Abstract:Objective To investigate the clinicopathological features,diagnosis,and differential diagnosis of spermatocytic tumor of the testis.Methods A retrospective analysis was conducted on the clinicopathological data of two cases of spermatocytic tumor diagnosed and treated at Renmin Hospital of Wuhan University between December 2024 and March 2025,along with a review of relevant literature.Results Both patients were middle-aged to elderly males.Case 1 was admitted due to swelling of the right scrotum for over one year,while Case 2 presented with right testicular pain for 10 days.Neither had a history of cryptorchidism.Microscopically,the tumors were relatively well-circumscribed,exhibiting solid nodular or nested growth patterns.The stroma showed delicate fibrous septa,hemorrhage,and edema,with focal pseudoglandular or trabecular structures.The tumor cells consisted of small,medium,and large cell types,with no evidence of germ cell neoplasia in situ(GCNIS)in the surrounding seminiferous tubules.Immunohistochemically,both cases demonstrated variable positivity for SALL4 and CD117,with a Ki-67 proliferation index of approximately 40%.All other immunomarkers were negative.Conclusion Spermatocytic tumor of the testis is a rare germ cell neoplasm unrelated to GCNIS.Its typical histological feature is the presence of three distinct cell types(small,medium,and large),with possible anaplastic or sarcomatoid changes.Radical orchiectomy remains the primary treatment for this tumor.

Abstract:Objective To investigate the clinicopathological features of atypical ductal hyperplasia and carcinoma transformation in breast fibroadenoma(FA).Methods A retrospective analysis was conducted on clinical and pathological data from 2012 to 2024,encompassing HE staining,immunohistochemical examination,and literature review.Results Among 3,975 patients with FA,3 cases developed atypical hyperplasia and 3 cases progressed to carcinoma,with an incidence rate of 0.15%(6/3,975).One case was an invasive carcinoma within a FA.All patients were female,aged between 19 and 71 years.Grossly,the tumors appeared as grayish-white nodules with well-defined margins,measuring 1.2 to 4.5 centimeters in diameter,having a solid texture,and a firm or hard consistency,with fissure-like patterns.Microscopically,there was ductal hyperplasia with epithelial and myoepithelial linings,and a loose connective tissue stroma.Atypical hyperplasia and ductal carcinoma in situ exhibited hyperplastic ductal epithelium with uniform cells but atypia,creating a sieve-like appearance.Invasive carcinoma showed nests of highly atypical cells infiltrating the surrounding tissue,accompanied by calcification,ossification,and fibrosis.The immunophenotype was as follows:CK5/6 was negative,and ER was positive in atypical hyperplasia and ductal carcinoma in situ(DCIS);ER,PR were negative,HER2 was strongly positive(3+),and CK5/6 was negative in invasive carcinoma.Imaging revealed that atypical hyperplasia and DCIS masses had regular morphology with well-defined borders,a BI-RADS-3 grade similar to benign FA,whereas invasive carcinoma exhibited a BI-RADS-4 grade comparable to malignant tumors,differing primarily in margin definition.Postoperative follow-up ranged from 4 to 57 months,with no recurrence or metastasis observed.Conclusion Malignant transformation of fibroadenoma is rare,while atypical hyperplasia and ductal carcinoma in situ are relatively more common compared to invasive carcinoma.After surgical resection,endocrine therapy or chemotherapy is administered,with follow-up ranging from 1 to 5 years,during which all patients exhibit favorable prognosis.The atypical hyperplasia and DCIS within fibroadenomas appear macroscopically and on ultrasound similarly to benign fibroadenomas,potentially leading to oversight.Therefore,even fibroadenomas warrant follow-up.Performing a biopsy or mass excision serves as an effective diagnostic and therapeutic approach.

