Pathologica - Journal of the Italian Society of Anatomic Pathology and Diagnostic Cytopathology

Standardisation of histologic reporting in eosinophilic oesophagitis: Expert recommendations

2026-01-26T07:53:03+00:00

Over the past decade, significant progress has been made in understanding eosinophilic oesophagitis (EoE), leading to the refinement of diagnostic criteria and the development of evidence-based management guidelines. Nevertheless, despite the central role of histology in both diagnosis and disease monitoring, significant variability remains in histopathological reporting across institutions and among pathologists.This study seeks to provide recommendations for standardised histological reporting in EoE. To this end, a multidisciplinary panel of gastroenterologists and pathologists convened to review current practices and address persistent challenges in histologic assessment. Through an extensive literature review and critical appraisal of existing scoring systems, the panel reached consensus on both essential and desirable histological features for routine reporting, including eosinophil counts, additional inflammatory parameters, and fibrostenotic changes.

MesoRet: a reticulin stain-based deep learning algorithm to assist diffuse mesothelioma subtyping

2025-10-13T16:10:52+00:00

Objective. To develop and validate a deep learning model trained on reticulin-stained whole slide images (MesoRet) to accurately identify transitional features and assist in the histologic subtyping of diffuse mesothelioma.

Methods. A total of 115 cases of diffuse mesothelioma were collected from two institutions and reviewed by expert thoracic pathologists. Reticulin-stained whole-slide images were used to train a supervised deep learning model on the Aiforia Create platform to distinguish epithelioid, sarcomatoid, and transitional patterns. Model performance was validated on independent slides and compared with expert pathologists’ assessments.

Results. MesoRet accurately identified reticulin patterns across mesothelioma histotypes achieving 96.32% precision and 99.06% sensitivity, excluding artifacts and non-tumour tissue. It outperformed pathologists in identifying transitional patterns, reducing diagnostic time and minimising errors.

Conclusions. MesoRet provides an accurate and objective approach for detecting reticulin patterns in mesothelioma, supporting histological subtyping and contributing to more consistent diagnoses. Although further validation is required, it represents a promising model to improve diagnostic precision and guide therapeutic decision-making.

Automated paraffin embedding of tissue samples significantly reduces overall workflow time in routine pathology practice.

2025-12-05T23:21:44+00:00

Objective: Automated paraffin embedding (AE) offers a solution to the operator-dependent variability and time demands manual embedding (ME), but comparative data are limited.

Methods: We quantitatively assessed AE versus ME using 186 endoscopic biopsies, 106 needle biopsies, and 62 transurethral resections, recording the time (seconds, s) required for preparation, embedding, trimming, and sectioning.

Results: AE substantially reduced embedding time (5s for all sample types) compared with ME (43 s for endoscopic biopsies, 66.5 s for needle biopsies, and 105 s for transurethral samples), and it allowed laboratory technicians to perform other tasks concurrently. AE also shortened total time: 150.2s (AE) vs. 250.4s (ME) for endoscopic biopsies, 176.9s (AE) vs. 324.2s (ME) for needle biopsies, and 149.5s (AE) vs. 335s (ME) for transurethral resections.

Conclusions: These real-world data provide quantitative evidence of AE-related time savings in daily routine activity, supporting its role in workflow automation and standardization in pathology units.

Analysis of histological parameters of aggressiveness in resected lung squamous cell carcinoma

2025-11-09T15:04:07+00:00

Introduction. Lung squamous cell carcinoma (LUSCC) lacks consistent morphological criteria for tumour grading. Tumour budding (TB), defined as isolated cells or clusters of fewer than 4 cells at the invasive front, is prognostic in several carcinomas but remains insufficiently validated in LUSCC.

Objective. To assess histopathological features of aggressiveness (including TB) in resected LUSCC as prognostic parameters and grading factors.

Methods. We retrospectively analysed 296 LUSCC cases (2010-2021, University of Turin). Clinical data were collected and slides were reviewed for subtype, nuclear features, mitotic count, infiltration pattern, TB, spread through air spaces (STAS), desmoplasia, pleural/vascular/perineural invasion, and tumour-infiltrating lymphocytes. Associations with recurrence-free and overall survival were tested.

Results. High TB (≥ 5 buds) correlated with pleural invasion and advanced T stage and was significantly associated with shorter recurrence-free (HR 1.84, p = 0.008) and overall survival (HR 1.73, p = 0.003), independently of stage. Nuclear enlargement and necrosis also predicted worse outcomes, while surgery had an overall protective impact.

Conclusion. TB, necrosis, and nuclear size are independent predictors of outcome in LUSCC. Their inclusion in pathology reports may improve grading, refine prognosis, and guide management.

