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JULY 2017


Summary of some abstracts from the Cancer Journal, the Journal from the American Cancer Society, July Items. Find more details at:

Cancer, Vol 123, Issue 13 and 14 (July 1 and July 15).

-Cervical Ca, a global crisis, 4th malignancy in the world, almost all cases HPV related and cause ¼ of a million deaths x year in developing countries.
-Recent report from MD Anderson Oncotype DX (21 gene expression assay) demonstrates similar outcomes with or without chemo among woman with early stage breast Ca, ER+/PR+, Her2 neg and lymph node negative who have tumors with score 11-25 and receive adjuvanct endocrine therapy.
-Cases of hereditary leiomyojmatosis and RCC are associated with positive fumarate hydratase mutations.
-Cervical Ca has bimodal peaks, one peak at 43 y/o and the second peak at 61 y/o, the second peak lower in number of cases and related with reduced rate of HPV in elderly and overtransmission of the p53 cancer variant.
-Extreme obesity doubles the risk of breast Ca death among women with luminal A tumor. There are no association of body mass index for other subtypes.
-Women with LCIS have 3 to 10 fold increase in invasive Ca. Options include surveillance, prophylactic bilateral mastectomy or chemoprevention. Chemoprevention remains the preffered management strategy
-In T1N0 and T2N0 breast Ca with high risk (<40 y/o, lymphovascular invasion, high grade, multifocal/multicentric and central/medial tumor location), the locoregional disease recurrence is 4.7%
-Study shows that risk for nasopharyngeal Ca is higher for maternal than paternal history. Risk for relatives of cases is up to 74 y/o is 3.7%, lower for relatives of controls
-Extranodal extension of HPV associated oro-pharyngeal SCC is correlated with inferior survival. However, adjuvant chemoradiation in those cases does not improve the benefit compared with adjuvant radiation alone.



Summary of some abstracts from Archives of Pathology & Laboratory Medicine, July 2017 item.
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Archives of Path & Lab Medicine, Vol 147, No 7(good lung path review)

-Cryobiopsy (large transbronchial forceps bx) shows minimal artifacts and allow pattern recognition approaching regular surgical lung biopsy. 80% dx with cryobiopsy compared with 90% for surgical lung biopsies. Mortality of criobiopsy is 0.1%, very low compared with 1.7% for regular surgical lung biopsy.
-Excelent review  of diagnostic approach of advanced fibrotic lung diseases including IPF, connective tissue disease, chronic hypersensitivity pneumonits, Langerhans, end stage sarcoidosis, Erdheim Chester, Hermansky Pudlak.
-Review of other acute lung injury histologic patterns different to DAD: acute eosinophilic pneumonia, acute fibrinous and OP, DAH with capillaritis
-New Lung Ca staging update published. New recommendations proposed to classify Tumor size, presence of multiple tumor nodules, N and M category
-Excelent article with recommendations for Management of Solitary Lung Nodule
-Review of challenges and pitfalls of Thoracic Pathology frozen sections. Potential problems with lesions like sclerosing pneumocytoma and alveolar adenoma
-Whole slide imaging may be used for frozen sections, consultations or primary dx in clinical pathology slides and even for quality assurance.
-Patients with Interstitial  Pneumonia with  Autoimmune features (IPAF) tend to be younger and female. Many with UIP but concurrent  NSIP, OP, interstitial lymphoid aggregates with GCs and lymhoplasmocitic infiltration
-ARIDIA1 deficient esophageal adenoCa by IHC (AT rich interactive domain 1A) is a primary driver of carcinogenesis, many cases with medullary or mucinous features but not necessarily related with MSI or MLH1 loss. Most are p53+
-Afirma Gen Expression, low predictive positive value (only 50% indeterminate nodules are classified as suspicious by Afirma).
-B Catenin, CD10 and E Cadherin are very important in dx of Pancreas SPN.


Summary of some abstracts from American Journal of Clinical Pathology, official Journal of the American Society for Clinical Pathology and Academy of Clinical Laboratory Physicians and Scientists July 2017 item

