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AUGUST 2017

 

-Great review of IHC in Cytopathology, undifferentiated tumors, panels for organ specific tumors : A lot about markers like Pax8, Pax2, Sox10, GATA3 and more.
-Breast IHC review: GATA3, androgen receptors, p16, p53 and PELP1 in triple negative breast Ca and more updates for benign and malignant breast lesions.
-Gyn IHC update: good review of IHC for LGSIL vs HGSIL, VIN, Paget, Endocervical Ca, Endometrioid Ca, uterine mesenchymal tumors, primary vs metastatic ovarian, gestational trophoblastic and more.
-Soft tissue IHC: algorithms for adipocytic, spindle cell, myxoid, round cell, epithelioid, pleomorphic, basic and specific panel with new markers for soft tissue tumors., More details about Undifferentiated sarcoma, round cell tumors, rhabdo, New Ewing Like Sarcomas and uses of CD34, STAT6, MPNST, SS, TLE1, epithelioid sarcoma. Many histologic hints and key IHC and molecular markers.
-Cutaneous Superficial tumors IHC and their differential diagnosis, including DFSP, acral fibromyxoma, DF, Superficial CD34 fibroblastic tumors, Pleomorphic Sarcomas, AFX, Myxofibrosarcoma, Myxoinflammatory Fibroblastic Sarcoma, Lipoid lesions, DFSP.

Archives of Pathology and Laboratory Medicine, August 2017, Vol 141, No 8 IHC UPDATE  .  
http://www.archivesofpathology.org/toc/arpa/current

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-For invasive encapsulated PTC papillary structures are < 1%.  NIFTP requires complete exam of the capsule and nodule to exclude papillary growth and capsular invasion
-Lineage switch between B-ALL and AML is a dismal outcome and could be intermediated by an occult MDS with genomically unstable clones of progenitor cells evolving to heterogenous subclones, a phenomenom selected by chemo
-An study in South Africa reveals that prevalence of anal high risk HPV in HIV infected woman is approximately 40%, almost the same using Cepheid Xpert than Hybrid Capture 2.
-Soft tissue granular cell tumors are common in upper extremity, mean age 38 y/o, medium size 2.1 cm, some cases with giant cells and cytologic atypia. Compared with the skin and organ confined, soft tissues cases may be slightly more aggressive.
-Performing Oncotype DX on low grade invasive Ca is unlikely to provide additional information beyond the Magee equation RS (recurrent score) that combines Nottingham score, ER, PR, Her2, Ki67 and tumor size.
-Complete loss lf H3K27me3 (methylation and modification of the  aminoacid lysine repressing adjacent genes, an epigenetic effect) is a highly specific marker for MPNST. This is not found in mimickers tumors like synovial sarc, schwannoma or SFT

American Journal of Clinical Pathology, August 2017, Vol 148, No 2.  
https://academic.oup.com/ajcp/issue/148/2

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-Cancer incidence in African born blacks is higher for infection related Ca (liver, stomach, Kaposi, lymphomas and leukemias) than the USA blacks. The proportion is lower than USA blacks for smoking related Ca.
-Women that have Medicaid or no insurance, unmarried and black women are more likely to have higher stage breast Cancer and die for the disease.
-Hispanics and non Hispanic blacks underuse the stem cell transplantation for Myeloma in USA
-Cancer types are different for people with germline R337H mutation vs the TP53 DNA binding domain mutation (Li Fraumeni)

Cancer, Vol 123, Issue 16. August 2017. More in
http://onlinelibrary.wiley.com/doi/10.1002/cncr.v123.15/issuetoc

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-90% of thyroid Ca in adolescents are dx as Papillary Carcinoma. Ultrasonography and  FNA is recommended for pediatric thyroid nodules
-Histiocytic sarcoma is a rare neoplasia with pleomorphic and epithelioid large cells with bi or multinucleation (or monster cells) in an inflammatory background. NGS reveals alterations in KMT2D and MLL2.
-Oncocytosis (small groups of oncocytic cells in elderly with paucicellular specimen of  salivary gland)  may overlap with Warthin and oncocytoma but it lacks the diagnostic findigs of oncocytic variants of other salivary gland malignancies as salivary duct Ca, acinic cell Ca, mammary analog secretory Ca and mucoep Ca.
-Pap and HPV contesting at a 3 year screening interval carry low risk of CIN-3 for women with baseline Pap/HPV contesting result.
-Aptima HPV E6/E7 testing has more specificity and PPA than Cobas HPV testing for bx confirmed high grade cervical lesions.

