Journal of Pathology and Translational Medicine

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

Case Reports

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.

Fibrosarcoma of bone masquerading as fibrous dysplasia: diagnostic pitfall and molecular correlates of aggressive behavior: Wangpan J. Shi, Brady K. Huang, Li Lei; Received March 7, 2026 Accepted May 29, 2026 Published online August 3, 2026; DOI: https://doi.org/10.4132/jptm.2026.05.29 [Epub ahead of print]

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Abstract PDF Supplementary Material: Low-grade fibro-osseous lesions can be challenging to classify. A 33-year-old man presented with synchronous lesions involving the ilium and T2 vertebra. Because of an impending pathologic fracture, he received several doses of denosumab. Initial biopsies showed bland fibro-osseous lesions lacking GNAS or MDM2 alterations and were favored to represent polyostotic fibrous dysplasia. Subsequent iliac curettage revealed a fascicular spindle cell proliferation with subtle atypia and focal ossification, leading to a revised diagnosis of low-grade fibrosarcoma. Re-biopsy of the T2 lesion demonstrated a similar spindle cell proliferation without ossification. Sequencing identified copy number gains involving KIT, PDGFRA, and TERT. At 16-month follow-up, two metastatic pulmonary nodules developed, one responsive to chemotherapy. The patient remains alive with disease at 27 months after presentation. This case highlights a diagnostic pitfall in which low-grade fibrosarcoma with denosumab-associated ossification may mimic fibrous dysplasia and underscores the prognostic value of molecular profiling beyond histologic grading.

Original Article

Development of a prognostic prediction model for tumor recurrence or progression in gastrointestinal stromal tumors: integrating inflammatory blood indices with 5 mm² versus 50 high-power field mitotic counts: Waratchaya Tirasarnvong, Thammasin Ingviya, Paramee Thongsuksai; Received February 10, 2026 Accepted June 15, 2026 Published online July 31, 2026; DOI: https://doi.org/10.4132/jptm.2026.06.15 [Epub ahead of print]

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Abstract PDF Supplementary Material: Background
The behavior of gastrointestinal stromal tumors varies according to tumor size, location, mitotic rate, and rupture. Traditional mitotic counting in 50 high-power fields (HPF; 5.3 mm2) may overestimate progression risk, as 5 mm2 corresponds to 20–25 HPF under modern microscopy. However, the 50-HPF method remains widely used. This study evaluated the impact of two mitotic counting methods on risk classification and developed a prognostic model combining inflammatory biomarkers with clinicopathological factors. Methods: We retrospectively analyzed 150 patients who underwent resection at Songklanagarind Hospital between 2009 and 2021. Patients who had received neoadjuvant therapy or had a second primary cancer were excluded. Mitosis was evaluated using both methods. Clinicopathological and serum biomarker data were collected. The primary outcome was 5-year disease-free or progression-free survival. The model was developed using forward stepwise variable selection based on the time-dependent area under the curve and internally validated by bootstrapping. Results: The 50-HPF method overestimated the Armed Forces Institute of Pathology classification in 14.2% of cases. A model incorporating tumor size, location, rupture, mitotic count within 5 mm2, and systemic immune-inflammation index achieved the highest area under the curve of 0.939 in both training and validation sets, outperforming previous models. The 5-mm2 method demonstrated superior performance to the 50-HPF method across all models (0.939 vs. 0.919 for the proposed model). Conclusions: Mitotic counting in 50 HPF overestimated risk classification in certain cases. Incorporating systemic immune-inflammation index and using a 5 mm2 mitotic count enhanced prognostic model performance.

Case Report

Clinicopathological characteristics of primary malignant cutaneous perivascular epithelioid cell tumor: case report and literature review: Huaming Li, Dan Zhang, Shiwu Zhang; Received February 28, 2026 Accepted May 10, 2026 Published online July 20, 2026; DOI: https://doi.org/10.4132/jptm.2026.05.10 [Epub ahead of print]

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Abstract PDF: Primary cutaneous malignant perivascular epithelioid cell tumors (PEComas) are extremely rare. Accurate diagnosis is critical for prognostic evaluation and guiding clinical management. Here, we report a case of a 19-year-old woman with a 1.1 cm exophytic red mass on her left upper limb. Histological examination revealed a dermal tumor composed of clear cells with prominent nucleoli. The tumor cells displayed cytologic atypia, nuclear pleomorphism, multinucleated giant cells, mitoses and invasive growth, with a multinodular distribution within the dermis and vascular invasion. Immunohistochemically, the tumor cells expressed cathepsin K, HMB45, and CD10. Based on morphological and immunohistochemical findings, we classified it as a primary malignant cutaneous PEComa. To date, only eight reported cases have been described as primary malignant cutaneous PEComas. The present case appears to be the youngest patient reported among all malignant PEComas.

Original Article

Bronchial lesions in a high serum IgA mouse model: pulmonary venular IgA deposition and spatially distinct lymphoid cell aggregation: Areum Kim, Minhyeok Lee, Yohan Park, Wan Jin Hwang, Hyeseung Lee, Joo Heon Kim, Jin Man Kim, Yong Min Kim, Jin Sun Park, Junguee Lee; Received March 10, 2026 Accepted June 1, 2026 Published online July 16, 2026; DOI: https://doi.org/10.4132/jptm.2026.06.01 [Epub ahead of print]

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Abstract PDF: Background
Immunoglobulin A (IgA) nephropathy is a systemic immune complex–mediated disease primarily affecting the kidneys, yet pulmonary involvement remains poorly characterized. This study investigated pulmonary structural alterations, IgA deposition, immune cell distribution, and the impact of chronic environmental immune stimulation. Methods: High-IgA (HIGA) mice and BALB/c controls were examined under baseline conditions and following chronic particulate matter (PM) exposure. Histopathology, immunofluorescence, immunohistochemistry, and lectin-based assays were used to assess pulmonary IgA deposition, lymphoid cell aggregation, and immune activation. Results: Compared with BALB/c controls, HIGA mice exhibited pulmonary venular remodeling characterized by thickening of the venular tunica media and IgA deposition within the smooth muscle layer. Under baseline conditions, lymphoid cell aggregation in HIGA mice was predominantly localized to peribronchial regions, whereas IgA deposition and C3a deposition were confined to pulmonary venules with minimal spatial overlap. Following PM exposure, HIGA mice developed additional perivenular lymphoid cell aggregation that spatially corresponded with IgA deposition, whereas BALB/c mice showed predominantly peribronchial aggregation. PM exposure was associated with increased pulmonary Toll-like receptor 9 (TLR9) expression in both strains. In HIGA mice, TLR9-positive immune cells and interleukin-6 (IL6) expression were enriched in perivenular lymphoid cell aggregates. Conclusions: Pulmonary IgA deposition in HIGA mice is associated with vascular remodeling and compartment-specific immune cell distribution, particularly under environmental stimulation. These findings support an association between IgA deposition and localized immune activation in the lung. However, the causal roles of TLR9 and IL6 in this process remain to be determined.

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