within the digital slide: this system was named DSDM (Digital Slide Dynamic Morphometry). This telepathology extension has various potential applications and might be a useful tool for histopathological assessment of diagnostic parameters that need to be quantified

DSDM (Digital Slide Dynamic Morphometry): targeting tumor budding in colorectal cancer.

Background: In histopathology, quantitative assessment of various morphologic features is based on published methods that were conceived on specific areas observed through the microscope and microscopical objective used. Failure to reproduce the same reference field size if using a different microscope may change the score assessed. When visualizing a digital slide on a computer screen, through a dedicated viewer, it is possible to select the adequate objective-magnification (zoom toolbar). However, the field of view is rectangular, different from the circular field area viewed by optical microscopy. In addition, the evaluation of the size of the selected area of the digital slide is not immediately evident and must be estimated with the draw functions of the viewer or the scale/axes grid. Methods: Using the tools offered by ImageScope, the virtual slide viewer of Aperio Technologies (Vista, USA), a system was conceived to reproduce the various methods published for assessing tumor budding, an important prognostic factor in colorectal cancer. Each method, based on counting tumor budding within a specific area, was reproduced as a colored circle, corresponding to a graphic overlay layer. The various circles were grouped in a target-like shape and then exported and saved as an .xml file. A web page was created giving access to 100 whole-slide digital scans. When each digital slide was opened the file containing the target-like area had to be imported in order to move it onto a tumor budding “hot spot” and to perform the measurements. Eighteen international experts in gastrointestinal pathology were invited to participate. Results: Twelve investigators completed the task, the majority of them performing the multiple assessments of each case in less than 12 minutes. Conclusions: The assessing system proposed appeared to be feasible for pathologists. It allows precise application of methods originally conceived for optical microscopy. The graphical layers that make the tool are freely moved within the digital slide: this system was named DSDM (Digital Slide Dynamic Morphometry). This telepathology extension has various potential applications and might be a useful tool for histopathological assessment of diagnostic parameters that need to be quantified

Accuracy of deep learning to differentiate the histopathological grading of meningiomas on MR images: a preliminary study

Background: Grading of meningiomas is important in the choice of the most effective treatment for each patient. Purpose: To determine the diagnostic accuracy of a deep convolutional neural network (DCNN) in the differentiation of the histopathological grading of meningiomas from MR images. Study Type: Retrospective. Population: In all, 117 meningioma-affected patients, 79 World Health Organization [WHO] Grade I, 32 WHO Grade II, and 6 WHO Grade III. Field Strength/Sequence: 1.5 T, 3.0 T postcontrast enhanced T1 W (PCT1W), apparent diffusion coefficient (ADC) maps (b values of 0, 500, and 1000 s/mm2). Assessment: WHO Grade II and WHO Grade III meningiomas were considered a single category. The diagnostic accuracy of the pretrained Inception-V3 and AlexNet DCNNs was tested on ADC maps and PCT1W images separately. Receiver operating characteristic curves (ROC) and area under the curve (AUC) were used to asses DCNN performance. Statistical Test: Leave-one-out cross-validation. Results: The application of the Inception-V3 DCNN on ADC maps provided the best diagnostic accuracy results, with an AUC of 0.94 (95% confidence interval [CI], 0.88\u20130.98). Remarkably, only 1/38 WHO Grade II\u2013III and 7/79 WHO Grade I lesions were misclassified by this model. The application of AlexNet on ADC maps had a low discriminating accuracy, with an AUC of 0.68 (95% CI, 0.59\u20130.76) and a high misclassification rate on both WHO Grade I and WHO Grade II\u2013III cases. The discriminating accuracy of both DCNNs on postcontrast T1W images was low, with Inception-V3 displaying an AUC of 0.68 (95% CI, 0.59\u20130.76) and AlexNet displaying an AUC of 0.55 (95% CI, 0.45\u20130.64). Data Conclusion: DCNNs can accurately discriminate between benign and atypical/anaplastic meningiomas from ADC maps but not from PCT1W images. Level of evidence: 2 Technical Efficacy: Stage