Abstract:Objective To improve the diagnostic level of extrathoracic SMARCA4-deficient tumors by summarizing and analyzing the clinicopathological features of cases of extrathoracic SMARCA4-deficient tumors and relevant reports in the databases.Methods Five cases of extrathoracic SMARCA4-deficient tumors diagnosed and treated in our hospital from 2023 to 2024,as well as primary extrathoracic SMARCA4-deficient tumor cases reported in China National Knowledge Infrastructure(CNKI)and PubMed databases during the same period,were retrospectively analyzed.The clinicopathological features,diagnosis and differential diagnosis,clinical treatment and prognosis of the above cases were summarized and analyzed.Results In addition to recurrent and metastatic SMARCA4-deficient tumors,primary extrathoracic SMARCA4-deficient tumors occurred in multiple systems throughout the body,predominantly in middle-aged and elderly male patients.These tumors progressed rapidly,were prone to recurrence,and lacked effective treatment modalities.Microscopically,the tumor cells exhibited significant atypia with frequent mitotic figures,showing undifferentiated epithelioid and rhabdoid morphology,reduced intercellular adhesion,and occasional collagen degeneration and coagulative necrosis.Immunohistochemically,CKpan was often weakly positive and SMARCA4 was negative,while molecular testing provided additional diagnostic value.Conclusion Extrathoracic SMARCA4-deficient tumors are highly malignant,prone to recurrence and metastasis,and can occur in multiple sites throughout the body.The characteristic rhabdoid morphology and reduced intercellular adhesion under microscope are suggestive,and the diagnosis can be confirmed by combining immunohistochemistry with molecular testing.

Abstract:Objective To investigate the clinicopathological characteristics,diagnostic criteria,and therapeutic strategies for uterine adenosarcoma.Methods Clinicopathological data from two cases of uterine adenosarcoma confirmed by hematoxylin-eosin(HE)staining and immunohistochemistry were retrospectively analyzed,supplemented by a comprehensive literature review.Results Histologically,the tumors exhibited a biphasic architecture comprising benign endometrial-like glands and sarcomatous spindle stromal cells arranged in fascicles or whorls.A distinctive"cuff-like"stromal condensation surrounding the glands was observed.One case demonstrated heterologous differentiation with chondrosarcomatous and rhabdomyosarcomatous components.Immunohistochemical analysis revealed positive expression of CD10,ER,and PR in stromal cells,while heterologous areas showed S-100 positivity,indicating chondrosarcomatous differentiation and myogenin/MyoD1 expression,suggesting rhabdomyosarcomatous differentiation.Epithelial markers(CK),myogenic markers(desmin,SMA),and P53 were uniformly negative.Conclusion Uterine adenosarcoma is a rare biphasic neoplasm characterized by benign glandular epithelium and sarcomatous stromal components.It lacks distinctive clinical manifestations,laboratory findings,or imaging features,and definitive diagnosis relies on the histomorphological characteristics and immunohistochemical analysis.

Abstract:Objective To investigate the clinicopathological characteristics,diagnosis,and differential diagnosis of pure large cell neuroendocrine carcinoma(PLCNEC)of the ovary.Methods Clinical and pathological data of a patient with PLCNEC of the ovary was collected,and relevant literature was reviewed.Results The patient was a 69-year-old female.Pelvic exploration revealed numerous cancer nodules throughout abdominal wall,severe adhesion between the uterine adnexa and intestinal tract,and an enlarged right ovary.Biopsy was performed on part of the ovarian tissue and metastatic lesions.Microscopically,the tumor cells were arranged irregularly in solid or sheet-like patterns,with extensive necrosis in the center and surrounding areas.The tumor cells were large in size,round or irregular,with eosinophilic cytoplasm,large and hyperchromatic nuclei,and mitotic figures were easily visible.Immunohistochemically,the tumor cells were diffusely positive for AE1/AE3,CD56,CgA,SYN,and INSM1,with a high Ki67 index.Conclusion PLCNEC of the ovary is extremely rare and prone to clinical misdiagnosis.It should be differentiated from common epithelial-derived malignant tumors of the ovary.Diagnosis requires comprehensive analyses of clinical data,microscopic morphology,and immunohistochemical results.Treatment primarily involves surgery combined with chemotherapy,and the prognosis is poor..

