Journal of Pathology and Translational Medicine

Volume 56(2); March 2022

Original Articles

Extremely well-differentiated adenocarcinoma of the stomach: diagnostic pitfalls in endoscopic biopsy: Jongwon Lee, In-Seob Lee, Ji Yong Ahn, Young Soo Park, Jihun Kim; J Pathol Transl Med. 2022;56(2):63-72. Published online November 16, 2021; DOI: https://doi.org/10.4132/jptm.2021.10.12

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Background
Extremely well-differentiated adenocarcinoma (EWDA) is a deceptively bland-looking adenocarcinoma of the stomach. It often causes diagnostic problems, especially in endoscopic biopsy samples. To better recognize this deceptively bland lesion, we carefully reviewed a series of EWDAs treated at our institution.
Methods
A total of 55 specimens from 19 patients were obtained. Endoscopic, gross and microscopic features defining EWDA were described and documented. For comparison, hyperplastic polyp specimens were randomly selected and analyzed.
Results
Most cases (18 of 19, 94.7%) were advanced gastric cancer (AGC) and primarily located in the body of the stomach (15 of 19, 79.0%). The majority of AGCs were non-ulcerated (11 of 18, 61.1%) with an undermining growth pattern and a relatively small mucosal involvement. Specific histologic features included an irregular glandular shape, an undulating apical cytoplasmic border, disproportionately large glands, a variably distended mucinous cytoplasm. Classical features, such as small infiltrating glands or desmoplastic reactions, were barely observed. Identification of irregularly spaced nuclei and disruption of the foveolar epithelial structure, along with atypical features described above were helpful in making a diagnosis especially in gastric forceps biopsies.
Conclusions
Awareness of the histomorphologic characteristics described in this report would lead to timely diagnosis and prevent repeated endoscopic procedures.

Citations

Citations to this article as recorded by

Artificial intelligence-assisted diagnosis of early gastric cancer: present practice and future prospects
Changda Lei, Wenqiang Sun, Kun Wang, Ruixia Weng, Xiuji Kan, Rui Li
Annals of Medicine.2025;[Epub] CrossRef
Unusual or Uncommon Histology of Gastric Cancer
Jinho Shin, Young Soo Park
Journal of Gastric Cancer.2024; 24(1): 69. CrossRef
A case of gastric adenocarcinoma with pyloric gland-type infiltrating submucosa
Kaiho Hirata, Shusuke Yagi, Hideki Miyazaki, Kazuhiko Yamada, Naoki Akazawa, Naoki Enomoto, Kyoko Nohara, Chizu Yokoi, Toru Igari, Norihiro Kokudo
Surgical Case Reports.2024;[Epub] CrossRef
Gastric-type extremely well-differentiated adenocarcinoma of the stomach: A rare tumor with diagnostic difficulties and high inter-observer variation in endoscopic pinch biopsies
Soomin Ahn, Sujin Park, Hyun Hee Koh, Han Gyeol Kim, Hyunjin Kim, Jae Yeong Son, Boram Lee, Hyunwoo Lee, Soohyun Hwang, Junhun Cho, Yun Kyung Lee, Ryoji Kushima, Amitabh Srivastava, Kyoung-Mee Kim
Pathology - Research and Practice.2024; 263: 155599. CrossRef

Fatty acid synthetase expression in triple-negative breast cancer: Jin Hee Park, Hye Seung Han, So Dug Lim, Wook Youn Kim, Kyoung Sik Park, Young Bum Yoo, Seung Eun Lee, Wan-Seop Kim; J Pathol Transl Med. 2022;56(2):73-80. Published online January 21, 2022; DOI: https://doi.org/10.4132/jptm.2021.10.27

