PJP 2022-06-28T22:01:33-07:00 Amado O. Tandoc III, MD, FPSP Open Journal Systems <p style="text-align: justify;"><strong>The Philippine Journal of Pathology (PJP)</strong> is an open-access, peer-reviewed, English language, medical science journal published by the Philippine Society of Pathologists, Inc. Committee on Publications. It shall serve as the official platform for publication of high quality original articles, case reports or series, feature articles, and editorials covering topics on clinical and anatomic pathology, laboratory medicine and medical technology, diagnostics, laboratory biosafety and biosecurity, as well as laboratory quality assurance.</p> <p style="text-align: justify;">The journal's primary target audience are laboratorians, diagnosticians, laboratory managers, pathologists, medical technologists, and all other medical and scientific disciplines interfacing with the laboratory.</p> <p><strong>IMPORTANT: PJP does NOT charge any Article Processing or Submission Fees from authors. It likewise does not charge any Subscription Fees or Download Fees to access scholarly content.</strong></p> <p>&nbsp;</p> President's Message 2022-06-28T15:20:27-07:00 Alan Koa <p>Welcome to the June 2022 issue of the Philippine Journal of Pathology. I commend the editorial staff for their unending efforts and aspiration to be able to regularly publish quality and peer-reviewed articles.</p> <p>The Board of Governors of the Philippine Society of Pathologists would like to encourage our junior and regular members to come up with scholarly research and fascinating case reports and series. Let us show our neighboring Asian countries and the world that the Filipinos are capable of generating quality research material.</p> <p>Let us help sustain this journal by consistently submitting articles for peer-review and eventual publication in our very own platform. The Philippine Society of Pathologists will always support the endeavor of the PJP editorial team in achieving its goal of serving as the official platform for publication of articles related to Pathology and Laboratory Medicine.</p> <p>Join us in proving the world that the Filipinos can deliver high-caliber and timely publication.</p> <p>Mabuhay tayong lahat!</p> 2022-06-23T00:00:00-07:00 Copyright (c) 2022 PJP The Distance Between Two Points 2022-06-28T20:52:27-07:00 Amado Tandoc III 2022-06-23T00:00:00-07:00 Copyright (c) 2022 PJP Anatomic Pathology Practice in the Philippines 2022-06-28T21:24:44-07:00 Raymundo Lo 2022-06-23T00:00:00-07:00 Copyright (c) 2022 PJP Position Paper on the Conduct of the Autopsy during and after the COVID Pandemic 2022-06-28T21:26:51-07:00 PSP <p><em>This document is a supplement to DOH memorandum 2021-0425.</em></p> <p>With the widespread availability of COVID-19 vaccines, pathologists – both in-training residents and consultants<br>– are attempting to return to their pre-pandemic workload and learning to live with COVID-19. One of the most<br>important jobs of the pathologist is the performance of the autopsy, and residents, as future pathologists, must also be trained to be adept at performing an autopsy. Fear of COVID-19 should not be a deterrent nor an excuse for not performing autopsies when the benefits of performing an autopsy outweighs its risks. In this light, the following updated recommendations are made.</p> 2022-06-28T15:30:06-07:00 Copyright (c) 2022 PJP Prevalence and Clinico-Pathologic Features of ALK Rearrangement Among Adult Filipinos with Non-Small Cell Lung Cancer in a Private Tertiary Care Hospital 2022-06-28T21:39:47-07:00 Steffanie Charlyne Tamayo Rebecca Nagtalon Joanmarie Balolong-Garcia Yancel Donna Mascardo Jose Jasper Andal Daphne Ang Marcelo Severino Imasa Rex Michael Santiago <p>Introduction. With advancements in the understanding of lung cancer biology, targeted therapy has become the rule rather than the exception. Patients with ALK rearrangements are amenable to therapy with Alectinib and other ALK inhibitors, which has been associated with better patient outcomes. While ALK rearrangement should be routinely tested in non-squamous non-small cell lung cancer (NSCLC), the cost and availability of this test is a prohibitive factor, particularly in the Philippine setting.</p> <p><strong>Objectives.</strong> This study aimed (1) to determine the prevalence of ALK-rearranged NSCLC among adult Filipino lung cancer patients in St. Luke’s Medical Center (SLMC) from 2016 to 2018 and (2) to determine the clinico-pathologic features of adult Filipinos with ALK-rearranged NSCLC.</p> <p><strong>Methodology.