American Journal of Clinical Pathology, Vol 148, Issue 1

-Molecular testing and prenatal testing, important role identifying carriers of thalassemia traits to avoid adverse outcomes in offspring.
-Royal College Point System is the best system for evaluating the workload in surgical pathology and cytopathology laboratories.
-When evaluating CD5- and CD10- mature B cell lymphoproliferative, CD200 is brightly positive and CD1d positive for HCL (low levels in the vHCL)
-3 causes of MDS Unclassifiable are: MDS-U PB (with refractory cytopenia and 1% blasts in peripheral blood), pancytopenia with unilineage dysplasia and persistent cytopenia with < 5% blasts, <10% dysplastic cells and cytogenetic abnormalities. The first category MDS with 1% blasts in peripheral blood is the worst progressing to Acute leukemia, not happening in the other 2 categories.
-Atypical histiocytoid cells are possible in metastatic PTC, not showing the diagnostic nuclear features (only large cells with abundant vacuolated cytoplasm)
-RUNX1 mutation should be integred in workup of AML NOS. RunX1, NPM1 and CEBPA mutations are mutually exclusive. RUNX1 is associated with intermediate risk and some cases with mutations in FLKT3-ITD, ASXL1, TET2 and DNMT3.
-Hyalinizing clear cell Ca is common tumor in head and neck pathology but it is very rare in lung. It presents in lung as bronchocentric with sheets, nests, cords of eosinophilic cells and hyalinized stroma, pankeratin+, p63+, CK7 neg and CK 20 neg, TTF1 is neg and NE markers negative. EWSR1-ATF fusion is common.
-New terminology recommended for Lower Anogenital Squamous Terminology (LAST) is:  benign, LSIL, HSIL. Cases of LSIL frequently are upgraded to HSIL with p16 expression and HSIL downgraded to LSIL with absence of expression.


Summary important abstracts for July issue of Diagnostic Cytopathology. More at:

Diagnostic Cytopathology, July 2017, Vol 45 Issue 7

-HPV cotest HPV-/NILM is associated with low CIN3+ risk. HPV testing alone has similar screening performance than cotesting and cytology alone.
-Age for reporting normal endometrial cells on Pap tests was changed to >45 in the latest Bethesda 2014. Increasing the required age to >50 would provide more optimal management.
-Addition of p53 immunocytochemistry to bile drainage cytology can be useful in identifying malignancy in samples with indeterminate results.
-Cytology and small biopsy have comparable specificity and accuracy in subtyping NSCLC.
-A second thyroid FNA more frequently reveal benign cytology in patients in the category of architectural atypia only (AA)  than nuclear atypia only (NA). Follicular neoplasia is more common in the AA category and PTC in the category of NA. Bethesda category III should be subclassified in architectural  atypia only (AA) vs nuclear atypia only (NA).
-FNA and ROSE for bone lesion are very useful dx techniques with high sensitivity if interpreted with pertinent clinical and radiologic findings, and bx.
-Dx of viral lower respiratory tract infections (VLRTI) is generalluy based in viral isolation in culture, antigen detection by fluorescent antibody staining and rapid immunoassay. Viral cytomorphologic changes in exfoliated cells is a valuable rapid and simple way to dx VLRTI.
-Excelent article about The Proffessional Twitter Account by Sara Jiang, Emilio Madrigal and Sinchita Roy.
-Case presentation of adolescent with Large cell calcifying sertoli cell tumor in testis and undiagnosed associated Carney Complex.
-Report of 13 y/o boy with sclerosing polycystic adenosis in salivary gland, entity resembling fibrocystic change in breast. Thjs is an entity that may be missed in cytology or misdiagnosed with other cystic lesions and particularly mucoep Ca.
-Report of case of Ca expleomorphic adenoma show FNA with malignant tumor cells, benign myoepithelial cells and chondromyxoid background. Histology shows salivary duct Ca with comedonecrosis mixed with areas of benign PA. IHC was positive for CK7 and GDCFP-15+;  negative for CK5/6 and 34BE12
-Be aware of the following pitfallas with breast ThinPrep:  fibroadenoma (bipolar cells may have cytoplasm and resemble Ca), disperse plasmocytoid cells in solid papillary Ca resembling lobular Ca, prominent nucleoli and atypia that can be overcalled, clumping of epithelioid atypical histiocytes that may increase suspicion of Ca, difficulty in preimplant seroma to recognize recurrent breast Ca vs implant associated ALCL.
-Report of a case of 15 y/o girl misdiagnosed as Ewing based in CD99+ and FLI1+. Then in metastatic work up of a popliteal lymph node revealed spindle and rhabdoid cells AE1AE3+, EMA+ and INI1/SMARCB1 positive and SS18 rearrangement by FISH. So be aware of cases with rhabdoid morphology initially misdiagnosed as Ewing, they may be cases of Synovial Sarc. 


Summary important abstracts for July 2017 issue of Cancer Cytopathology. More at:

Cancer Cytopathology, Vol 125, Issue 7, July 2017.

-When you dx SCC or NSCLC favoring SCC, you should request PDL1 and treat with chemotherapy if PDL1 IHC score <50 or treat with anti PD1 if IHC score > 50. For  other NSCLC including ADC, adenosquamous, NSCLC NOS, NEC + ADC and SCC or other NSCLC in never smokers (or light smokers) recommendation is to add ALK, ROS1 and EGFR
-PDL1 has a potential role in application of immune checkpoint inhibitors for selected cancers of head and neck.
-Pancreatic neuroendocrine tumors commonly correlates with ATRX/DAXX alterations and poor outcomes. Telomere specific FISH for alternative lengthening of telomeres and ATRX/DAXX Immunohistochemistry can be performed with FNA.
-Evaluation of p16/Ki67 dual labeling in urine cytology appears to help to identify underlying high grade urothelial Ca and progression in patients with negative cytology results or low grade lesions, a finding with potential implications in the clinical management.
-Undifferentiated pancreatic Ca with osteoclastic giant cells is a rare tumor, commonly with ductal component and with cytology showing osteoclastic giant cells, pleomorphic giant cells and spindle/histiocytoid cells.


