Majalah Patologi Indonesia

Relationship between Mismatch Repair (MMR) Status and Chemotherapy Response in Colorectal Carcinoma

Soraya Sagita Desmeradd — 2025-10-16

Background

Colorectal carcinoma has several pathways that play a role in normal colonic mucosa development into carcinoma, one of microsatellite instability (MSI) pathway. This pathway results from a deficiency in one of the MMR proteins that normally repair genome damage, leading to microsatellite instability high (MSI-H) and excessive mutations. MSI-H is closely associated with Lynch syndrome and often experiences resistance to chemotherapy treatment, one of which is 5-fluorouracil (5-FU), so it is necessary to conduct initial screening in colorectal carcinoma to assess MMR status on patient with Lynch syndrome . This study aims to see relationship between MMR status and chemotherapy response in colorectal carcinoma.

Methods

This study is cross sectional study using 30 archival block and slaid samples of all colorectal carcinoma cases from hemicolectomy and biopsy results that have been histopathologically diagnosed in Anatomic Pathology Section of Faculty of Medicine Unsri/RSMH Palembang January 2017-December 2021. Each sample was immunohistochemically stained using four antibodies namely anti-MLH1, anti-MSH2, anti-MSH6 and anti-PMS2 (ventana). Interpretation was qualitative by assessing cell positivity. Categorized into intact and missing with cut-off point value of >10% positive declared intact. MMR deficiency was considered if there was loss of cell positivity, at least one MMR CPI marker and MMR proficiency if all MMR CPI were intact. Analysis of relationship between MMR status and chemotherapy response was performed using Fisher's exact test.

Results

Fisher's exact test showed an association between MMR status and chemotherapy response. The results were significantly significant with p-value of 0.045 where MMR deficiency status had a 6 times chance of not responding to chemotherapy compared to MMR proficiency. There was no association between MMR status and age, gender, histopathological subtype and tumor location with p-values of 0.139, 1.000, 0.657 and 0.174 respectively.

Conclusion

There was a significant association between MMR status and chemotherapy response.

Clinicopathological Characteristics of Diffuse Large B-Cell Lymphoma Not Otherwise Specified in Dr. Hasan Sadikin General Hospital Bandung from 2018 to 2023

Afiati — 2025-10-16

Introduction

Diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), is the most common group of non-Hodgkin malignant lymphoma globally, representing 25%-40% of adult lymphoma cases. According to the cell of origin(COO), DLBCL NOS is classified into DLBCL germinal center B-cell like(GCB) and DLBCL non-germinal center B-cell like(non-GCB). Since the COO affects the prognosis of DLBCL NOS, this examination is important. Hans algorithm is the most frequently used to distinguish the GCB from non-GCB. This study aims to describe clinicopathological characteristics of DLBCL NOS at Dr. Hasan Sadikin General Hospital Bandung, 2018-2023.

Methods

The subjects of this retrospective descriptive study were DLBCL GCB and non-GCB patients based on Hans algorithm by IHC examination of CD10, BCL6, and MUM1 who received R-CHOP therapy at Dr. Hasan Sadikin General Hospital from 2018 to 2023. All data contained age, gender, B-symptoms, primary tumor location, stage, total International Prognostic Index (IPI) score, and immunochemotherapy status.

Results

A total of 55 patients diagnosed with DLBCL NOS were collected in this study. 50 patients(90.9%) were classified as DLBCL non-GCB and 5 patients(9.1%) were classified as DLBCL GCB. The average age was 62 years, predominantly males(52.7%), extranodal disease(54.5%), no B symptoms(76.4%), and early stage(83.7%). 52 patients(94.6%) had a total IPI score of 0-1, 3 patients(5.4%) had a total IPI score of 2. 21 patients(38.2%) had a response, 13 patients(23.6%) had non-response, and 21 patients(38.2%) are still ongoing to R-CHOP therapy.

Conclusion

DLBCL NOS at Dr. Hasan Sadikin General Hospital from 2018-2023 mainly occurred in men with an average 62 years old and extranodal disease without B-symptoms. DLBCL non-GCB was predominant than GCB. Both DLBCL Non-GCB and GCB were mostly diagnosed at early stage, IPI low-risk group, and had response status to R-CHOP therapy similar to those are still ongoing to R-CHOP therapy.

Subcategorization of the AUS/FLUS Thyroid Nodule Based on the 2017 Bethesda System at Dr. Cipto Mangunkusumo Hospital from 2018-2021

Michelle Linggodigdo — 2025-10-16

Introduction
The AUS/FLUS (Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance) category is one of the most challenging diagnoses in thyroid fine-needle aspiration biopsy (FNAB) for pathologists. This is due to the heterogeneous cytomorphological features with low Risk of Malignancy (ROM) accuracy, which is crucial to determining further management. The 2017 Bethesda System introduced subcategorization of AUS/FLUS to improve ROM accuracy. However, the widespread adoption of this subcategorization remains limited.