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Abstract PDF

Background
Triple-negative breast cancer (TNBC) has a relatively poor prognosis. Research has identified potential metabolic targets, including fatty acid metabolism, in TNBC. The absence of effective target therapies for TNBC led to exploration of the role of fatty acid synthetase (FASN) as a potential target for TNBC therapy. Here, we analyzed the expression of FASN, a representative lipid metabolism–related protein, and investigated the association between FASN expression and Ki-67 and the programmed death ligand 1 (PD-L1) biomarkers in TNBC.
Methods
Immunohistochemical expression of FASN was analyzed in 166 patients with TNBC. For analytical purposes, patients with 0–1+ FASN staining were grouped as low-grade FASN and patients with 2–3+ FASN staining as high-grade FASN.
Results
FASN expression was observed in 47.1% of TNBC patients. Low and high expression of FASN was identified in 75.9% and 24.1%, respectively, and no statistically significant difference was found in T category, N category, American Joint Committee on Cancer stage, or recurrence rate between the low and high-FASN expression groups. Ki-67 proliferation level was significantly different between the low and high-FASN expression groups. FASN expression was significantly related to Ki-67 as the level increased. There was no significant difference in PD-L1 positivity between the low- and high-FASN expression groups.
Conclusions
We identified FASN expression in 166 TNBC patients. The Ki-67 proliferation index was positively correlated with FASN level, indicating higher proliferation activity as FASN increases. However, there was no statistical association with PD-L1 SP142, the currently FDA-approved assay, or FASN expression level.

Citations

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Lipid metabolism involved in progression and drug resistance of breast cancer
Wenxiang Fu, Aijun Sun, Huijuan Dai
Genes & Diseases.2025; 12(4): 101376. CrossRef
Protein biomarkers for diagnosis of breast cancer
Emeka Eze Joshua Iweala, Doris Nnenna Amuji, Faith Chinasaokwu Nnaji
Scientific African.2024; 25: e02308. CrossRef
Microarray analysis points to LMNB1 and JUN as potential target genes for predicting metastasis promotion by etoposide in colorectal cancer
Jiafei Liu, Hongjie Yang, Peng Li, Yuanda Zhou, Zhichun Zhang, Qingsheng Zeng, Xipeng Zhang, Yi Sun
Scientific Reports.2024;[Epub] CrossRef
The signature of extracellular vesicles in hypoxic breast cancer and their therapeutic engineering
Baiheng Zhu, Kehao Xiang, Tanghua Li, Xin Li, Fujun Shi
Cell Communication and Signaling.2024;[Epub] CrossRef
NFYA promotes malignant behavior of triple-negative breast cancer in mice through the regulation of lipid metabolism
Nobuhiro Okada, Chihiro Ueki, Masahiro Shimazaki, Goki Tsujimoto, Susumu Kohno, Hayato Muranaka, Kiyotsugu Yoshikawa, Chiaki Takahashi
Communications Biology.2023;[Epub] CrossRef
Role of EGFR and FASN in breast cancer progression
Suchi Chaturvedi, Mainak Biswas, Sushabhan Sadhukhan, Avinash Sonawane
Journal of Cell Communication and Signaling.2023; 17(4): 1249. CrossRef
Bioinformatics Method Was Used to Analyze the Highly Expressed Gene FAM83A of Breast Cancer in Young Women
Yongzhe Tang, Hao Wang, Qi He, Yuanyuan Chen, Jie Wang, Fahd Abd Algalil
Applied Bionics and Biomechanics.2022; 2022: 1. CrossRef
NCAPH promotes proliferation as well as motility of breast cancer cells by activating the PI3K/AKT pathway
Ting Zhang, Peng Li, Wanying Guo, Qipeng Liu, Weiqiang Qiao, Miao Deng
Physiology International.2022;[Epub] CrossRef

Blocking Toll-like receptor 9 attenuates bleomycin-induced pulmonary injury: Badr Alzahrani, Mohamed M. S. Gaballa, Ahmed A. Tantawy, Maha A. Moussa, Salma A. Shoulah, Said M. Elshafae; J Pathol Transl Med. 2022;56(2):81-91. Published online March 2, 2022; DOI: https://doi.org/10.4132/jptm.2021.12.27