Cancer cytopathology Vol 125, Issue 8 August 2017.  
 http://onlinelibrary.wiley.com/doi/10.1002/cncy.v125.8/issuetoc

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-Macronuclei and nuclear buds are useful to detect papillary carcinoma in FNA. They are a lot more frequent in malignant thyroid cases than benign, and particularly common in conventional PTC, compared to FV 

-Dx is not commonly provided in FNA aspiration of adnexal skin tumors due to sampling error and overlap of the cytologic features.
-Papillae with nuclear atypia and swirls are specific for PTC, not seen in NIFTP. True papillae with fibrovascular cores without cytologic features of papillary Ca are benign and should not be dx as AUS
-Upper urinary tract washings outperform voided urine specimens to detect upper tract high grade urothelial Ca.
-Nice article published in this issue for Jared Gardner: Fine Social aspiration, Twitter as a voice for cytopathology. Jared explain how cytopathologists can share through cell phones their pearls and discuss difficult cases on a global scale.
-Distinction of pneumocytoma from well diff adenoca or carcinoid is challenging. Very important to recognize in pneumocytoma the dual population, papillary architecture and hemorrhagic background with foamy macrophages
-In patients with nuclear features of PTC and micropapillary architecture with hobnail configuration, the dx may be Hobnail variant of PTC, and aggressive variant or PTC.
-Clear cell Neuroendocrine tumors in VHL are positive for neuroendocrine markers and also inhibin. Be aware of differential with metastatic clear renal cell Ca and paraganglioma.
-Be also aware of the unusual cytologic finding of islands of cartilage in FNA of neonates with clear cell sarcoma of the kidney

Diagnostic Cytopathology, Vol 45, Issue 8, August 2017. 
http://onlinelibrary.wiley.com/doi/10.1002/dc.v45.8/issuetoc

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-Hyalinizing trabecular tumor of thyroid shows intertrabecular hyalinization. They are difficult to recognize in cytology and commonly misdiagnosed as PTC, but also confused with Medullary and NIFTP
-Molecular PCR tests are rapid and sensitive  to detect somatic insertions/deletions in exon 9 of calreticulin (CALR) identified in patients with ET and PMF.  55 mutations have been detected but 80% consist of  type 1 52-bp deletion or the type 2 5-bp insertion
-DNMT3A mutations detected with NGS are associated with unfavorable px in southeast Asian patients with AML.
-Fusion gene detection using Next gen sequencing multiplex PCR (Archer FusionPlex Sarcoma Panel) can be uses to detect CIC-DUX4 sarcoma, an undifferentiated sarcoma that involve extremities in young people.

Journal of Clinical Pathology, Vol 70-Issue 8, August 2017.
More in  http://jcp.bmj.com/content/70/8

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-Risk of endometrial Ca is associated with 32 genes. They can be selected today for clinical and research gene testing of germline DNA.
-Secretory Ca of breast have t(12;15), ETV6-NTRK3 fusion, similar to mammary analog secretory Ca in other sites. Breast secretory Ca are triple neg ER-PR-Her2 with basal phenotype.
-Aggressive NK leukemia lymphoma is a fulminant disease more common in Asians associated with EBV. Overexpression of PD-L1 and negative JAK-STAT may be a pathway associated with the rare negative EBV cases.
-In Lynch, 79% of all colon adenocarcinomas are MMR deficient (sporadic adenoca are MMR proficient). Adenomas in Lynch have less APC or CTNNB1 mutations, mutations present in the majority of sporadic cases of Adenoca. The WNT pathway drives the colorectal adenoma formation in Lynch syndrome, preceded by the MMR deficiency.
-Early Barrett neoplasia is always associated with intestinal metaplasia, a prerequisite for intraepithelial neoplasia and adenoCa. The absence of Intestinal Metaplasia may be due to obliteration of the metaplasia by the advancing Ca.
-Both KRAS and BRAF are the pathways governing development of sporadic colorectal mucinous adenocarcionomas.

