This study analyzes the modern (2021) WHO classification of lung tumors and reviews publications in Russian and English from databases including PubMed, Google Scholar, ClinicalTrials.gov, eLibrary, and CyberLeninka. The aim of this review is to identify key changes in the 2021 WHO classification compared to the 2015 edition and assess their significance for the diagnosis and personalized treatment of non-small cell lung cancer. Special attention is given to the handling of small biopsy specimens, which requires an integrated approach involving morphological examination, immunohistochemistry, and molecular genetic testing.
OBJECTIVE:Clinical and morphologic analysis of pathologic changes of digestive system organs in COVID-19 patients according to autopsy data of 2021-2024. MATERIAL AND METHODS:A retrospective clinical and morphologic analysis of data from 69 autopsies of patients who underwent COVID-19 (confirmed by polymerase chain reaction test) and had symptoms of digestive system lesions, according to clinical data, was performed. The data of case histories, autopsies, pathologoanatomic diagnoses and causes of death of patients were studied. Microscopic studies of tissue samples of stomach, intestine, liver, pancreas were performed. Immunohistochemical study with antibodies CD3, CD45, CD68, spike- and nucleocapsid-protein SARS-CoV-2 was performed. RESULTS:According to autopsy data, pathologic changes of the stomach that first developed and pre-existing more than 3 months after SARS-CoV-2 infection were detected in 49 (71.01%) of 69 cases. Among them, chronic superficial gastritis was the most common with 17 (34.99%) observations and acute stress-induced gastric erosions and ulcers with 13 (26.53%). Small and large intestinal lesions were seen in 15 (30.61%) cases, among which intestinal adenocarcinomas predominated with 6 (40.00%), colonic diverticula and chronic lymphocytic colitis with 3 (20.00%) cases each. Liver pathology, new-onset and pre-existing, was present in 100.00% cases: muscadic liver 45 (65.22%), massive liver necrosis (7.25%), hepatic steatosis and steatohepatitis (26.09%), brown atrophy (8.70%). Pancreatic lesions, new-onset and pre-existing, were detected in 57 (82.60%) cases. Among them, sclerosis and lipomatosis were more frequently registered in type 2 diabetes mellitus - 46 (80.70%) observations, pancreonecrosis - 11 (19.30%). CONCLUSIONS:Gastric, intestinal, liver, and pancreatic pathology in COVID-19 patients may be either first-onset or preexisting. The detected persistence of nucleocapsid and spike proteins of the virus in tissues may cause direct and autoimmune tissue damage, leading to the development of new and progressive chronic diseases of the digestive organs.
Breast tumors are one of the most common locations of malignant neoplasms. Every year, new aspects of the pathogenesis of breast cancer are discovered; along with genetic, hormonal and other factors, the issue of implantation and metastatic damage to the organ by tumors of other localizations is being increasingly discussed. With evolving diagnostic methods, more and more reports are emerging indicating that sometimes a breast tumor is not a primary lesion, but a site of metastasis. In this paper, the authors present a clinical case of metastasis of endometrioid adenocarcinoma of the endometrium to the breast. In this paper, the authors present a clinical case of metastasis of endometrioid adenocarcinoma of the endometrium to the mammary gland. The final diagnosis was made through analysis of a combination of morphological and immunohistochemical features. This clinical case is unique from a clinical and pathological perspective.
