ecc: introduces the vascular proliferation characteristic

[madetunj]

This pull request adds the Vascular Proliferation ECC

Close #7

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[Ssandor13]

state: proposed
name: Vascular Proliferation
identifier: ECC-MORPH-000001
rfc: #7
assignment: morphological
description: |
Judah Folkman first discovered the concept of rapid blood vessel growth in 1971, as detailed in his publication in the New England Journal of Medicine (NEJM), referenced here.
His work laid the foundation for further research into angiogenesis, the process of forming new blood vessels.

Few things:

1. I think we should extend the definition for this ECC. The description is too vague, e.g., "Vascular proliferation refers to the abnormal increase in the number of blood vessels within a tissue, often as a response to hypoxia, tumor growth, or injury. In the context of brain tumors, particularly high-grade gliomas (e.g., glioblastoma, diffuse midline glioma), vascular proliferation is a hallmark feature of aggressive tumor behavior and is associated with rapid growth, resistance to therapy, and poor prognosis."
2. There are different forms of vascular proliferation and we should consider how to model that here. Increased Microvascular Density (MVD) is a characteristic for this ECC, Endothelial Cell Hyperplasia, Glomeruloid Vascular Proliferation (GVP), etc - I think this is context of what Clay is alluding to in the binary section.

[madetunj]

@Ssandor13 @mcrusch @claymcleod. I added a binary true/false value to the characteristic based on the question: "Is vascular proliferation (VP) observed, and what features indicate this?"

That said, based on Stephanie’s second comment (#9 (comment)), should the different types of VP go under the values section instead, which would make the values section the sub-characteristics of VP or should they be treated as separate ECCs?

[claymcleod]

Vascular proliferation is observed in the ???.

[claymcleod]

Same thought here.

[claymcleod]

Is there any concrete measurement that we can reference or grade here? Or is it just totally up to the pathologist's experience and opinion?

[madetunj]

There are some concrete metrics like microvessel density (MVD) and Ki-67 proliferation index that can be used, especially in research or tumor grading. But in routine pathology, it's usually a semi-quantitative call—based on pattern recognition and experience, with numbers used when more precision is needed.

[claymcleod]

Perhaps there should be mention of tissue-specific definitions of "within normal limits"? That would be something I would assume, but could not be true.

[claymcleod]

We should also address the failing CI issues below.