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October 2017

Summary of interesting abstracts of the Archives of Pathology and laboratory medicine, Oct 2017, Vol 141, No 10. More in:

-Non uterine high grade serous Ca are precursors in the fallopian tube (serous tubal intraepithelial Ca-STIC). Before diagnosing STIC, consider the possitility of mets, particularly if widespread disease present.
-Talamic gliomas in pediatric population are 2/3 diffuse astrocytomas, more commonly high than low grade and 1/3 are PA (look for Rosenthal fibers, microcysts and eosinophilic granular bodies). H3K27M mutate tumors are malignant gliomas that appear bland with ependymal, pilomyxoid, PXA like or with primitive neuroectodermal features.
-Most simple mucinous  cysts of pancreas are benign in behavior without malignant transformation. They show flat gastric type mucinous epithelium without papillary architecture or ovarian type stroma.
-Eosinophilic variant of chromophobe renal cell Ca often has solid architecture (rather than round nests). Low grade oncocytic renal cell Ca and succinate dehydrogenase deficient RCC shows a lot more atypia than oncocytoma. All this tumors may be CD117+, opposite to the RCC classic that is CD117 neg. Papillary RCC shows papillary architecture and hemosiderin deposits.
-The CAP proficieny testing for ER demonstrated the the SP1 clone yeld more positive results than other clones.
-SATB2 is a good immunohistochemical marker for Colorectal Ca.

2 interesting abstracts of the American Journal of Clinical Pathology. October 2017, Vol 148, No 4. More in:

-Following the 2013 ASCO/CAP guidelines lead to a higher number of Her2 FISH positive and equivocal cases, compared with the 2007 guidelines.
-Determining depth of invasion of myometrial invasion in Endometrial Ca is problematic, with 36% underestimation and 2.6% overestimation. Obtaining random sections in the absence of lesion has no significant benefit.


Interesting topic in CAP Today, Sep 2017, More:

-The CDC lab algorithm for HIV calls for intitial test by an antigen-antibody combination assay. If positive, the next step is and antibody based differentiation assay between HIV-1 and HIV-2. If there is a discrepancy between the initial screening  and the supplemental assay, the next step is nuclei acid test, the Hologic Aptima HIV-1 RNA Qualitative assay, the only FDA approved.


Interesting topics in Cancer Journal, Oct 2017, Vol 122 , Issues Oct 1 and 15.  More in:;jsessionid=44C411B0BEC05F1C5FF49CFD3B63E98E.f02t01

-The 3 most prevalent Ca in 2016 are prostate Ca, Colon Ca and Melanoma in men. In women breast Ca, uterus Ca  and Colon Ca. What happen with lung Ca ? Lung is the second most common tumor in both sexes, but it is only 8th in prevalence, due to the poor survival rate. 

-Higher BMI and wrist circumference is related with prostate Ca.
-By identifying EWS-ETS breakpoint in Ewing Sarc, a plasma DNA detection system with droplet digital PCR correlate the number of breakproint fragments with the tumor burden and metastatic recurrence.
-Second primary malignancies develop in 1 in 12 cancer survivors. Bladder Ca survivors has a particular common incidence of second primary malignancies.
-Low fat diet in postmenopause can lower risk of death from invasive breast Ca.
-Surgery in indicated for all intestinal GIST and for small gastric GIST in patients with symptoms and /or high risk features.
-Some salivary ductal Carcinomas show morphologic evidence of PA without molecular evience (intact PLAG1 and HMGA2). Other show only molecular evidence (alteration of PLAG1 and HMGA2). Other tumors show no morphologic nor molecular evidence o PA. HRAS/PIK3 is more commonly detected in de novo cases. PT53 mutation more in SDC ex PA.


Interesting topics in Cancer Cytopathology, Oct 2017, Vol  125, Issue 10       More in:

-Core needle biopsy of breast Ca is associated with higher rate of distant mets 5 to15 years after the diagnosis than FNA biopsy. No difference in local mets found between the 2 procedures.
-In the strongly supported and very well stablished unified Milan System (for report of salivary gland cytopath), the acceptable rate for nondiagnostic samples should not be higher than 10%.
-Cytology smears and liquid based provide adequate DNA for NGS at a rate comparable to core biopsies or cell blocks, and even higher quality of DNA than formalin fixed material.
-There is a subset of patients with positive cytologic screen and negative HPV screen that would be missed by the primary HPV testing.


Interesting topics in Diagnostic Cytopathology, Oct 2017, Vol  45, Issue 10   More in:

-High incidence of neoplasia is linked to AGC, including cervical and endometrial neo or rarely mets. It is important to investigate these cases using multiple test modalities.
-Leading cause for unsatisfactory TPS is the lubricanting gel, followed by blood. There is no difference in management of unsatisfactory when patients > 60 are reclassified into satisfactory category with the new Bethesda criteria.
-In endometrial cytology, pathologists very commonly agree in categories benign, ACE-L (Atypical Cells of endometrium with low probability of malignancy) and the malignant category. The agreement is fair for  ACE-H and only slight for ACE-U
-Diagnostic accuracy of FNA with non aspiration techniques is significatively higher than aspiration techniques for superficial cervical lymph nodes.
-Urine liquid based cytology is better to identify HGUTUCs (high grade upper tract urothelial Ca) than FISH, FISH highly valuable for LGUTUCs.  IHC with p16/Ki67 dual is good  to distinguish between HGUTUCs and LGUTUCs.
-Flower pot cells (with polar hair like processes) are common  in borderline serous tumors, mesothelioma and reactive mesothelial cells.