OBJECTIVE:Study of morphometric and ultrastructural features of follicular adenomas of the thyroid gland. MATERIAL AND METHODS:The study was conducted on the surgical material of the thyroid glands of 11 patients with a preliminary cytological conclusion of "Follicular neoplasia" and a further histologically established diagnosis of "Follicular adenoma". Material - fragments obtained from morphologically verified nodes of follicular adenoma, fragments of tissue outside the nodular formation served as control samples. Light and transmission electron microscopy were used to study semi-thin and ultra-thin sections of the thyroid glands, respectively. Morphometric analysis and statistical processing were performed on semi-thin sections. RESULTS:In follicular adenoma, the formation of intracellular microfollicles and narrowing of the lumen of the follicles with hypertrophy of the tumor cells: a reliable increase in the area of cells and their nuclei (p≤0.01), the numerical density of mitochondria (p≤0.001), a decrease in the diameter of the follicles (p≤0.001) were noted. The common ultrastructural features of the studied follicular adenomas are heterogeneous changes in the synthetic apparatus against the background of a sharp increase in the number of mitochondria. A possible mechanism of morphological rearrangements of tumor cells in follicular adenoma is compensatory adaptation at the level of cellular energy systems in response to dysfunction of the synthetic apparatus of thyrocytes. In the studied follicular adenomas with classical microfollicular morphology, signs of other, rarer histological patterns were found in a number of cells or in individual follicles, in particular, signet ring cell and clear cell patterns. CONCLUSION:The diversity of the detected morphological rearrangements reflects the stage-by-stage development of follicular adenomas. A number of ultrastructural features suggest that the rarer histological patterns described for follicular adenomas originate from the classical microfollicular pattern as a result of multidirectional transformation.
OBJECTIVE:To improve the stratification algorithm for aggressive B-cell lymphomas in children based on the analysis of genetic changes in the genes TP53, MYC, BCL2, BCL6 and the long arm of chromosome 11 (11q). MATERIAL AND METHODS:A comprehensive cytogenetic and molecular genetic analysis of tumor samples was carried out using NGS and FISH methods. Rearrangements of the MYC locus and the presence of translocations with different chromosomal partners were investigated, as well as the analysis of mutations and deletions of the TP53 gene. The presence of MYC, BCL2, BCL6 rearrangements and 11q aberrations was investigated as part of the algorithm. RESULTS:It has been shown that the classical translocation, t(8;14)(q24;q32) MYC::IGH, is detected in 77% of cases with typical Burkitt lymphoma histology. This translocation was not present in 23% of the samples. In a group of cases with classic histology of Burkitt lymphoma, where the t(8;14)(q24;q32) translocation was absent, rare genetic variations were identified - 11q gain/loss, and atypical FISH patterns indicative of complex genetic changes. TP53 mutations were detected in 26-30% of cases, localized mainly in the DNA-binding domain. A wide range of genetic changes has been identified, including monoallelic TP53 deletions and atypical FISH patterns that require attention and additional research. CONCLUSION:An improved diagnostic algorithm based on the combined use of FISH and NGS methods makes it possible to increase the accuracy of identification of genetic subtypes of aggressive B-cell lymphomas in children. This helps to categorize the diagnosis based on the molecular and genetic characteristics of the tumor, paving the way for improved prognosis and treatment effectiveness.
OBJECTIVE:To analyze the pathomorphological and immunohistochemical characteristics of the hearts of patients who died from COVID-19. MATERIAL AND METHODS:A comprehensive pathomorphologic study of the heart in 88 autopsies of patients who died from severe COVID-19 was performed. The presence of SARS-CoV-2 infection was confirmed by positive PCR tests in all cases. Immunohistochemical study was used to analyze the expression of viral nucleocapsid protein (NP), CD3, CD68, CD31, CD34, Willebrand factor (vWF) in cell populations and myocardial structures. RESULTS:In most cases, polymorphism of structural changes was observed, which was expressed in a combination of signs of chronic and acute myocardial damage. Numerous foci of interstitial and perivascular fibrosis and lipomatosis, irregular hypertrophy of cardiomyocytes, amyloid deposits were indicative of previous cardiovascular diseases. Acute and subacute pathological changes in myocardium included circulatory disorders (hyperemia, intraluminal megakaryocytes, microvascular thrombosis, interstitial edema), vascular damage, and alterative changes in cardiomyocytes. Lymphomacrophage infiltration was present in 45% of cases and was associated with immunohistochemical detection of NP in cardiomyocytes and vascular cells. Weak expression of CD31 and high expression of vWF in microvascular endothelium was found. CONCLUSION:NP expression in cardiomyocytes, macrophages and endothelial cells of cardiac vessels indicates their direct infection with SARS-CoV-2 virus and possible long-term persistence of viral infection. It was found that in severe COVID-19 CD3- and CD68-positive cells are detected in the heart; endothelial dysfunction is observed, which is indicated by decreased expression of CD31 and high expression of vWF. The identified myocardial changes may influence the development of post-COVID cardiovascular complications.
