Inflammatory and granulomatous expansive lesions of the pituitary

BACKGROUND Differentiation between glioblastoma and brain metastasis is highly important due to differing medical treatment strategies. While MRI is the modality of choice for the assessment of patients with brain tumors, differentiation between glioblastoma and solitary brain metastasis may be challenging due to their similar appearance on MRI. PURPOSE To differentiate between glioblastoma and brain metastasis subtypes using radiomics analysis based on conventional post-contrast T1 -weighted (T1 W) MRI. STUDY TYPE Retrospective. SUBJECTS Data were acquired from 439 patients: 212 patients with glioblastoma and 227 patients with brain metastasis (breast, lung, and others). FIELD STRENGTH/SEQUENCE Post-contrast 3D T1 W gradient echo images, acquired with 1.5 and 3.0 T MR systems. ASSESSMENT Analysis included image preprocessing, segmentation of tumor area, and features extraction including: patients' clinical information, tumor location, first- and second-order statistical, morphological, wavelet features, and bag-of-features. Following dimension reduction, classification was performed using various machine-learning algorithms including support-vector machine (SVM), k-nearest neighbor, decision trees, and ensemble classifiers. STATISTICAL TESTS For classification, the data were divided into training (80%) and testing datasets (20%). Following optimization of the classifiers, mean sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS For the testing dataset, the best results for differentiation of glioblastoma from brain metastasis were obtained using the SVM classifier with mean accuracy = 0.85, sensitivity = 0.86, specificity = 0.85, and AUC = 0.96. The best classification results between glioblastoma and brain metastasis subtypes were obtained using SVM classifier with mean accuracy = 0.85, 0.89, 0.75, 0.90; sensitivity = 1.00, 0.60, 0.57, 0.11; specificity = 0.76, 0.92, 0.87, 0.99; and AUC = 0.98, 0.81, 0.83, 0.57 for the glioblastoma, breast, lung, and other brain metastases, respectively. DATA CONCLUSION Differentiation between glioblastoma and brain metastasis showed a high success rate based on postcontrast T1 W MRI. Classification between glioblastoma and brain metastasis subtypes may require additional MR sequences with other tissue contrasts. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:519-528.

Differentiation between glioblastoma, brain metastasis and subtypes using radiomics analysis.

Object Frozen-section analysis is the current standard for the intraoperative diagnosis of brain tumors. Intraoperative confocal microscopy is an emerging technology with the potential to visualize tumor histopathological features and cell morphology in real time. The authors report their findings using this new intraoperative technology in vivo with sodium fluorescein contrast during the course of 50 microsurgical tumor resections. Methods Eighty-eight regions were visualized with confocal microscopy, and corresponding biopsy samples were examined with routine neuropathological analysis. The tumors studied included meningiomas, schwannomas, gliomas of various grades, and a hemangioblastoma. The confocal microscopic features of each tumor and of various artifacts inherent to the technology were documented. A pathologist working in a blinded fashion reviewed a subset of the images in a further evaluation of the usefulness of the device as a diagnostic tool. Results Overall, intraoperative confocal imaging ...

In vivo intraoperative confocal microscopy for real-time histopathological imaging of brain tumors.

Background: AUB is one of the most common problems in women of all ages especially those in the peri-menopausal age group. The abnormal bleeding can be caused by a wide variety of disorders and it is one of the commonest complaints leading to endometrial sampling. Objectives: Our study aimed at determining the types and frequencies of endometrial pathologies in patients presenting with abnormal uterine bleeding at our hospital which caters largely to women of low socioeconomic status. Material and Methods: The present study was conducted at the Hakeem Abdul Hameed Centenary Hospital, New Delhi. This was a retrospective age specific comparative analysis of 638 women presenting with abnormal uterine bleeding, who underwent endometrial sampling at our hospital. The pattern of endometrial histopathological changes were identified and classified. Results: Age of the patients ranged from 15 to 70 years, maximum patients (35.89 %) in the age group 41-50 years. The most common clinical presentation was represented by menorrhagia (41%) Various patterns on histopathology were secretory endometrium(28.99%)the commonest, followed by proliferative endometrium (24.92%). Incidence of malignancy was low in the present study. Conclusion: Endometrial curetting and biopsy is an important diagnostic procedure in evaluation of AUB.. Endometrial causes of AUB are age related, therefore it is specially recommended in women of the perimenopausal age presenting with AUB, to rule out preneoplasia and malignancy.

