Ex vivo digital microscopy uses light in the visible and adjacent spectra to obtain digital images of tissues. They are optical imaging techniques that allow the acquisition of digital images of tissues with minimal or no tissue preparation and are currently available for evaluation of fresh and/or fixed tissues. This review will provide an overview of the different types of ex vivo digital microscopy techniques, including confocal microscopy (CM), optical coherence tomography (OCT), stimulated Raman Spectroscopy (SRS), light sheet microscopy (LSM), microscopy with ultraviolet excitation (MUSE), structured illumination microscopy (SIM), and nonlinear microscopy (NLM). Except for OCT and SRS, all the other tissue imaging techniques require labeling of tissues with fluorescent dyes to obtain digital images. An advantage of several of these techniques, including fluorescence CM, SRS, LSM, MUSE, SIM, and NLM, is that they can produce hematoxylin and eosin-like images. The promising potential of ex vivo digital microscopy techniques in surgical pathology practice is supported by several retrospective and limited prospective studies. Applications of ex vivo digital microscopy techniques include real-time evaluation of fresh tissue at the bedside in clinics and radiology suites, as well as intraoperatively in pathology laboratories. These techniques have great potential for incorporation into standard-of-care surgical pathology practice.
Families in rural and remote communities face travel and financial barriers to pediatric surgical care. This quality improvement initiative aimed to enhance access through virtual and outreach care in pediatric urology. Using statistical process control charts, we compared mean wait times and travel distances before (2018) and after virtual care implementation (2021) for pediatric hydronephrosis and testicular pathology consultations. Cost savings from virtual and outreach care, and travel reductions from outreach care were analyzed. Caregiver surveys assessed satisfaction, accessibility, and perceived cost savings. Among 1,288 patients (618 in 2018; 670 in 2021), X-bar charts demonstrated process stability with a sustained reduction in mean travel distances from 240 km to 143 km (-40.4%). Mean wait times remained stable at 115 days (p=0.42) with decreased variability after virtual care implementation, which yielded an estimated $41,700 CAD in family savings from reduced vehicle and parking costs in 2021. Outreach clinics generated additional savings of $8,600-$10,900 CAD in total, reducing average travel distances by 649-1,445 km (82-88%) per visit. By 2024, average wait times increased to 149 days as consultation volumes rose by 56%. Caregiver satisfaction remained high (81.5% in-person vs 82.4% virtual), with 87.1% reporting cost savings and 82.7% reporting time savings. Virtual and outreach care reduced travel and financial burdens without compromising satisfaction or wait times, supporting hybrid care as a sustainable approach to pediatric surgical service delivery. Rising 2024 wait times under increased demand underscore the need for workflow optimization and resource scaling to sustain timely access.
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BACKGROUND: Elastofibroma dorsi is a rare, slow-growing, benign soft tissue tumor typically located under the scapula. Although elastofibroma dorsi is a benign lesion, it may cause symptoms such as pain and restriction of movement, and its mass-like appearance can lead to considerable patient anxiety. We aimed to present patients diagnosed with elastofibroma dorsi who had clinical complaints and underwent surgical treatment, in conjunction with the literature in this study. METHODS: Our study retrospectively analyzed lesions surgically treated in the Orthopedics and Traumatology and Thoracic Surgery Clinics over the past five years, which were pathologically confirmed as elastofibroma dorsi. All patients were operated on in the prone position under general anesthesia, and all excised lesions underwent postoperative pathological examination. RESULTS: A total of 22 elastofibroma dorsi lesions were identified in 16 patients, including 6 patients with bilateral involvement. The mean age of the patients was 62.3 years (range, 46–76). Of these lesions, 13 (59.1%) were located on the right side and 9 (40.9%) on the left. The predominant presenting symptoms were pain, limitation of shoulder motion, cosmetic concerns, and the presence of a palpable mass. Lesion sizes ranged from 5 to 10 cm in diameter. Magnetic resonance imaging or computed tomography consistently demonstrated well-defined tumors situated posterolaterally in the chest wall, between the serratus anterior and latissimus dorsi muscles. All patients underwent marginal resection following anatomical dissection of the involved muscle groups. Postoperatively, seromas developed in 8 lesions (36.4%) and a hematoma in 1 lesion (4.5%). The seromas were successfully managed with aspiration and compression bandaging, while the hematoma required surgical reintervention. CONCLUSIONS: Elastofibroma dorsi is a slowly growing benign lesion typically located beneath the inferior scapula. In symptomatic patients, surgical excision results in a marked improvement of symptoms. The most common surgical complication is the development of postoperative seroma.