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Abstract PDF

Background
Acute respiratory distress syndrome (ARDS) is one of the most common complications in coronavirus disease 2019 patients suffering from acute lung injury (ALI). In ARDS, marked distortion of pulmonary architecture has been reported. The pulmonary lesions in ARDS include hemodynamic derangements (such as alveolar edema and hemorrhage), vascular and bronchiolar damage, interstitial inflammatory cellular aggregations, and eventually fibrosis. Bleomycin induces ARDS-representative pulmonary damage in mice and rats; therefore, we used bleomycin model mice in our study. Recently, Toll-like receptor 9 (TLR9) was implicated in the development of ARDS and ALI.
Methods
In this study, we evaluated the efficiency of a TLR9 blocker (ODN2088) on bleomycin-induced pulmonary damage. We measured the apoptosis rate, inflammatory reaction, and fibroplasia in bleomycin- and bleomycin + ODN2088-treated mice.
Results
Our results showed a significant amelioration in bleomycin-induced damage to pulmonary architecture following ODN2088 treatment. A marked decrease in pulmonary epithelial and endothelial apoptosis rate as measured by cleaved caspase-3 expression, inflammatory reaction as indicated by tumor necrosis factor α expression, and pulmonary fibrosis as demonstrated by Van Gieson staining and α-smooth muscle actin immunohistochemistry were observed following ODN2088 treatment.
Conclusions
All these findings indicate that blocking downstream TLR9 signaling could be beneficial in prevention or mitigation of ARDS through hemodynamic derangements, inflammation, apoptosis, and fibrosis.

Citations

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A novel mouse model of myositis-associated interstitial lung disease was established by using TLR9 agonist combined with muscle homogenate
Ling Bai, Jiarui Zhu, Wenlan Ma, Peipei Zhao, Feifei Li, Cen Zhang, Sigong Zhang
Clinical and Experimental Immunology.2025;[Epub] CrossRef
Toll-like Receptor 9 Inhibition Mitigates Fibroproliferative Responses in Translational Models of Pulmonary Fibrosis
Glenda Trujillo, Alicia Regueiro-Ren, Chunjian Liu, Buqu Hu, Ying Sun, Farida Ahangari, Vitoria Fiorini, Genta Ishikawa, Karam Al Jumaily, Johad Khoury, John McGovern, Chris J. Lee, Xue Yan Peng, Taylor Pivarnik, Huanxing Sun, Anjali Walia, Samuel Woo, Sh
American Journal of Respiratory and Critical Care Medicine.2025; 211(1): 91. CrossRef
CD103+ dendritic cell–fibroblast crosstalk via TLR9, TDO2, and AHR signaling drives lung fibrogenesis
Hannah Carter, Rita Medina Costa, Taylor S. Adams, Talon M. Gilchrist, Claire E. Emch, Monica Bame, Justin M. Oldham, Steven K. Huang, Angela L. Linderholm, Imre Noth, Naftali Kaminski, Bethany B. Moore, Stephen J. Gurczynski
JCI Insight.2025;[Epub] CrossRef
Study of the biological activity of compositions based on a recombinant interleukin-1 receptor antagonist upon injection and inhalation administration in a model of pulmonary inflammation in mice
Alexander M. Ischenko, Kseniya A. Nekrasova, Denis S. Laptev, Dmitry V. Bobkov, Alexandr A. Kolobov, Andrey S. Simbirtsev
Cytokines and inflammation.2025;[Epub] CrossRef
Mechanisms underlying dose-limiting toxicities of conventional chemotherapeutic agents
Mohammad Amin Manavi, Mohammad Hosein Fathian Nasab, Razieh Mohammad Jafari, Ahmad Reza Dehpour
Journal of Chemotherapy.2024; 36(8): 623. CrossRef
Innate Immune Response-Mediated Inflammation in Viral Pneumonia
Weiwei Ni, Xin Wei, Rui Wu
Journal of Pediatric Infectious Diseases.2024; 19(03): 140. CrossRef
Combination of losartan with pirfenidone: a protective anti-fibrotic against pulmonary fibrosis induced by bleomycin in rats
Arian Amirkhosravi, Maryamossadat Mirtajaddini Goki, Mahmoud Reza Heidari, Somayyeh Karami-Mohajeri, Maryam Iranpour, Maryam Torshabi, Mitra Mehrabani, Ali Mandegary, Mehrnaz Mehrabani
Scientific Reports.2024;[Epub] CrossRef
Suppression of miR-17 Alleviates Acute Respiratory Distress-associated Lung Fibrosis by Regulating Mfn2
Mei-xia Xu, Tao Xu, Ning An
Current Medical Science.2024; 44(5): 964. CrossRef
TLR9: A friend or a foe
Mona M. Saber, Nada Monir, Azza S. Awad, Marwa E. Elsherbiny, Hala F. Zaki
Life Sciences.2022; 307: 120874. CrossRef

