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June 2017

 

JOURNAL REVIEW

Cancer, Vol 123, Issue 11 and 12

-Soy food may decrease the risk of breast Ca
-Mammographic breast densities are associated with development of contralateral breast Ca.
- 2 common drivers of Melanoma are BRAF mutation in the MAPK pathway and PI3K –PTEN pathway (PTEN loss).
-Many barriers explain the unsuccessful implementation of the HPV vaccines in latinoamerica.
-Mutations predisposing to Sporadic Osteosarcoma are Tp53 and RB1. Also increase risk in the Li Framumeni and hereditary Rb syndromes.

 

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Cancer Cytopathology, Vol 125, Issue 6

-Good quality DNA-RNA can be obtained from fresh cell suspensions, paraffin blocks, stained smears, unstained cytospin preps, liquid base cytology slides, FTA cards and cryopreserved cells.

-The possibility of NIFTP (non invasive follicular thyroid with papillary features) may be raised at the time of FNA if presence of the following features: nuclear enlargement, crowding, clearing and presence of microfollicles.
-The columnar variant of PTC shows hypercellular sample with papillary structures covered by pseudostratified nuclei with paucity of pseudonuclear inclusions and grooves.
-The Paris system requires for the dx of HGUC the presence of high N/C ratio > 0.7, atypical nuclear borders, nuclear hyperchromasia and coarse chromatin.

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Diagnostic Cytopathology, Vol 45, Issue 6

-Urovysion FISH is useful for the diagnosis of Low and High grade urothelial Carcinoma, but it is non informative in around 11.94% of the cases.
-Application of oral toloudine  improves detection of premalignant and malignant lesions in oral exfoliative cytological smears.
-Thyroid sonogram can help in the diff from NIFTP vs infiltrative or invasive encapsulated follicular variant of PTC
-Dutcher bodies may present in extranodal marginal zone Lymphoma with plasma cell differentiation.

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Human Pathology, Vol 64

-Tumor infiltrating lymphocytes imply better overall survival in triple negative breast Ca.
-CDX2 can be aberrantly expressed in some hepatocellular Ca.
-Lepidic predominant adenoca exhibit a specific gene signature compared with other histologic patterns, showing 13 genes with unique behavior.

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Journal of Clinical Pathology, Vol 70, Issue 6
-Common GI vasculitis are PA and the 3 cANCA+ related: microscopic polyangitis, eosinophilic granulomatosis polyangitis (Churg Strauss) and granulomatosis with polyangitis (Wegener).
-IgG4 should be considered routinely in bx of all cases of Tubulo interstitial nephritis.
-Better quality genomic material may be obtained from cells recovered after core needle bx washing than material from paraffin blocks or frozen sections.
-Some assays using microRNA expression can differentiate benign from malignant thyroid nodules, something possible using single FNA smears, without fresh tissue.
-SFT in genitourinary organs express NAB2-STAT6 fusion in 64% with FISH, but do not discriminate low vs high risk tumors.
-The reduction of E Cadherin expression is very common in primary Signet ring adenocarcinomas.
-Using the Idylla Automated Platform, it is possible to evaluate EGFR and KRAS in formalin fixed for NSCLC in less than a day.

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Modern Pathology, Vol 30, Issue 6, June 2017

