Sheila Friedrich Faraj

Carnoy's solution is an adequate tissue fixative for routine surgical pathology, preserving cell morphology and molecular integrity.

To compare Carnoys solution (CS) and 10% neutral buffered formalin solution (NBF) as tissue fixatives in colorectal cancer specimens.

Pathological factors and prognosis of resected liver metastases of colorectal carcinoma: implications and proposal for a pathological reporting protocol

Colorectal cancer is a leading cause of death worldwide. The liver is the most common site of distant metastases, and surgery is the only potentially curative treatment, although the recurrence rate following surgery is high. In order to define prognosis after surgery, many histopathological features have been identified in the primary tumour. In turn, pathologists routinely report specific findings to guide oncologists on the decision to recommend adjuvant therapy. In general, the pathological report of resected colorectal liver metastases is limited to confirmation of the malignancy and details regarding the margin status. Most pathological reports of a liver resection for colorectal liver metastasis lack information on other important features that have been reported to be independent prognostic factors. We herein review the evidence to support a more detailed pathological report of the resected liver specimen, with attention to: the number and size of liver metastases; margin size; the presence of lymphatic, vascular, perineural and biliary invasion; mucinous pattern; tumour growth pattern; the presence of a tumour pseudocapsule; and the pathological response to neoadjuvant chemotherapy. In addition, we propose a new protocol for the evaluation of colorectal liver metastasis resection specimens.

Risk Factors for Lymph Node Metastasis in Western Early Gastric Cancer After Optimal Surgical Treatment

BackgroundLymph node metastasis (LNM) has a strong influence on the prognosis of patients with early gastric cancer (EGC). As minimally invasive treatments are considered appropriate for EGC, and lymphadenectomy may be restricted or even eliminated in some cases; it is imperative to identify the main risk factors for LNM to individualize the therapeutic approach. This study aims to evaluate the risk factors for LNM in EGC and to determine the adequacy of the endoscopic resection criteria in a western population.MethodsEGC patients who underwent gastrectomy with lymphadenectomy were retrospectively analyzed utilizing a prospective database. The clinicopathological variables were assessed to determine which factors were associated to LNM.ResultsAmong 474 enrolled patients, 105 had EGC (22.1%). LNM occurred in 13.3% of all EGC (10% T1a; 15.4% T1b). Tumor size, venous, lymphatic, and perineural invasions were confirmed as independent predictors of LNM by multivariate analysis. Expanded criteria were safely adopted only in selected cases, and 13.6% of patients who matched expanded indication had LNM.ConclusionsTumor size, venous, lymphatic, and perineural invasions were associated with LNM and should be considered as surrogate markers for surgical treatment of EGC. Expanded criteria for endoscopic resection can be safely adopted only in selected cases.

Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases

Histomorphological features have been described as prognostic factors after resection of colorectal liver metastases (CLM). The objectives of this study were to assess the prognostic significance of tumor budding (TB) and poorly differentiated clusters (PDC) among CLM, and their association with other prognostic factors.

DETECTION OF OCCULT LYMPH NODE TUMOR CELLS IN NODE-NEGATIVE GASTRIC CANCER PATIENTS

ABSTRACT Background: The presence of lymph nodes metastasis is one of the most important prognostic indicators in gastric cancer. The micrometastases have been studied as prognostic factor in gastric cancer, which are related to decrease overall survival and increased risk of recurrence. However, their identification is limited by conventional methodology, since they can be overlooked after routine staining. Aim: To investigate the presence of occult tumor cells using cytokeratin (CK) AE1/AE3 immunostaining in gastric cancer patients histologically lymph node negative (pN0) by H&E. Methods: Forty patients (T1-T4N0) submitted to a potentially curative gastrectomy with D2 lymphadenectomy were evaluated. The results for metastases, micrometastases and isolated tumor cells were also associated to clinicopathological characteristics and their impact on stage grouping. Tumor deposits within lymph nodes were defined according to the tumor-node-metastases guidelines (7th TNM). Results: A total of 1439 lymph nodes were obtained (~36 per patient). Tumor cells were detected by immunohistochemistry in 24 lymph nodes from 12 patients (30%). Neoplasic cells were detected as a single or cluster tumor cells. Tumor (p=0.002), venous (p=0.016), lymphatic (p=0.006) and perineural invasions (p=0.04), as well as peritumoral lymphocytic response (p=0.012) were correlated to CK-positive immunostaining tumor cells in originally negative lymph nodes by H&E. The histologic stage of two patients was upstaged from stage IB to stage IIA. Four of the 28 CK-negative patients (14.3%) and three among 12 CK-positive patients (25%) had disease recurrence (p=0.65). Conclusion: The CK-immunostaining is an effective method for detecting occult tumor cells in lymph nodes and may be recommended to precisely determine tumor stage. It may be useful as supplement to H&E routine to provide better pathological staging.