TRPS1 (Tricho-rhino-phalangeal syndrome type 1) - a transcription factor of the GATA family, has recently emerged as a promising immunohistochemical marker for breast cancer. This review summarizes current data on the diagnostic, prognostic, and potential therapeutic relevance of TRPS1, as well as its molecular functions and expression patterns across different breast cancer subtypes. TRPS1 demonstrates high sensitivity, including in diagnostically challenging cases such as triple-negative and poorly differentiated carcinomas, where traditional markers (GATA3, mammaglobin) may be absent or weakly expressed. The advantages of TRPS1 in the differential diagnosis of metastatic lesions and its possible role in prognostic panels are highlighted. Methodological limitations of the using marker, standardization needs and future perspectives for clinical implementation are also discussed in article.
OBJECTIVE:To evaluate changes in gene expression activity during preoperative testing for tumor hormone sensitivity to aromatase inhibitors and tamoxifen in postmenopausal women with ESR+/HER2- breast cancer. MATERIAL AND METHODS:The study included 174 breast cancer patients. Pathological examination of FFPE core biopsy specimens, performed before the hormone response test, and surgical specimens were examined, as well as immunohistochemistry (Ki67, ER, PR, HER2/neu) and molecular genetic testing of an expression panel of 45 target genes using quantitative real-time PCR. RESULTS:The use of aromatase inhibitors in the preoperative hormone response test is accompanied by statistically significant changes in the mRNA expression of 37 genes in breast tumors, of which a decrease in the expression level was found for 35 genes (ESR1, PGR, AR, ERBB2, FGFR4, MKI67, MYBL2, CCNB1, AURKA, BIRC5, CCND1, CCNE1, CDKN2A, KIF14, PPP2R2A, PTTG1, TMEM45B, TPX2, ANLN, MMP11, CTSL2, EMSY, PAK1, BCL2, BAG1, PTEN, TYMS, EXO1, UBE2T, NAT1, SCGB2A2, GATA3, FOXA1, ZNF703, CD274/PD-L1), an increase - for two genes (SFRP1, KRT5). While the use of tamoxifen statistically significantly correlates with a decrease in the level of mRNA expression of 35 genes: ESR1, PGR, AR, EGFR, ERBB2, FGFR4, MKI67, MYBL2, CCNB1, AURKA, BIRC5, CCND1, CCNE1, CDKN2A, KIF14, PPP2R2A, PTTG1, TMEM45A, TMEM45B, TPX2, ANLN, MMP11, EMSY, PAK1, BCL2, BAG1, PTEN, TYMS, EXO1, UBE2T, NAT1, GATA3, FOXA1, ZNF703, CD274/PD-L1, and an increase in only one gene - MYC. CONCLUSION:Comparative mRNA expression analysis confirms that a short preoperative course of aromatase inhibitors induces a more potent and uniform molecular response, characterized by profound suppression of proliferation and complete inhibition of estrogen-dependent signaling. Tamoxifen therapy is also effective but results in less pronounced suppression of key targets and, crucially, may be accompanied by early activation of the MYC oncogene, a potential marker for resistance development.