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With the growth of spinal surgery, in terms of numbers of operations, as well as the techniques and implants used, surgeons and spine physicians are turning more to imaging for clinical management decisions and surgical planning for spinal disorders. Medicolegal implications also make it mandatory in all cases. We discuss the importance of imaging in modern spinal surgical practice, with an emphasis on decision making in clinics, preoperative surgical work-up, and operative use, as well as in a postoperative setting when complications occur. The increasing use of endoscopic techniques has made the role of imaging even more important because precise techniques can enable viewing the sites of pathology with minimal damage to normal anatomy.
In breast cancer, one of the main objectives of neoadjuvant treatment, regardless of the specific breast cancer subtype, is to downstage the disease in both the breast and the lymph nodes, thereby allowing surgical de-escalation. In patients with inoperable disease, downstaging could lead to a feasible surgical resection; whereas, in patients presenting with operable disease, it could increase the eligibility for breast-conserving surgery (i.e., lumpectomy) instead of a mastectomy as well as spare some patients an axillary lymph node dissection. In patients with hormone receptor-positive (HR + ) human epidermal growth factor receptor 2 (HER2)-negative early-stage breast cancer, neoadjuvant treatment modalities include chemotherapy (NCT) and endocrine therapy (NET). The 21-gene Oncotype DX Breast Recurrence Score® assay is a multigene assay that determines a Recurrence Score® (RS) result (range, 0-100) based on gene expression profile within the primary tumor. The RS is a validated prognosticator and predictor of benefit from adjuvant CT. Beyond its validation, it has shown clinical utility in 3 prospective randomized clinical trials in the adjuvant setting (TAILORx, RxPONDER, and WSG PlanB). In these studies, all assays were performed on surgical excision samples. This review focuses on the utility of the 21-gene assay in patients with HR + HER2-negative early-stage breast cancer in the neoadjuvant setting. It discusses the analytical validation of performing the assay on core biopsies, its clinical validation as a tool to guide neoadjuvant treatment decisions (primary surgery, NET, or NCT), the association of the RS result with clinical outcomes, the impact of the RS results on neoadjuvant treatment decisions in real-life clinical practice, the inclusion of the assay in the neoadjuvant setting in clinical-practice guidelines, access of patients worldwide to this approach, and potential directions for additional studies examining the role of the RS in other steps in the clinical pathway of HR + HER2-negative early-stage breast cancer.
Endometrial cancer is the most frequently occurring gynecologic malignancy in the Western world. It has previously been classified using histologic determinants, but more recent classifications have incorporated features of molecular pathology. Most commonly, evaluation for DNA mismatch repair deficiency, POLE mutational status, and p53 mutational and/or protein status is conducted as part of molecular testing. The method of detection, such as immunohistochemistry or mutational analysis, has been debated for these molecular features. This article summarizes the current state of molecular pathology in endometrial cancer, including methods of testing, gaps in current approaches, molecular features with potential relevance, and therapeutic applicability.
Endocrine gland tumors are characterized by a wide spectrum of pathologic, clinical, and molecular features. Next-generation sequencing technologies have greatly improved our knowledge of this group of neoplasms, showing robust genotype-phenotype correlation. This review summarizes the main molecular changes found in endocrine gland tumors, highlighting the interplay between tumor-specific somatic or germline genetic changes, pathology, and clinical features. The aim of the article is to provide essential information about the role of molecular pathology in defining diagnosis, prognosis, and identification of biomarkers for molecular targeted therapy.