Abstract:Objective To investigate the relationship between the expression of transient receptor potential channel 1(TRPC1)and small mammary epithelial mucin(SBEM)in breast cancer tissues and the clinicopathological characteristics of patients,and to analyze the clinical value of the combination of TRPC1 and SBEM in early diagnosis of breast cancer.Methods A total of 108 breast cancer patients who were treated in Jianyang People's Hospital from April 2020 to November 2023 were selected.Immunohistochemistry was used to evaluate the protein expression levels of TRPC1 and SBEM in normal tissues and breast cancer tissues.The mRNA expression levels of TRPC1 and SBEM was detected by quantitative reverse transcription polymerase chain reaction(qRT-PCR)in breast cancer patients and normal breast tissues.The correlation between the expression levels of TRPC1 and SBEM and the clinicopathological characteristics of patients was analyzed with Spearman test.The risk factors of breast cancer metastasis in patients with breast cancer were analyzed by logistic univariate and multivariate analysis.ROC curve was used to evaluate the clinical value of TRPC1 combined with SBEM in the early diagnosis of breast cancer.Results Immunohistochemistry showed that the expression of TRPC1 and SBEM in breast cancer tissues was significantly higher than those in normal breast tissues(χ2=49.63,χ2=44.09,P<0.001).The mRNA expression levels of TRPC1 and SBEM were not related to age,histological grade,histological type,tumor size and breast cancer type,but related to tumor stages and lymph node metastasis(P<0.001).The relative expression levels of TRPC1 and SBEM were positively correlated with the clinical stage of breast cancer(r=9404,r=0.9145,P<0.001).Logistic regression analysis showed that clinical stage of breast cancer(OR=2.514,P=0.042),TRPC1(OR=9.325,P=0.01)and SBEM(OR=1.581,P=0.029)were independent risk factors for lymph node metastasis of breast cancer.ROC curve showed that TRPC1 combined with SBEM had a good predictive value in the early diagnosis of breast cancer.Conclusion The expression of TRPC1 and SBEM is increased in breast cancer tissues,which are closely related to tumor stages and lymph node metastasis of breast cancer,and have good predictive values for early diagnosis of breast cancer..

Abstract:Objective To quantitatively evaluate the effect of artificial intelligence(AI)-assisted teaching on the diagnostic accuracy of prostate cancer among resident pathologists.Methods This was a prospective self-controlled study.A total of 249 hematoxylin-eosin(H&E)slides were obtained from 51 patients who underwent prostate biopsies at China-Japanese Friendship Hospital between May and July 2025.Four resident pathologists in standardized training participated in a three-stage evaluation:(1)initial diagnosis;(2)review and AI-assisted teaching;and(3)post-teaching diagnosis.Slides from May were used for stages(1)and(2),and slides from June were used for stage(3)to minimize memory bias.The gold standard for pathological diagnosis of prostate biopsy was determined by two senior pathologists using histology and confirmatory immunohistochemistry.Diagnostic accuracy,sensitivity,and specificity were compared between stages(1)and(3).Results After AI-assisted teaching,the third-year resident's accuracy increased from 83.3%to 94.6%,and sensitivity increased from 57.9%to 100%;the second-year resident's accuracy increased from 73.9%to 92.8%,and specificity increased from 72.0%to 96.2%(all P<0.05).After AI-assisted teaching,diagnostic performance of first-year resident pathologists was significantly improved.Resident C showed overall enhancement in diagnostic accuracy(from 54.35%to 69.37%),sensitivity(from 81.58%to 90.63%),and specificity(from 44.00%to 60.76%).Resident D shifted from a defensive"all-positive"pattern(accuracy 27.54%,specificity 0%)to a more balanced diagnosis(accuracy 65.77%,specificity 67.09%).Conclusion Preliminary quantitative data demonstrates that short-term AI-assisted teaching can significantly improve the diagnostic accuracy,sensitivity,and specificity of junior pathologists in prostate cancer.It is operable and worthy of promotion,and further validation in larger cohorts is needed.

Abstract:Objective To analyze the clinical features,pathological characteristics,treatment modalities,and prognosis of 14 cases of mixed neuroendocrine-non-neuroendocrine tumors of the cervix,with review of the relevant literature to deepen the cognition of these tumors.Methods We retrospectively analyzed and summarized the clinical data,microscopic morphological features,immunohistochemical phenotypes,treatment,and prognosis of 14 cases of mixed neuroendocrine-non-neuroendocrine tumors of the cervix from 2014 to 2024 at the Affiliated Hospital of Binzhou Medical University.The clinicopathological features,treatment methods,and prognosis-related factors of these tumors were investigated.Results The age of patients ranged from 29 to 72 years,with an average age of 49.5 years.According to the International Federation of Gynecology(FIGO)clinical stage,1 case was in stage IA1,2 cases were in stage IB1,5 cases in stage IB2,1 case in stage II A,1 case in stage IIB,1 case in stage Ⅲ,and 3 cases in stage IV.The neuroendocrine component was most commonly small cell carcinoma(SCNEC)(9/14),while the non-neuroendocrine component was the most common type of adenocarcinoma(5/14).Immunohistochemical staining showed neuroendocrine markers of Syn,CgA,and CD56 were positive in 92.8%(13/14),71.4%(10/14),and 78.6%(11/14)of cases,respectively.Ki-67 proliferation index was 60%～90%.The results of HPV detection were positive in 14 cases,and 9 cases were HPV18 positive.13 patients were followed up for 6 to 119 months,of which 3 died,and 3 cases were found to have metastasis.Conclusion Mixed neuroendocrine-non-neuroendocrine tumors of cervix are rare malignant tumors with a poor prognosis.Diagnosis needs to be combined with histological morphology and immunohistochemical markers.