The genes of mismatch repair system (MMR) are responsible for correcting errors in DNA replication. MMR defects (dMMR) lead to mutations in microsatellites - repetitive nucleotide base sequences - resulting in microsatellite instability (MSI). Determination of dMMR/MSI status in tumors is an important factor for the development of patient management tactics, as the dMMR/MSI phenotype serves as both a marker of favorable prognosis and a predictor of response to immunotherapy in tumors of many localizations. MMR status is assessed via immunohistochemistry (IHC) on histological material. However, in some cases heterogeneity of intratumoral MMR protein expression (MMR heterogeneity) becomes an obstacle to this. MMR heterogeneity (areas of weak/absent staining on the background of normal expression) is poorly studied, especially in gastric cancer, in contrast to colorectal cancer and endometrial cancer. The lack of a methodology for interpreting this phenomenon leads to significant difficulties in stratifying patients who are indicated for dMMR/MSI status determination. The article systematizes current data on MMR heterogeneity in gastric cancer and tumors of other localizations, discusses molecular mechanisms, clinical significance and recommendations to overcome diagnostic limitations.
One of the key differences between ovarian borderline serous tumors and low-grade serous carcinoma is the pattern of extraovarian tumor spread. Therefore, accurate diagnostics of the peritoneal implant's histotype plays a crucial role in treatment and disease prognosis. Despite established histological criteria for differential diagnosis, the classification of implant type remains subjective, and the interobserver reproducibility among pathologists is still understudied. OBJECTIVE:To assess the level of reproducibility in implant type classification among pathologists for ovarian borderline serous tumors and low-grade serous carcinoma. MATERIAL AND METHODS:A series of 33 slides from resected omentum and peritoneum specimens obtained from 23 patients with ovarian borderline serous tumors and low-grade serous carcinoma were independently evaluated by three gynecologic pathologists and three oncopathologists with varying experience in gynecologic pathology to determine implant type. A consensus diagnosis was established by majority agreement among gynecologic pathologists. RESULTS:The consensus diagnosis classified 42.4% of cases as low-grade serous carcinoma metastases and 57.6% as non-invasive implants of borderline serous tumors. The Fleiss' kappa was 0.61, indicating substantial reproducibility among all pathologists, but Cohen's kappa varied significantly (0.348-0.817). Reproducibility was perfect between gynecologic pathologists and between them and the consensus diagnosis. However, reproducibility among general pathologists was only moderate, while their agreement with the consensus diagnosis ranged from minimal to substantial. CONCLUSION:This study confirms significant diagnostic challenges in distinguishing non-invasive implants of borderline serous tumors from low-grade serous carcinoma metastases among pathologists, highlighting the need for developing and implementing standardized diagnostic algorithms.
Infertility is a significant medical problem associated with morphological and functional changes in the endometrium and ovarian diseases that can lead to endometrial dysfunction. In this regard, it remains extremely important to study the role of endometrial and ovarian pathology in the development of infertility. OBJECTIVE:Comparative analysis of endometrial receptivity in young women with endometrial and ovarian factors of infertility. MATERIAL AND METHODS:We conducted a retrospective study that included 195 patients of reproductive age. Group 1 included patients with endometrial infertility factor (n=97), Group 2 included patients with ovarian infertility factor (n=38), Group 3 included women with a combination of both infertility factors (n=35). The comparison group consisted of women with infertility associated with male factor who were examined before IVF procedure (n=25). For pathomorphologic and immunohistochemical studies, the endometrium was sampled by pipelle biopsy on the 19th-22nd day of the menstrual cycle during the expected implantation window period. RESULTS:Analysis of the results of the pathomorphologic study revealed different degrees of impaired development of pinopodes and delayed secretory transformation of the endometrium in patients of the three groups. Immunohistochemical study revealed a significant decrease in the expression level of estrogen receptors (ER) and increase in the expression of progesterone receptors (PR) in the glandular compartment in all studied groups compared to the comparison group, as well as a decrease in the expression level of ER in the stromal compartment of the endometrium in patients of groups 1 and 3. CONCLUSION:One of the leading causes of implantation disorders in patients with endometrial and ovarian infertility factors is impaired maturation of pinopodes, delayed secretory transformation of the endometrium and displacement of the implantation window, as well as decreased expression of ER and increased expression of PR in glandular compartments in patients of the studied groups compared to the morphological control group, decreased expression of ER in the stromal compartment, in patients of groups 1 and 3.