Case Studies

An unusual case of microsatellite instability–high/deficient mismatch repair (MSI-H/dMMR) diffuse large B-cell lymphoma revealed by targeted gene sequencing: Bogyeong Han, Sehui Kim, Jiwon Koh, Jeong Mo Bae, Hongseok Yun, Yoon Kyung Jeon; J Pathol Transl Med. 2022;56(2):92-96. Published online November 16, 2021; DOI: https://doi.org/10.4132/jptm.2021.10.15

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Abstract PDF

Microsatellite instability-high/deficient mismatch repair (MSI-H/dMMR) status has been approved as a tissue-agnostic biomarker for immune checkpoint inhibitor therapy in patients with solid tumors. We report the case of an MSI-H/dMMR diffuse large B-cell lymphoma (DLBCL) identified by targeted gene sequencing (TGS). A 90-year-old female who presented with vaginal bleeding and a large mass in the upper vagina was diagnosed with germinal center-B-cell-like DLBCL, which recurred at the uterine cervix at 9 months after chemotherapy. Based on TGS of 121 lymphoma-related genes and the LymphGen algorithm, the tumor was classified genetically as DLBCL of EZB subtype. Mutations in multiple genes, including frequent frameshift mutations, were detected by TGS and further suggested MSI. The MSI-H/dMMR and loss of MLH1 and PMS2 expression were determined in MSI-fragment analysis, MSI real-time polymerase chain reaction, and immunohistochemical tests. This case demonstrates the potential diagnostic and therapeutic utility of lymphoma panel sequencing for DLBCL with MSI-H/dMMR.

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Chimeric and mutant CARD9 constructs enable analyses of conserved and diverged autoinhibition mechanisms in the CARD‐CC protein family
Jens Staal, Yasmine Driege, Femke Van Gaever, Jill Steels, Rudi Beyaert
The FEBS Journal.2024; 291(6): 1220. CrossRef
PD-L1+diffuse large B-cell lymphoma with extremely high mutational burden and microsatellite instability due to acquiredPMS2mutation
Andrew W. Allbee, James Gerson, Guang Yang, Adam Bagg
Molecular Case Studies.2023; 9(4): a006318. CrossRef

Colorectal adenocarcinoma with enteroblastic differentiation: diagnostic challenges of a rare case encountered in clinical practice: Evi Abada, Ifeoma C. Anaya, Othuke Abada, Anthony Lebbos, Rafic Beydoun; J Pathol Transl Med. 2022;56(2):97-102. Published online January 21, 2022; DOI: https://doi.org/10.4132/jptm.2021.10.28

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Abstract PDF

Colorectal adenocarcinoma with enteroblastic differentiation (CAED) is a rare subtype of colonic adenocarcinoma characterized by increased α-fetoprotein (AFP) production and the expression of at least one enteroblastic marker including AFP, glypican 3 (GPC3), or Spalt like transcription factor 4 (SALL4). We report a case of a 26-year-old female who presented with low back pain and constipation which persisted despite supportive measures. Imaging revealed multiple liver lesions and enlarged retroperitoneal nodes. Tumor markers including AFP were markedly elevated. On biopsy, samples from the liver revealed infiltrating glands lined by columnar-type epithelium with mostly eosinophilic granular to focally clear cytoplasm. By immunohistochemistry, the tumor showed immunoreactivity with AFP, hepatocyte antigen, GPC3, SALL4, CDX2, SATB2, and cytokeratin 20. A colonoscopy performed subsequently revealed a mass in the sigmoid colon and biopsy of this mass revealed a similar histology as that seen in the liver. A diagnosis of CAED was made, following the results of gene expression profiling by the tumor with next-generation sequencing which identified pathogenic variants in MUTYH, TP53, and KDM6A genes and therefore supported its colonic origin. Cases such as this underscores the use of ancillary diagnostic techniques in arriving at the correct diagnosis in lesions with overlapping clinicopathologic characteristics.

