Clinicopathological study of non-granulomatous necrotizing lymphadenopathies

Non-granulomatous necrotizing lymphadenopathy (NGNL) is not a specific entity. It is seen in various conditions like Kikuchi-Fujimoto disease (KFD), Systemic Lupus Erythematosus (SLE), tuberculosis, lymphoma/metastasis and lymph node infarction. These conditions mimic each other histologically but it is necessary to identify the correct pathology as the treatment differs significantly. To highlight the subtle morphological features which lead to the etiological diagnosis in NGNL. The lymphnode biopsies (N=198), reported in our institute as NGNL, over 4½ year study period, were retrieved. Of these, the benign cases were 64 in total, with 40 cases of KFD and 8 cases of SLE. H&E, special stains and immunohistochemistry slides were reviewed by two pathologists. Histomorphological features like amount of necrosis, apoptotic debris, vasculitis, presence of neutrophils, eosinophils, histiocytes, plasma cells, hematoxylin bodies, Azzopardi phenomenon and thrombus formation were studied. Logistic regression analysis was performed to identify the most significant histopathological parameter with each disease. Kendall’s Tau matrix plot analysis was used to measure the correlation between the disease and the histopathologic variables. Features like vasculitis, hematoxylin bodies and Azzopardi phenomenon showed strong correlation with SLE and inverse correlation with KFD. Apoptotic debris, paucity of neutrophils and eosinophils had a strong positive association with KFD. The histological features help in differentiating the various entities associated with NGNL. It is necessary to correlate with clinical details and various laboratory parameters to reach a conclusive diagnosis because these conditions have varied treatment modalities.

DESCRIPTIVE STUDY OF HYDATIDIFORM MOLE ACCORDING TO TYPE AND AGE AMONG PATIENTS IN WASIT PROVINCE, IRAQ

Introduction: Hydatidiform mole is the most common among gestational trophoblastic diseases in women, which characterized by abnormal gestation, and subdivide to complete and partial hydatidiform mole. It continues to be a significant problem among women, because of complete H mole has a tendency to be a malignant. The diagnosis of this disease is very important because it has the potential to be transformed into choriocarcinoma and to differentiate it to a complete or partial. Methods: In this study, data was collected from fifty-two patients selected randomly from Al-Karama Teaching Hospital and Al-Zahraa Teaching Hospital in Wasit Province. Specialized histopathologists examined the sections with haematoxylin and eosin (H & E) to confirm the diagnosis. Clinical information, clinical examination and histopathological parameter include type and age were obtained. The data collection period was from October 2018 to April 2019. Results: The descriptive data showed that forty-eight percent of patients have a complete hydatidiform mole (CHM) and fifty-two percent have a partial hydatidiform mole (PHM). Moreover, the same results demonstrated that the age group of patients between (14-21) and )22-29) years were more common than the other groups. Conclusion: The age group under 30 years is the most common hydatidiform mole infected and Partial hydatidiform mole was the most common type of hydatiform mole.

BRAF Mutations and Dysregulation of the MAP Kinase Pathway Associated to Sinonasal Mucosal Melanomas

Sinonasal mucosal melanoma (SNM) is a rare and aggressive type of melanoma, and because of this, we currently have a limited understanding of its genetic and molecular constitution. The incidence among SNMs of somatic mutations in the genes involved in the main molecular pathways, which have been largely associated with cutaneous melanoma, is not yet fully understood. Through a next-generation sequencing (NGS) approach using a panel of 25 genes involved in melanoma pathogenesis customized by our group, we performed a mutation analysis in a cohort of 25 SNM patients. Results showed that pathogenic mutations were found in more than 60% of SNM cases at a somatic level, with strikingly 32% of them carrying deleterious mutations in the BRAF gene. The identified mutations mostly lack the typical UV signature associated with cutaneous melanomas and showed no significant association with any histopathological parameter. Oncogenic activation of the BRAF-depending pathway, which may induce immune tolerance into the tumour microenvironment (i.e., by increasing the VEGF production) was poorly associated with mutations in genes that have been related to diminished clinical benefit of the treatment with BRAF inhibitors. Screening for mutations in BRAF and other MAPK genes should be included in the routine diagnostic test for a better classification of SNM patients.

Analysis of interobserver reproducibility in grading histological patterns of dysplastic nevi*

BACKGROUND: Dysplastic nevi are among the most important cutaneous melanoma simulators. They are important risk markers for this neoplasia and can be its potential precursors. Some authors found a statistically significant relationship between the degree of dysplasia and the risk for developing melanoma. However, reproducibility of grading criteria ranged from poor to fair in the researched articles. OBJECTIVE: To test the reproducibility of the grading criteria proposed by Sagebiel et al. regarding dysplastic nevi. METHODS: Histological specimens of 75 dysplastic nevi were graded, independently and in a blinded fashion, according to preestablished criteria, by a panel of 10 pathologists with different levels of experience. Diagnostic agreement was calculated using weighted kappa and intraclass correlation coefficients. RESULTS: The average of weighted kappa values was 0.13 for all observers, 0.12 for dermatopathologists, 0.18 for general pathologists and 0.05 for residents. Intraclass correlation coefficient values were 0.2 for all observers, 0.18 for dermatopathologists, 0.33 for general pathologists and 0.15 for residents. CONCLUSIONS: Histopathological grading for dysplastic nevi was not reproducible in this Brazilian series, so the criteria used are not a helpful histopathological parameter for clinicopathological correlation.