Methods
A retrospective analytical cross-sectional study was carried out using secondary data of thyroid FNAB cases diagnosed with AUS/FLUS followed by surgical procedures at the Department of Anatomical Pathology, Faculty of Medicine, University Indonesia/Dr. Cipto Mangunkusumo Hospital from 2018 to 2021. Furthermore, a review and subcategorization into AUS-C1 (focal nuclear atypia), AUS-C2 (mild nuclear atypia), AUS-A (architectural atypia), AUS-C&A (nuclear and architectural atypia), AUS-H (Hűrthle cell aspiration), AUS-NOS (atypia not otherwise specified), and AUS-L (lymphoid cell atypia other than lymphoma) was performed.

Result
Among a total of 2,082 patients, 599 (28.7%) were diagnosed as AUS/FLUS. There were 75 patients with AUS/FLUS who proceeded with surgery, while 64 (85.3%) showed malignancy. The most common subcategory was AUS-C1 (60%), followed by AUS-NOS (21.3%), AUS-C&A (9.3%), AUS-C2 (8%), and AUS-H (1.4%). ROM subcategory AUS-C1 was significantly higher compared to AUS-C2 (p=0.009) and AUS-NOS (p=0.011).

Conclusion

The percentage of AUS/FLUS diagnoses at Dr. Cipto Mangunkusumo Hospital from 2018 to 2021 was 28.7% with ROM ranging from 10.6% to 85.3%. There was a significant difference in ROM between AUS-C1 and AUS-C2, as well as AUS-C1 and AUS-NOS. Therefore, it was concluded that AUS-C1 thyroid nodules with or without architectural atypia require more aggressive management compared to those with AUS-C2 and AUS-NOS features.

Relationship Between Histopathology Grading (Nottingham System) and Expression of HER2/Subtype Luminal B in Breast Carcinoma with Lymph Node Metastases

Dita Irmaya — 2025-10-16

Background

Molecular subtypes of breast carcinoma, histological grade, and lymph node msetastases are significant in determining the therapy and prognosis of the patient. The luminal B subtype comprises 15%-20% of breast cancers and has a more aggressive phenotype, higher histological grade, proliferative index, and a worse prognosis. This study aimed to evaluate the relationship between histopathological grading and expression of HER2 with lymph node metastases in luminal B subtype breast carcinoma.

Methods

We analyzed 279 invasive breast carcinoma luminal-B subtypes from the anatomic pathology laboratory of Dr. Hasan Sadikin Bandung between January 2017 and March 2023. Histological grade using the Nottingham system, expression of HER2 using immunohistochemistry examination, and lymph node metastases status were obtained from anatomic pathology records. The association between histological grade and expression of HER2 with lymph node metastases was examined with chi-square tests.

Result: In the current study, we included 279 subjects, dominated by patients whose age at diagnosis was less than 50 years old. The Chi-square analysis showed no statistically significant difference in tumor size between patients with metastasis and those without metastasis,P = 0.74. The Chi-square analysis showed a significant relationship between histopathological grade and lymph node metastases, p < 0.01 and expression HER2 status and lymph node metastasis p < 0.05

Conclusion

This study found that patients present with larger tumors classified as T3 and moderate to poor grade III and grade II histological grades. The statistical analysis showed no significant difference in the age of diagnosis between patients with metastasis and those without. However, the Chi-square analysis revealed a significant correlation between the histopathological grade and HER2 expression with lymph node metastasis.

SOX10 and The Tendency of Perineural Invasion in Salivary Gland Adenoid Cystic Carcinoma

Dewi Safnita — 2025-10-16

Background

Adenoid cystic carcinoma is a malignant salivary gland tumor with unique features, including slow growth, progressive, poor prognosis, recurrence propensity, and perineural invasion tendency. SOX10 is a transcription factor expressed in the majority of tumors. SOX10 overexpression was hypothesized to play an important role in tumor-stroma interactions, especially perineural invasion and histopathological patterns.

Method

A cross-sectional study was performed using 30 blocks of formalin-fixed embedded specimens previously diagnosed as salivary gland adenoid cystic carcinomas. Perineural invasion and histopathological patterns were evaluated followed by immunohistochemical staining to evaluate SOX10 expression. The staining intensity and proportion of positively stained cells in both tumor and stroma cells were grouped into high and low expression levels. Chi-square tests were used for statistical analysis.

Result

The cribriform pattern was the most common histopathological pattern in both high and low SOX10 expression. The majority of tumors with high SOX10 expression (66.67% in stroma cells and 73.33% in tumor cells) were found to have more perineural invasion.

Conclusion

There was a tendency for perineural invasion in tumors with high SOX10 expression, although this was not statistically significant. There was no significant association between SOX10 expression and histopathological pattern.