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SALL4 in gastrointestinal tract cancers: upstream and downstream regulatory mechanisms
Tairan Wang, Yan Jin, Mengyao Wang, Boya Chen, Jinyu Sun, Jiaying Zhang, Hui Yang, Xinyao Deng, Xingyue Cao, Lidong Wang, Yuanyuan Tang
Molecular Medicine.2024;[Epub] CrossRef
Gastric adenocarcinoma with enteroblastic differentiation in a 67-year-old man in Korea: a case report
Hae Rin Lee, Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyung Bin Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Colorectal adenocarcinoma with clear cell changes: immunohistological and molecular findings in three cases
Andreas Gocht, Carsten Heidel, Jutta Kirfel, Rita Vesce, Pamela Lazar-Karsten, Helen Pasternack, Madelaine Melzer, Phillip Hildebrand, Nicole Warkentin, Hendrik Schimmelpenning, Verena-Wilbeth Sailer
Virchows Archiv.2024; 485(3): 569. CrossRef
Ureteral Metastasis of Colonic Adenocarcinoma with Enteroblastic Differentiation: A Rare Case to be Distinguished from Clear Cell Adenocarcinoma of the Urinary Tract
Hiroshi Minato, Akane Yoshikawa, Sho Tsuyama, Kazuyoshi Katayanagi, Kengo Hayashi, Yusuke Sakimura, Hiroyuki Bando, Tomohiro Hori, Yosuke Kito
International Journal of Surgical Pathology.2023; 31(8): 1553. CrossRef
Beyond liver cancer, more application scenarios for alpha-fetoprotein in clinical practice
Chenyu Ma, Yuexinzi Jin, Yuhan Wang, Huaguo Xu, Jiexin Zhang
Frontiers in Oncology.2023;[Epub] CrossRef
AIEgens assisted label free DNA supersandwich immunoassay for ultrasensitive α-fetoprotein detection
Xiaowen Ou, Jingman Dai, Yiting Huang, Xiaoqin Xiong, Zhi Zheng, Xiaoding Lou, Fan Xia
Giant.2022; 11: 100110. CrossRef
Rectal carcinoma with dual differentiation toward enteroblastic and neuroendocrine features arising in a patient with ulcerative colitis: a case report
Takako Kihara, Ryuichi Kuwahara, Kurando Kusunoki, Tomohiro Minagawa, Yuki Horio, Motoi Uchino, Hiroki Ikeuchi, Seiichi Hirota
World Journal of Surgical Oncology.2022;[Epub] CrossRef

Recurrent malignant solitary fibrous tumor of the scalp: a case report and literature review: Ahmed Rabie, Abdulkarim Hasan, Yasein Mohammed, Ayman Abdelmaksoud, Ali A. Rabaan; J Pathol Transl Med. 2022;56(2):103-108. Published online January 21, 2022; DOI: https://doi.org/10.4132/jptm.2021.10.29

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Abstract PDF

Solitary fibrous tumor (SFT) is a rare type of mesenchymal neoplasm that first was discovered in the pleura but can also affect the peritoneum, lungs, mediastinum, and skin. Cutaneous malignant SFT is an extremely rare tumor that resembles dermatofibrosacoma protuberance (DFSP) histologically and immunohistochemically. Herein, we describe a case of malignant SFT that presented as a recurrent mass on the scalp. The first lesion was totally excised one year before recurrence and was diagnosed as a DFSP based on the histopathology and cluster of differentiation 34 immunostaining positivity. Re-examination of the previously examined specimen was considered. Activator of transcription 6 positivity was also detected in the tissue, confirming the diagnosis of a recurrent malignant SFT rather than DFSP. There was no evidence of recurrence, locoregional, or distant metastases at six months after lesion removal with a safety margin.

