1.Prevalence and clinico-pathologic features of ALK rearrangement among adult Filipinos with non-small cell lung cancer in a Private Tertiary Care Hospital
Steffanie Charlyne Tamayo ; Rebecca Nagtalon ; Joanmarie Balolong-Garcia ; Yancel Donna Mascardo ; Jose Jasper Andal ; Daphne Ang ; Marcelo Severino Imasa ; Rex Michael Santiago
Philippine Journal of Pathology 2022;7(1):9-14
Introduction:
With advancements in the understanding of lung cancer biology, targeted therapy has become the rule rather than the exception. Patients with ALK rearrangements are amenable to therapy with Alectinib and other ALK inhibitors, which has been associated with better patient outcomes. While ALK rearrangement should be routinely tested in non-squamous non-small cell lung cancer (NSCLC), the cost and availability of this test is a prohibitive factor, particularly in the Philippine setting.
Objectives:
This study aimed (1) to determine the prevalence of ALK-rearranged NSCLC among adult Filipino lung cancer patients in St. Luke’s Medical Center (SLMC) from 2016 to 2018 and (2) to determine the clinico-pathologic features of adult Filipinos with ALK-rearranged NSCLC.
Methodology:
This is a retrospective cross-sectional descriptive study wherein the prevalence of ALK-rearranged NSCLC, detected using fluorescence in-situ hybridization (FISH) or immunohistochemistry (IHC), was determined. Clinical data of patients for whom ALK testing was performed were collected. Hematoxylin and Eosin (H&E) slides were retrieved and reviewed for the presence of certain morphologic features. Patients whose H&E slides cannot be retrieved were excluded from the study.
Results:
ALK rearrangement was seen in 7.8% (8/103) of tumors submitted for ALK testing. Patients with ALK-rearranged tumors were generally young, light smokers, and presented with advanced clinical stage. Clear cell features and solid pattern were noted in one case and three cases, respectively. However, due to small sample size, further statistical analysis could not be performed to analyze the association of these features with the presence of ALK rearrangement.
Conclusion
Despite a small sample size, the prevalence and clinical profile of ALK-rearranged NSCLC in our institution are congruent with those previously described in Western populations. The association of clinical profile and morphologic features with the presence of ALK rearrangement can be further explored in future studies.
Lung Neoplasms
;
Anaplastic Lymphoma Kinase
2.Application of the Milan System of reporting salivary gland cytopathology: A retrospective cytohistological study in a Tertiary Medical Center
Carolyn Marie Legaspi ; Elizabeth Ann Alcazaren ; Jose Carnate Jr.
Philippine Journal of Pathology 2022;7(1):15-23
Background:
A fine needle aspiration biopsy has been established as a safe, minimally invasive procedure in evaluation of salivary gland lesions. The complex overlapping cytomorphology of these lesions are challenging for pathologists, hence the introduction of an evidence-based system, the Milan System of Reporting Salivary Gland Cytopathology, to improve overall patient care. The study was taken up to reclassify salivary gland lesions from previous FNA biopsies in order to determine sensitivity, specificity, positive and negative predictive values of FNA, and evaluate the risk of malignancy of the various categories of the Milan system.
Methodology:
This was a 6-year retrospective descriptive study in a tertiary medical center. All salivary gland FNA cases were reviewed by two pathologists, and re-classified into the six categories of the Milan System. The number of false positive, false negative, true positive and true negative cases were obtained by comparing with the final histopathology diagnosis, and the risk of malignancy per category were calculated.
Results:
A total of 76 cases were reviewed and the overall average of the two readers diagnostic accuracy were 85.02% (95% CI: 84.50-85.60%), sensitivity and specificity were 80.77% (95% CI: 79.90-81.60%) and 86.19% (95% CI: 85.70-86.70%), respectively; positive and negative predictive values were 62.16% (95% CI: 60.70-63.60%) and 94.17% (95% CI: 94.00-94.40%), respectively.
Conclusion
The Milan System category with highest risk of malignancy was Malignant (Category VI – 100%). FNAB is still a reliable tool for clinicians, and use of the Milan System of Reporting Salivary Gland Cytopathology is beneficial in increasing efficacy of communication among clinicians to improve patient care.
Cytology
;
Salivary Glands
3.Preliminary study on prevalence of P16-Positive Squamous Cell Carcinoma of the oral cavity, oropharynx and larynx in Rizal Medical Center and its histomorphologic correlation
Jorel Renly Gamboa ; Thomas Jeff Lim Jr.
Philippine Journal of Pathology 2022;7(1):24-30
Background:
A considerably large portion of the cases of cancer, particularly squamous cell carcinoma (SCC) involving the head and the neck may be due to consumption of tobacco and alcohol. However, its increase in occurrence at specific sites of the head and neck may indicate the possibility of other etiological factors. One of which is infection by certain high-risk human papillomavirus (HPV). P16 immunochemistry serves as a very good surrogate marker of active HPV in these tumors. The detection of HPV-related head and neck cancers have relevance in clinical practice because of its prognostic implications.