</strong> This is a retrospective cross-sectional descriptive study wherein the prevalence of ALK-rearranged NSCLC, detected using fluorescence in-situ hybridization (FISH) or immunohistochemistry (IHC), was determined. Clinical data of patients for whom ALK testing was performed were collected. Hematoxylin and Eosin (H&amp;E) slides were retrieved and reviewed for the presence of certain morphologic features. Patients whose H&amp;E slides cannot be retrieved were excluded from the study.</p> <p><strong>Results.</strong> ALK rearrangement was seen in 7.8% (8/103) of tumors submitted for ALK testing. Patients with ALK-rearranged tumors were generally young, light smokers, and presented with advanced clinical stage. Clear cell features and solid pattern were noted in one case and three cases, respectively. However, due to small sample size, further statistical analysis could not be performed to analyze the association of these features with the presence of ALK rearrangement.</p> <p><strong>Conclusion.</strong> Despite a small sample size, the prevalence and clinical profile of ALK-rearranged NSCLC in our institution are congruent with those previously described in Western populations. The association of clinical profile and morphologic features with the presence of ALK rearrangement can be further explored in future studies.</p> 2022-04-05T00:00:00-07:00 Copyright (c) 2022 PJP Application of the Milan System of Reporting Salivary Gland Cytopathology: A Retrospective Cytohistological Study in a Tertiary Medical Center 2022-06-28T21:43:22-07:00 Carolyn Marie Legaspi Elizabeth Ann Alcazaren Jose Carnate Jr. <p><strong>Background.</strong> A fine needle aspiration biopsy has been established as a safe, minimally invasive procedure in evaluation of salivary gland lesions. The complex overlapping cytomorphology of these lesions are challenging for pathologists, hence the introduction of an evidence-based system, the Milan System of Reporting Salivary Gland Cytopathology, to improve overall patient care. The study was taken up to reclassify salivary gland lesions from previous FNA biopsies in order to determine sensitivity, specificity, positive and negative predictive values of FNA, and evaluate the risk of malignancy of the various categories of the Milan system.</p> <p><strong>Methodology.</strong> This was a 6-year retrospective descriptive study in a tertiary medical center. All salivary gland FNA cases were reviewed by two pathologists, and re-classified into the six categories of the Milan System. The number of false positive, false negative, true positive and true negative cases were obtained by comparing<br>with the final histopathology diagnosis, and the risk of malignancy per category were calculated.</p> <p><strong>Results.</strong> A total of 76 cases were reviewed and the overall average of the two readers diagnostic accuracy were 85.02% (95% CI: 84.50-85.60%), sensitivity and specificity were 80.77% (95% CI: 79.90-81.60%) and 86.19% (95% CI: 85.70-86.70%), respectively; positive and negative predictive values were 62.16% (95% CI: 60.70-63.60%) and 94.17% (95% CI: 94.00-94.40%), respectively.</p> <p><strong>Conclusion.</strong> The Milan System category with highest risk of malignancy was Malignant (Category VI – 100%). FNAB is still a reliable tool for clinicians, and use of the Milan System of Reporting Salivary Gland Cytopathology is beneficial in increasing efficacy of communication among clinicians to improve patient care.</p> 2022-04-07T00:00:00-07:00 Copyright (c) 2022 PJP Preliminary Study on Prevalence of P16-Positive Squamous Cell Carcinoma of the Oral Cavity, Oropharynx and Larynx in Rizal Medical Center and its Histomorphologic Correlation 2022-06-28T21:44:40-07:00 Jorel Renly Gamboa Thomas Jeff Lim Jr. <p><strong>Background. </strong>A considerably large portion of the cases of cancer, particularly squamous cell carcinoma (SCC) involving the head and the neck may be due to consumption of tobacco and alcohol. However, its increase in occurrence at specific sites of the head and neck may indicate the possibility of other etiological factors. One of which is infection by certain high-risk human papillomavirus (HPV). P16 immunochemistry serves as a very good surrogate marker of active HPV in these tumors. The detection of HPV-related head and neck cancers have relevance in clinical practice because of its prognostic implications.</p> <p><strong>Objectives.</strong> The general objective of this study is to determine the prevalence of p16-positive squamous cell carcinoma in the oral cavity, oropharynx, and larynx in Rizal Medical Center from January 2019 to December 2019.