Soft-tissue tumors are rare mesenchymal neoplasms characterized by extensive morphologic and genetic heterogeneity. Advances in molecular pathology have transformed their diagnosis, classification, and therapeutic management. Recurrent genomic alterations such as gene fusions, mutations, amplifications, and epigenetic changes define distinct tumor subtypes, guiding targeted therapy. Modern diagnostic platforms, from fluorescence in situ hybridization to next-generation and methylation-based sequencing, enable precise molecular characterization of these tumors. Integration of molecular and genomic data will continue to inform diagnosis, prognosis, and treatment response. Emerging technologies, including circulating biomarkers and artificial intelligence, further expand the role of molecular pathology in soft-tissue tumor care.
Despite preventive measures, silicone breast implants can develop severe pathologies that necessitate surgical revision. At present, there is no standardized classification for the capsular tissue excised during such revisions, yet establishing one would be critical for elucidating the underlying causes and pathogenesis of implant failure. A histopathological typing scheme for capsular tissue in breast implant-related pathologies (PBI classification) was developed and its sensitivity compared with the clinical diagnosis. A newly adapted, substantially time-reduced Oil Red O staining protocol is to be applied to assess whether direct detection of silicone is sufficiently feasible. Three types were defined: fibrosis type 1 is characterized by a fibrous reaction with variable fibroblast cellularity. Silicone type 2 is defined by the presence of silicone deposits within and outside the capsular tissue. Malignancy type 3 is characterized by the presence of malignancies. A total of 150 cases from five different clinics (period: 2001–2018) were characterized as follows: fibrosis type 1, n = 104 (69.3%); silicone type 2, n = 42 (28.0%); malignancy type 3, n = 4 (2.7%). The sensitivity of clinical diagnosis for breast implant-related pathologies was 80.8%, 95% CI [71.9%, 87.4%] for fibrosis type 1; 54.8%, 95% CI [38.7%, 70.2%] for silicone type 2; and 0%, 95% CI [0%, 17.7%] for malignancy type 3. This classification makes a significant contribution to elucidating their etiology. The results for the interobserver (κ = 0.87) and intraobserver (κ = 1.0) reliability showed a high agreement, which adds to the robustness and reproducibility of this classification. Comparison of histopathological and clinical diagnoses revealed a marked discrepancy in the correct identification of silicone type 2. The newly adapted time shortened and readily applicable Oil Red O staining enables direct detection of silicone and is proposed, in addition to this classification, as a specific method for silicone detection in routine diagnostics.
Internal hernias are an uncommon cause of small bowel obstruction (SBO), accounting for approximately 1% of cases. Among these, broad ligament hernias represent a rare subtype, comprising approximately 4% of internal hernias. Despite their rarity, they carry a significant risk of bowel strangulation and ischemia, necessitating prompt recognition and surgical intervention. We report the case of a 35-year-old G5P3023 woman with no prior abdominal surgeries who presented with a 2-day history of sharp abdominal pain, nausea, and vomiting. Initial imaging findings were suggestive of a tubo-ovarian abscess (TOA); the patient was managed with broad-spectrum antibiotics and subsequently underwent an unsuccessful image-guided drainage attempt. Due to clinical deterioration, a diagnostic laparoscopy was performed, revealing a broad ligament hernia with incarcerated small bowel. The procedure was converted to an exploratory laparotomy, during which the ischemic ileum was resected and a primary was anastomosis performed. The broad ligament defect was subsequently repaired. This case highlights the diagnostic challenges associated with internal hernias, particularly when presentation mimics gynecologic pathology. Failure to include internal hernias in the differential diagnosis may delay appropriate intervention. Early recognition based on clinical and radiologic findings is critical to improving outcomes and preventing bowel compromise.
The understanding of the biologic basis of mature lymphoid neoplasms has been impacted through the sequential integration of emerging molecular technologies. Early techniques such as Southern blotting were foundational in establishing molecular hematopathology by demonstrating antigen receptor gene rearrangements and supporting the identification of lymphoid clonality. The development of FISH and PCR allowed for sensitive detection of specific translocations. Most notably, mutation detection via high-throughput sequencing and its various additional applications to DNA and RNA has transformed hematopathology, enabling comprehensive genomic profiling into not only routine diagnostics but also determining prognosis and guiding therapy for these diverse neoplasms.
