The staging of gastritis with the olga system in the italian setting. histological features and gastric cancer risk

BACKGROUND: Recently OLGA (Operative Link on Gastritis Assessment) classification has been proposed to identify high-risk forms of gastritis that can evolve in gastric cancer (stages III and IV). Helicobacter pylori infection and age older than 40 have been considered as independent risk factor for high-risk OLGA stages

UTILITY OF CYTOKERATIN 20 IN IDENTIFYING THE ORIGIN OF METASTATIC CARCINOMAS IN EFFUSIONS

Using a commercially available monoclonal antibody (K(s)20.1) and the avidin-biotin peroxidase method on cytospins and cell blocks, we analyzed cytokeratin (CK) 20 expression in 169 serous effusions. Cytoplasmic staining was observed in 44/151 malignant fluids. Colon, gastric, and pancreatic adenocarcinomas and mucinous ovarian tumors were most frequently positive. Single cases of transitional-cell and squamous cell carcinomas were reactive as well. Lung and breast cancers were mostly negative. Nonmucinous ovarian tumors were invariably unlabeled as were mesotheliomas and normal mesothelial cells. The study shows that CK 20 is valuable in distinguishing tumor cell origin in effusions. In particular, it identifies a set of carcinomas with the majority arising from the gastrointestinal tract, and represents a highly characteristics marker for colorectal cancer. Diagn Cytopathol 1995; 12:303-308. (C) 1995 Wiley-Liss, Inc

Desmoplastic Fibroblastoma (Collagenous Fibroma): A Case Report.

Desmoplastic Fibroblastoma (DF) is a rare fibrotic tumor that has a wide anatomic distribution and it can appearin deep sections of the subcutis, in fascia, in aponeurosis or in skeletal muscles that rare- ly involving bone. The differential diagnosis of DF includes benign and malignant soft tissue tumors and the misdiagnosis may cause unnecessary surgical overtreatment, especially for those involving bone. We report the case of a 54-year-old man admitted to the Hand and Microsurgery Unitwith a painless, slow-growing mass in the left- foot. Magnetic Resonance Imaging (MRI) revealed a well-defined, lobulated soft tissue mass with some areas of hypointense signal on T1-weighted images, predominantly hyperintense signal with some areas of hypointense signal on T2-weighted images. The dimension of tumor is5.5 x 5 cm and a cut section appeared to bewell-circum- scribed and homogeneously gray-white and very firm in nature. The lesion was totally removed by surgical excision and it was pathologically confirmed to DF

Immunocytochemistry Profile of Benign Thyroid Nodules Not Responding to Thermal Ablation: A Retrospective Study

International audiencePurpose. Thermal ablations (TA) are gaining ground as alternative options to conventional therapies for symptomatic benign thyroid nodules. Little is known about the impact of nodule biology on the outcomes of TA. The aim of our study was to evaluate the baseline immunocytochemistry profile of thyroid nodules that were poorly responsive to TA in order to identify potential predictors of the treatment response. Methods. From a cohort of 406 patients with benign thyroid nodules treated with TA and followed for 5 years, we retrospectively selected two groups of patients: NONRESPONDERS (patients who did not respond to TA and were later surgically treated) and RESPONDERS (patients who responded to TA). The fine-needle aspiration cytology (FNAC) slides obtained before TA were stained for Galectin-3, HBME-1, CK-19, and Ki-67. Results. Benign nodules of NONRESPONDERS (n = 19) did not express CK-19 ( p = 0.03 ), as compared to RESPONDERS (n = 26). We combined the absence of CK-19 and the presence of Ki-67 to obtain a composite biomarker of resistance to TA, which discriminated between likelihood of retreatment and no retreatment with an AUC of 0.68 (95%CI: 0.55-0.81) and a sensitivity, specificity, PPV, and NPV of 29%, 91%, 71%, and 64%, respectively. Conclusion. In benign thyroid nodules, the absence of CK-19 was associated with resistance to TA, while the presence of CK-19 was predictive of response to TA. If confirmed, this finding could provide rapid and inexpensive information about the potential outcome of TA on benign thyroid nodules. In addition, as CK-19 can be expressed in adenomatous hyperplasia, it could be speculated that these nodules, rather than follicular adenomas, might be better candidates for TA

Thin core biopsy should help to discriminate thyroid nodules cytologically classified as indeterminate. A new sampling technique