&nbsp; The specific objective is to compare the Hematoxylin and Eosin (H&amp;E) stain histomorphology (keratinization and mitotic activity) of p16-positive versus p16-negative specimens.</p> <p><strong>Methodology. </strong>This is a cross-sectional study which included all routine histopathology specimens coming from the oral cavity, oropharynx and larynx in Rizal Medical Center for the year 2019 with a diagnosis of squamous cell carcinoma. The tissue specimens considered were those that measured at least 1 cm in diameter, or aggregate diameter if tissue is fragmented. The slides of all eligible cases were reviewed and immunohistochemically stained for p16. The p16 IHC slides were read as either positive or negative, while the mitotic activity and keratinization were observed in the H&amp;E-stained slides. The interpretation of the diplomate pathologists for each of the slides were documented and corresponding statistical analyses were performed.</p> <p><strong>Results. </strong>P16 IHC showed twenty-one (88%) p16 negative cases and three (12%) p16 positive cases. In terms of mitosis, ten cases have mitosis falling within the 1-10 per high power field (HPF) range (42%), six within 11-20 per HPF (25%), and 8 cases have ≥21 mitosis per HPF (33%). In terms of keratinization, three cases are non-keratinizing (12%) and twenty-one cases are keratinizing (88%).&nbsp; There is significant difference in the keratinization histology (<em>p</em>&lt;0.05) of the p16-positive versus the P16-negative cases. On the other hand, no significant difference in the mitotic activity (<em>p</em>&gt;0.05) was noted<strong>.</strong></p> <p><strong>Conclusion. </strong>There is a low prevalence of HPV-related SCC of the oral cavity, oropharynx, and larynx in Rizal Medical Center.&nbsp; The histomorphologic findings confirm that keratinization, significantly predicts HPV status in oropharyngeal SCC. Mitotic activity may not be reliable in predicting the HPV status or p16 IHC reactivity of a case. Keratinization in oropharyngeal SCCs may provide valuable information in certain instances, particularly when HPV testing is not immediately available, although the combined tumor morphology and p16 IHC is more ideal.</p> 2022-06-16T00:00:00-07:00 Copyright (c) 2022 PJP Determination of Rates of Malignancy on Archival Salivary Gland Fine-Needle Aspiration Biopsy after Application of the Milan System for Reporting Salivary Gland Cytopathology in the Philippine General Hospital 2022-06-28T21:45:36-07:00 Nikko Paolo Cablao Pauleen de Grano Agustina Abelardo Jose Ma. Avila Dahlia Teresa Argamosa <p style="text-align: justify;"><strong>Background.</strong> The Milan System for Reporting Salivary Gland Cytopathology (MSRGC) aims to increase the overall effectiveness of salivary gland FNAB by defining six general diagnostic categories with corresponding Rates of Malignancies (ROM). This study aims to use this system to categorize salivary gland FNAB in the Philippine General Hospital and stratify ROM per category.</p> <p style="text-align: justify;"><strong>Methodology.</strong> In this study a total of 326 cases have been collected and reviewed, of which 154 (47.2%) had either surgical or clinical follow-up. The cases were assigned a Milan category by 3 cytopathologists blinded from the original diagnoses and from each other’s readings.</p> <p style="text-align: justify;"><strong>Results.</strong> The overall sensitivity, specificity, PPV, and NPV in detecting neoplasm is at 71.6%, 90.9%, 88.3%, and 76.9%, respectively. On the other hand, the sensitivity, specificity, PPV, and NPV in detecting malignancy is at 52%, 92.9%, 59.1%, and 90.7%, respectively. The computed ROM is as follows: Category I 7.89%, Category II 9.43%, Category III 20%, Category IVa 10.53%, Category IVb 60%, Category V 75%, and Category VI 100%.</p> <p style="text-align: justify;"><strong>Conclusion.</strong> The overall diagnostic utility of salivary gland FNAB, as well as the computed ROM per diagnostic category are comparable to internationally published literature. This study also validates the MSRSGC as a valuable tool in stratifying ROM in salivary gland lesions.