Anatomic pathology selected abstracts

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Editors: Rouzan Karabakhtsian, MD, PhD, professor of pathology and director of the Women’s Health Pathology Fellowship, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Shaomin Hu, MD, PhD, staff pathologist, Cleveland Clinic; S. Emily Bachert, MD, associate pathologist, Brigham and Women’s Hospital, Boston; and Amarpreet Bhalla, MD, assistant professor of pathology, Albert Einstein College of Medicine, Montefiore Medical Center.

Surgical pathology of diffuse parenchymal lung disease in patients with psoriasis or psoriatic arthritis

January 2024—Diffuse parenchymal lung disease is a well-recognized complication of systemic connective tissue disease but rarely arises in patients with psoriasis or psoriatic arthritis, which are poorly understood. Therefore, the authors conducted a study to characterize diffuse parenchymal lung disease (DPLD) associated with psoriasis or psoriatic arthritis, with or without prior immunomodulation. Their pathology consultation files were searched for patients having psoriasis or psoriatic arthritis and DPLD. After excluding cases with active infection or smoking-related DPLD only, 44 patients (22 of whom were women; median age, 60 years; range, 23–81 years) were enrolled in the study. Clinical history and pathology slides were reviewed. Twenty-seven of 44 (61 percent) patients had psoriatic arthritis and the remainder had psoriasis alone. Most presented many years later with nonspecific respiratory symptoms. Nearly one-third had no prior immunosuppression, and most had no concomitant connective tissue disease. Radiographically, ground-glass opacities, consolidation, and/or reticulation were typical. Histologically, nonspecific interstitial pneumonia and unclassifiable fibrosis were seen in 24 (55 percent) patients and eight (18 percent) patients, respectively. Usual interstitial pneumonia and airway-centered fibrosis were rare. Superimposed acute lung injury was common, usually manifesting as organizing pneumonia. Lymphoplasmacytic infiltrates, lymphoid aggregates, and chronic pleuritis were frequent. Interstitial granulomas were seen in 17 (39 percent) patients but were usually rare, poorly formed, and nonnecrotizing. No histologic differences were apparent among patients with or without concomitant connective tissue diseases or prior therapy. The authors concluded that some patients who have psoriasis or psoriatic arthritis developed clinically significant DPLD, even without prior therapy. The histopathologic findings mirrored changes seen with other connective tissue diseases. Additional studies are warranted to clarify the association between psoriasis or psoriatic arthritis and DPLD.

Butt YM, Smith ML, Tazelaar HD, et al. Surgical pathology of diffuse parenchymal lung disease in patients with psoriasis or psoriatic arthritis. Arch Pathol Lab Med. 2023;147:525–533.

Correspondence: Dr. Brandon T. Larsen at larsen.brandon@mayo.edu

Ability of apoptosis, crypt dropout, and IHC to indicate cytomegalovirus infection in IBD patients

Cytomegalovirus colitis superimposed on inflammatory bowel disease can be challenging to diagnose. Therefore, the authors conducted a study to determine which histologic clues and IHC utilization practices, if any, can help diagnose cytomegalovirus (CMV) superinfection in inflammatory bowel disease (IBD). Colon biopsies were reviewed for all patients with CMV colitis with and without IBD between 2010 and 2021 at one institution, as was a separate cohort of IBD patients with negative CMV IHC. Biopsies were assessed for histologic features of activity and chronicity, phlebitis, fibrin thrombi, basal crypt apoptosis, CMV viral cytopathic effect (VCE), and CMV IHC positivity. Features between groups were compared, with statistical significance set at P < .05. The study included 251 biopsies from 143 cases—21 CMV only, 44 CMV plus IBD, and 78 IBD only. The CMV plus IBD group was more likely than the IBD-only group to show apoptotic bodies (83 versus 64 percent; P = .035) and crypt dropout (75 versus 55 percent; P = .045). CMV was detected by IHC in 18 CMV plus IBD cases without VCE on H&E (41 percent). In the 23 CMV plus IBD cases in which IHC was performed on all concurrent biopsies, IHC was positive in at least one biopsy in 22 cases. Six individual CMV plus IBD biopsies with no VCE on H&E demonstrated equivocal IHC staining, five of which had evidence of CMV infection. The authors concluded that IBD patients with superimposed CMV infection are more likely to demonstrate apoptotic bodies and crypt dropout compared with their noninfected counterparts. Equivocal IHC staining for CMV may indicate true infection in IBD patients, and staining multiple biopsies from the same accession can improve CMV detection.

Ono Y, Gonzalez RS. Apoptosis, crypt dropout, and equivocal immunohistochemical staining may indicate cytomegalovirus infection in inflammatory bowel disease patients. Am J Surg Pathol. 2023;47(8):933–941.

Correspondence: Dr. Raul S. Gonzalez at rsgonza@emory.edu

Assessment of HER2 in gastric-type endocervical adenocarcinoma and its prognostic significance

As the most common type of human papillomavirus-independent endocervical adenocarcinoma, gastric-type endocervical adenocarcinoma accounts for approximately 10 percent of all endocervical adenocarcinomas. However, data about HER2 expression and amplification in endocervical adenocarcinoma (ECA), including gastric-type endocervical adenocarcinomas (GEAs), are limited and inconsistent. The limited data regarding HER2 in GEAs and ECAs vary considerably and are likely due to differences in tumor type selection, testing methods, and scoring criteria. The authors conducted a study to systematically investigate HER2 overexpression and amplification in GEAs to set the foundation for eventually developing HER2 scoring recommendations for GEAs. They also examined the prognostic value of HER2 overexpression and amplification and their association with other known and potential prognostic factors. The authors selected 58 GEA cases for the purpose of analyzing HER2 status using IHC and FISH. When strong complete or lateral/basolateral membranous reactivity in 10 percent or more of tumor cells was used to define HER2 positivity, a relatively high prevalence of HER2 overexpression (10 of 58 [17.2 percent]) and amplification (nine of 58 [15.5 percent]) and a high IHC-FISH concordance rate (nine of 10 [90 percent]) were found in GEAs. A lateral/basolateral staining pattern (U shaped) was observed, at least focally, in most HER2-positive (3+) and equivocal (2+) tumors. Considerable heterogeneity of HER2 expression was observed in HER2-positive and equivocal cases (80 and 83.3 percent, respectively). HER2 overexpression and amplification were associated with worse progression-free survival (P=.047 and .032, respectively). Programmed death-ligand 1 expression was also associated with worse progression-free survival (P=.032), whereas mutant-type p53 demonstrated no prognostic significance. The authors concluded that their findings create a solid foundation for the eventual development of a standard HER2-testing guideline for GEAs.

Wang S, Zhou X, Niu S, et al. Assessment of HER2 in gastric-type endocervical adenocarcinoma and its prognostic significance. Mod Pathol. 2023. https://doi.org/10.1016/j.modpat.2023.100148

Correspondence: Dr. Huijuan Zhang at zhanghj815@sjtu.edu.cn or Dr. Hao Chen at hao.chen@utsouthwestern.edu