Objectives:
The general objective of this study is to determine the prevalence of p16-positive squamous cell carcinoma in the oral cavity, oropharynx, and larynx in Rizal Medical Center from January 2019 to December 2019. The specific objective is to compare the Hematoxylin and Eosin (H&E) stain histomorphology (keratinization and mitotic activity) of p16-positive versus p16-negative specimens.
Methodology:
This is a cross-sectional study which included all routine histopathology specimens coming from the oral cavity, oropharynx and larynx in Rizal Medical Center for the year 2019 with a diagnosis of squamous cell carcinoma. The tissue specimens considered were those that measured at least 1 cm in diameter, or aggregate diameter if tissue is fragmented. The slides of all eligible cases were reviewed and immunohistochemically stained for p16. The p16 IHC slides were read as either positive or negative, while the mitotic activity and keratinization were observed in the H&E-stained slides. The interpretation of the diplomate pathologists for each of the slides were documented and corresponding statistical analyses were performed.
Results:
P16 IHC showed twenty-one (88%) p16 negative cases and three (12%) p16 positive cases. In terms of mitosis, ten cases have mitosis falling within the 1-10 per high power field (HPF) range (42%), six within 11-20 per HPF (25%), and 8 cases have ≥21 mitosis per HPF (33%). In terms of keratinization, three cases are non-keratinizing (12%) and twenty-one cases are keratinizing (88%). There is significant difference in the keratinization histology (p<0.05) of the p16-positive versus the P16-negative cases. On the other hand, no significant difference in the mitotic activity (p>0.05) was noted.
Conclusion
There is a low prevalence of HPV-related SCC of the oral cavity, oropharynx, and larynx in Rizal Medical Center. The histomorphologic findings confirm that keratinization, significantly predicts HPV status in oropharyngeal SCC. Mitotic activity may not be reliable in predicting the HPV status or p16 IHC reactivity of a case. Keratinization in oropharyngeal SCCs may provide valuable information in certain instances, particularly when HPV testing is not immediately available, although the combined tumor morphology and p16 IHC is more ideal.
Papillomavirus Infections
;
Squamous Cell Carcinoma of Head and Neck
;
Mouth
;
Larynx
4.Determination of rates of malignancy on archival salivary gland fine-needle aspiration biopsy after application of the Milan System for Reporting Salivary Gland Cytopathology in the Philippine General Hospital: A 1-year retrospective study
Nikko Paolo Cablao ; Pauleen de Grano ; Agustina Abelardo ; Jose Ma. Avila ; Dahlia Teresa Argamosa
Philippine Journal of Pathology 2022;7(1):31-37
Background:
The Milan System for Reporting Salivary Gland Cytopathology (MSRGC) aims to increase the overall effectiveness of salivary gland FNAB by defining six general diagnostic categories with corresponding Rates of Malignancies (ROM). This study aims to use this system to categorize salivary gland FNAB in the Philippine General Hospital and stratify ROM per category.
Methodology:
In this study a total of 326 cases have been collected and reviewed, of which 154 (47.2%) had either surgical or clinical follow-up. The cases were assigned a Milan category by 3 cytopathologists blinded from the original diagnoses and from each other’s readings.
Results:
The overall sensitivity, specificity, PPV, and NPV in detecting neoplasm is at 71.6%, 90.9%, 88.3%, and 76.9%, respectively. On the other hand, the sensitivity, specificity, PPV, and NPV in detecting malignancy is at 52%, 92.9%, 59.1%, and 90.7%, respectively. The computed ROM is as follows: Category I 7.89%, Category II 9.43%, Category III 20%, Category IVa 10.53%, Category IVb 60%, Category V 75%, and Category VI 100%.
Conclusion
The overall diagnostic utility of salivary gland FNAB, as well as the computed ROM per diagnostic category are comparable to internationally published literature. This study also validates the MSRSGC as a valuable tool in stratifying ROM in salivary gland lesions.
Cytology
;
Salivary Glands
5.The utility of immunohistochemistry in diagnosing tubulocystic renal cell carcinoma with papillary morphology
Allison Kaye Pagarigan ; Erland del Rosario
Philippine Journal of Pathology 2022;7(1):39-45
Tubulocystic renal cell carcinoma (TC-RCC) is a recently recognized, rare but distinct malignant entity. Pathologists have endeavored to completely define its histomorphologic, immunohistochemical and molecular features. Recounted is a case where the diagnosis of TC-RCC was confounded by presence of papillary morphology. Immunohistochemical expression of alpha-methyl acyl-CoA-racemase and vimentin with corresponding negativity for CK7 and CD10, following distinctive gross and microscopic findings, confirmed a diagnosis of TC-RCC. This report demonstrates the strategic value of performing immunohistochemistry studies to establish a diagnosis of TC-RCC especially when unusual histologic features are encountered. Immunohistochemistry continues to be the most practical approach to diagnosis as molecular testing methods, such as next generation sequencing, remain unfeasible in the local setting. Cautious prognostication is required as accounts of recurrence and metastasis continue to emerge.