Summary of some important abstracts for July 2017 issue of Modern Pathology.
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Modern Pathology, Vol 30, Issue 7, July 2017

-Polyembryoma, a distinctive pattern of mixed germ cell neoplasia or maybe a variant of high grade teratoma.
-Mutations of BAP1 or SF3B1 distinguish blue nevus type Melanoma from the conventional epidermal derived melanomas.
-3q26.2 rearrangement in Ph chromosome negative MPN neoplasms is associated with rapid disease progression, blast transformation and poor px
-Intestinal neuronal dysplasia type B dx depends on rectal bipsy including hyperplasia of the sumbucous plexus, hyperganglionosis, hypertrophy of nerve trunks, > 20% giant ganglia in submucosa with more than 8 neurons each on 25 ganglia, and children > 1 y/o. Neurons stain with calretinin.
-Perihiliar cholangioCa may be associate with low grade biliary intraepithelial neo in adjacent ducts, something not identified in the peripheral type cholangioCa.  MUC5AC and MUC6 is expressed in perihiliar Cholangiocarcinoma. SMAD4 mutations, loss of BAP1 and IDH1 mutations are restricted to peripheral type cholangioCa. So hiliar type vs peripheral type CholangioCa appear to be different entities based in the molecular profile.
-A subset of aggressive RCC shows TFEB overexpression (MALAT1-TFEB gene fusion). All these cases are associated with VEGFA amplification. This patients may respond to anti VEGF therapy, something that has to be proved.
-Most penile SCC are HPV related. Somatic TP53 mutations are implicated in many HPV negative cases, either due to oncongenic activation or loss of TP53 supression function. IHC with p53 do not identify all cases. Next generation sequencing is a stragegy that helps recognizing cases with p53 mutations.
-p16/Ki67 triage of all high risk HPV positive samples is a reliable strategy in triage of high risk HPV positive women with high sensitivity and specificity.
-TP53 mutations or CTNNB1 mutation (beta catenin) are good predictor to identify a subset of low grade early stage endometrial Ca patients at high risk of recurrence.

Summary important abstracts American Journal of Surgical Pathology. More at:

American Journal of Surgical Pathology, July 2017, Vol 47, Issue 7

- MUC1/MUC2/CK7/CK20/CDX2 do not have any direct px correlation in cases of ampullary carcinomas. MUC5AC is the best marker as independent prognosticator and best marker to stratify intestinal vs pancreatobiliary type.
-MYC translocation is a feature of BL, and for the category of DLBCL with Myc and BCL/2 and /or BCL6. LMO2 (a germinal center marker) loss may be a good predictor for presence of MYC translocation in CD10+ DLBCL.
-Some cases of Invasive solid papillary breast Carcinomas may resemble tall variant of PTC. They show low Ki67 and ER/PR/Her2 negative. They may be mammoglobin and GATA3 positive and negative for thyroglobulin and TTF1.
-Microcystic, elongated and fragmented (MELF) pattern in endometrioid adenocarcinomas have litte impact in the outcome of patients with low grade endometrioid AdenoCa. They are Ki67 negative suggesting growth arrest.
-Markers that help predicting the origin of liver metastatic well differentiated neuroendocrine Ca are TTF1 (lung), CDX2 (small intestine), ISL1 (pancreas),
-The Grading of soft tissue smooth muscle tumor biopsies has lower accuracy compared with other adult soft tissue sarcomas.
-Sellar ATRT behaves different than most ATRT. Not necessarily happen in kids (most in women 21-69 years), shows a vascular hemangioperycytoma like patern and they have different patterns  of alterations in the INI1 than pediatric ATRT.
-CIC-DUX4 gene fusion is the most common genetic abnormality in EWSR1 negative small blue round cell tumors, most common young adults, tumors with round/epithelioid/spindle cell pattern, aggressive course and inferior survival to Ewing.
-Nodal  metastasis probality in oral SCC can be predicted using  a score including T stage, grading, budding, thickness, depth invasion, shape tumor nests, lymphoid response at tumor host interphase, eosinophilic reaction, foreign body giant cell reaction and  lymphovascular or perineural invasion.
-Radiologist using 18G needle and on site evaluation of adequacy collect more glomeruli than those not using the on site evaluation.
-MYB labeling by IHC is better than FISH for the evaluation of brest adenoid cystic.
-Couple of cases of mesotheliomas associated with EWSR1/FUS-ATF1 fusion.