Aims: Tumour grading is an essential part of the pathologic assessment that promotes patient management. The International Association for the Study of Lung Cancer (IASLC) proposed a grading system for non‐mucinous lung adenocarcinoma in 2020. We aimed to validate the prognostic impact of this novel grading system on overall survival (OS) and recurrence‐free survival (RFS) based on literature data.Methods and Results: The review protocol was registered in PROSPERO (CRD42023396059). We aimed to identify randomized or non‐randomized controlled trials published after 2020 comparing different IASLC grade categories in Medline, Embase, and CENTRAL. Hazard ratios (HRs) with 95% confidence intervals (CIs) of OS and RFS were pooled and the Quality In Prognosis Studies (QUIPS) tool was used to assess the risk of bias in the included studies. Ten articles were eligible for this review. Regarding OS estimates, grade 1 lung adenocarcinomas were better than grade 3 both in univariate and multivariate analyses (HR_OSuni = 0.19, 95% CI: 0.05–0.66, p = 0.009; HR_OSmulti = 0.21, 95% CI: 0.12–0.38, p < 0.001). Regarding RFS estimates, grade 3 adenocarcinomas had a worse prognosis than grade 1 in multivariate analysis (HR_RFSmulti: 0.22, 95% CI: 0.14–0.35, p < 0.001).Conclusion: The literature data and the result of our meta‐analysis demonstrate the prognostic relevance of the IASLC grading system. This supports the inclusion of this prognostic parameter in daily routine worldwide.

A kevert nagysejtes neuroendokrin carcinoma ritka, nem kissejtes morfológiájú tüdőrák, melynek kezelésére kevés kutatás fókuszál. Ezen esetek patogenezisében az anaplasticus lymphoma kináz (ALK) fúziós gén szerepe ritkaság, ugyanakkor a mutáció jelenléte esetén az ALK-inhibitorok ígéretes terápiás lehetőséget jelentenek a citosztatikumok helyett. Az 52 éves, tünetmentes nőnél rutin mellkasröntgenvizsgálat során térfoglaló folyamat merült fel, melyet a mellkasi komputertomográfiás vizsgálat megerősített. A tumort lobectomia révén eltávolították. A szövettani vizsgálat papillaris predomináns tüdő adenocarcinomát igazolt, melyet posztoperatív kemoterápia és besugárzás követett. 3 évvel később központi idegrendszeri tünetek miatt koponya képalkotó vizsgálat történt, melynek során áttét igazolódott. Az agyi metasztázisok eltávolításra kerültek. A szövettani vizsgálat nagysejtes neuroendokrin carcinoma áttétét igazolta. Az áttét és a kimetszett tüdőrészlet metszeteinek újbóli elemzése, illetve a molekuláris vizsgálat alapján ALK-transzlokált, kevert, nagysejtes neuroendokrin carcinomát kórisméztünk. Alectinib (Alecensa)-kezelés indult, melynek hatására az időközben megjelent májáttétek regressziót mutattak. A kontroll radiológiai vizsgálatok a kezelés kezdete óta eltelt 3 évben progressziót nem igazoltak. Az ALK-transzlokáció kimutatása, illetve az ALK-inhibitorok alkalmazásának kutatása elsősorban a tüdő adenocarcinomákra helyezi a hangsúlyt. Esetismertetésünkkel arra szeretnénk felhívni a figyelmet, hogy a kevert, adenocarcinoma-komponenst is tartalmazó, neuroendokrin tumorok esetén is érdemes a ’driver’ mutációk vizsgálata, mivel a célzott kezelés eredményes alternatívát jelenthet. Orv Hetil. 2023; 164(14): 548–554.

Foreign material is an uncommon finding in routine gastrointestinal histopathology, but may occasionally contribute to disease pathogenesis or create diagnostic pitfalls. We report two illustrative cases highlighting the diverse clinical and histologic implications of ingested plant material. The first case involves a 10-year-old boy who presented with clinical features consistent with acute appendicitis and underwent appendectomy. Although gross examination revealed a macroscopically unremarkable appendix, histological evaluation demonstrated mucosal ulceration associated with an impacted plant seed within the appendiceal lumen, supporting a diagnosis of obstructive acute appendicitis. The second case describes a 60-year-old woman undergoing a screening colonoscopy, during which a small sessile lesion in the transverse colon was resected. Histologic examination revealed no colonic mucosa; instead, the specimen consisted entirely of plant material, morphologically consistent with a tomato seed, representing an incidental finding mimicking a colonic polyp. These cases underscore that plant seeds, while rare, may act as obstructive agents in appendicitis or simulate true pathological lesions during endoscopic and histologic evaluation. Awareness of the characteristic microscopic features of plant material is essential to avoid misdiagnosis and to recognise their potential clinical and forensic relevance.

We hereby present a case of a 51-year-old woman with a pigmented nodule in the right axillary region. Histopathological examination revealed features consistent with an intradermal nevus. Notably, adjacent to the nevus, intralymphatic protrusion and lymphatic invasion were observed, comprising cells with morphological and immunohistochemical characteristics consistent with nevus cells. Next-generation sequencing revealed the BRAF V600E mutation. To date, 26 similar cases involving intralymphatic nevus cell protrusion and lymphatic invasion have been reported in the literature. Although this finding is rare and may pose a diagnostic challenge for pathologists, it should not be interpreted as indicative of malignancy. Rather, it must be assessed in the context of the lesion’s overall histological architecture.

Several grading methods had been proposed for pulmonary adenocarcinomas in the past decades. We aimed to evaluate and compare the prognostic performance of these grading schemes on overall survival (OS) and recurrence-free survival (RFS) in a single center study. Our retrospective study included patients diagnosed with lung adenocarcinoma who underwent surgery between 2010 and 2016 at the clinic of Szeged. Morphological patterns were recorded and revised on histological slides. As statistical analyses, Cox proportional hazard models, Kaplan-Meier analyses, log rank test and ROC analyses were applied. Altogether 304 patients were included in our study. In multivariate analysis of OS, type of surgery (HR:1.81, 95%CI:1.08–3.02, p = 0.025), architectural grade combined with spread through air spaces (STAS) (HR:4.38, 95%CI:1.88–10.20, p < 0.001), lymphovascular (HR:1.87, 95%CI:1.13–3.09, p = 0.014), and vascular spread (HR:2.07, 95%CI:1.00-4.25, p = 0.049) were independent prognostic factors. In multivariate analysis of RFS, stage (HR:2.84, 95%CI:1.42–5.67, p = 0.003) architectural grade combined with STAS (HR:3.13, 95%CI:1.70–5.32, p < 0.010) and vascular spread (HR:2.42, 95%CI:1.31–4.48, p = 0.005) proved to be independent prognosticators. In a subgroup analysis excluding the adverse factors the architectural grade combined with STAS preserved its prognostic impact on OS and RFS. Most grading systems of pulmonary adenocarcinoma take into consideration the architectural features; however, some of them focus on nuclear features or STAS. We have compared the available grading systems and have proven that almost all of them have prognostic role on survival. The architectural grade combined with STAS was superior to others even in subgroup analysis where adverse factors were omitted.