Interesting topics in Human Pathology, Sept 17, 2017, Vol 67

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-Patients with NF1 develop multiple NF, 8-15% develop MPNST, tipically transformation occur in plexiform Neurofibromas.
-Solid variant of PTC shows a solid component with cytologic features of PTC. It has poor px compared with the well diff PTC. IHC may be performed with HBME1 and CK19
-RCC with Xp11 translocation result in gene fusion between TFE3 with  a second gene. It is 1-4% of the RCC in adults and commonly shows clear cells and papillary architecture. microRNA is useful to understand the molecular biology of this tumor.
-Sinonasal NUT is a very rare neo in sinonasal location. Only few cases with undifferentiated morphology has been reported in this location.


Interesting topics in last issue of International Journal of Gyn Pathology, Sept 2017       More in:

-Endometrial Ca with AR expression shows increase survival and late disease recurrence
-Expression of p16, p53 and PAX8 in both epithelial and stromal component of MMMT support the monoclonal theory of tumorigenesis in this tumor
-AR, ER and PR are more commonly expressed in Low Grade ESS than high grade.
-Extraovarian unclassifiable malignant sex cord stromal tumor are rare and poorly diff type of tumors in pelvis, peritoneum and omentum
-Degree of epithelial prolif, autoimplants, adenofibroma pattern and eosinophilic cells are important features to report in the ovarian serous borderline tumors.
-Micropapillary pattern in endocervical adenoCa is related with high rate of mets. Survival also worse if diffuse destructive tumor.
-Expression of p16 may not be a predictor of HSIL risk in vulvar LSIL. Vulvar LSIL appears to behave different from other LSIL in the lower anogenital sites.


2 interesting topics in the Journal of Clinical Pathology.  Oct 2017, Vol 70, Issue 10.  More in:
-Cyclin D1 overexpression in the proliferation centers of small lymphocytic lymphoma (SLL/CLL) is present in some cases, none carrying the translocation t(11;14).
-Increased tumor infiltrating lymphocytes and programmed cell death ligand 1 (PDL1) in breast carcinomas is associated with aggressive forms of  breast Carcinoma, both already found in in situ stages.


Interesting topics in Modern Pathology,  Oct 2017, Vol 30, Issue 10.  More in:

-Many mature B cell neo show recurrent mutations in TP53, BIRC3, ATM, in the signaling pathways (like CD79 A and B, CARD11, TCF3, ID3), in Toll Receptors (like MYD88, NOTCH, nuclear factor Kb and mitogen activated kinase signaling).
-An study detected mutually exclusive KRAS and MAP2K1 mutations in 1/3 of cases of Rosai Dorfman (clonal subgroup of the disease)
-TP53 deletion in Myeloma, a high risk finding with poor px. Px is even worse if patient has a complex karyotype.
-Concordance between PD-L1 antibodies is better between pathologists using > 50% as cutoff.
-SMARC4 deficient sarcoma is a subset of thoracic sarcoma with undifferentiated high grade rhabdoid morphology. Tumor has aggressive behavior and poor px. IHC with BRG1 (SMARCA4) helps to confirm. These tumors are commonly positive for cytokeratin in rare cells, rarely TTF1+, desmin-, NUT- and S100-
-SFT, a tumor with NAB2-STAT6 gene fusion, metastasize in 5-25% of cases. Patient age, size, mitotic rate and tumor necrosis help to predict low, intermediate or high risk of mets.
-Celiac disease associated small bowel Carcinomas is a different entity with both common nuclear B catenin and SOX-9 expression.
-Leyomiomas associated with hereditary leiomyomatosis and RCC syndrome and Leimyomas with bizarre nuclei often show overlapping morphologic features like esosinophilic nucleoli, perinuclear halos and eosinophilic cytoplasmic inclusions.
-IMT of uterus are frequent ALK positive with a variety of ALK fusion partners.


Interesting topics in The American Journal of Surgical Pathology, Vol 41, Issue 10, Oct 2017. More in:.   More in: 

-Eosinophilic solid and cystic RCC is an indolent tumor in female with tuberous sclerosis, commonly CK20+. It is commonly yellow with cysts and microscopically with granular eosinophilic cytoplasm. There are many typical gene copy gains and losses, making this a tumor with a distinct nature.
-Primary DLBCL  are generally germinal cell type, centrocytic in origin and compared with other DLBCL has a favorable px.
-Anaplastic DLBCL commonly have a non germinal center phenotype, commonly express CD30 and p53 and also concurrent abnormalities of MYC, BCL2 and BCL6. Most patient have aggressive course with poor px.
-IHC is highly sensitive in Non mycobacterial Tuberculosis with lower sensitivity for MTB. PCR is better for MTB, even when AFB and IHC are negative.
-It  is not easy to separate chronic hypersensitivity pneumonia (HN) from fibrosing interstitial pneumonias associated with connective tissue disease (CTD-ILD). Numerous foci of peribronchiolar metaplasia favor HN.  Numerous germinal centers, lymphoid aggregates and plasma cells favor CTD-ILD.
-Inflammatory Myofibroblastic tumors of the female genital tract have a lower threshold for ALK IHC.