A Rare Case of Pulmonary Carcinosarcoma with Unusual Presentation: A Diagnostic Dilemma

Pulmonary carcinosarcoma is a rare malignancy of the lung and has poor prognosis than non-small cell lung cancer. Effective treatment has not been developed for non-resect able advanced stage. We report a case in a 51-year-old female who presented with a right sided massive pleural effusion. Pleural biopsy tissue histology and immunohistochemistry revealed carcinosarcoma.

Neuroendocrine carcinoma admixed adenocarcinoma of cervix: A case report of young female

Neuroendocrine carcinoma coexisted with adenocarcinoma in cervix is very rare. This disease has a very poor prognosis and so far no standard treatment has been obtained. A 35-years-old woman seeks medical attention with chief complaint of bleeding per vagina outside of menstruation. Ultrasound shows cervical mass of 4.2 cm × 2.9 cm. Microscopic biopsy suggestive of a mixture of neuroendocrine cervical carcinoma and adenocarcinoma, moderate-poor differentiation. Several immunohistochemical staining of the biopsy tissue was done to detect neuroendocrine and adenocarcinoma. In biopsy tissue, P63 immunohistochemical staining was performed to detect squamous cell carcinoma with negative results. Furthermore chromogranin, synaptophycin, CD 56, NSE, and P40 immunohistochemical staining were performed to detect neuroendocrine with positive results and so did CK 19, CEA, and CK 7 staining to detect positive adenocarcinomas. This rare case had a positive immunohistochemical staining of both neuroendocrine carcinoma and adenocarcinoma cervix. Patient received definitive concurrent chemo-radiotherpay.

An analysis of research biopsy core variability from over 5000 prospectively collected core samples

Factors correlated with biopsy tissue adequacy and the prevalence of within-biopsy variability were evaluated. Totally, 1149 research biopsies were performed on 686 patients from which 5090 cores were assessed. Biopsy cores were reviewed for malignant percentage (estimated percentage of cells in the core that were malignant) and malignant area (estimated area occupied by malignant cells). Linear mixed models and generalized linear mixed models were used for the analysis. A total of 641 (55.8%) biopsies contained a core with <10% malignant percentage (inadequate core). The chance of an inadequate core was not influenced by core order, though the malignant area decreased with each consecutive core (p < 0.001). Younger age, bone biopsy location, appendiceal tumor pathology, and responding/stable disease prior to biopsy increased the odds of a biopsy containing zero adequate cores. Within-biopsy variability in core adequacy is prevalent and suggests the need for histological tumor quality assessment of each core in order to optimize translational analyses.

Microbiomes and Resistomes in Biopsy Tissue and Intestinal Lavage Fluid of Colorectal Cancer

Aim: The gut microbiome plays a crucial role in colorectal cancer (CRC) tumorigenesis, but compositions of microorganisms have been inconsistent in previous studies due to the different types of specimens. We investigated the microbiomes and resistomes of CRC patients with colonic biopsy tissue and intestinal lavage fluid (IVF).Methods: Paired samples (biopsy tissue and IVF) were collected from 20 patients with CRC, and their gut microbiomes and resistomes were measured by shotgun metagenomics. Clinical and laboratory data were recorded. Bioinformatics (KneadData, Kraken2, and FMAP) and statistical analysis were done using the R (v4.0.2) software.Results: Bacterial diversity in IVF was higher than in tissue samples, and bacterial operational taxonomic units (OTUs) were 2,757 in IVF vs. 197 in tissue. β-diversity showed distinct clusters in paired samples. The predominant bacteria in IVF were phylum Proteobacteria, while the predominant bacteria of tissue were phylum Actinobacteria. Twenty-seven representative bacteria were selected to form six bacterial clusters, which showed only Firmicutes Cluster 1, and the Bacteroidetes Cluster 1 were significantly more abundant in the IVF group than those in the tissue group (p &lt; 0.05). The Firmicutes Cluster 2, Bacteroidetes Cluster 2, Pathogen Cluster, and Prevotella Cluster were not significantly different between IVF and tissue (p &gt; 0.05). Correlation analysis revealed that some bacteria could have effects on metabolic and inflammatory parameters of CRC patients. A total of 1,295 antibiotic resistance genes (ARGs) were detected in the gut microbiomes, which conferred multidrug resistance, as well as resistance to tetracycline, aminoglycoside, and more. Co-occurrence patterns revealed by the network showed mainly ARG-carrying bacteria to be similar between IVF and tissue, but leading bacteria located in the hub differed between IVF and tissue.Conclusion: Heterogeneity of microbiota is particularly evident when studied with IVF and tissue samples, but bacterial clusters that have close relationships with CRC carcinogenesis are not significantly different, using IVF as an alternative to tissue for gut microbiome, and resistome assessment may be a feasible method.

