Journal of Pathology and Translational Medicine

Articles in E-pub version are posted online ahead of regular printed publication.

Case Study

Colorectal intramucosal carcinoma with lymphatic invasion and lymph node metastasis: a case report: Joon Mee Kim, Lucia Kim, Jee Young Han, Suk Jin Choi, Jongbeom Shin, Sun Keun Choi; Received July 23, 2026 Accepted August 14, 2026 Published online October 19, 2026; DOI: https://doi.org/10.4132/jptm.2026.08.14 [Epub ahead of print]

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Abstract PDF: Colorectal intramucosal carcinoma (IMC) is considered to carry negligible risk of lymph node metastasis, reflecting the presumed absence of lymphatics within the lamina propria, and current guidelines endorse endoscopic resection alone as curative. We report a 64-year-old man in whom endoscopic submucosal dissection of a lower rectal tumor revealed a well-differentiated IMC with extensive lymphatic invasion confirmed by D2-40 immunostaining. Subsequent laparoscopic ultralow anterior resection showed no residual tumor at the primary site but confirmed metastasis in one of 12 regional lymph nodes. The tumor was microsatellite-stable, epidermal growth factor receptor–positive, and harbored a KRAS codon 13 mutation (G13X). The patient received adjuvant chemoradiotherapy and remained disease-free at 2 years. This case demonstrates that regional lymph node metastasis can occur in colorectal IMC even without conventional adverse histologic features such as poor differentiation or tumor budding, challenging current risk-stratification frameworks and supporting a more cautious approach when lymphatic invasion is identified.

Original Article

Digital image analysis–based quantification of p53 immunohistochemistry in gastric cancer: a systematic comparison of three-tier cutoff-derivation strategies in tissue microarrays: Jaeyoung Ahn, Kyungeun Kim, Hee-Jung Yang, Boram Song, Dong Hoon Kim, Yumin Chung, Seoung Wan Chae; Received March 23, 2026 Accepted August 13, 2026 Published online October 19, 2026; DOI: https://doi.org/10.4132/jptm.2026.08.13 [Epub ahead of print]

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Abstract PDF Supplementary Material: Background
p53 immunohistochemistry (IHC) is a common surrogate for TP53 alteration, but in gastric cancer, its concordance is imperfect and depends on a non-standardized cutoff. Digital pathology enables H-score quantification, yet neither its reproducibility nor the choice of cutoff- derivation strategy has been systematically compared. Methods: A semi-automated digital workflow quantified p53 IHC in tissue microarrays from 528 gastric cancer patients. Tumor cells were detected with a deep-learning model (InstanSeg), and nuclear staining was expressed as a continuous H-score (0–300). Reproducibility was assessed at each observer-dependent step. Five thresholding strategies were compared: manual cutoffs, tertiles, log-rank optimization, the extended Youden index, and volume under the receiver operating characteristic surface (VUS). The latter two strategies used the manual three-tier IHC interpretation as the reference standard. Results: Quantification was reproducible: two independent manual interpretations agreed in 91.7% of cores (κ = 0.845). The H-score was robust to the detection algorithm (intraclass correlation coefficient, 0.990) and to repeated threshold determination (0.954). H-scores were right-skewed (median, 45.5), and the strategies yielded distinct cutoffs (8.0–27.6 and 78.6–106.0). Log-rank optimization provided the widest separation but lost significance after multiplicity adjustment (p = .168). The extended Youden and VUS cutoffs were statistically indistinguishable. As a supporting check, all classifications showed nominal overall-survival separation, with low and overexpression faring similarly worse than wild-type. Conclusions: Digital p53 IHC quantification was reproducible at each observer-dependent step. The extended Youden and VUS criteria performed equivalently; therefore, we propose Youden as a reasonable default, pending validation and TP53 correlation.

Case Study

Gastric amphicrine carcinoma in the stomach: an unexpected presentation of MUTYH-associated polyposis: Seungkyun Lee, Byung-Hoon Min, Young-Gon Kim, Soomin Ahn, Kyoung-Mee Kim; Received April 17, 2026 Accepted June 24, 2026 Published online September 7, 2026; DOI: https://doi.org/10.4132/jptm.2026.06.24 [Epub ahead of print]

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Abstract PDF: Amphicrine carcinomas of the stomach, defined by dual exocrine and neuroendocrine differentiation within the same neoplastic cell, are exceedingly rare. MUTYH-associated polyposis (MAP) is an autosomal recessive polyposis syndrome characterized by multiple colorectal adenomas and variable upper gastrointestinal involvement; however, amphicrine carcinomas have not been previously documented in this setting. We report a gastric amphicrine carcinoma arising in the background of extensive fundic gland polyposis in a patient with MAP. Endoscopy revealed a 3.5-cm flat elevated lesion in the gastric fundus amid extensive fundic gland polyposis. Histologically, the tumor consisted of a single population of cells exhibiting combined glandular and neuroendocrine differentiation without zonal or biphasic architecture, and many of these cells demonstrated true amphicrine morphology. Immunohistochemistry confirmed co-expression of cytokeratin and the neuroendocrine markers chromogranin A and synaptophysin in the same cell population. Germline targeted next-generation sequencing identified biallelic MUTYH variants in trans (c.733C>T, p.Arg245Cys [likely pathogenic]; c.842C>T, p.Ala281Val [variant of uncertain significance]), supporting a diagnosis of MAP. To our knowledge, this is the first reported case of a gastric amphicrine carcinoma in a MAP patient, expanding the spectrum of MAP-associated upper gastrointestinal neoplasia and underscoring the importance of vigilant endoscopic surveillance in hereditary polyposis syndromes.

Case Report

Ultrasound-guided cryoablation of recurrent thyroid cancer: radiologic-pathologic correlation: Yeseul Kim, Jae Ho Shin, Kyeong Jin Kim, Soo Myoung Shin, Dawon Park; Received February 11, 2026 Accepted June 4, 2026 Published online August 3, 2026; DOI: https://doi.org/10.4132/jptm.2026.06.04 [Epub ahead of print]

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Abstract PDF Supplementary Material: Cryoablation is a minimally invasive thermal ablation modality that destroys tumor cells through intracellular ice crystal formation and osmotic injury. Although it offers theoretical advantages, its application in recurrent papillary thyroid cancer (PTC) remains limited, and the radiologic-pathologic findings of treatment response have not been well characterized. A 55-year-old male patient with biopsy-proven recurrent PTC in the left supraclavicular fossa and a history of total thyroidectomy, neck dissection, and advanced colorectal cancer underwent a single-session ultrasound-guided cryoablation. The 20-minute procedure was completed without complications. Immediately post-ablation, the lesion volume increased by over 200% with marked hypoechogenicity and obliteration of abnormal feeding vessels on microvascular imaging. Pathology demonstrated disrupted tumor cell membranes, necrotic changes, and myxoid peritumoral stromal alteration, consistent with direct and indirect injuries caused by cryoablation. At the first-month follow-up, repeat biopsy showed no viable tumor, with subacute inflammatory infiltrates, histiocytic aggregates, and progressive fibrosis. On ultrasound, a volume reduction rate of 71.4% was achieved at one month follow-up and 97.1% at three months follow-up. This case report provides the first radiologic-pathologic findings of both immediate and delayed effects of cryoablation in recurrent PTC, supporting its role as a promising minimally invasive palliative therapy.

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