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Advances in Anatomic Pathology
Journal Prestige (SJR): 1.012
Citation Impact (citeScore): 3
Number of Followers: 22  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1072-4109 - ISSN (Online) 1533-4031
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Role of the Surgical Pathologist in Diagnosis of Drug-induced Liver
           Injury: Recognizing Specific Patterns of Drug Injury

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      Authors: Chopra; Shefali; Gawrieh, Samer; Vuppalanchi, Raj; Saxena, Romil
      Abstract: imageEighteen histologic patterns of drug-induced liver injury (DILI) are described, most of which are also seen in other commonly occurring acute and chronic liver diseases. However, certain patterns such as sinusoidal obstruction syndrome/veno-occlusive disease, “bland” cholestasis and cholestatic hepatitis are more often caused by drugs than other competing etiologies. Amiodarone, acetaminophen, anabolic androgenic steroids and estrogens, result in histologic patterns that are virtually diagnostic of the respective drug. Recognition of a DILI or drug specific injury pattern enables the clinician to focus on eliciting an appropriate history to identify the offending agent, which may otherwise be rare and not immediately apparent. Although drugs can mimic any and every liver disease, the mimicry is often imperfect. Unusual features that do not completely fit the clinicopathologic paradigm of the mimicked liver disease are clues to diagnosis of DILI. When mimicking a liver disease, drugs tend to hasten or accelerate the natural progression of the disease. Novel immunomodulatory drugs for inflammatory disorders and cancer may cause unintended effects on the immune system, resulting in immune-related side effects. The role of the pathologist in diagnosis of DILI is to recognize known patterns of DILI, and either confirm a diagnosis when clinically suspected, or alert the clinician to the possibility of DILI when it is not suspected. The latter is particularly vital in contemporary practice, which is witnessing an accelerated pace of drug development, and a surge in consumption of nutritional supplements and herbal compounds by an increasingly health conscious society.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Low-grade Oncocytic Fumarate Hydratase-deficient Renal Cell Carcinoma: An
           Update on Biologic Potential, Morphologic Spectrum, and Differential
           Diagnosis With Other Low-grade Oncocytic Tumors

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      Authors: Hamza; Ameer; Sirohi, Deepika; Smith, Steven C.; Amin, Mahul B.
      Abstract: imageFumarate hydratase-deficient renal cell carcinoma (FH-deficient RCC) is typically considered a high-grade, aggressive subtype of RCC that frequently arises in the setting of hereditary leiomyomatosis-renal cell carcinoma (HLRCC) syndrome. Increasing experience with HLRCC-associated RCC and FH-deficient RCC has resulted in recognition of tumors with lower grade morphologic features, overlapping with those of succinate dehydrogenase–deficient RCC and other low-grade oncocytic tumors. In this review article, we report a previously unpublished case that was recently encountered in our practice and review cases in the current literature with an aim of getting a better understanding of these oncocytic tumors and their morphologic spectrum. The 13 cases reviewed were approximately equally distributed across males and females, occurred at a younger age, and were more frequently seen in the right kidney, with both unifocal and multifocal presentations. While most presented an exclusive, low-grade oncocytic morphology, in 4 cases they were associated with either separate high-grade tumors, or as a secondary pattern in an otherwise conventional high-grade FH-deficient RCC. Loss of FH and 2 succinyl cysteine (2SC) positivity by immunohistochemistry supported their diagnosis, and are recommended to be performed alongside CD117, CK7, and CK20 in to aid classification in challenging oncocytic tumors. When occurring in isolation, these tumors are distinctive from their high-grade counterparts, with no reported adverse outcomes in cases reported thus far. As such, accurate diagnosis of this low-grade pattern among FH-deficient RCCs is worthwhile not only due to its association with HLRCC and need of genetic counseling and surveillance, but also due to more favorable prognosis. Finally, increasing experience with the low-grade end of the morphologic spectrum of FH deficient RCC reiterates that not all tumors of this subtype of RCC have a uniformly aggressive outcome.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Regression of Hepatic Fibrosis and Evolution of Cirrhosis: A Concise
           Review

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      Authors: Khan; Shahbaz; Saxena, Romil
      Abstract: imageFibrosis is not a unidirectional, linear process, but a dynamic one resulting from an interplay of fibrogenesis and fibrolysis depending on the extent and severity of a biologic insult, or lack thereof. Regression of fibrosis has been documented best in patients treated with phlebotomies for hemochromatosis, and after successful suppression and eradication of chronic hepatitis B and C infections. This evidence mandates a reconsideration of the term “cirrhosis,” which implies an inevitable progression towards liver failure. Furthermore, it also necessitates a staging system that acknowledges the bidirectional nature of evolution of fibrosis, and has the ability to predict if the disease process is progressing or regressing. The Beijing classification attempts to fill this gap in contemporary practice. It is based on microscopic features termed “the hepatic repair complex,” defined originally by Wanless and colleagues. The elements of the hepatic repair complex represent the 3 processes of fragmentation and regression of scar, vascular remodeling (resolution), and parenchymal regeneration. However, regression of fibrosis does not imply resolution of cirrhosis, which is more than just a stage of fibrosis. So far, there is little to no evidence to suggest that large regions of parenchymal extinction can be repopulated by regenerating hepatocytes. Similarly, the vascular lesions of cirrhosis persist, and there is no evidence of complete return to normal microcirculation in cirrhotic livers. In addition, the risk of hepatocellular carcinoma is higher compared with the general population and these patients need continued screening and surveillance.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Amyloid Arthropathy: A Review