The PDCD4 (programmed cell death protein 4) protein is a key target protein, in particular for the well-studied miR-21. By suppressing its synthesis, miR-21 exerts its influence on key cellular biological processes. Furthermore, miR-21 itself is one of the most relevant predictor markers for assessing the risk of developing gastric cancer. OBJECTIVE:Evaluation of PDCD4 expression as a potential marker for gastric cancer prediction and in the differential diagnosis of gastric mucosal dysplasia. MATERIAL AND METHODS:Comparative immunohistochemical analysis of PDCD4 protein was performed in biopsy specimens of the antral gastric mucosa with signs of chronic gastritis and gastric mucosal dysplasia, as well as in surgical specimens from stomachs resected for adenocarcinoma. RESULTS:In gastric mucosa with signs of chronic gastritis, high immunohistochemical expression of PDCD4 was maintained, regardless of the severity of inflammation, atrophy, and type of metaplasia. PDCD4 protein expression in the dysplasia group was significantly lower compared to gastric mucosal biopsy samples with signs of chronic gastritis (p=0.00001) and did not differ from that in adenocarcinoma tissues (p=0.43). A simple logistic regression model demonstrated a significant negative association between PDCD4 protein expression and dysplasia in the gastric mucosa (OR=0.27, CI=[0.16-0.46]). CONCLUSION:Low PDCD4 protein expression in dysplasia in the gastric mucosa and high levels regardless of the presence and severity of atrophy and inflammation may indicate its high potential for use in the differential diagnosis of indefinite for dysplasia and true dysplasia of the gastric mucosa.
Eosinophilic esophagitis (EoE) is characterized by predominant eosinophilic infiltration of esophageal mucosa, >15 eosinophils in a high power field (HPF). Proton pomp inhibitors (PPI) are medications of choice to start therapy of EoE. OBJECTIVE:To perform histological and morphometric analysis of biopsy pieces of esophageal mucosa before and after treatment with PPI. MATERIAL AND METHODS:Of the 84 patients newly diagnosed with EoE, 30 were in the PPI therapy group. Patients underwent esophagogastroduodenoscopy with biopsy for initial diagnosis and follow-up evaluation. Biopsy specimens were stained with hematoxylin and eosin, combined PAS/Alcian blue staining and Mallory staining to detect fibrosis. Morphometric analysis was performed using the Eosinophilic Esophagitis Histologic Scoring System (EoEHSS) for initial diagnosis and Eosinophilic Esophagitis Histology Remission Score (EoEHRS) to assess the onset of remission. RESULTS:In initial biopsies peak eosinophil count comprised 46 (25-89) eosinophils HPF, rates of basal zone hyperplasia and dilated intercellular spaces were both 100%, followed by lamina propria fibrosis (98.04%), surface epithelial alteration (77.38%), eosinophilic abscesses (57.14%), eosinophil surface layering (28.57%) and dyskeratosis (21.43%). Using EoEHSS, the total score for the grade was 12 (8-13.75) and the total score for the stage was 10 (8-12). Peak eosinophil count after the treatment alleviated in all the patients (4 (1-12) eosinophils HPF, p<0.05). The severity and the extent of other parameters has significantly decreased. Using EoEHSS, the total score for the grade was 4 [3-8] and the total score for the stage was 4 (3-7), p<0.05. CONCLUSION:Not only peak eosinophil count, but structural changes of esophageal mucosa should be taken into account while evaluating biopsies for initial diagnostic and to analyze the treatment response. EoEHRS remission criteria were reached in 40% patients on PPI therapy.
