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.
S100 protein expression in neuroendocrine neoplasms as a marker of pancreatic origin
June 2024—Neuroendocrine neoplasms can arise in a variety of anatomic sites, including the gastrointestinal tract, pancreas, and lung. The authors conducted a study in which they examined the diagnostic utility of S100 protein expression by IHC. They reported on the expression of S100 protein in a tissue microarray composed of 919 primary and metastatic neuroendocrine neoplasms from 548 patients. S100 protein is commonly used by laboratories to identify neural and melanocytic neoplasms. It is occasionally used in the workup of neuroendocrine neoplasms when the diagnosis of paraganglioma is being considered. The authors showed that strong S100 protein expression is highly specific for well-differentiated neuroendocrine tumors of pancreatic origin. This finding suggests the potential diagnostic utility of the marker in cases of tumors of unknown origin. The authors concluded that S100 protein expression should not be an unexpected finding in neuroendocrine tumors of pancreatic origin.
Pepper MA, Dulken BW, Wang Y, et al. S100 protein expression in primary and metastatic neuroendocrine neoplasms: a specific marker of pancreatic origin. Am J Surg Pathol. 2024;48(2):157–162.
Correspondence: Dr. Teri A. Longacre at longacre@stanford.edu or Dr. Vivek Charu at vcharu@stanford.edu
Standardizing clinical annotation of digital histopathology slides at point of diagnosis
As digital pathology replaces conventional glass slide microscopy as a means of reporting cellular pathology samples, the annotation of digital pathology whole slide images is rapidly becoming part of the pathologist’s regular practice. However, no standardized system of organization exists for digital annotation, and there is no preformed menu of annotations. Consequently, pathologists adopt arbitrary approaches to defining regions of interest, leading to irregularity and inconsistency and making it difficult to measure return on investment. The authors developed a proposal in which they presented a standardized annotating reporting style for digital whole slide images created by a group of researchers in the United Kingdom’s Pathology Image Data Lake for Analytics Knowledge and Education (PathLAKE) network. A list of 167 commonly annotated entities in 12 specialty subcategories was formed based on various factors, including review of Royal College of Pathologists and College of American Pathologists documents and feedback from reporting pathologists. Each entity was assigned a suitable annotation shape, Systematized Nomenclature of Medicine Clinical Terms (SNOMED International) code, and unique color. All lung tumors in the fifth World Health Organization classification of thoracic tumors 2021 were included as an example of how a similar approach could be expanded to specific tumor types. The authors proposed that the standardized approach to annotations increases the utility of annotations and makes them searchable across and between cases. This would aid pathologists in reporting and reviewing cases and allow annotations to be used in research. The proposed structured approach could serve as the basis for an industry standard and be easily adopted for routine clinical examination of digital slides.
Evans H, Hero E, Minhas F, et al. Standardized clinical annotation of digital histopathology slides at the point of diagnosis. Mod Pathol. 2023;36. doi:10.1016/j.modpat.2023.100297
Correspondence: Dr. Harriet Evans at harriet.evans4@nhs.net
Urine cytology in patients with gender-confirmation surgery and hormone therapy: evaluation of an underserved patient population
Medical practice gaps and educational needs have been linked to performing urine cytology in patients with a history of gender-confirmation surgery or hormone therapy. This potentially impacts diagnostic accuracy in this medically underserved population. The authors reported on a methodology for evaluating urine cytology in this cohort. For their retrospective study, two institutional pathology archives were searched from 2000 to 2021 using relevant keywords to identify urine cytology specimens from patients with gender-confirmation surgery (GCS) or hormone therapy. Patient demographics, relevant clinical history, and history of hormone therapy or GCS were noted for each specimen. A cytopathologist blindly reviewed each case according to the Paris System for reporting urinary cytology. Thirty-two urine cytology specimens from 15 patients with a history of GCS or hormone therapy were identified. The cohort consisted of 13 male-to-female and two female-to-male transgender patients. The original diagnoses were negative for high-grade urothelial carcinoma (NHGUC) in 24 of 32 (75 percent) cases and atypical urothelial cells (AUC) in eight of 32 (25 percent) cases. The most common atypical features were irregular nuclear membranes and prominent small nucleoli in seven of eight (87.5 percent) cases. Degenerative changes were present in five of eight (62.5 percent) cases. On re-review, based on the cytologic features listed and clinical history, all cases were reclassified as NHGUC. The original diagnosis of AUC in these cases likely reflects reactive changes after GCS or hormone therapy. The authors concluded that transgender patients are at risk of being overdiagnosed with AUC, particularly if the pathologist is unaware of the patient’s clinical history. Pathologists need to recognize reactive cytomorphologic changes in these patients. Additional multi-institutional studies are warranted to increase knowledge about performing urine cytology in this cohort.
Khorsandi N, Ding CC, VandenBussche CJ, et al. Urine cytology in patients with gender confirmation surgery and hormone therapy: evaluation of urine cytology performance in an underserved patient population. J Am Soc Cytopathol. 2023;12(4):267–274.
Correspondence: Dr. Poonam Vohra at poonam.vohra@ucsf.edu