Background: Contemporary breast cancer treatment relies on precise diagnostic categorization for tailored therapy. HER2 status, assessed using immunohistochemistry (IHC), is a key biomarker guiding the choice for the antibody-drug conjugate trastuzumab deruxtecan, which is effective even in HER2-low/ ultralow breast cancer (defined as HER2 IHC score 0+, 1+ or 2+ without ISH amplification). While manual slide interpretation of IHC is subjective and prone to inter- and intraobserver variability, digitization potentially enables computer-assisted image analysis to improve accuracy. However, implementation and infrastructure barriers persist, especially in low- to middleincome countries such as the Philippines. Objective: This study evaluated the concordance between manual and AI-assisted HER2 IHC scoring at St. Luke’s Medical Center – Quezon City (SLMC QC) and identified areas of discrepancy and their possible causes. Methodology: This retrospective study included all Invasive Breast Carcinoma, No Special Type (IBC, NST) tumors diagnosed on core needle biopsy and with HER2 IHC performed in SLMC QC from January 1 to December 31, 2024. Original HER2 IHC slides were independently scored by two breast pathology consultants; consensus results served as the ground truth. Slides were digitized using Microvisioneer, and three regions of interest (with ≥ 100 tumor cells) selected by a senior breast pathologist were analyzed using an AI-based image deconvolution algorithm to produce computer image-enhanced HER2 scores. After a minimum of two-week washout, the senior breast pathologist re-evaluated the digitized slides with AI-generated outputs to derive the Computer Image-Enhanced (AI-Assisted) Scores. Concordance between ground truth and AI scores was then assessed. Results: A total of 161 HER2 IHC slides from patients with invasive breast carcinoma were evaluated. Manual and AI-assisted scoring showed an overall percent agreement of 65.22% and a Cohen’s kappa of 0.53, indicating moderate concordance. Weighted analysis demonstrated markedly higher alignment (95.10% agreement; kappa 0.85, almost perfect). Discrepancies were most common among manual scores of 0 to 2+, largely driven by background staining, whereas manual score 3+ classifications remained highly consistent with AI output. Conclusion The study supports the emerging role of AI as a valuable complementary tool in HER2 interpretation. With proper validation and integration, AI-assisted image analysis can strengthen standardization in HER2 assessment, improving precision in patient care especially in resourcelimited settings.
Artificial Intelligence

Introduction: Müllerian tumors are rare in males, with serous tumors representing the most often subtype with only 50 cases documented. Excluding the benign/ borderline counterparts, only 29 are reported as primary malignant testicular masses and only 4 are reported in the elderly. Due to rarity, there is no exact consensus in the optimal grouping and management of these patients. Herein we report a case of serous cystadenocarcinoma of the paratestis in an elderly Filipino male. Case Description: A 66 y/o male presented with scrotal enlargement. He had previously undergone a Hartmann’s procedure for fecal impaction. An incidental finding of a complicated hydrocele was noted on CT scan done few months prior his scheduled colostomy takedown. He was subsequently referred to urology service for evaluation. Tumor markers (AFP and βHCG) were all normal. One month prior to admission, a marked increase in the size of the right scrotum was observed, prompting decision to proceed with surgery. Discussion: Orchiectomy specimen evaluation requires careful assessment of tumor appearance, location, and extent. In this case, the tumor arises in the paratestis without involvement of the testicular parenchyma, showing solid and cystic areas with papillary excrescences. The tumor showed enlarged, hyperchromatic nuclei with irregular contours, abundant cytoplasm, and psammoma bodies. IHC revealed negative for calretinin, glypican3, CDX2, SATB2, and CK20, but positive for CK7, Pax8, ER, and WT1. Paratesticular serous cystadenocarcinoma diagnosis was made after carefully ruling-out mesothelioma, YST and/or metastases. P53 staining was equivocal, with 5% of cells positive amid broad negativity. Molecular testing was advised for grading and prognosis. Conclusion Serous cancers are rare in males and must require IHC for diagnosis and radical surgery due to high resistance to other treatments. Hydrocele being a frequent finding can sometimes delay the diagnosis. Careful monitoring remains critical for detecting progression and metastasis.
Cystadenocarcinoma, Serous ; Orchiectomy

RUNX1::RUNX1T1 is a core-binding factor driving fusion gene which arises from t(8;21)(q22;q22). It is one of the most common chromosomal rearrangements in both pediatric and adult Acute Myeloid Leukemia (AML) with a reported incidence o 15% in children and young adults. There are few case reports documenting RUNX1::RUNX1T1 translocation in pediatric AML. Although this is generally associated with a favorable prognosis, we report two (2) cases of de novo pediatric AML in the Philippines harboring a RUNX1::RUNX1T1 translocation, one eventually relapsed while the other attained remission but succumbed to sepsis.
Next Generation Sequencing ; RUNX1::RUNX1T1 fusion

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

SARS-CoV-2 has infected more than 643 million individuals worldwide and accounts for close to 64,950 deaths in the Philippines. Due to COVID-19’s clinical overlap with other diseases and non-specific radiologic findings, its diagnosis rests primarily on laboratory methods, including reverse transcription polymerase chain reaction (RT-PCR) and multiplexed molecular platforms for rapid syndromic testing. Compared to RT-PCR which has a turnaround time of 24 to 72 hours, multiplexed molecular platforms can provide alternative diagnoses to COVID-19 in an average of one hour, providing meaningful data that can impact clinical and resource management when handling acute surge of patients with respiratory symptoms.
COVID-19 ; SARS-CoV-2