Biliary Involvement in Type 2 Autoimmune Pancreatitis

Autoimmune pancreatitis (AIP) is a rare condition classified in 2 subtypes. Their distinction relies on a combination of clinical, serological, morphological and histological features. Type 1 is a pancreatic manifestation of IgG4-related disease characterized by multiorgan infiltration by IgG4 plasmocytes. In this condition, hepatobiliary infiltration is frequent and often mimics cholangiocarcinoma or primary sclerosing cholangitis. On the other hand, type 2 is commonly limited to the pancreas. Herein, we describe the case of a patient who presented a type 2 AIP associated with cholangiopathy, a condition not described in the established criteria. He first developed a pancreatitis identified as type 2 by the typical histopathological features and lack of IgG4 in the serum and tissue. Despite a good clinical response to steroids, cholestasis persisted, identified by MR cholangiography as a stricture of the left hepatic duct with dilatation of the intrahepatic bile duct in segments 2 and 3. Biliary cytology was negative. Evolution was favorable but after steroid tapering a few months later, the patient suffered from recurrence of the pancreatitis as well as progression of biliary attempt, suspicious for cholangiocarcinoma. As the investigations again ruled out neoplastic infiltration or primary sclerosing cholangitis, azathioprine was initiated with resolution of both pancreatic and biliary attempts

Small primary adenocarcinoma in adenomyosis with nodal metastasis: a case report

<p>Abstract</p> <p>Background</p> <p>Malignant transformation of adenomyosis is a very rare event. Only about 30 cases of this occurrence have been documented till now.</p> <p>Case presentation</p> <p>The patient was a 57-year-old woman with a slightly enlarged uterus, who underwent total hysterectomy and unilateral adnexectomy. On gross inspection, the uterine wall displayed a single nodule measuring 5 cm and several small gelatinous lesions. Microscopic examination revealed a common leiomyoma and multiple adenomyotic foci. A few of these glands were transformed into a moderately differentiated adenocarcinoma. The endometrium was completely examined and tumor free. The carcinoma was, therefore, considered to be an endometrioid adenocarcinoma arising from adenomyosis. Four months later, an ultrasound scan revealed enlarged pelvic lymph nodes: a cytological diagnosis of metastatic adenocarcinoma was made.</p> <p>Immunohistochemical studies showed an enhanced positivity of the tumor site together with the neighbouring adenomyotic foci for estrogen receptors, aromatase, p53 and COX-2 expression when compared to the distant adenomyotic glands and the endometrium. We therefore postulate that the neoplastic transformation of adenomyosis implies an early carcinogenic event involving p53 and COX-2; further tumor growth is sustained by an autocrine-paracrine loop, based on a modulation of hormone receptors as well as aromatase and COX-2 local expression.</p> <p>Conclusion</p> <p>Adenocarcinoma in adenomyosis may be affected by local hormonal influence and, despite its small size, may metastasize.</p

Acute Delta Hepatitis in Italy spanning three decades (1991–2019): Evidence for the effectiveness of the hepatitis B vaccination campaign

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p &lt; .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p &lt; .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come

DSDM (Digital Slide Dynamic Morphometry): targeting tumor budding in colorectal cancer.

Background: In histopathology, quantitative assessment of various morphologic features is based on published methods that were conceived on specific areas observed through the microscope and microscopical objective used. Failure to reproduce the same reference field size if using a different microscope may change the score assessed. When visualizing a digital slide on a computer screen, through a dedicated viewer, it is possible to select the adequate objective-magnification (zoom toolbar). However, the field of view is rectangular, different from the circular field area viewed by optical microscopy. In addition, the evaluation of the size of the selected area of the digital slide is not immediately evident and must be estimated with the draw functions of the viewer or the scale/axes grid. Methods: Using the tools offered by ImageScope, the virtual slide viewer of Aperio Technologies (Vista, USA), a system was conceived to reproduce the various methods published for assessing tumor budding, an important prognostic factor in colorectal cancer. Each method, based on counting tumor budding within a specific area, was reproduced as a colored circle, corresponding to a graphic overlay layer. The various circles were grouped in a target-like shape and then exported and saved as an .xml file. A web page was created giving access to 100 whole-slide digital scans. When each digital slide was opened the file containing the target-like area had to be imported in order to move it onto a tumor budding “hot spot” and to perform the measurements. Eighteen international experts in gastrointestinal pathology were invited to participate. Results: Twelve investigators completed the task, the majority of them performing the multiple assessments of each case in less than 12 minutes. Conclusions: The assessing system proposed appeared to be feasible for pathologists. It allows precise application of methods originally conceived for optical microscopy. The graphical layers that make the tool are freely moved within the digital slide: this system was named DSDM (Digital Slide Dynamic Morphometry). This telepathology extension has various potential applications and might be a useful tool for histopathological assessment of diagnostic parameters that need to be quantified