Abstract:Objective To investigate the clinicopathological characteristics of intravenous leiomyomatosis(IVL)in order to improve diagnostic accuracy and reduce the risk of misdiagnosis.Methods A retrospective analysis was performed on the clinical data of 4 patients with IVL.Surgical specimens were examined using HE staining and immunohistochemistry(EnVision method).Their pathological features were discussed in conjunction with a literature review.Results The average age of the patients was 48.5 years.The main clinical manifestations included pelvic masses,menstrual disorders,and lower abdominal pain.Preoperative imaging misdiagnosed 3 cases as multiple uterine leiomyomas and suspected sarcoma with adnexal invasion in 1 case.Postoperative pathology revealed multiple intramural nodules within the uterine myometrium,some with edematous degeneration and soft to medium consistency.Worm-like tumor masses grew within vascular lumens in the myometrium.Tumor extension into the broad ligament was observed in 3 cases,and involvement of the ovarian vein occurred in 1 case.Microscopically,spindle-shaped smooth muscle cells were seen,exhibiting low-grade atypia and absence of necrosis,accompanied by hyaline degeneration and thick-walled blood vessels.Immunohistochemistry showed that the tumor cells were strongly positive for ER and PR,weakly positive for SMA,H-caldesmon,and desmin,and negative for CD10.CD34 and ERG were expressed in the endothelial cells lining the intravascular tumor surfaces.Conclusion The clinical and imaging presentations of IVL lack specificity.Pathological examination is essential for a definitive diagnosis,particularly for large intramural masses with significant edema and broad ligament masses.Standardized specimen sampling can reduce missed diagnoses.The pathological diagnosis of IVL has guiding significance for treatment and follow-up..

Abstract:Objective To summarize the clinicopathological features of Lhermitte-Duclos disease(LDD)accompanied with Cowden syndrome.Methods Clinicopathological data of LDD were retrospectively collected and comprehensively analyzed using hematoxylin-eosin staining,immunohistochemical analysis and molecular testing.Results The lesion was located in the right cerebellar hemisphere.Microscopic examination revealed that the molecular layer,Purkinje cell layer,and granular cell layer of the cerebellar cortex were replaced by abnormally proliferating myelinated axonal bundles and dysplastic ganglion cells.Immunohistochemical analysis demonstrated positivity for S-100,CgA,NSE,and Syn.GFAP staining was positive in the background glial fibers but negative in tumor cells.PTEN,Olig-2 and CD34 expression were absent,Ki-67 labeling index was less than 1%,and P53 showed weak positivity in approximately 1%of cells.Molecular testing confirmed a PTEN gene mutation.Conclusion LDD is a rare central nervous system tumor often associated with Cowden syndrome.Accurate diagnosis relies on histopathological evaluation and immunohistochemical findings.Genetic counseling is recommended for patients to reduce misdiagnosis of Cowden syndrome and to improve long-term outcomes.