Palisading adenocarcinoma. State of the art and first case report in the parotid gland of a 44-year-old woman

2025-10-31T11:46:16+00:00

Palisading adenocarcinoma is a newly described salivary gland tumor known for its predilection for sublingual and submandibular glands. The mass tends to have a non-invasive growth, although signs of infiltrative growth can occur resulting in a neoformation more adherent to deep neck structures. The main histological feature is a biphasic cellular pattern composed of polygonal epithelioid cells with small nuclei arranged in trabeculae and pseudo-rosette like structures and a second population of scattered well-formed ductal structures with occasional mucocytes. The mass, located in the parotid gland, resembled a neuroendocrine neoplasia regarding its histological architecture and positivity for CD56, whereas the cytological examination resembled that of a pleomorphic adenoma. An accurate histological and immunohistochemical study was crucial to guide the differential diagnosis.

Here we present the first case of palisading adenocarcinoma affecting the parotid gland to further enrich the literature and to shed additional light on this peculiar and recently investigated neoplastic entity.

Early-onset gestational pemphigoid in the first trimester: a diagnostic pitfall

2025-12-27T13:44:02+00:00

This letter reports a case of a gestational pemphigoid (GP), a rare autoimmune subepidermal blistering disorder, typically arising in the third trimester of pregnancy. Early-onset presentations, during the first trimester, are exceptionally uncommon and may mimic other pregnancy-related dermatoses, delaying diagnosis. We report a rare early-onset case of GP and discuss the diagnostic challenges and management implications, allowing timely diagnosis and treatment, reducing maternal morbidity and potential obstetric complications.

“Adnexotropic” lichen striatus: a potential histological mimicker of mycosis fungoides

2026-01-20T20:18:46+00:00

Dear Editor,

Lichen striatus (LS) is a self-limiting inflammatory dermatosis of childhood, typically presenting as linear papules distributed along the lines of Blaschko¹. Although the diagnosis is often clinical, LS may display a broad histopathological spectrum, occasionally overlapping with features of cutaneous lymphoproliferative disorders. We report a pediatric case of LS with striking adnexotropism closely mimicking mycosis fungoides (MF).

A consideration of the trends in thyroid fine-needle aspiration cytology – Results from the Italian Cytopathology Committee National Practice Survey in Thyroidology

2025-12-05T15:45:35+00:00

Dear Editor

It is with the utmost deference and profound interest that we peruse the recent contribution to these pages by Acanfora et al.¹, which offers a most valuable aperçu of the current state of thyroid fine-needle aspiration (FNA) cytology practice across the Italian peninsula in thyroidology. The authors are to be commended for their diligent undertaking, which illuminated several salient points of contemporary practice, particularly in the context of the Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC). This survey, being a work of no small relevance, shall surely serve as a critical datum for future considerations.

The finding that the volume of thyroid FNAs returned to pre-pandemic levels by the year 2022 is indeed a welcome sign of the restoration of clinical normalcy, and the widespread adoption of the ICCRTC system (90.4%) speaks volumes to the success of national standardization efforts. Such uniformity in reporting is, without question, a cornerstone of robust inter-institutional communication and patient care. Yet, a careful examination of the reported data prompts a gentle query regarding specific procedural nuances. The observation that the majority of FNAs (75%) are performed by non-pathologist physicians – chiefly endocrinologists and radiologists – is a point of interest. While the skill and dedication of these clinicians are not to be underestimated, the established literature suggests that the immediate presence of a cytopathologist for rapid on-site evaluation (ROSE) can significantly enhance specimen adequacy and diagnostic yield. One might, therefore, consider the potential for further optimization of the pre-analytical phase, perhaps through enhanced collaborative models that more closely integrate the proceduralist and the diagnostic cytologist, a matter of no slight consequence for patient management.

A case of chorea, epilepsy and cerebral atrophy in the work of Ettore Ravenna (1920s)

2025-12-17T11:09:24+00:00

This study re-examines a rare neuropathological case documented by Ettore Ravenna in 1900, involving a young patient with chorea, epilepsy, and marked frontal lobe atrophy. Using Ravenna’s original autopsy notes and the preserved anatomical preparation at the Morgagni Museum of Human Anatomy (Padua), the case is reassessed in light of modern neurological knowledge. Macroscopic examination confirmed severe anterior frontal atrophy with relative preservation of peri-Sylvian regions, consistent with the patient’s ability to sing despite profound language impairment. Ravenna described gliosis, fibrotic tissue replacement, and neuronal hyaline degeneration, interpreted as ulegyria of inflammatory origin. Although he considered epilepsy and chorea expressions of a single pathology, current research differentiates their mechanisms. However, juvenile neurodegenerative disorders such as Huntington disease show overlapping seizures, chorea, and cortical atrophy, partially supporting his observations. Re-evaluating this case highlights its historical relevance and the value of anatomical collections in reassessing early diagnoses.