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November 2017

Summary of interesting abstracts of the Archives of Pathology and laboratory medicine, Nov 2017, Vol 141, No 11.More in:

-A mixed phenotype acute leukemia coepress lymphoid markers (B cell markers CD19 and CD79a or T cell marker like cCd3, CD7, TdT) with myeloid markers like cytoplasmic myeloperoxidase and CD15.
-Primary cutaneous CD8 T cell lymphoma occurs in adults older than 50s, as a solitary nodule in the ear, nose, hands and feet with an indolent behavior and low Ki67 proliferation rate. Do not confuse with subcutaneous panniculitis like T cell lymphoma, an aggressive process with high Ki67 proliferation rate.
-IgG4 related disease is a systemic autoimmune disease with sclerotic pseudo tumoral masses with dense lymphoplasmocytic infiltrate, rich in IgG4 plasma cells (greater than 10 plasma cells/HPF) with IgG4 seric > 135 mg/dl. It is a process with storiform fibrosis and obliterative vasculitis. It may affect almost every organ system (most common in orbit, CNS, lymph nodes, retroperitoneum, genitourinary, mediastinum, thyroid, salivary and lacrimal glands).
-The list of mimics of Basal Cell Carcinoma includes follicular induction over dermatofibroma, trichoepithelioma, trichoblastoma, basaloid follicular hamartoma, tumor of follicular infundibulum, syringoma, microcystic adnexal carcinoma, sebaceous carcinoma, SCC and Merkel.
-Myxoinflammatory Fibroblastic Sarcoma is a soft tissue tumor affecting extremities of adult with high rate of local recurrence and low rate of mets.  Look for myxoid nodules, inflammation, stemberoid cells, cells with smudged chromatin, hyaline fibrosis, large epithelioid cells, pseudolipoblasts and cells with emperipolesis with PMNs in the cytoplasm.
-Biomarkers used for endometrial Ca includes MlH1, MSH2, MSH6, PMS2 and p53 (abnormal if diffuse overexpression > 90% of null expression).
-PDL1 expression in tumor cells or infiltrating immune cells correlate with solid, high grade lung Adenoca and high smoking pack years.
-Histologic features of transplant associated GI thrombotic microangiopathy include endothelial swelling, endothelial cell separation, perivascular mucosal hemorrhage, intraluminal shcistocytes, intraluminal fibrin, microthrombi, loss of glands and denudation of mucosa.
-Social media for pathologists, excellent review, by Erig Freitag, Michael Aarnold, Jerad Gardner and Crhistian Arnold.
-Neuroendocrine differentiation in breast tumors (synaptophisin or chromogranin positive) is commonly associated with mucinous or solid papillary carcinoma.

Interesting abstracts of the American Journal of Clinical Pathology. November 2017, Vol 148, No 5. More in:

-Decreasing SLN frozen section in patients with history of DCIS represents an opportunity for pathology cost containment.

-Submucosal invasive depth in squamous carcinoma of the esohatus is a predictor of lymph node mets and poor px. 

-Undifferentiated pancreatic ductal Carcinoma is enriched in PD-1 and PD-L1. Anti PD-1 agents may represent a valuable therapeutic approach in this subset of highly aggressive pancreatic Ca.

Interesting topics in Cancer Journal, Nov 2017, Vol 123   , Issues 21 and 22. More in;jsessionid=44C411B0BEC05F1C5FF49CFD3B63E98E.f02t01

-Human epidermal growth factor receptor 2 (Her2) mutations are reported in 3% of patients with lung adenoCa. 

-HPV 16 E6 antibodies may be a marker for dx and recurrence of HPV driven oropharyngeal Ca. The vast majority of patints with human papillomavirus driven oropharyngeal Ca moung an antibody response at the time of dx, and those who do not mount an antibody response are at high risk of recurrence.

