Amanda Charlton

Standardised reporting protocol for endoscopic resection for Barrett oesophagus associated neoplasia: expert consensus recommendations

Summary Endoscopic resection (ER) is considered the therapy of choice for intraepithelial neoplasia associated with visible lesions and T1a adenocarcinoma. Pathologists are bound to encounter specimens collected via these techniques more frequently in their practice. A standardised protocol for handling, grossing, and assessing ER specimens should be adopted to ensure that all prognostic information and characteristics influencing treatment are included in reports (see Supplementary Video Abstract, http://links.lww.com/PAT/A22). The entire specimen should be appropriately oriented, processed and assessed. An ER specimen will commonly show intraepithelial neoplasia or invasive carcinoma. There are essential features that should be recorded if invasive carcinoma is found as they dictate further management and follow-up. These features are the margin status, depth of invasion, degree of differentiation and presence or absence of lymphovascular invasion. Important features such as duplication of muscularis mucosae should be recognised to avoid misinterpretation of depth of invasion. Key diagnostic and prognostic elements that are essential for optimal clinical decisions have been included in the reporting format proposed by the Structured Pathology Reporting committee of the Royal College of Pathologists of Australasia (RCPA).

Testicular microlithiasis: the importance of self-examination.

Aim:  To explore the issue of appropriate management of testicular microlithiasis. We report the third ever case of tumour arising from a testis previously known to have microlithiasis in childhood and review the literature to provide an evidence‐based approach to management of testicular microlithiasis.

Metachronous multifocal desmoid-type fibromatoses along the neuraxis with adenomatous polyposis syndrome.

Desmoid-type fibromatosis, aggressive fibromatosis, or desmoid tumor is an uncommon benign but locally aggressive fibroblastic lesion. Although intraabdominal desmoid-type fibromatoses are well described in association with adenomatous polyposis syndrome, their occurrence along the neuraxis is extremely rare. The authors report the case of a 14-year-old boy with metachronous intracranial and spinal desmoid-type fibromatoses with preceding medulloblastoma. He was ultimately diagnosed with adenomatous polyposis syndrome. This is the first reported case of spinal desmoid-type fibromatosis in association with adenomatous polyposis syndrome. The identification of an underlying genetic instability allows for screening to detect lesions and institute measures to avoid preventable mortality from nonneurological tumors.

Can Archival Tissue Reveal Answers to Modern Research Questions?: Computer-Aided Histological Assessment of Neuroblastoma Tumours Collected over 60 Years

Despite neuroblastoma being the most common extracranial solid cancer in childhood, it is still a rare disease. Consequently, the unavailability of tissue for research limits the statistical power of studies. Pathology archives are possible sources of rare tissue, which, if proven to remain consistent over time, could prove useful to research of rare disease types. We applied immunohistochemistry to investigate whether long term storage caused any changes to antigens used diagnostically for neuroblastoma. We constructed and quantitatively assessed a tissue microarray containing neuroblastoma archival material dating between 1950 and 2007. A total of 119 neuroblastoma tissue cores were included spanning 6 decades. Fourteen antibodies were screened across the tissue microarray (TMA). These included seven positive neuroblastoma diagnosis markers (NB84, Chromogranin A, NSE, Ki-67, INI1, Neurofilament Protein, Synaptophysin), two anticipated to be negative (S100A, CD99), and five research antibodies (IL-7, IL-7R, JAK1, JAK3, STAT5). The staining of these antibodies was evaluated using Aperio ImageScope software along with novel pattern recognition and quantification algorithms. This analysis demonstrated that marker signal intensity did not decrease over time and that storage for 60 years had little effect on antigenicity. The construction and assessment of this neuroblastoma TMA has demonstrated the feasibility of using archival samples for research.

Parvovirus Infection: An Immunohistochemical Study Using Fetal and Placental Tissue:

Parvovirus B19 infection causes 5% to 15% of cases of nonimmune hydrops fetalis. The aim of our study was to evaluate the use of immunohistochemistry in diagnosing parvovirus infection in fetal and placental tissue during routine fetal and perinatal autopsies. Histology slides of 20 cases of confirmed parvovirus infection were reviewed, and immunohistochemistry was applied to selected blocks of fetal and placental tissue. Immunohistochemistry was positive in all 20 cases, and histologic viral inclusions were seen in 19 cases. Immunohistochemical staining was closely correlated with histology and was more sensitive than histology in detecting virally infected cells, especially in autolyzed tissue. All cases also had confirmatory evidence of parvovirus infection by polymerase chain reaction of fetal liver and positive maternal serology, where it was available. We conclude that parvovirus immunohistochemistry is a reliable method for diagnosing parvovirus infection, especially in autolyzed tissue where histologic assessment may be suboptimal.

β-HCG Elevation in Wilms Tumor: An Uncommon Presentation.