Low-grade serous carcinoma is a rare type of ovarian cancer, which is characterized with an indolent course, long-term survival, and relative resistance to chemotherapy. Although various patterns of destructive invasion have been described, data on the crosstalk between the morphological characteristics of this tumor and the clinical course are presented only in a few studies. OBJECTIVE:To reveal the crosstalk between patterns of invasion, stromal desmoplasia, and relapse-free survival in patients with low grade serous carcinoma. MATERIAL AND METHODS:The study was performed on 26 samples of ovarian low grade serous carcinomas obtained from patients aged 30 to 83 years. All slides were reviewed by 2 gynecological pathologists to identify macropapillary and micropapillary invasion patterns, as well as the presence of a desmoplastic stromal reaction in the tumor. Survival was assessed using the Kaplan-Meier method. RESULTS:Overall survival of patients was 96.1%, relapse-free survival was 76.9%. Advanced FIGO stages were observed in 88.5% of cases. The most common invasion pattern was the macropapillary variant, which was detected in 73.1% of cases. Micropapillary pattern was observed in 15.4% of cases. Desmoplasia was noted in equal proportions in both invasion variants (n=4). Tumor recurrence was detected in 16% of cases with macropapillary pattern, in 75% of cases with micropapillary pattern and in 100% of cases in the group with desmoplasia. The probability of recurrence depending on the invasion pattern using the Kaplan-Meier method was higher in the absence of the macropapillary invasion variant and in the presence of the micropapillary pattern. CONCLUSION:The results of the study revealed a crosstalk between specific morphological characteristics and the clinical course of ovarian low grade serous carcinoma. The micropapillary pattern was associated with an increased risk of recurrence, which emphasizes the importance of scrutinized histological analysis of the tumor for predicting disease outcomes.
Immunohistochemistry is one of the key methods of modern morphological diagnostics, providing both differential diagnosis of neoplastic and non-neoplastic processes and the assessment of prognostic and predictive biomarkers relevant for the selection of drug therapy. The multistep nature of immunohistochemical studies is associated with a high risk of methodological errors at the preanalytical, analytical, and postanalytical stages, which may lead to reduced reproducibility of results and the development of clinically significant diagnostic inaccuracies. OBJECTIVE:To assess the quality of immunohistochemical studies at all stages of the laboratory workflow in medical institutions participating in the external quality assessment program of the Immunohistochemistry Quality Control Center of the Russian Medical Academy of Continuous Professional Education in 2025. MATERIAL AND METHODS:The results of 18 external quality assessment rounds covering the preanalytical, analytical, and postanalytical stages of immunohistochemical studies were analyzed. Expert evaluation was performed by the Expert Council of the Immunohistochemistry Quality Control Center in accordance with approved assessment criteria and current clinical guidelines. RESULTS:At the preanalytical stage, typical violations related to fixation and histological processing of biological material were identified, significantly affecting the quality of immunohistochemical and molecular genetic studies. At the analytical stage, the main causes of unsatisfactory results were insufficient intralaboratory validation of protocols, the use of non-recommended antibody clones, and the absence of adequate control samples. At the postanalytical stage, errors in result interpretation not compliant with current clinical guideline requirements were detected. Laboratories that repeatedly participated in external quality assessment rounds demonstrated a statistically significant improvement in results following the implementation of individualized expert recommendations. CONCLUSION:External quality assessment of immunohistochemical studies is an effective tool for improving the reproducibility and clinical relevance of morphological research results. Regular participation of laboratories in quality control programs, standardization of methodological approaches, and systematic professional training of specialists contribute to a reduction in diagnostic errors and to improving the quality of morphological diagnostics and personalized patient management.