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Atypical uterine bleeding-Histopathological audit of endometrium A study of 638 cases

The primary purpose of intraoperative pathologist consultation (IC) is to guide immediate surgical management;1 ICs can provide surgeons with important information that may be used to modify or even terminate a surgical procedure. Frozen sections performed during ICs can also be used to establish the nature and extent of a lesion, to determine the status of surgical margins and to confirm that sampling of lesional tissue is sufficient for further investigations.2

Periodic review of the correlation between frozen section diagnosis and final diagnosis is useful for several reasons. It can serve as a measure of an institution’s quality of service.3 Once errors are identified, the potential cause of the frozen section error can be investigated, and measures can be implemented to help prevent similar occurrences. Errors can occur because of diagnostic misinterpretation (i.e., the pathologist may make a false diagnosis or miss the diagnosis on the frozen section slide); the frozen sections may not be taken from lesional tissue; or technical issues, such as tissue section folds or uneven staining, may preclude proper evaluation.1,2,4,5 The impact of frozen section errors on changes to diagnoses can also be investigated, and some studies have categorized these as false-positive or false-negative frozen section diagnoses.1,2,4,5

The accuracy of frozen section diagnosis can be documented by comparing the diagnosis made on the frozen sections to the final diagnosis made on the pathology specimen after review of both the frozen and permanent sections. Given the limited amount of tissue that can be submitted or sampled during frozen section examination, and given the technical quality of frozen sections compared with permanent sections, discrepancies can be expected between frozen section diagnoses and final diagnoses. The literature reports discordance rates between frozen section diagnoses and final diagnoses ranging from 1.4% to 12.9%; about 75% of studies report a discordance rate below 5%, with an overall median of 2.9%.5–30 Whereas most studies have focused on the discordance between frozen section diagnoses and final diagnoses, 1 study reported that errors impacting patient care, defined as frozen section errors that may have affected intraoperative patient management, occurred in 0.1% of the frozen sections performed.5

We report the results of a review of ICs performed in the Hamilton Regional Laboratory Medicine Program (HRLMP) in Hamilton, Ont., and add to the Canadian data. This review was performed by a panel of staff pathologists and senior pathology residents from the HRLMP academic hospitals. We assessed the discordance rate between frozen section diagnoses and final diagnoses, the causes of frozen section errors and the impact of change in diagnosis on patient care.

/pdf/intraoperative-pathology-consultation-error-cause-and-impact-1expmspbi3.pdf

Intraoperative pathology consultation: error, cause and impact

Introduction
Abnormal uterine bleeding (AUB) is the commonest presenting symptom in gynaecology out-patient department. Endometrial sampling could be effectively used as the first diagnostic step in AUB, although at times, its interpretation could be quite challenging to the practicing pathologists. This study was done to evaluate histopathology of endometrium for identifying the endometrial causes of AUB. We also tried to observe the incidence of various pathology in different age groups presenting with abnormal uterine bleeding.