The DaneSpine registry is Denmark's national clinical quality and research database for spine surgery, established in 2009 under the Danish Spine Surgical Society (DRKS). It currently holds more than 115,000 cases and represents the largest patient-reported outcome (PRO)-based surgical registry in the country. To describe surgical trends and outcomes in degenerative spine surgery in Denmark using aggregated data from the DaneSpine registry's annual reports (2010-2024). Aggregated descriptive data from DaneSpine annual reports were reviewed. Key variables included patient demographics, diagnostic categories, procedure counts, patient-reported outcome measures (PROMs), and temporal trends. PROMs were collected preoperatively and at 1, 2, 5, and 10 years postoperatively. From 2009 to 2024, approximately 115,000 surgical cases were registered across 16 participating clinics (9 public and 7 private). The most common diagnoses were lumbar spinal stenosis (38%) and lumbar disc herniation (32%). There was a statistically significant and meaningful mean improvement in EQ-5D, Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) pain scores at 1-year follow-up. Satisfaction with treatment outcome was reported in more than 75% of patients. Over time, registry completeness and PROM compliance remained high, with gradual improvements in outcome measures across several diagnostic groups. Over its 15-year history, DaneSpine has emerged as a cornerstone of spinal surgical quality assessment in Denmark. It provides reliable outcome benchmarks, supports clinical decision-making, and offers a model for integrating PROMs into surgical registries. Continued development of the registry will enable even more precise patient selection and support value-based spine care.
This article explores the expanding role of molecular diagnostics in breast pathology. It emphasizes how immunohistochemistry, fluorescence in situ hybridization, and next-generation sequencing define tumor subtypes with recurrent genetic alterations, while predictive biomarkers such as ESR1, human epidermal growth factor receptor 2, PD-L1, and BRCA1/2 direct targeted therapies. The article highlights the diagnostic value of entity-specific fusions and mutations, the therapeutic implications of rare molecular events, and the promise of artificial intelligence-driven gene expression-based prediction models in cancers of unknown primary. These advances illustrate how molecular tools complement morphology, refine classification, and enable precision medicine in breast cancer care.
This article summarizes the contemporary diagnostic and prognostic frameworks for myeloid neoplasms, with a focus on myelodysplastic neoplasms/syndromes and acute myeloid leukemia. The authors focus on the updated classification systems per the fifth edition of the World Health Organization Classification and International Consensus Classification and specifically emphasize the increasing role of cytomolecular profiling in disease classification and risk-stratification models. The authors expand on testing methodologies, practical guidelines for implementation, and therapeutic implications of key molecular alterations to provide actionable insights for clinicians and pathologists.
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For a subset of tumors of the central nervous system (CNS), immunohistochemistry (IHC) allows for reaching a histomolecular diagnosis conform or close to the World Health Organization classification without the necessity of performing molecular tests. This article summarizes how IHC can be used for this goal for primary CNS tumors, distinguishing: (1) tumor types that can be diagnosed with certainty by using IHC; (2) tumor types for which a likely diagnosis can be made using IHC, especially so when clinicoradiological features are considered, and (3) tumors for which IHC provides some guidance but is insufficient to suggest a precise, WHO CNS5-conform diagnosis.
Recent advances in molecular profiling, including next-generation sequencing and bioinformatic approaches, have enabled detailed characterization of tumor biology and facilitated patient stratification based on prognostic and predictive factors associated with clinical outcomes and therapeutic response. This article summarizes key biomarkers with established clinical relevance in kidney, bladder, and prostate cancers. In bladder and prostate cancer, novel insights into tumor biology have reshaped therapeutic strategies and supported the approval of targeted therapies, thereby enhancing patient care. Selecting appropriate molecular tests-such as FGFR screening in urothelial carcinoma and BRCA1/2 testing in prostate cancer-has become critical for guiding treatment decisions.
The identification of actionable genomic alterations in lung cancer represents the established standard of care, serving as the foundation for selecting the most efficacious therapies. As the scope of molecular and biomarker testing in lung cancer continues to evolve, pathologists play a critical role in determining which specimens are appropriate for testing, identifying the relevant molecular targets, and selecting the optimal methodologies. This article will summarize the biomarker landscape in non-small cell lung cancer (NSCLC), current recommendations for their implementation, and how to maximize the diagnostic and predictive value of the limited tissue samples obtained from patients with NSCLC.