-Medial fibrosis and chronic inflammation may persist in temporal giant arteritis many months after steroid treatment.
-SMARCC4 deficient thoracic sarcomas are highly letal distinctive tumors, common in smokers with emphysema, and different from other SMARCC4 deficient rhabdoid tumors, epithelioid sarcomas or lung carcinomas.
-In the Follicular Thyroid Neo with papillary like nuclear features, when the absence of papillary structures is applied as a dx criteria, V600 BRAF is not found. However, this is not a benign neoplasia because lymph node micromets are present in 3% of cases.
-PD1 And PDL1 are expressed in 82% of thymic epithelial neo. Target therapy should be considered. Cases with membranous staining in > 5% T Cells (PD1) or > 5% tumor cells (PDL1) are considered positives.
-Some patient with non alcoholic steatohepatitis rarely present in acute liver failure (even requiring transplant) with rapid weigth loss or malnutrition, probably related to rapid fat mobilization and oxidative stress. Histology: extensive zone 3  fibrosis, perivenular occlusion, hepatocellular dropout, ballooning and Mallory.
-Hyperdiploidy predicts additional chromosomal aberrations and poor px in Myeloma.
-BCOR and BCL6 immunoreactivity is present in > 90% nuclei of Myxoid Mesenchymal Tumor of Infancy, they are negative in congenital infantile fibrosarc.
-A cople of cases of fibrolamelar Ca have been described before 1945, arguing against the theory claiming that these tumor are related with post World War II environmental response.

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THE AMERICAN JOURNAL OF SURGICAL PATHOLOGY, Vol 41, Issue 6


-Ovarian serous borderline same as APST. The  small subset with micropapillary architecture should be called “non invasive low grade serous carcinomas” (niLGSC). Why is important ? Micropapillary tumors greater risk of bilaterality, residual disease after surgery, microinvasion, advanced stage and invasive implants at presentation.
-PNET of female genital tract is rare, median age 20 to 51 y/o. Some shows features of central PNET (resembling tumors like medulloblastomas and medulloepitheliomas) but other are composed of undifferentiated small round blue cells (Ewing/peripheral PNET type). Many are NSE, CD56 positive. Some GFAP (central type). Some show EWSR1 rearrangements and CD99 (peripheral type)

-Uterine inflammatory myofibroblastic tumor in the uterus expresses Alk but the usual Alk FISH may not detect the fusion because they are 3 different partners for this Alk fusion (some located in the same chromosome).
-A subset of medulloblastomas express Alk, indicator of good prognosis.
-Cystic trophoblastic tumors may happen in lymph nodes of patients with testicular germ tumors postchemo. It may represent a regressed chorioCa or transformation of ChorioCa to teratoma.
- 2 new cases reported of KSHV associated and EBV associated germinotropic lymhoproliferative disorders in patients from African endemic regions for KSHV, both with general lymphadenopathy and changes reminiscent of multicentric Castleman.
-Loss of fumarate hydratase gene is a marker for hereditary leiomyomatosis and renal cell carcinoma.
-HPV is negative in penile squamous hyperplasia, differentiated PeIN and low grade keratinizing Ca. It is positive in condylomas, flat lesions with atypia and high risk HPV, commonly serotypes 16 and 18. Multicentric lesions generally are associated with multiple HPV phenotypes, single lesions only with one phenotype.
-Adenocarcinomas are rarely observed adjacent in the stomach in pancreatic tissue showing heterotopic pancreas with PanINs/IPMNs.

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PATHOLOGY CASE REVIEWS, MAY/JUNE 2017, VOL 22- ISSUE 3


-RCC mets are common in lung, liver, bone, 4% in skin and even in sites as unexpected as eyelid, sometimes with atypical presentations like an eyelid rash.  Diagnosis can be confirmed with combination of markers including pancytokeratin and markers like PAX8 or PAX 2.

-Melanotic Schwanomas are commonly associated to Carney complex in spinal nerve roots. Differential dx with Melanoma is important. An alternative for the differentiation is the identification by Next Generation Sequencing of the PRKAR1A mutation, frequent en Melanotic Schwanomas and infrequent in Melanoma.

-Adrenocortical Carcinoma may be related with Lynch Syndrome and germline mutation of genes like MSH2.

-Be aware of a liver with marked sinusoidal histiocytic infiltrate, may be Syphilis, the great mimicker.

-Cases of angiomyolipoma of the liver sometimes show peritumoral hepatocyte hyperplasia so severe that is difficult to differentiate from HCC.