OBJECTIVE:To define the role of SLC7A5 expression in establishing an aggressive phenotype in primary breast cancer, specifically its correlation with major clinicopathological characteristics and the capacity for early lymphatic spread. MATERIAL AND METHODS:The study included tumor samples from 358 breast cancer patients. SLC7A5 expression was assessed by immunohistochemistry and correlated with tumor parameters (size, histological type, grade (G), molecular subtype, ER, PR, HER2 status, Ki-67 index) and axillary lymph node status. Analysis was performed using the χ² test, Kruskal-Wallis test, and univariate logistic regression. RESULTS:SLC7A5 expression was detected in 55.6% of cases (intense staining in 26.5%) and was associated with aggressive features: pT2-3 (p=0.033), G3 (p=0.001), Ki-67≥30% (p<0.001), ER-negative (p=0.022), and PR-negative status (p=0.013). A subtype-specific pattern was observed: maximal frequency in HER2-positive non-luminal tumors (80%), minimal in luminal A (42.8%; p<0.001). Expression in ≥10% of cells was more frequent in the lymph node metastasis group (51.8% vs. 31.8% in pN0; p<0.001), and metastatic risk increased with expression intensity (p<0.001). In age groups 18-44 and 60-74 years, as well as in ER-positive and G1 tumors, SLC7A5 positivity increased the odds of lymph node involvement by 2.26-6.5 times. CONCLUSION:SLC7A5 expression serves as an integral marker of breast cancer aggressiveness, associated with unfavorable immunophenotypes and independently predictive of lymphogenous metastasis. Its assessment may improve risk stratification and help identify candidates for LAT1 inhibitor-targeted therapy.
OBJECTIVE:To identify differential diagnostic pathomorphological features of the aortic wall structure in various forms of aortic aneurysm. MATERIAL AND METHODS:The study was conducted in the Pathology Department of the Republican Research Center of Emergency Medicine (Tashkent, Uzbekistan) from January 2024 to September 2025. A total of 19 biological samples of aorta from patients with aortic aneurysms, from whom biological material was obtained intraoperatively, were studied. These included atherosclerotic lesions (n=9), Marfan syndrome (n=5), sinus of Valsalva rupture (n=3), and Takayasu syndrome (n=2). Histological preparations were examined using a Carl ZEISS Axiostar Plus microscope. Quantitative analysis was performed using Fiji by ImageJ software, and statistical analysis was conducted in SPSS 23.0. RESULTS:In atherosclerosis, typical plaques with lipid cores, pronounced medial layer calcification, and cholesterol crystals were identified. In Marfan syndrome, focal destruction of elastic fibers in the tunica media and mucoid degeneration of the media with uneven accumulation of mucopolysaccharides were found. In sinus of Valsalva aneurysms, uneven thickness of collagen and reticulin fibers with pronounced edema of the middle layer was present. In Takayasu syndrome, inflammatory infiltration of the middle layer and marked reduction in smooth muscle fiber quantity were detected. CONCLUSION:Morphological examination of the aortic wall revealed significant differences in the structure and composition of wall components, confirming the heterogeneity of aortic aneurysm pathogenesis. Quantitative morphometric criteria for diagnosis verification were determined: elastic fiber density (<20% characteristic of Marfan syndrome), inflammatory cell count (>250/mm² specific for Takayasu arteritis), medial calcification (>40% indicates atherosclerotic origin).