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      Authors: Diaz-Perez; Julio A.; Conway, Sheila A.; Zuo, Yiqin; Nielsen, Gunnlaugur Petur; Selig, Martin; Rosenberg, Andrew E.
      Abstract: imageAmyloid arthropathy is a joint disease associated with systemic amyloidosis. Herein, we present a model case and review the clinicopathologic features and pathophysiology of this disorder. Amyloid arthropathy results from elevation of serum amyloidogenic proteins and their deposition as aggregates in synovial fluid and articular tissues. The most common proteins are beta-2-microglobulin in the context of long-term hemodialysis therapy and immunoglobulin light chains associated with plasma cell proliferations. We provide a comprehensive update on the pathogenesis, clinical manifestations, and pathologic features of amyloid arthropathy. We provide detailed insights on amyloid protein deposition and aggregation in joints and proper details for diagnosis.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Dedifferentiated Liposarcoma: A Comprehensive Historical Review With
           Proposed Evidence-based Guidelines Regarding a Diagnosis in Need of
           Further Clarification

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      Authors: Kilpatrick; Scott E.
      Abstract: imageAmong all sarcoma types, liposarcoma is the most common sarcoma that develops “dedifferentiation.” Since its initial description by Dr Harry Evans, the spectrum of what is now acceptably included under the rubric of “dedifferentiated liposarcoma” (DL) has expanded, sometimes supported by cytogenetic and molecular advances. Similarly, the range of morphologic appearances considered to represent the precursor of DL, atypical lipomatous tumor (ALT)/well-differentiated liposarcoma, also has broadened, not uncommonly creating variants with significant, almost indistinguishable, morphologic overlap with occasional forms of DL, especially problematic in small biopsy specimens. More specifically, the precise criteria separating cellular forms of ALT from what some consider “low-grade” variants of DL remains controversial and inconsistently applied, even among individual pathologists within institutions. For this separation, the only objective and reproducible criteria historically shown to accurately predict a statistically significant difference in prognosis and survival is mitotic rate, alone or incorporated into a histologic grade [eg, Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC)], consistently identifying a higher grade neoplasm capable of metastases. While DL may have a better prognosis than other nonmyoid adult pleomorphic soft tissue sarcomas, definitive conclusions are difficult to establish due to nonuniform criteria for staging and establishing tumor size/volume of the high-grade component, compounded by variable definitions and thresholds for rendering the diagnosis of DL. If appropriate therapeutic approaches are to be applied to DL, there needs to uniform agreement regarding the histologic definition, grading, and staging of DL. Herein, is a comprehensive historical perspective on DL and ALT/well-differentiated liposarcoma, seeking to provide insights, updates, and a proposal for uniform, evidence-based guidelines.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • A Review of Artificial Intelligence in Precise Assessment of Programmed
           Cell Death-ligand 1 and Tumor-infiltrating Lymphocytes in Non‚ąíSmall Cell
           Lung Cancer

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      Authors: Wu; Jianghua; Lin, Dongmei
      Abstract: imageAdvances in immunotherapy have increased the need for stratified predictive biomarkers in patients with non−small cell lung cancer. However, precise evaluation of tumor tissue-based immune biomarkers, such as programmed cell death-ligand 1 (PD-L1) and the characteristics of tumor infiltrating lymphocytes (TILs), is a challenge in clinical practice. In recent years, the digitization of whole-slide images of tissue has accelerated the implementation of artificial intelligence (AI) approaches in tumor pathology and provided an opportunity to use AI tools to improve the interpretation of immune biomarkers. This review describes the current challenges in the assessment of PD-L1 scoring and TILs and demonstrates the role of AI in helping pathologists integrate PD-L1 and biomarkers of the tumor immune microenvironment. Computer-aided PD-L1 scoring is highly consistent with pathologists and reduces the variation among interobservers, providing a promising diagnostic tool in pathology clinics. In addition, applications of image analysis algorithms, in combination with multiplex staining, enable in-depth quantitative and spatial analysis of the broader tumor microenvironment. Upon combining digital pathology and AI, an automatic analysis system of PD-L1 and TILs, which was established using a set of digital staining images and deep learning algorithms, might be an effective way to overcome the challenges in the precise assessment of immune biomarkers.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Grossing, Staging, and Reporting—An Integrated Manual of Modern
           Surgical Pathology

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      Authors: Hoda; Raza S.; Hoda, Syed A.
      Abstract: imageNo abstract available
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
 
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