Journal of Pathology and Translational Medicine

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

Case Studies

Silicone lymphadenopathy of the axilla: a potential for misdiagnosis as metastatic carcinoma on fine-needle aspiration cytology: Nah Ihm Kim, Hyo-Jae Lee, Ji Shin Lee; Received July 1, 2026 Accepted September 7, 2026 Published online November 3, 2026; DOI: https://doi.org/10.4132/jptm.2026.09.08 [Epub ahead of print]

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Abstract PDF: Silicone lymphadenopathy is an uncommon but well-recognized complication of silicone implant placement resulting from migration of silicone to regional lymph nodes. In patients with prior breast implantation, silicone lymphadenopathy most commonly involves the axillary lymph nodes. Because axillary lymphadenopathy may reflect malignant disease, including metastatic carcinoma, thorough evaluation to exclude neoplasia is essential. Fine-needle aspiration cytology (FNAC) serves as a valuable initial diagnostic modality in the assessment of axillary lymphadenopathy; however, silicone-induced foreign body reactions within lymph nodes may be misinterpreted as metastatic malignancy when silicone lymphadenopathy is not included in the initial differential diagnosis. Herein, a case of axillary silicone lymphadenopathy initially misdiagnosed as metastatic carcinoma on FNAC is presented. This case highlights the importance of recognizing the distinctive cytomorphologic features of silicone lymphadenopathy, which may be sufficiently characteristic to prompt consideration of prior breast implant history during cytopathologic evaluation.

Meningioma harboring IDH1 R132H mutation: a case report: Soyeon Ahn, Chung Lee, Jong-Pil Park, Se Hoon Kim; Received June 24, 2026 Accepted August 19, 2026 Published online November 3, 2026; DOI: https://doi.org/10.4132/jptm.2026.08.19 [Epub ahead of print]

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Abstract PDF: Meningiomas are the most common primary central nervous system tumors. Monosomy of chromosome 22 is the most frequently reported genetic abnormality in meningioma and the occurrence of IDH1 mutations in meningioma is exceedingly rare. We report an uncommon case of IDH1 R132H-mutant meningioma. A 69-year-old man presented with two intracranial masses, one of which was identified as an IDH1 R132H-mutant meningioma by next-generation sequencing and further confirmed by pyrosequencing and immunohistochemistry. The rarity of this molecular finding and the potentially favorable prognosis observed in previously reported cases highlight the need for its recognition as a distinct molecular subset. Isocitrate dehydrogenase–targeted therapy may represent a future therapeutic option, pending validation through prospective studies and larger case series.

Newsletter

What’s new in gastrointestinal pathology 2026: updates from the latest WHO classification: Raul S. Gonzalez; Received September 20, 2026 Accepted October 20, 2026 Published online October 27, 2026; DOI: https://doi.org/10.4132/jptm.2026.10.20 [Epub ahead of print]

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Abstract PDF: The 6th edition of the World Health Organization Classification of Tumors: Digestive System Tumors was released online in a beta edition in spring 2026, with a physical print edition released in August. Compared to the 5th edition from 2019, the new edition includes several new entities, completely overhauls a few key concepts, and offers timely updates on most additional neoplasms. Most entries also include new photomicrographs and example wholeslides images. This newsletter will cover selected highlights from the new online edition.

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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