1.Double trouble: Establishing synchronous primary tumors of the urothelium and prostate by Immunohistomorphology: A report of two cases
David Jerome Ong ; Elizabeth Ann Alcazaren ; Jose Carnate Jr.
Philippine Journal of Pathology 2020;5(1):44-49
Synchronous primary tumors of the urothelium and prostate are a diagnostic challenge among
pathologists. Differentiating carcinomas of urothelial and prostatic origin requires careful assessment of histomorphology coupled with ancillary studies such as immunohistochemistry stains (IHC) to support the diagnosis. We report two cases of adult patients who underwent transurethral resection of the prostate (TURP), with two distinct morphologies noted on routine H&E sections. After a panel of immunohistochemical stains (HMWCK, CK5/6, CK7, CK20, GATA-3, p63, NKX3.1, and PSA), both cases were signed out as papillary urothelial carcinoma and prostatic acinar adenocarcinoma. Correlation of histomorphology with an IHC panel consisting of cytokeratins (CK5/6, CK7, CK20), a urothelial marker (GATA-3), and at least two prostatic markers (PSA, NKX3.1) is recommended in such cases.
2.SARS-CoV-2 RT-PCR Ct Value and Laboratory Tests: Clinicopathologic characteristics among adult Filipino Inpatients diagnosed with COVID-19 in a tertiary medical center.
Carolyn Marie Legaspi ; David Jerome Ong ; Jose Inigo Remulla ; Rose Lou Marie Agbay
Philippine Journal of Pathology 2023;8(1):32-40
INTRODUCTION:
The role of the laboratory during the COVID-19 pandemic is not limited to just diagnosis of the
disease, but also in clinical decision-making, by providing information on relevant laboratory biomarkers.
Clinicians also use Ct value to guide patient management. There are limited studies available locally
regarding the significance of Ct value and pertinent laboratory biomarkers in COVID-19 patients. This study
aimed to assess the aforementioned laboratory data, along with the clinicopathologic characteristics of
affected patients, and determined if this information may be useful for robust clinical decision-makin
METHODOLOGY:
In this retrospective analytic study, we identified 325 out of 1,049 adult Filipino inpatients
diagnosed with COVID-19 and analyzed their Ct values and pertinent laboratory biomarkers such as
neutrophil and lymphocyte count, platelet count, LDH, ferritin, procalcitonin, CRP, AST/SGOT, ALT/SGPT, PT/
INR, and D-dimer, and correlated them with the severity of the disease.
RESULTS:
Two hundred twenty (67.7%) patients had non-severe disease, while 105 (32.3%) had severe disease.
Lower Ct values of ORF1ab (median = 26.4) and N (median = 24.8) genes were seen in the severe group
compared to the non-severe group and were found to be significant (p<0.001). Laboratory markers
(neutrophil, platelet counts, LDH, ferritin, procalcitonin, CRP, AST, PT/INR, and D-dimer) were associated
with severe COVID-19. On the other hand, ALT was not associated with severe disease.
CONCLUSION
The laboratory biomarkers together with Ct value and overall clinical picture may provide
valuable information to physicians for more robust clinical decision-making.
COVID-19
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laboratory biomarkers
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SARS-CoV-2
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RT-PCR
3.Intraobserver and interobserver agreement in the scoring of PD-L1 (SP142) and tumor-infiltrating lymphocytes in triple negative breast cancers
David Jerome Ong ; Pier Angeli Medina ; Sarah Jane Datay-Lim ; Elizabeth Ann Alcazaren
Philippine Journal of Pathology 2021;6(2):30-36
Objectives:
Known for their poor outcomes, triple negative breast cancers (TNBCs) have been investigated for immune checkpoint inhibitors that target Programmed death ligand 1 (PD-L1). In the recent decade, tumor-infiltrating lymphocytes (TILs) have also become potential biomarkers. The aim of the study is to determine the reproducibility of PD-L1 scoring system for TNBC (SP142 clone) and TILs interpretation in the local setting through intra- and interobserver agreement.
Methodology:
Forty-three primary resection specimens TNBC were evaluated on two occasions with PD-L1 (Roche VENTANA SP142 assay) and TILs by two breast pathologists and one general pathologist on physical glass slides. PD-L1 expression was determined by at least 1% positivity among immune cells within the tumoral area and contiguous peritumoral stroma while TILs was assessed based on International Immuno-Oncology Biomarker Working Group on Breast Cancer. Kappa statistic for PD-L1 and TILs categories while intraclass correlation coefficient (ICC) were assessed, with cutoffs of 0.80 and 0.70, respectively.
Results:
The overall interrater kappa statistic for PD-L1 on the first and second rounds were weak at 0.506 (95% CI: 0.334-0.679) and minimal at 0.314 (95% CI: 0.142-0.487), respectively. Intraobserver kappa statistic for PD-L1 were varied across the three readers while interobserver kappa values for PD-L1 showed none (0.181) to moderate (0.789) agreement. The TILs intraobserver reliability showed poor to good agreement, with the highest ICC of 0.889 (95% CI: 0.805-0.938).
Conclusion
This study demonstrated variable intra and interobserver agreement for both TILs and PD-L1 expression. Although it is desirable to have strong to almost perfect agreement, the kappa and ICC values suggest additional room for improvement. In light of the repercussions in management of patients who will undergo immune checkpoint inhibitor therapy, regular training sessions, concurrences of equivocal results, and possible use of digital pathology as a medium in interpreting TILs and PD-L1 stains to achieve consistent results.
Breast Neoplasms
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Triple Negative Breast Neoplasms
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Immunohistochemistry