Indeterminate neoplasms (IN) represent the gray zone of thyroid cytology in which malignant and benign tumors cannot be discriminated. Recently, the approach by thin core needle biopsy has been proposed. Here we report a new thin core needle biopsy approach in 40 consecutive patients with thyroid IN at cytology. In this study, a 21-G needle was inserted into the nodule, advanced within the lesion, and moved ahead reaching extranodular tissue. The resulting sample allowed to evaluate the cytomorphology of nodular tissue, its relationship with extranodular parenchyma, and the nodule's capsule when present. All biopsies were adequate for diagnosis but one. Of the 39 adequate samples, 5 cases were papillary cancer as confirmed at histology, while 14 nodules avoided surgery because of Hurthle cell hyperplasia in thyroiditis (n = 6) and microfollicular adenomatous hyperplasia (n = 8). The remaining 20 cases were assessed as follicular neoplasms because of encapsulation and were evaluated by immunohistochemistry. Of these, 6 had positive markers in different degree and 1/6 has follicular cancer at histology, while the other 14 were benign after surgery. Overall, this approach by thin core needle biopsy identified benignancy in 14/40 (35 %) IN avoiding surgery. As a conclusion, thin core biopsy should help to discern the nature of thyroid lesions cytologically classified as indeterminate, and it should be used as a complementary test in thyroid nodule assessment

Predictive Value of Malignancy of Thyroid Nodule Ultrasound Classification Systems: A Prospective Study

Context British Thyroid Association (BTA), American Thyroid Association (ATA), and American Association of Clinical Endocrinologists (AACE/ACE/AME) recommend for thyroid nodules an ultrasound (US)-based stratification of risk of malignancy. Aim of our study was to assess the diagnostic accuracy of US classification systems and their reliability for indication to fine-needle aspiration (FNA). Design Prospective study on 987 thyroid nodules consecutively referred for FNA. US images were independently reviewed by four experts for assignment of malignancy risk. Cytologically benign nodules had confirmation with a second FNA, whereas Bethesda class IV, V, and VI nodules were operated upon. Class III nodules had surgery or follow-up on the basis of clinical, immunocytochemical, and US features. Results BTA: Malignancy rate was 2.8% in benign, 10.0% in indeterminate, 51.3% in suspicion, and 80.9% in malignant US class. Sensitivity was 0.74, specificity was 0.92, and accuracy was 0.89. ATA: Malignancy rate was 0.0% in benign, 2.2% in very low suspicion, 3.0% in low suspicion, 5.8% in intermediate, and 55.0% in high suspicion US class. Sensitivity was 0.81, specificity was 0.87, and accuracy was 0.86. AACE/ACE/AME: Malignancy rate was 1.1% in low-risk, 4.4% in intermediate-risk, and 54.9% in high-risk US class. Sensitivity was 0.82, specificity was 0.87, and accuracy was 0.86. K correlation coefficient was 78.9%, 76.9%, and 82.0% for BTA, ATA, and AACE/ACE/AME classifications. Conclusions Classification systems had elevated predictive value of malignancy in high-risk classes. ATA and AACE/ACE/AME systems were effective for ruling out indication to FNA in low-US-risk nodules. A similar diagnostic accuracy and a substantial interobserver agreement was provided by the three- and the five-category classifications

Evaluating PD-L1 in head & neck squamous cell carcinoma: concordance between 22C3 PharmaDx and SP263 assays on whole sections from a multicenter study

Aims: The introduction of immunotherapy in head and neck squamous cell carcinoma (HNSCC) raises the need for harmonization between different types of antibodies and immunohistochemistry platforms for evaluating the expression of (Programmed death-ligand 1) PD-L1 with Combined Positive Score (CPS) in this tumor. We compare the expression of PD-L1, using the CPS and two widely used antibody (22C3 pharma Dx and SP263 assay) in a cohort of HNSCC. Methods and results: We analyzed forty-three whole sections of HNSCC with two different anti-PD-L1 antibodies, 22C3 pharma Dx and SP263 assay. Results, expressed as CPS, were evaluated by ten trained pathologists and statistical analyses, including interobserver agreement, were performed. We found a very similar distribution for PD-L1 expression between 22C3 pharmaDx assay and SP263 assay in our cohort and a strong significant correlation between the two assays for all specimens (Spearman r= 0.945; p<0.0001). The interobserver reliability among pathologists for the continuous scores of CPS with ICC and the correlation between the two assays was both good. Moreover, the agreement rate between assays was high at all cut-offs and was best for the most relevant cut-off of CPS ≥1, while the kappa values were always in the range of almost perfect. Conclusions: Two different assays (22C3 pharmaDx assay and SP263 assay) for PD-L1 in HNSCC showed high agreement. This data suggests the interchangeability of these two antibodies in the selection of patients with HNSCC for immunotherapy

Observations and Orbits of Comets and A/ Objects

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