Identification of Morphologic Criteria Associated with Biochemical Recurrence in Intraductal Carcinoma of the Prostate

Intraductal carcinoma of the prostate (IDC-P) is an aggressive subtype of prostate cancer strongly associated with an increased risk of biochemical recurrence (BCR). However, approximately 40% of men with IDC-P remain BCR-free five years after radical prostatectomy. In this retrospective multicenter study, we aimed to identify histologic criteria associated with BCR for IDC-P lesions. A total of 108 first-line radical prostatectomy specimens were reviewed. In our test cohort (n = 39), presence of larger duct size (>573 µm in diameter), cells with irregular nuclear contours (CINC) (≥5 CINC in two distinct high-power fields), high mitotic score (>1.81 mitoses/mm2), blood vessels, and comedonecrosis were associated with early BCR (<18 months) (p < 0.05). In our validation cohort (n = 69), the presence of CINC or blood vessels was independently associated with an increased risk of BCR (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.09-4.96, p = 0.029). When combining the criteria, the presence of any CINC, blood vessels, high mitotic score, or comedonecrosis showed a stronger association with BCR (HR 2.74, 95% CI 1.21-6.19, p = 0.015). Our results suggest that IDC-P can be classified as low versus high-risk of BCR. The defined morphologic criteria can be easily assessed and should be integrated for clinical application following validation in larger cohorts.

Classifying multiple lung cancers using morphological features: a meta-analysis

Multiple lung cancers may be intrapulmonary metastases or multiple primaries. Management and prognosis of both entities are different and make the pathologist's role challenging. In fact, distinguishing both entities may be difficult especially when the tumors present the same microscopic subtype. The microscopic diagnoses of these tumors have been improved based on the 2015 WHO classification. The aim of the authors was to assess the diagnostic value of morphologic features in comparison to the gold standard test represented by molecular testing in the distinction between intrapulmonary metastases and multiple lung primaries. To retrieve all eligible articles, PubMed and Embase databases and Cochrane Library were comprehensively searched from 1999 to 2020 with limitation to French andEnglish language. The Meta-Disc software 5.1.32 was used to conduct this meta-analysis. The pSEN, pSPE, NLR, PLR, and DOR with the 95% confidence intervals were calculated. The area under the SROC was calculated based on the SEN and SPE of each study. Q test and I² statistics were carried out to explore the heterogeneity among studies. P value <.1 for q test or I² value >50% represented substantial between-study heterogeneity. Meta-regressions were performed to explore the sources of heterogeneity if necessary. Twelve eligible articles with 309 patients were included. pSEN was estimated to 65% with I-square estimated to 53%. pSPE reached 49% with I-square estimated to 56%. PLR was estimated to 1.23 with I-square estimated to 33%. NLR was estimated to 0.65 with I-square estimated to 23.1%. dOR was estimated to 2.13 [1.07-4.25] with I-square estimated to 26.5%. AUC was estimated to 0.63. The meta-regression analysis showed non-significant effect of the WHO classification, next-generation sequencing, or nucleotide-specific sequencing with p reaching respectively 0.38, 0.06, and 0.36. These results highlight that morphologic features may be useful in the diagnosis of multiple lung cancers especially when dealing with surgical specimen. The mild heterogeneity observed in this meta-analysis may be due to other covariates that were not described in the different articles including the sample nature.

[Morphological features of IgG4-related lesions at various sites]

OBJECTIVE

To determine the morphological features of IgG4-related lesions and to improve pathomorphological criteria for diagnosing various clinical variants of IgG4-related disease.

MATERIAL AND METHODS

Biopsy and surgical materials from 100 patients with tumor-like lesions at various sites (63 cases of IgG4-related lesion and 37 cases of non-IgG4-related inflammatory processes) were studied. Histological and immunohistochemical studies were conducted to determine the absolute counts of CD138+ cells, IgG+ and IgG4+ in the inflammatory infiltrates, as well as IgG4/IgG and IgG4/CD138 cell ratios.

RESULTS

When IgG4-related disease manifested, pancreatic, lacrimal, and salivary gland lesions prevailed. Brisk lymphoplasmacytic infiltration is characteristic for tissue damage in the eye, salivary glands, thyroid, pancreas, and skin. The formation of moiré fibrosis was specific to damages to the pancreas, liver and bile ducts, and eye tissues. Obliterative phlebitis is most often observed in pancreatic and salivary gland lesions. According to international criteria, the frequency of achieving the required level of IgG4+ plasma cells in each organ was high in lesions of the pancreas, bile ducts, and lymph nodes and that was low in lesions of the salivary and lacrimal glands and skin. The IgG4+/CD138+ and IgG4+/IgG+ cell ratios exceeded 40% in all cases.

CONCLUSION

The morphologic diagnosis of IgG4-related disease is based on the detection of lymphoplasmacytic infiltration, moiré fibrosis, and obliterative phlebitis, as well as on the calculation of the absolute number of IgG4+ plasma cells in the inflammatory infiltrate and on the determination of IgG4+/IgG+ and IgG4+/CD138+ cell ratios. The number of IgG4+ plasma cells depends on the location of the lesion and on the phase of the process.

Morphologic Criteria of Lesion Activity in Neovascular Age-Related Macular Degeneration: A Consensus Article

Intravitreal antivascular endothelial growth factor drugs represent the current standard of care for neovascular age-related macular degeneration (nAMD). Individualized treatment regimens aim at obtaining the same visual benefits of monthly injections with a reduced number of injections and follow-up visits, and, consequently, of treatment burden. The target of these strategies is to timely recognize lesion recurrence, even before visual deterioration. Early detection of lesion activity is critical to ensure that clinical outcomes are not compromised by inappropriate delays in treatment, but questions remain on how to effectively monitor the choroidal neovascularization (CNV) activity. To assess the persistence/recurrence of lesion activity in patients undergoing treatment for nAMD, an expert panel developed a decision algorithm based on the morphological features of CNV. After evaluating all current retinal imaging techniques, the panel identified optical coherent tomography as the most reliable tool to ascertain lesion activity when funduscopy is not obvious.