Eosinophilic Solid and Cystic Renal Cell Carcinoma: Imaging Features of a Novel Neoplasm

Eosinophilic solid and cystic renal cell carcinoma (ESC RCC) is a recently described entity with distinct clinical, pathologic, and molecular features. However, the radiological aspects of ESC RCC have not been characterized. In this report, we describe the imaging findings of 2 ESC RCCs. We found 2 distinct imaging patterns that varied depending on histopathologic features (solid or cystic predominance). In conclusion, it is important to know the imaging characteristics and pathologic correlation of this novel neoplasm to increase its recognition and to improve the decision-making process.

Reply to “Poorly differentiated clusters in colorectal liver metastases: Prognostic significance in synchronous and metachronous metastases”

Dear Dr. Barresi and colleagues, We thank you for your interest in our recently published paper entitled “Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases.” The papers published by Ueno et al and your group 3 about poorly differentiated clusters (PDC) in colorectal cancer inspired us to study PDC in colorectal liver metastasis (CLM). The different results in the studies may be explained by several differences in the methodological approach. For example, we evaluated the largest tumor among patients with more than one metastatic nodule, which was consistent with several previous reports. In contrast, the study by your group analyzed all metastatic nodules and reported the nodulewith the highest number of PDC (80% of patients with PDC versus 49.3% in our study). Another difference was that we identified 11 patients (4.8%) with PDC G3 (ten or more PDC under a microscopic field of ×20) versus only three patients (2%) with PDC G3 identified in your study. In turn, the low number of patients with PDC G3 might explain the lack of a statistical difference in overall survival (OS) and disease-free survival (DFS) in your study. Of note, similarly to your results, patients in our cohort who had PDC in CLMhad aworseOS andDFS (P = 0.019 and P = 0.002) comparedwith patients without PDC. However, we chose to use PDC G3 among patients with CLM because this variable was an independent prognostic factor in the logistic regression. In addition, according the original definition described by Ueno et al, PDC can appear within the tumor and/or at the advancing edge. In our study, we considered the sum of PDC rather than a specific location as in your series. Further studies are needed to validate the PDC location as a prognostic factor. There are different definitions of synchronous/metachronous CLM. We considered metachronous disease when CLM appeared after 12 months from diagnosis of primary tumor as proposed by Fong et al. In an era of multidisciplinary care for CLM that combines surgery and systemic therapy, patients with CLM diagnosed at or before surgery for the primary tumor are usually submitted to neoadjuvant chemotherapy as recommended by the European consensus. In our cohort, 83 patients (36.2%) had CLM diagnosed at or before colorectal resection and 59 of them (71.1%) received chemotherapy before liver resection (unpublished data). The effects of chemotherapy on histopathology are complex 9 and its consequences in CLM associated PDC are unknown. In contrast to the primary colorectal tumor where a pre-treatment biopsy is usually available, pre-chemotherapy pathological evaluation of the CLM was generally not available. In addition, patients with less aggressive disease (eg, small single nodule, metachronous disease, low CEA levels) tend to be operated without preoperative chemotherapy, while patients with more aggressive CLM are usually submitted to neoadjuvant systemic treatment, which may lead to a possible bias. Our understanding of CLM continues to grow and many new pathological prognostic factors have been described in the last years. CLM has increasingly been recognized not only as a secondary metastatic tumor, but also as an independent tumor with its own specific characteristics, behavior, and prognosis. Recently, our group published a proposal regarding standardized pathological reporting of CLM specimens based on described prognostic factors. Such standardize reporting can provide more information beyond margin status and secondary tumor confirmation. In an era where costefficiency is an important concern, the reporting of PDC does not add charges related to immunohistochemical staining, since PDC can be evaluated in routine hematoxilin and eosin staining. We completely agree that further studies are needed to elucidate the role of PDC in CLM. Despite questions about the prognostic impact of PDC grade, presence, or location, both studies indicate that PDC in CLMmay be a promising prognostic factor.

One-level step section histological analysis is insufficient to confirm complete pathological response after neoadjuvant chemoradiation for rectal cancer (vol 21, pg 745, 2017)

Unfortunately, one of the author name was wrongly published in the original publication. The complete correct name should read as follows “Beatriz Camargo Azevedo”. The original article was updated.