Tumors originating from the remnants of the mesonephral (Wolf's) duct, known as FATWO (Female Adnexal Tumor of Probable Wolffian Origin), belong to the category of rare neoplasms of the female reproductive system. The tumor was first described in 1973 by doctors Kariminijad and Scully from the University of Texas M.D. Anderson Cancer Center. Since then, about 100 cases of FATWO have been recorded worldwide. The localization of the tumor is associated with the threefold laying of the Wolf duct in embryogenesis: from the ovarian gate, along the mesosalpinx, in the wide ligament of the uterus along its lateral wall to the outer third of the vagina. This publication presents the case of a 57-year-old patient whose abdominal ultrasound revealed a bulky tumor of the right ovary. During intraoperative revision of the abdominal cavity and pelvic cavity, tumor masses were also found on the parietal peritoneum, mesentery of the sigmoid colon, in the large omentum, and fatty tissue of the anterior abdominal wall. A radical surgical intervention was performed with the removal of all metastatic foci. Upon histological examination, the structure and cytological signs of the formation were not characteristic of a tumor with a high degree of malignancy. Taking into account the results of the immunohistochemical study and the data of the clinical course, the diagnosis of FATWO was made. The rarity of this nosological form and its genetic heterogeneity create difficulties in the pathohistological diagnosis of neoplasms due to the presence of only relatively specific immunohistochemical markers, which make it possible to exclude more common tumors with a similar morphological pattern.
Gastrointestinal stromal tumors (GISTs) are the most common subtype of soft tissue sarcomas, with diagnosis based on a combination of clinical presentation, anatomical localization of the tumor, histological and immunohistochemical (IHC) studies. This paper explores the potential of artificial intelligence (AI) technologies for the automated detection of mitotic figures in histological images of GISTs. A literature review on the application of AI in morphological diagnostics of various tumors is presented. A test dataset of 220 digitized histological slides annotated in CVAT was created as part of the study. A convolutional neural network, YOLOv11, trained over 300 epochs, was used to analyze mitotic activity. Model performance evaluation showed that its accuracy was limited due to the small size of the training dataset. Future work will focus on expanding the dataset and improving the accuracy of pathological mitosis detection.
OBJECTIVE:To investigate the histological and immunohistochemical characteristics of epithelial neoplasia of the extrahepatic bile ducts (EHBD) and to develop a diagnostic algorithm. MATERIAL AND METHODS:The study included 104 patients. All patients underwent biliary tract biopsy. Morphological and immunohistochemical parameters were compared in biopsies with inflammation, low- and high-grade biliary intraepithelial neoplasia (BilIN), low- and high-grade intraductal papillary neoplasia (IPNB), and cholangiocarcinoma (CC). The main parameters in the study of the histological characteristics of epithelial neoplasia of the EHBD were: cellular atypia, nuclear polymorphism, nuclear polarity, the state of the brush border, inflammatory infiltration, and histological architecture. Immunohistochemical studies were performed using antibodies to MUC1, MUC2, MUC5AC, MUC6, and CD10. When studying the IHC characteristics of epithelial neoplasms of the EHBD, the localization of the reaction in epithelial cells, its intensity, and prevalence were assessed, and specificity and sensitivity were evaluated. Statistical analysis of the data used the two-sided Pearson χ2 criterion (p<0.05). RESULTS:Based on the results of the morphological stage of the study, a scale for assessing the degree of dysplasia in biopsy specimens was developed; a certain number of points were assigned to each type of epithelial neoplasia of the EHBD. Based on the results of the IHC study, taking into account statistically significant changes, an immunophenotype was established for each type of epithelial neoplasia of the EHBD: inflammation and BilIN LG - MUC1, MUC2, MUC6, CD10; BilIN HG - MUC1, MUC2, MUC5AC, MUC6; IPNB LG - MUC1, MUC2, MUC5AC, MUC6, CD10; IPNB HG - MUC1, MUC2, MUC5AC, MUC6; CC - MUC1, MUC5AC, MUC6. For differential diagnosis of the degree of dysplasia in epithelial neoplasia of the EHBD, it is recommended to use an IHC panel with the presence of antibodies to MUC1, MUC2, CD10. It is proposed to use antibodies to MUC2, MUC5AC and MUC6 as an IHC panel for differential diagnosis of IPNB subtypes. CONCLUSION:Clear morphological and immunohistochemical criteria for the differential diagnosis of non-invasive lesions of the EHBD, inflammation and cholangiocarcinoma have been identified, and an algorithm for the comprehensive differential diagnosis of epithelial neoplasia of the EHBD has been developed.