Interesting topics in Human Pathology, Oct 17, Vol 68. More in

-Reactive germinal centers in bone marrow occur commonly not paratrabecular in autoimmune disorders, infections, malignancy, drug therapy or isolated without underlying disease. Many have small B cell lymphomas, some MDS and Melanoma. GC are CD10+, BCL6+ and BCL2 neg. CD3 and CD5 around detected around the follicles. CD21 and 23 highlighting the follicular dendritic cells.
-p53 alteration is a necessary step in tumorigenesis in BRCA carrier. Focal
 p53+ in  adjacent normal/benign luminal cells was identified in 4 of the 7 cases with p53-positive carcinomas but not in breasts with p53-negative carcinomas
-Gastric adenoca intestinal type has better px than diffuse. Tumor budding in intestinal Ca predicts nodal mets.
-Ring chromosome in myeloid neo is associated with complex karyotype and disease progression.
-Extranodal NK/T cell lymphoma of nasal type has worse px than nasal variant. They can happen in skin of head/ neck or extremities (not trunk) , GI and  CNS
-Drug induced liver injury (DILI) accounts for 10% of cases of acute hepatitis. They may be related with bile duct injury, lobular hepatitis or mixed changes. They may be related with herbal products, antimicrobials, chemo, antilipidemics and immunomodulatory agents.
-PD1 and PDL1 interaction is linked to tumor immune evasion in NSCLC. The PD-L1 expression is higher in SqCC than ADC. Among Adenoca is higher in papillary and solid types than lepidic and acinar. PD-L1 expression  is associated with short free survival outcome and lymph node mets.
-FL with features reminiscent of hyaline vascular Castleman (with hyalinized vessels penetrating germinal centers lollipop like, onion skin, 2 or more general germinal centers within follicle, etc) is unusual. Request BCL-2, flow, and FISH to confirm FL in this cases.
-Pulmonary interstitial glycogenosis (PIG), confirmed with PAS may be associated with cardiovascular disorders, hypertensive changes, congenital heart disease, congenital pulmonary airways malformation, congenital lobar emphysema and Noonan.

Interesting topics International Journal of Gyn Pathology, Nov 2017, Vol 36, Issue 6. More in:

-Differentiated (dVIN) is a human papilloma virus independent precursor of SCC. This patients are likely to progress to invasive Ca over a relatively short period with guarded px.
-Small cell Ca of ovary, hypercalcemic type, affect young females. A case reported with a concurrent pleomorphic cervix liposarcoma show next generation sequencing with heterozygous TP53 mutation and lost TP53 expression by immunohistochemistry, confirming Li-Fraumeni.

Interesting topics in the Journal of Clinical Pathology, Nov 2017, Vol 70, Issue 11. More in:

-GATA 3 is more sensitive than GCDFP15 and mamoglobin in luminal like and Her2 overexpression subtypes. GATA3 is associated with breast Ca of luminal subtype and low histological grade.
-BRAF status by immunohistochemistry is a potentially viable cost effective alternative to PCR for the screening in Melanoma.
-In acute presentation of AIH you can see the entire spectrum of acute hepatitis and chronic hepatitis including various activity grades and staging grades. Common findings are lobular and perivascular inflammatory activity, pigmented macrophages, cobblestone appearance of hepatocytes, plasma cell infiltration and emperipolesis.

Interesting topics in Modern Pathology, Nov 2017, Vol 30, Issue 11. More in

-The amplification of chromo 9p24.1 encoding PD-L1 and JAK2 has been reported associated with poor outcome in multiple types of Cancer with upregulation of PD-L1 and activation of JAK.
-PTC derived anaplastic Ca is characterized by BRAF and TERT promoter mutations, these mutation occuring prior to the anaplastic transformation.
-Presence of neurotropism in melanoma does not alter the risk of melanoma recurrence or survival but does reduce the likelihood of sentinel node positivity.
-Her2  staining by IHC may be equivocal in micropapillary Ca. It is frequently reported 1+ (negative) by immunohistochemistry but may actually be Her2-amplified by FISH.

Interesting topics in the American Journal of Surgical Pathology, Vol 41, Issue 11. Nov 2017.  More in:

-Atypical spindle cell lipomatous tumor (ASLT) in important subset of cases has deletion/losses of 13q14, including RB1, also reported in pleomorphic liposarcs. There is  genetic, IHC and morphologic overlap in the spectrum of atypical spindle cell and pleomorphic lipomatous tumors.
-Myxoinflammatory fibroblastic sarc is a low grade sarc common in acral sites, frequently recuring but rarely with distant mets. It is a tumor with plump histiocytoid to epithelioid cells, focal or predominant myxoid background and inflammatory infiltrate of large virocyte like cells with macronucleoli. ERK immunostain is positive, a downstream effector of BRAF activation. BRAF rearrangement is common in this tumor.
-Epithelioid morphology in  dedifferentiated liposarcoma may suggest aggressive behavior
-Insulinoma associated protein 1 show a superior performance in the immunohistochemistry of neuroendocrine thoracic tumors than the combination of synaptophysin, chromogranin and CD56.
-Plasmocytoid urothelial Ca may be differentiated from lobular breast ca metastatic to bladder using mammoglobin, ER and Uroplakin II. CDX2 and pCEA can not be used to differentiate signet ring GI adenoca from plasmocytoid urothelial Ca. GATA 3 or uroplakin II us good to rule out a gastric primary signet ring adenoca (negative in stomach signet ring adenoCa).