Carcinoma, Renal Cell
;
Histology
;
Immunohistochemistry
;
Diagnosis
;
Pathology, Surgical
6.Glomangiopericytoma: A rare sinonasal neoplasm
Philippine Journal of Pathology 2022;7(1):46-49
Glomangiopericytoma is a rare neoplasm of the nasal and paranasal sinuses comprising less than 1% of all tumors of the said region. We report of a 59-year-old hypertensive male who presented with epistaxis. CT scan findings showed a mass in the right nasal cavity with extension into the ethmoid and sphenoid sinuses. Histopathologic diagnosis was glomangiopericytoma confirmed with immunohistochemistry studies. Prognosis is favorable with complete resection of tumor and long-term monitoring.
Paranasal Sinus Neoplasms
7.Brain metastasis of papillary ovarian adenocarcinoma
Sonia Chhabra ; Niti Dalal ; Sunita Singh
Philippine Journal of Pathology 2022;7(1):50-52
Brain metastasis from epithelial ovarian cancer is a rare diagnostic entity with a reported incidence of 1- 2%. Serous epithelial ovarian cancer is usually associated with a poor prognosis and is the most common malignancy metastasizing to the brain. The median time from primary diagnosis to development of cerebral lesions is directly correlated with the initial tumour grade and stage. The median survival after diagnosis of brain metastases is 6 months. It is suggested that brain imaging studies should be included in the follow up of patients after treatment for ovarian carcinoma. We report a case of brain metastasis of ovarian adenocarcinoma 2 years post-surgery and six cycles of chemotherapy.
Brain
;
Neoplasm Metastasis
;
Adenocarcinoma
8.Ectopic schistosomiasis presenting as ruptured appendicitis with periappendiceal abscess formation: An alternative pathogenetic perspective
Marcel Joshua del Fierro ; Yvette Tan ; Larissa Lara Torno
Philippine Journal of Pathology 2022;7(1):53-56
Schistosomiasis is still a public health burden in the Philippines. Chronic infection with Schistosoma japonicum, the only species endemic in the Philippines, clinically manifests itself in a wide variety of pathologies usually correlated with the anatomical site of adult worm activity and deposition of eggs. One of the documented ectopic sites for Schistosoma ova is the appendix. A rare sequela of this is acute appendicitis and an even rarer consequence is progression to appendiceal rupture leading to acute peritonitis. We present a case of a 27-year-old Filipino residing in Davao City but born in Agusan Province who initially complained of right lower quadrant abdominal pain but presented at the emergency room with generalized abdominal tenderness with signs of peritoneal irritation. Exploratory laparotomy with an infraumbilical incision revealed ruptured appendicitis with periappendiceal abscess formation and appendectomy was subsequently done. Schistosoma infection of the appendix was subsequently established by histopathological analysis. Furthermore, features observed suggest an atypical pathogenetic process contrary to the putative pathogenesis of most cases of acute appendicitis.
Schistosomiasis
;
Schistosoma japonicum
9.A case report on carcinosarcoma of the pancreas with a concise literature review
Christine Santos ; Rosalie Sabina Michiko Samonte
Philippine Journal of Pathology 2022;7(1):57-64
Carcinosarcoma is a rare neoplasm that most commonly affects the uterus. In the pancreas, fewer than thirty cases are reported worldwide. We present a 47-year-old female with epigastric pain, and jaundice. Histopathology revealed a pancreatic head mass showing a biphasic tumor composed of seventy percent Pancreatic Ductal Adenocarcinoma, and thirty percent High Grade Sarcoma with immunohistochemistry using Pancytokeratin, Vimentin, Desmin, S-100, Smooth Muscle Actin, CD34, and Ki-67.
Pancreas
;
Carcinosarcoma
;
Immunohistochemistry
;
Pathology, Surgical
;
Diagnosis
10.Institutionalization of the Philippine Health Laboratory System (PHLS)
Hyacinth Joy Balderama ; Valerie Anne Tesoro ; Terence John Antonio ; Richard Albert Ramones
Philippine Journal of Pathology 2022;7(2):5-12
In 1966, Section 3 of Republic Act (R.A.) 4688, entitled “An Act Regulating the Operation and Maintenance of Clinical Laboratories and Requiring the Registration of the Same with the Department of Health, Providing Penalty for the Violation Thereof, and for Other Purposes,” provided for the establishment of the Bureau of Research and Laboratories (BRL) under the Department of Health (DOH). The BRL served as the central laboratory that governed the operation of regional public health laboratories. The BRL’s function was delegated to different offices in 2000 by Executive Order 102 s. 1999 entitled “Redirecting the Functions and Operations of the Department of Health,” which was premised in part with Section 78 of the General Provisions of R.A. 8522 (“General Appropriations Act of 1998”) authorizing the President to direct changes in organization and key positions of any department, bureau, or agency.
Towards this direction, the function of the BRL was distributed to different agencies, and the Philippines designated six (6) national reference laboratories that catered to communicable and non-communicable diseases. Five (5) subnational reference laboratories for emerging and re-emerging infectious diseases were established in response to the 2009 Influenza AH1N1 pandemic. The DOH issued Administrative Order No 2012-0021 to establish a national and regional network of laboratories.