</p> 2022-06-25T00:00:00-07:00 Copyright (c) 2022 PJP The Utility of Immunohistochemistry in Diagnosing Tubulocystic Renal Cell Carcinoma with Papillary Morphology 2022-06-28T21:49:29-07:00 Allison Kaye Pagarigan Erland Del Rosario <p>Tubulocystic renal cell carcinoma (TC-RCC) is a recently recognized, rare but distinct malignant entity. Pathologists have endeavored to completely define its histomorphologic, immunohistochemical and molecular features. Recounted is a case where the diagnosis of TC-RCC was confounded by presence of papillary morphology. Immunohistochemical expression of alpha-methyl acyl-CoA-racemase and vimentin with corresponding negativity for CK7 and CD10, following distinctive gross and microscopic findings, confirmed a diagnosis of TC-RCC. This report demonstrates the strategic value of performing immunohistochemistry studies to establish a diagnosis of TC-RCC especially when unusual histologic features are encountered. Immunohistochemistry continues to be the most practical approach to diagnosis as molecular testing methods, such as next generation sequencing, remain unfeasible in the local setting. Cautious prognostication is required as accounts of recurrence and metastasis continue to emerge.</p> 2022-04-01T00:00:00-07:00 Copyright (c) 2022 PJP Glomangiopericytoma 2022-06-28T21:54:28-07:00 Karen Damian Rachel Alegata <p>Glomangiopericytoma is a rare neoplasm of the nasal and paranasal sinuses comprising less than 1% of all tumors of the said region. We report of a 59-year-old hypertensive male who presented with epistaxis. CT scan findings showed a mass in the right nasal cavity with extension into the ethmoid and sphenoid sinuses. Histopathologic diagnosis was glomangiopericytoma confirmed with immunohistochemistry studies. Prognosis is favorable with complete resection of tumor and long-term monitoring.</p> 2022-04-05T00:00:00-07:00 Copyright (c) 2022 PJP Brain Metastasis of Papillary Ovarian Adenocarcinoma 2022-06-28T21:57:03-07:00 Sonia Chhabra Niti Dalal Sunita Singh <p>Brain metastasis from epithelial ovarian cancer is a rare diagnostic entity with a reported incidence of 1- 2%. Serous epithelial ovarian cancer is usually associated with a poor prognosis and is the most common malignancy metastasizing to the brain. The median time from primary diagnosis to development of cerebral lesions is directly correlated with the initial tumour grade and stage.&nbsp; The median survival after diagnosis of brain metastases is 6 months. It is suggested that brain imaging studies should be included in the follow up of patients after treatment for ovarian carcinoma. We report a case of brain metastasis of ovarian adenocarcinoma 2 years post-surgery and six cycles of chemotherapy.</p> 2022-04-22T00:00:00-07:00 Copyright (c) 2022 PJP Ectopic Schistosomiasis Presenting as Ruptured Appendicitis with Periappendiceal Abscess Formation 2022-06-28T21:58:55-07:00 Marcel Joshua Del Fierro Yvette Tan Larissa Lara Torno <p style="text-align: justify;">Schistosomiasis is still a public health burden in the Philippines. Chronic infection with <em>Schistosoma</em> <em>japonicum</em>, the only species endemic in the Philippines, clinically manifests itself in a wide variety of pathologies usually correlated with the anatomical site of adult worm activity and deposition of eggs. One of the documented ectopic sites for Schistosoma ova is the appendix. A rare sequela of this is acute appendicitis and an even rarer consequence is progression to appendiceal rupture leading to acute peritonitis. We present a case of a 27-year-old Filipino residing in Davao City but born in Agusan Province who initially complained of right lower quadrant abdominal pain but presented at the emergency room with generalized abdominal tenderness with signs of peritoneal irritation. Exploratory laparotomy with an infraumbilical incision revealed ruptured appendicitis with periappendiceal abscess formation and appendectomy was subsequently done. Schistosoma infection of the appendix was subsequently established by histopathological analysis. Furthermore, features observed suggest an atypical pathogenetic process contrary to the putative pathogenesis of most cases of acute appendicitis.</p> 2022-06-10T00:00:00-07:00 Copyright (c) 2022 PJP A Case Report on Carcinosarcoma of the Pancreas with a Concise Literature Review 2022-06-28T22:01:33-07:00 Christine Santos Rosalie Sabina Michiko Samonte <p>Carcinosarcoma is a rare neoplasm that most commonly affects the uterus. In the pancreas, fewer than thirty cases are reported worldwide. We present a 47-year-old female with epigastric pain, and jaundice. Histopathology revealed a pancreatic head mass showing a biphasic tumor composed of seventy percent Pancreatic Ductal Adenocarcinoma, and thirty percent High Grade Sarcoma with immunohistochemistry using Pancytokeratin, Vimentin, Desmin, S-100, Smooth Muscle Actin, CD34, and Ki-67.</p> 2022-06-28T00:00:00-07:00 Copyright (c) 2022 PJP Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals 2022-06-28T18:54:51-07:00 ICMJE 2022-06-28T18:54:20-07:00 Copyright (c) 2022 PJP