https://www.jogi.co.in/jul_aug_2011/11_oa_studyof_endometrial.pdf

Study of Endometrial Pathology in Abnormal Uterine Bleeding

Background: Intraoperative consultation for neurosurgical specimens can be difficult at times, despite the use of both frozen section and squash preparation. Various factors influence the diagnostic accuracy of these procedures. This study was conducted to evaluate reasons for discordant case results in neurosurgical intraoperative consultations and make a comparative analysis of these two commonly used methods to identify the possible pitfalls, errors, and limitations. Materials and Methods: All the neurosurgical cases received in the Department of Pathology for intraoperative consultation over a period of 3 years were studied retrospectively. The slides of frozen sections and squash preparation were retrieved and the diagnosis was compared with the final diagnosis given on paraffin-embedded sections. Results and Observations: A total of 6% of the cases were found to be discordant; these included angiomatous meningioma, Non-Hodgkins lymphoma, metastatic renal cell carcinoma, cerebellopontine angle fibrous meningioma, and craniopharyngioma. Highly vascular lesions, unavailability of squash preparation in a few cases and technical errors like thick smears, excessively crushed specimen, freezing, and cautery induced and crushing artifacts contributed to misdiagnosis. Conclusion: The discrepant cases need to be reviewed regularly by pathologists to familiarize themselves with the morphological changes and artifacts. The knowledge of possible errors could minimize misinterpretation and help in providing a more conclusive opinion to the operating surgeon.

/pdf/challenges-in-neurosurgical-intraoperative-consultation-2echj7tw9p.pdf

Challenges in neurosurgical intraoperative consultation.

Background: Synovial lipomatosis is a rare disorder of the synovium, commonly affecting the knee joint, resulting in joint pain, swelling, and effusion. The etiology of this condition still remains unclear. Aim: This was a study done to evaluate the disease process in synovial lipomatosis, with respect to the clinical parameters and pathological features. Materials and Methods: Case files of synovial lipomatosis diagnosed on histopathology between 2007 and 2009 were perused, to study the case history, and tissue sections were reviewed for the histomorphological changes. Results: Eight cases of synovial lipomatosis were diagnosed on histopathology from year 2007 to 2009, of which one occurred in the wrist joint and the rest were localized to the knee joint. Age ranged from one year to seventy-three years, with a male preponderance. Pain and swelling were major complaints. Three had a significant past history, one occurring post-trauma, one following chikungunya, and another with septic arthritis. Three of the cases had osteoarthritis. Body mass index was elevated in four cases and one case had protein energy malnutrition. On histopathological examination, all the cases showed villous proliferation of the synovium, with focal and diffuse infiltration by mature adipocytes. Four cases showed focal hyperplasia of the lining epithelium and five cases revealed variable fibrosis. Conclusion: Synovial lipomatosis may mimic tumorous, lesion-like synovial lipoma or hemangioma and its distinct histomorphology helps in distinguishing it from these lesions. It possibly represents a secondary phenomenon following the degenerative process of articular disease of the joints.

Pathology of synovial lipomatosis and its clinical significance.

Angiomatous meningioma accounts for 2.1% of all meningiomas. It has features of a typical benign meningioma with many small or large vascular channels which may predominate over its meningothelial elements. We present here a series of three cases of angiomatous meningioma, which posed diagnostic difficulty to clinicians, radiologists, and pathologists. All the three cases showed a tumor entirely composed of thin-walled vascular channels and cells with bland morphology in the background. The diagnosis was confirmed by immunohistochemistry. We present series of three cases to highlight the histomorphological features of this uncommon variant of meningioma that could help in distinguishing it from hemangioblastoma and hemangiopericytoma.

Angiomatous meningioma: a diagnostic dilemma.

Inflammatory lesions of the hypophysis account for 0.5% of all symptomatic diseases of the pituitary, which include lymphocytic hypophysitis, granulomatous hypophysitis with or without specific etiology and pituitary abscess. Sellar tuberculoma is a rare type of granulomatous hypophysitis. We document a case of a postmenopausal lady who presented with galactorrhea, headache and blurring of vision. Based on preliminary investigations, a clinical diagnosis of pituitary adenoma was made and the pituitary gland was surgically excised. Histopathological examination showed caseating granulomas, along with normal areas of preserved pituitary gland and a final diagnosis of tuberculous hypophysitis was made. This case is being documented due to the extremely rare involvement of the pituitary gland by granulomatous lesions such as tuberculosis and to emphasize the role of intraoperative consultation to obviate the need for radical surgery in such lesions.

Aarthi Rajkumar

Papers

Study of Endometrial Pathology in Abnormal Uterine Bleeding

Challenges in neurosurgical intraoperative consultation.

Pathology of synovial lipomatosis and its clinical significance.

Angiomatous meningioma: a diagnostic dilemma.

Sellar lesion: not always a pituitary adenoma.