Meta-analysis of gene expression disease signatures in colonic biopsy tissue from patients with ulcerative colitis

Publicly available ulcerative colitis (UC) gene expression datasets from observational studies and clinical trials include inherently heterogeneous disease characteristics and methodology. We used meta-analysis to identify a robust UC gene signature from inflamed biopsies. Eight gene expression datasets derived from biopsy tissue samples from noninflammatory bowel disease (IBD) controls and areas of active inflammation from patients with UC were publicly available. Expression- and meta-data were downloaded with GEOquery. Differentially expressed genes (DEG) in individual datasets were defined as those with fold change > 1.5 and a Benjamini–Hochberg adjusted P value < .05. Meta-analysis of all DEG used a random effects model. Reactome pathway enrichment analysis was conducted. Meta-analysis identified 946 up- and 543 down-regulated genes in patients with UC compared to non-IBD controls (1.2 and 1.7 times fewer up- and down-regulated genes than the median of the individual datasets). Top-ranked up- and down-regulated DEG were LCN2 and AQP8. Multiple immune-related pathways (e.g., ‘Chemokine receptors bind chemokine’ and ‘Interleukin-10 signaling’) were significantly up-regulated in UC, while ‘Biological oxidations’ and ‘Fatty acid metabolism’ were downregulated. A web-based data-mining tool with the meta-analysis results was made available (https://premedibd.com/genes.html). A UC inflamed biopsy disease gene signature was derived. This signature may be an unbiased reference for comparison and improve the efficiency of UC biomarker studies by increasing confidence for identification of disease-related genes and pathways.

Advantages and Challenges of Using Breast Biopsy Markers

Percutaneous image-guided biopsy procedures are the standard of care for histologic assessment of suspicious breast lesions. Post-biopsy tissue markers (clips) optimize patient management by allowing for assessment on follow-up imaging and precise lesion localization. Markers are used to ensure accurate correlation between imaging modalities, guide preoperative localization for malignant and high-risk lesions, and facilitate accurate identification of benign lesions at follow-up. Local practices differ widely, and there are no data detailing the exact frequency of use of clips for different breast biopsies. There are many indications for biopsy marker deployment, and some difficulties may be encountered after placement. The placement of biopsy markers has many advantages and few disadvantages, such that deployment should be routinely used after percutaneous biopsy procedures with rare exception.

Deep learning-based transformation of H&E stained tissues into special stains

Pathology is practiced by visual inspection of histochemically stained tissue slides. While the hematoxylin and eosin (H&E) stain is most commonly used, special stains can provide additional contrast to different tissue components. Here, we demonstrate the utility of supervised learning-based computational stain transformation from H&E to special stains (Masson’s Trichrome, periodic acid-Schiff and Jones silver stain) using kidney needle core biopsy tissue sections. Based on the evaluation by three renal pathologists, followed by adjudication by a fourth pathologist, we show that the generation of virtual special stains from existing H&E images improves the diagnosis of several non-neoplastic kidney diseases, sampled from 58 unique subjects (P = 0.0095). A second study found that the quality of the computationally generated special stains was statistically equivalent to those which were histochemically stained. This stain-to-stain transformation framework can improve preliminary diagnoses when additional special stains are needed, also providing significant savings in time and cost.

Attenuation of CALCR protein expression in stone affected region of kidney biopsy tissue: Case presentation

Calcitonin is one of the most important hormones in human body which regulates calcium homeostasis. It binds with Calcitonin Receptor (CALCR) and reduces serum calcium level by inhibiting bone resorption and proximal renal reabsorption. Alteration in calcium homeostasis promotes diseases like osteoporosis, urolithiasis etc. An interesting finding of reduced CALCR protein expression in a urolithiasis patient motivated us to investigate its level in stone affected region of kidney biopsy tissue and hence in the present study, CALCR expression was checked in urolithiasis patients who had gone through open nephrolithotomy for stone removal. Basic and clinical parameters of the patients were recorded followed by analysis of stone composition, genotypic analysis and studying CALCR protein expression level in the kidney biopsy tissue samples (in the location of stone and an adjacent control area). CALCR protein expression was found to be attenuated in the stone affected region of kidney biopsy tissue as compared to adjacent control tissues (4-6 cm apart from the stone affected region) in all our studied samples (n=5). This case series represents an interesting finding as it is the first time report in the world, regarding expression of CALCR protein in kidney tissues of urolithiasis patients. Keywords: Urolithiasis; CALCR; Protein expression; SNP.