Interesting topics in Acta Cytologica. Vol 61, No 6, Nov/Dec 2017. More in:

-Central PNET show cytology with single and clusters of atypical round or oval cells with scant cytoplasm, naked nuclei (diff quick), crushing, molding, fine chromatin, pseudorosettes and synapto +. Differential diagnoses include Ewing sarcoma/peripheral PNET, alveolar rhabdo and neuroblastoma.
-Comparing to Phyllodes, fibroadenomas had larger number of epithelial fragments and small number of stromal fragments (lower stromal to epithelial ratio).
-When compared with the HPV test, self collected samples by lavage have lower accuracy in predicting high grade CIN.
-Average national false neg for papanicolao test measured for L-SIL and higher is 13.8%
-An study shows the difficulty in the cytologic diagnosis of MASC of minor salivary gland. This tumor has a characteristic ETV6-NTRK3

Interesting topics in Cancer Cytopathology, Vol 25, Issue 11. More in:

-FISH and IHC can be applied on cytologic samples for ALK and ROS1. Next generation sequencing in the future will probably replace FISH and IHC for the simultaneous evaluation of ALK and ROS1.
-SOX-11 is a sensitive and specific marker for solid pseudopapillary neoplasm of pancreas in EUS aspiration specimens. TFE is useful in histologic speciments, not in cytological specimens.
-Obtaining DNA for evaluation of Kras in ductal pancreatic adenocarcinoma of pancreas, FNA material is preferable to formalin fixed paraffin embedded resection.
-Combining all cases in the literature demonstrated that performing only 3 bx in a patient with at least 4 suspicious thyroid nodules had a risk of malignancy of 1.2%, most cases PTC.  
-Noninvasive follicular thyroid neo with papillary like nuclear features can be rule out if stringent criteria used for dx of PTC like pseudo-inclusions, papillae and psamomma bodies. Some cases can only be reported as suggestive of possible NIFTP.  NIFTP commonly show a microfollicular pattern without nuclear pseudoinclusions and less frequent nuclear grooves.

Interesting topics in Advances in anatomic pathology. Vol 24, issue 6. More in:

-GIST, a tumor arising from the GI pacemaker cell of Cajal, a tumor with spindled or epithelioid morphology that depends for the dx of detection of CD117 and DOG1. Most are associated with mutations of KIT, PDGFRA or BRAF. Rare subsets are associated with NF1 or the succinate dehydrogenase complex.
-Uterine inflammatory myofibroblastic tumor frequently harbors ALK rearrangements.
-Lynch is a hereditary Ca syndrome causesd by mutation of MLH1, MSH2, MSH6 and PMS2. Immunohistochemistry, PCR based test and MLH1 methylation analyisis (for sporadic MLH1 loss) is important evaluation in endometrial Ca.
-Differential dx of GBM include pleomorphic xanthoastrocytoma and  the anaplastic variant of ganglioglioma

Interesting topics in Diagnostic Cytopathology, Vol 45 , Issue 11    More in:

-Cytological findings of Alk positive lung Ca include signet ring, pink mucin, green/vacuolar/vesicular cytoplasm, cluster formation, mucinous cribiform pattern.
-Signs of host reaction to Cysticercosis on FNAC are multinucleated giant cells, mixed inflammation with eos, histios and palisading granulomas
-Study of 2592 FNA performed in Arabian gulf shows dx of AUS/FLUS in 4.4%, FN/SFN in 1.5%. Risk of malignancy in those categories were 29% and 45% respectively.
-Study of lytic bone samples was diagnostic in 84% of cases. Of malignant cases 78.5% were mets, 17% lymphoproliferative lesions and 4.4% primary bone tumors. Mets were more common in pelvic and vertebral bones, more common from breast, lung and prostate. Dx accuracy was improved by cell block and IHC.

Interesting topics in CAP Today, Nov 2017, more in:

-28000 cases of primary and secondary syphilis reported in US in 2016. Traditional algorithm for diagnosis is first the nontreponemal assay as automated RPR or VDRL, followed  by a treponemal assay like the fluorescent treponemal antibody adsorption test, or other.
-Case of FL published in the gallbladder. Rare cases may show negative IGH/BCL2 FISH results or negative IGH rearrangement PCR studies.