Abstract:Objective To investigate the clinicopathological and molecular genetic features of atypical meningioma and its recurrence risk.Methods A total of 10 cases of atypical meningioma were collected from the Fourth Affiliated Hospital of Soochow University(Suzhou Dushu Lake Hospital)from 2021 to 2023.The molecular genetic characteristics were detected by second-generation sequencing,and the factors related to recurrence risk were analyzed by histopathology and molecular genetic characteristics.Results Among the 10 cases of atypical meningiomas,there were 5 cases of brain tissue invasion,5 cases of high mitotic figures(4-19/10HPF),8 cases of increased cell density,7 cases of lamellar structure,4 cases of obvious nucleolus,3 cases of high nucleo-plasma ratio,and 2 cases of spontaneous necrosis.Second-generation sequencing detected 1 case of homozygous CDKN2A/B deletion and 1 case of heterozygous deletion,8 cases of 22q deletion,6 cases of 1p deletion,4 cases of 10p/q deletion,4 cases of 18p/q deletion,3 cases of 6q and 14p/q deletion,2 cases of 3p,4p/q deletion and 17q amplification,and 1 case of 19q deletion,5p/q amplification and 20q amplification.NF2 mutation was detected in 7 cases,ARID1A mutation in 2 cases,TRAF7,AKT1,KDM6A mutation in 1 case each.Co-deletion of chromosomes 1p and 22q or deletion of chromosome 10p/q or 18p/q were statistically associated with recurrence in atypical meningioma.There was a significant difference between the grade of integrated grading and recurrence(P<0.05).Conclusion Atypical meningioma has many molecular genetic changes.Co-deletion of chromosomes 1p and 22q or deletion of chromosome 10p/q or 18p/q in atypical meningioma may indicate a higher risk of recurrence.The integrated grade may be better than the histological grade in evaluating the recurrence risk of atypical meningiomas.

Abstract:Objective To compare and analyze the positive rates of single and combined detection methods in bronchofibroscopic brush smear,centrifugal smear of alveolar lavage fluid and liquid-based thin-layer cytology of bronchofibroscopic brush,and to explore the most effective cytological detection method for lung cancer screening.Methods The cytological examination results of 116 patients with lung cancer diagnosed by pathology were analyzed retrospectively,and the brush smears compared(n=109),the positive rates of single and combined detection in liquid-based thin-layer cytology(n=108)and lavage fluid smear(n=31)were statistically analyzed by chi-square test.Results Among 116 confirmed cases of lung cancer,brush,liquid-based thin-layer cytology(TCT),lavage fluid smear(BALF),brush+liquid-based thin-layer cytology,brush+lavage fluid smear(BALF)and liquid-based thin-layer cytology+lavage fluid smear(BALF)were analyzed;the positive rates of diagnosis were 70.6%,69.4%,29.0%,78.8%,66.7%and 66.7%,respectively.It was found that there was no significant difference in the positive rate between brush smear and liquid-based thin-layer chromatography(TCT)(70.6%vs.69.4%,P>0.05),but they were significantly higher than BALF of lavage fluid smear(29.0%,P<0.001).The positive rate of brush+TCT was the highest(78.8%),which was better than brush+BALF(66.7%)or TCT+BALF(66.7%)(χ2=27.996,P<0.001).Conclusion In the cytological screening of lung cancer,brushing and TCT alone have the same detection efficiency,and the combination of them can significantly improve the positive rate of cytological diagnosis of lung cancer,which is recommended as the preferred detection strategy in clinic.

Abstract:Objective To investigate the positive rates of clonal immunoglobulin(Ig)and T-cell receptor(TCR)gene rearrangements in lymphoproliferative disorders and their clinical significance in diagnosis.Methods A standardized BIOMED-2 multiplex PCR strategy was applied to detect clonal IGH,IGK,IGL and/or TCRB,TCRD,TCRG rearrangements in 80 cases of B-cell lymphoma,37 cases of T-cell lymphoma,and 38 cases of benign proliferative disorders.Results In mature B-cell lymphomas,the overall positive rate of clonal Ig gene rearrangement was 91.14%(72/79),with detection rates of 83.54%(66/79)for IGH,56.96%(45/79)for IGK,and 30.38%(24/79)for IGL.Combined analysis of IGH and IGK achieved a positivity rate of 89.87%(71/79).In mature T-cell lymphomas,the overall positive rate of clonal TCR gene rearrangement was 60.00%(21/35),with detection rates of 48.57%(17/35)for TCRB,14.29%(5/35)for TCRG,and 8.57%(3/35)for TCRD.Combined TCRB and TCRG clonal analysis yielded a positive rate of 57.14%(20/35).Among 117 lymphoma cases,17.95%(21/117)exhibited dual Ig/TCR clonal rearrangements.In benign proliferative disorders,the positive rates for Ig and TCR gene clonal rearrangements were 26.32%(10/38)and 28.95%(11/38),respectively.Conclusion The BIOMED-2 multiplex PCR strategy provides complementary diagnostic value for clonal Ig/TCR gene rearrangement analysis in lymphoproliferative disorders.However,comprehensive diagnosis should integrate morphological,immunohistochemical,and clinical features.