Michelle D Reid

Mucinous cystic neoplasm in men: a comparative study

AimsMucinous cystic neoplasms (MCN) are defined by the presence of an ovarian‐type stroma (OTS). Once ovarian stroma has become a requirement for the diagnosis of MCNs, studies using this criterion have disclosed that MCNs are seen almost exclusively (97%) in women. The occurrence of MCNs (with ovarian stroma) in men is exceedingly rare and raises questions about the origin of OTS and the role of hormones in tumourigenesis. This study aims to investigate the clinical and histopathological features of pancreatic or hepatic MCNs in men.Methods and resultsWe examined the MCN cases in men and compared them with age‐matched women. We further investigated MCN in premenopausal and postmenopausal women to explore the impact of hormonal status.The stromal cellularity tended to be lower in men as compared to women; however, limited numbers prevented statistical significance. Clinical presentation, tumour location, body mass index and cyst complexity were similar between men and age‐matched women, similarly in pre‐ and postmenopausal woman groups. All MCN cases, regardless of gender or hormonal status, showed OTS with positivity for oestrogen receptor (ER), androgen receptor (AR) and SF‐1 immunostains. Additionally, the presence of AR and ER‐beta in lining epithelial cells, in addition to the stromal cells, raised the probability for a potential role for local hormonal signalling in the pathogenesis of these tumours.ConclusionsMCNs in men had overlapping histopathologic and immunohistochemical profiles with those in women, regardless of menopausal status.

Retrospective analysis of HPV infection: Cotesting and HPV genotyping in cervical cancer screening within a large academic health care system

AbstractBackgroundIn 2019, the American Society for Colposcopy and Cervical Pathology introduced fundamental shifts toward “risk‐based” guidelines, with human papillomavirus (HPV) genotyping as a principal test for investigating squamous intraepithelial lesions. This study aims to provide practice‐based evidence and supplement the updated guidelines by investigating HPV demographic distribution and uncovering the pathological features of high‐grade squamous intraepithelial lesions (HSILs) caused by high‐risk HPV (hrHPV) subtypes.MethodsPatients who underwent Papanicolaou screening and HPV testing in two hospital systems over the course of 4 years were recruited. The cytology results were categorized on the basis of the 2014 Bethesda classification. DNA sequences of 14 types of hrHPV were detected by Aptima test. The histological features of HSILs caused by different subtypes were compared between biopsies and excisions.ResultsA total of 63,709 cases were included. The HPV prevalence was 14.70%, predominantly in the 30 to 39‐year‐old age group, with slightly higher rates observed in African Americans. There was no significant racial distribution difference between HPV 16/18/45 and other types. HPV 16/18/45 infection was directly correlated with the severity of abnormal cytology, although the other subtypes were the major causes of cytological abnormalities. The trend for HPV prevalence was consistent across calendar years, and was associated with 8.77% negative for intraepithelial lesion or malignancy, 30.46% atypical squamous cell of undetermined significance, 64.62% low‐grade squamous intraepithelial lesion, 66.75% atypical squamous cell‐cannot exclude a high‐grade squamous intraepithelial lesion, and 91.80% HSIL. Furthermore, 29.09% of HSILs associated with other subtypes were not detectable on subsequent resections.ConclusionsGiven the HPV demographic distribution and the histological features of HSILs caused by different subtypes, cotesting with reflex HPV genotyping in specific populations, or expanding the subtypes in the primary HPV screening test, should be considered.