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Prolonged generalized osteomalacia associated with a sinonasal cavity phosphaturic mesenchymal tumor: A case report
Mehdi Montazer, Naser Tayyebi Meibodi, Elmira Teymouri, Zohreh Mousavi, Sedigheh Reisian, Motahare Ebrahimnejad
Clinical Case Reports.2024;[Epub] CrossRef
Giant Cell Tumor of Soft Tissue on the Forearm Skin: Case Report and Literature Review
Abdulkarim Hasan, Khalid Nafie, Mohamed Adwi, Ayman Abdelmaksoud, Mohammed S. Abdelwahed, Abdulhadi Samman, Mohammad A. Alghamdi, Hasan S. Al-Ghamdi, Hind Ali Hendi, S. K. A. Horsu
Open Access Macedonian Journal of Medical Sciences.2023; 11(C): 71. CrossRef
Primary sclerosing liposarcoma of the ovary: Case report and a review of the literature
Thyagaraja Dhanurjaya, Turnbull Hilary, Jasenka Mazibrada
International Journal of Surgery Case Reports.2023; 109: 108513. CrossRef
Favorable outcome of a histiocytic sarcoma patient treated with immune checkpoint inhibitor: a case report
Long Thanh Nguyen, Giang Hoang Pham, Phuong Thi Vu, Hyeon Gyu Yi
Annals of Medicine & Surgery.2023; 85(12): 6274. CrossRef
Adrenal Solitary Fibrous Tumor: A Case Report
Elena Casademunt-Gras, Isabel Salinas, Pau Moreno Santabarbara, Gustavo Tapia Melendo, Jordi L Reverter
Cureus.2023;[Epub] CrossRef
A Rare Case of Malignant Solitary Fibrous Tumor on the Scalp
Kwang-Ryeol Kim, Ki Hong Kim
Keimyung Medical Journal.2023; 42(2): 107. CrossRef

Letters to the Editor

And the story goes on: non-conventional dysplasia of the colorectum: Lavisha S. Punjabi, Yi Neng Lai, Anjula Thomas; J Pathol Transl Med. 2022;56(2):109-110. Published online February 3, 2022; DOI: https://doi.org/10.4132/jptm.2021.12.29

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Seeing the random forest through the decision trees. Supporting learning health systems from histopathology with machine learning models: Challenges and opportunities
Ricardo Gonzalez, Ashirbani Saha, Clinton J.V. Campbell, Peyman Nejat, Cynthia Lokker, Andrew P. Norgan
Journal of Pathology Informatics.2024; 15: 100347. CrossRef

Renal cell carcinoma concomitant with multiple myeloma: Anubhav Narwal, Prashant Ramteke, Lalit Kumar, Saumyaranjan Mallick; J Pathol Transl Med. 2022;56(2):111-112. Published online March 11, 2022; DOI: https://doi.org/10.4132/jptm.2022.01.21

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Citations

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Autologous stem cell transplant for multiple myeloma: Impact of melphalan dose on the transplant outcome
Lalit Kumar, Ranjit Kumar Sahoo, Sudhir Kumar, Annie K. Baa, Ghazal Tansir, Neha Pathak, Prabhat S. Malik, Om Dutt Sharma, Anisha Mathew, Ankit Jha, Ritu Gupta, Atul Sharma, Ahitagni Biswas, Rakesh Kumar, Sanjay Thulkar, Soumyaranjan Malik, Ashish Dutt
Leukemia & Lymphoma.2023; 64(2): 378. CrossRef

Newsletter

What’s new in molecular genetic pathology 2022: immune checkpoint inhibitor biomarkers and select solid tumors: Patricia C. Tsang, Guoli Chen; J Pathol Transl Med. 2022;56(2):113-114. Published online March 11, 2022; DOI: https://doi.org/10.4132/jptm.2022.01.25

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Abstract PDF: Predictive biomarker testing plays a critical role in targeted immuno-oncology, including the use of immune checkpoint inhibitors (ICI) for various solid tumors. Molecular advancements in cancers of the breast, kidney and brain have continued to propel tumor classification and precision therapy.

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