Modern Pathology, Vol 30, Issue 8, August 2017.   More in:
http://www.nature.com/modpathol/journal/v30/n8/index.html

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-4 new described entities in salivary gland pathology are mammary analog secretory carcinoma (t12-15 ETV6 NTRK3 fusion), cribriform  adenoCa of minor salivary glands (similar to PLGA but with prominent nuclear clearing, located in tongue, with common mets to lymph nodes but so far indolent clinical course), sclerosing polycystic adenosis (closely packed ductal structures combined with cystic ductal structures) and the mucinous variant of myoepithelioma (tumor with prominent clearing and signet ring morphology).
-SMARCB1/INI1 loss is observed in subset of epithelioid schwannomas, most located superficial in the extremities. All show diffuse S100 and SOX10. Some with cytologic atypia but most with benign clinical course.
-Gastric type adenoCa in situ of the Cervix is a tumor show intestinal differentiation and lacking association with HPV.
-Myopericytoma show infiltration of superficial soft tissues by diffuse infiltration of many myofibroma like nodules  of spindle/ovoid cells that are SMA+ in perivascular distribution. PDGFRB mutation are present in myopericytoma and infantile myofibroma, entities within a histologic continuum.
-DAB2 is another good new marker to differentiate epithelioid mesothelioma from lung adenoca.
-Columnar cell change and  atypical ductal hyperplasia from anogenital mammary like glands probably play a significant role in the pathogenesis of extrammamary anogenital Paget.
-H3F3A (Histone 3.3)  IHC is a reliable marker defining Benign and Malignant Giant cell tumor of the bone.
-A subset of cutaneous AL amyloidomas may represent a manifestation of cutaneous MZL.
-Tumor spread through air apaces is an independent predictor  of recurrence and aggressive behavior in lung adenoCa.
-Synovial sarcoma or peripheral nerve is a rare entity often mistaken by benign or malignant PNST.
-Tumor budding and cell nest size is and excellent predictor in esophageal SCC, findings identical to those published for pulmonary and oral origen carcinomas.

American Journal of Surgical Pathology, August 2017, Vol 41 Issue 8.
http://journals.lww.com/ajsp/toc/2017/08000

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-Review of Pathology of Pituitary tumors Update with WHO new classification 2017. Atypical Adenomas (Ki67> 3% and strong p53 immunostaining) is not used anymore and the recommended terminology is clinically aggressive adenoma. EM is not required routinely anymore.
-Medullary thyroid Ca, tumor with C cell differentiation is 3% of thyroid tumors, 70% sporadic, remainder are part of MEN2 with multifocal C cell hyperplasia as precursor.
-New WHO 2017 classification of thyroid tumors include follicular tumor of uncertain malignant potential  and the NFITP. A new histologic variant in PTC is the hobnail variant. Follicular Ca is divided in minimally invasive, encapsulated angioinvasive and widely invasive. Hurhtle  cell tumors are considered different from follicular adenomas/carcinomas.
-Developments in adrenal tumor in New WHO 2017:  Aldosterone producing adenoma related with KCNJ5 mutations are half of the aldosterone producing adenomas, but exact role still unknown. The use of the monoclonal antibody against CYP11B2 allows classification into microadenoma, multiple nodules or diffuse hyperplasia. The classification of adrenocortical Ca is aided by Ki67 and silver staining and histologic  variants are pediatric, sarcomatoid, myxoid and oncocytic adrenocortical Ca. In the use of EUS for core needle biopsies to differential between primary adrenocortical vs metastatic, the IHC with steroidogenic factor 1 plays an important role.

AJSP Reviews and Reports  July/August 2017, Vol 22-Issue 4
http://journals.lww.com/pathologycasereviews/pages/currenttoc.aspx