Wilms tumor (nephroblastoma) is a readily diagnosed common abdominal tumor in children. Rarely, it may present with factors that may confound the diagnosis. We report a 6‐year‐old female child who presented with a rapidly growing and invasive abdominal mass with the histopathologic features of Wilms tumor associated with an elevated serum beta human chorionic gonadotropin, which has not been previously reported in this condition.Wilms tumor (nephroblastoma) is a readily diagnosed common abdominal tumor in children. Rarely, it may present with factors that may confound the diagnosis. We report a 6-year-old female child who presented with a rapidly growing and invasive abdominal mass with the histopathologic features of Wilms tumor associated with an elevated serum beta human chorionic gonadotropin, which has not been previously reported in this condition.

Computer Aided Classification of Neuroblastoma Histological Images Using Scale Invariant Feature Transform with Feature Encoding

Neuroblastoma is the most common extracranial solid malignancy in early childhood. Optimal management of neuroblastoma depends on many factors, including histopathological classification. Although histopathology study is considered the gold standard for classification of neuroblastoma histological images, computers can help to extract many more features some of which may not be recognizable by human eyes. This paper, proposes a combination of Scale Invariant Feature Transform with feature encoding algorithm to extract highly discriminative features. Then, distinctive image features are classified by Support Vector Machine classifier into five clinically relevant classes. The advantage of our model is extracting features which are more robust to scale variation compared to the Patched Completed Local Binary Pattern and Completed Local Binary Pattern methods. We gathered a database of 1043 histologic images of neuroblastic tumours classified into five subtypes. Our approach identified features that outperformed the state-of-the-art on both our neuroblastoma dataset and a benchmark breast cancer dataset. Our method shows promise for classification of neuroblastoma histological images.

Patched Completed Local Binary Pattern is an Effective Method for Neuroblastoma Histological Image Classification

Neuroblastoma is the most common extra cranial solid tumour in children. The histology of neuroblastoma has high intra-class variation, which misleads existing computer-aided histological image classification methods that use global features. To tackle this problem, we propose a new Patched Completed Local Binary Pattern (PCLBP) method combining Sign Binary Pattern (SBP) and Magnitude Binary Pattern (MBP) within local patches to build feature vectors which are classified by k-Nearest Neighbor (k-NN) and Support Vector Machine (SVM) classifiers. The advantage of our method is extracting local features which are more robust to intra-class variation compared to global ones. We gathered a database of 1043 histologic images of neuroblastic tumours classified into five subtypes. Our experiments show the proposed method improves the weighted average F-measure by 1.89% and 0.81% with k-NN and SVM classifiers, respectively.

Congenital lobar emphysema: diagnostic and therapeutic challenges

Congenital lobar emphysema (CLE), a rare condition that usually presents in the neonatal period, can be a diagnostic and therapeutic challenge for the treating clinician. If unrecognised, it is a significant risk at the time of anaesthetic induction. We describe a case of CLE in a 3-month-old boy who was initially treated for suspected aspiration pneumonia at the referring hospital. We highlight the importance of careful consideration of common childhood respiratory illness as well as pneumothorax in the differential diagnosis, and the significance of appropriate preoperative anaesthetic management. We also emphasise the importance of acknowledging a mothers concerns when taking a paediatric history.

Pheochromocytoma-paraganglioma due to germline SDHB mutation in children are common

Introduction: Pheochromoctyoma-paraganglioma syndrome (PHEO-PGL) due to SDH germline mutation is easily identified by loss of SDHB by immunohistochemistry. Pham et al. showed a 16% (5/30) prevalence of SDH mutation in a retrospective review of the Mayo clinic involving thirty patients (1975–2005). Aim: Ascertain the prevalence of PHEO-PGL due to SDHB germline mutations in a local paediatric population by using IHC. Method: 14 patients were ascertained from the pathology database with pheochromocytoma and or paraganglioma, SDHA and SDHB IHC was performed on FFPE blocks. Results: Three patients had SDHB germline mutations, three had VHL mutation and eight had no genetic studies performed. Of the 14 patients, four had multiple tumours and of these, three showed loss of SDHB staining. All three patients with loss of SDHB by IHC had genetically confirmed germline mutations of SDHB. A novel observation was that three patients with VHL syndrome showed a characteristic weak granular cytoplasmic staining, a pattern distinct from SDHB loss and normal controls. Discussion: (1) We found the prevalence of SDH germline mutations was 28% in children with PHEO-PGL, which is higher than historically identified. (2) In patients with multiple tumours the prevalence was 75% (3/4 patients). (3) We found a distinctive weak granular positive cytoplasmic SDHB staining pattern in tumours with VHL germline mutations. ReferencesGill A. Succinate dehydrogenase (SDH) and mitochondrial driven neoplasia: Review. Pathology 2012; 44: 285–92.Pham TH, Moir C, Thompson GB, et al. Pheochromocytoma and paragnaglioma in children: A review of medical and surgical management at a tertiary care centre. Pediatrics 2006; 118: 1109–17.