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ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE, Vol 141,  No 6

-A validation study shows that the the Oncopanel Next Generation Sequencing has excellent sensitivity and specificity to detect single nucleotide variants and insertions or deletions compared with single gene assays and mass spectrometry based genotyping 

-The true Sight Myeloid Sequencing panel cover most targeted regions. Howewer large insertions, deletions, regions with high GC content and variant of CEBPA, FLT3 and CALR require supplementation with non Next generation assays.
-NGS tests for infectious diseases are increasingly being validated.
-Pannels of NGS for detection of germline variants of inherited diseases are increasing. Same thing is happening with Whole Genome Sequencing for detection of germline variants or inherited diseases.
-HLA typing by NGS is highly accurate, reproducible and efficient.
-Dual staining CD103 and Pax5 improve specificity and sensitivity in dx of Hairy Cell Leukemia (HCL).
-Lower serum bilirubin is associatd with Takayasu Arteritis
-Future methods beyond IHC are needed as reliable biomarkers to select patients that will benefit from PD-1 and PDL-1 therapy.
-Gastric angiolipoma is a rare polypoid and ulcerated lesion with histology similar to the cutaneous lesion, except absence or fibrin thrombi.

-Typical findings in chondroblastoma are: mature cartilage (polyhedral cells with grooves), some giant cells, scattered calcifications, bland necrosis without calcification and small areas of aneurysmal bone cyst associated. Atypical findings in  Chondroblastoma are  hemosiderin deposition, many giant cells or large aneurysmal bone cyst. DOG1 and SOX9 has been described.

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AMERICAN JOURNAL OF CLINICAL PATHOLOGY, VOL 147, No 6, june 2017

-Oncotype Dx is a 21 gene panel used in ER+ Her2- breast Ca. The Magee equation uses  combination of NG, Ki67, tumor size and semiqueantitative ER, PR, Her2 and is able to detect the 12% of patients unlikely to benefit from the Oncotype Dx testing. 

-B-catenin activated adenomas (nuclear positivity for B catenin) and inflammatory adenomas (harboring  IL6/Jak/STAT abnormalities) are the adenomas with increased risk of harboring foci of HCC, foci that can be detecteded with the glutamine synthetase IHC.
-Recent literature shows that p40 has higher specificity than p63 in the differentiation of SCC from Adenocarcinoma. They are both positive in all SCC but both show false positivity in some adenocarcinomas.
-THRLBCL is generally missed in flow cytometry. Most neoplastic cells coexpress CD4 and CD57. Previous studies mentioned that most neoplastic cells are CD8, probably not true.
-Free light chain measurement is gaining a lot of interest in dx of monoclonal gammopathy but  monitoring disease has a limitation: requires use of same platform and same reagents
-Bruker MALDI Biotyper CA system identifies most clinically important bacteria and fungi.
-AJCC Cancer Staging manual now stratifies the T descriptor for lung Ca by each increasing 1 cm in diameter, up to 5 cm. Compared to radiologic measurements by CT, gross pathologic meassurements has bias that can lead to an incorrect pathologic tumor staging

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REFERENCES USED

American Journal of Clinical Pathology
http://ajcp.ascpjournals.org/

Archives of Pathology & Laboratory Medicine   
http://www.archivesofpathology.org/

Cancer  
http://onlinelibrary.wiley.com/

Cancer Cytopathology. 
http://onlinelibrary.wiley.com/

CAP Today  
http://www.captodayonline.com/

Diagnostic Cytopathology.  
http://onlinelibrary.wiley.com/

Human Pathology   
http://www.journals.elsevier.com/human-pathology/

International Journal of GynPath   
http://journals.lww.com/intjgynpathology/pages/default.aspx

Journal of Clinical Pathology.    
http://jcp.bmjjournals.com/

LabMedicine
www.labmedicine.com

Modern Pathology.   
http://www.nature.com/modpathol/index.html

The American Journal of Surgical Pathology.    
http://journals.lww.com/ajsp/pages/default.aspx

Pathology Case Reviews.   
http://journals.lww.com/pathologycasereviews/pages/currenttoc.aspx