The 2021 WHO Classification of Lung Tumors: Impact of Advances Since 2015

The 2021 WHO Classification of Thoracic Tumours was published earlier this year, with classification of lung tumors being one of the chapters. The principles remain those of using morphology first, supported by immunohistochemistry, and then molecular techniques. In 2015, there was particular emphasis on using immunohistochemistry to make classification more accurate. In 2021, there is greater emphasis throughout the book on advances in molecular pathology across all tumor types. Major features within this edition are (1) broader emphasis on genetic testing than in the 2015 WHO Classification; (2) a section entirely dedicated to the classification of small diagnostic samples; (3) continued recommendation to document percentages of histologic patterns in invasive nonmucinous adenocarcinomas, with utilization of these features to apply a formal grading system, and using only invasive size for T-factor size determination in part lepidic nonmucinous lung adenocarcinomas as recommended by the eighth edition TNM classification; (4) recognition of spread through airspaces as a histologic feature with prognostic significance; (5) moving lymphoepithelial carcinoma to squamous cell carcinomas; (6) update on evolving concepts in lung neuroendocrine neoplasm classification; (7) recognition of bronchiolar adenoma/ciliated muconodular papillary tumor as a new entity within the adenoma subgroup; (8) recognition of thoracic SMARCA4-deficient undifferentiated tumor; and (9) inclusion of essential and desirable diagnostic criteria for each tumor.     

一种预测子宫内膜病变患者内膜病理类型的临床模型＊

目的 开发并评估一种用于预测子宫内膜病变患者内膜病理类型的临床模型；方法 选取2019年11月至2021年11月因妇科B超发现子宫内膜病变并于山东中医药大学附属医院行宫腔镜下内膜活检的患者，结合其病史与最小绝对收缩和选择算子法（Least absolute shrinkage and selection operator，LASSO）筛选影响内膜病变的独立危险因素，列线图（nomogram）函数建立列线图模型，采用ROC曲线下方的面积大小（Area Under Curve， AUC）、C指数（C-index）、拟合优度（Hosmer-Lemeshow）检验、自举法（bootstrap）评估及验证模型，依据列线图对纳入患者进行风险赋分，绘制ROC曲线获取风险评分的截断值，从而划分高低风险的人群；结果 阴道流血、绝经、无流产史、并发高血压、B超内膜厚度增厚、内膜回声不正常，中医证型为虚实夹杂证是发生子宫内膜癌及癌前病变的独立危险因素，评估模型所得AUC值与C-index均>0.9，Hosmer-Lemeshow检验显示P>0.05，bootstrap内部验证法所得C-index亦高于0.9，均说明模型准确度、区分度及可信度良好，当患者的风险评分总和≥177分时，属于高风险人群；结论 本模型可以预测B超提示子宫内膜病变患者的内膜病理类型为癌前或恶变型的概率并识别高风险人群。     

Effects of preoperative radiotherapy or chemoradiotherapy on postoperative pathological outcome of cervical cancer——from the large database of 46,313 cases of cervical cancer in China

ObjectiveTo investigate the effect of preoperative radiotherapy or chemoradiotherapy combined with radical surgery on pathological outcomes in cervical cancer patients.MethodsBased on a large Chinese cervical cancer database of clinical diagnosis and treatment (C4 Project), the postoperative pathological outcomes of patients who received preoperative radiotherapy or chemoradiotherapy followed by open surgery (PR group) or surgery alone (SD group) were compared.ResultsAmong the strictly selected patients, the incidence of lymph node metastasis in the PR group (n = 574) was higher than that in the SD group (231 VS 9; P < 0.001), while the incidence of vascular space invasion was lower than that in the SD group (72 VS 2041; P < 0.001). The logistic regression analysis showed that preoperative radiotherapy was a protective factor for parametrial involvement, positive surgical margins, deep cervical stromal invasion, and vascular space invasion (P < 0.05). The median number of resected lymph nodes in both groups was 18. After 1:1 case matching, the incidence of deep cervical stromal invasion and vascular space invasion was reduced by preoperative radiotherapy (292 vs 376, P < 0.001; 60 vs 106, P < 0.001). Logistic regression analysis indicated that preoperative radiotherapy was a protective factor for deep cervical stromal invasion and vascular space invasion (P < 0.05). The median numbers of resected lymph nodes in the two groups were 18 and 19, separately.ConclusionPreoperative radiotherapy can reduce both the incidence of deep cervical stromal invasion and vascular space invasion, but it cannot reduce lymph node positivity, parametrial involvement and positive surgical margins.     

错配修复基因在右半结肠癌的表达对病理特征的影响

目的:研究散发性结肠癌错配修复基因MLH1、MSH2、MSH6和PMS2在右半结肠癌的蛋白质表达缺失情况,进一步分析错配修复基因的表达缺失与右半结肠癌病理特征的相关性。方法:收集2015年1月至2020年8月期间,在我院就诊的206例结肠癌病人手术切除组织标本及病历资料,左半结肠癌116例,右半结肠癌90例。应用免疫组织化学检测MLH1、MSH2、MSH6和PMS2基因的蛋白质表达情况,分析错配修复基因的蛋白质表达缺失与结肠癌病理特征的相关性。结果:错配修复基因在右半结肠癌的蛋白质表达缺失率高于左半结肠癌。右半结肠癌错配修复基因的蛋白质表达缺失与肿瘤分化程度、肿瘤神经浸润显著相关(P<0.05)。结论:散发性结肠癌中右半结肠癌病人错配修复基因的蛋白质表达缺失比例高于左半结肠癌。错配修复基因的蛋白质表达缺失右半结肠癌病人分化程度低,不易发生神经浸润。