Literature Update - Surgical Pathology
(Snippets in Surgical Pathology)
January 2010
American Journal of Surgical Pathology, Vol. 34, No. 1, January 2010
- Page 1: The controversy regarding lymph node involvement (LNI) in borderline ovarian
serous tumors (OST) seems closer to resolution with this study demonstrating that LNI is not
an independent predictor of disease-free survival (but is associated with a higher rate of
implants – both invasive and non-invasive). Nevertheless, LN sampling in all borderline
OST is essential since LNI does upstage.
- Page 10: A florid regenerative phenomenon involving skeletal muscle adjacent to
endometriosis in the abdominal wall may mimic a malignant process (especially in needle
core biopsies). Worth taking a look at some of these photomicrographs!
- Page 27: A classic morphologic study supporting the pathogenetic sequence of intestinal
metaplasia → dysplasia → cholangiocarcinoma in primary sclerosing cholangitis associated
cholangiocarcinoma. There was no correlation with age, sex or duration of IBD.
- Page 44: Papillary thyroid carcinoma with hobnail features (moderately differentiated)
appears to demonstrate an aggressive behavior with significant mortality.
- Page 65: The mode of hepatic spread from gallbladder carcinoma (42 cases) is usually direct
liver invasion and/or portal tract invasion (intrahepatic lymphatic invasion) and is a strong
independent predictor of prognosis. Further, hepatic metastatic nodules indicate a dismal
outcome following resection.
- Page 75: The morphologic variation of cutaneous manifestation of blastic plasmacytoid
dendritic cell neoplasm (previously known as CD4/CD56+ hematodermic neoplasm) is
reviewed with perivascular and pleomorphic patterns being highlighted. Interestingly, these
cells are thought to be derived from plasmacytoid dendritic cell precursors and are
functionally professional type 1 interferon-producing cells.
- Page 115: A timeous effort to raise awareness among surgical/cytopathologist: embrace
molecular pathology into contemporary diagnostic pathology. This special article/review
also explores essential tests that can be offered/performed alongside morphologic diagnostic
pathology. A must read!
- Page 118: Another special article reporting on a collaborative effort/model with pathology
assistance to developing countries (Haiti and Rwanda). A model for us all to aspire towards!
- Page 124: Recent studies have highlighted vascular pseudo-invasion in endometrial cancers
(?increased intra-uterine pressure during laparoscopic hysterectomy) and pseudolipomatous
changes in endometrial curettings (due to air insufflation). This study demonstrates rare
mesothelial cells in endometrial biopsies (similar to that seen occasionally in bronchial
biopsies).
Advances in Anatomic Pathology, Vol. 17, No. 1, January 2010
- Page 1: Small round cell tumors of bone are reviewed in this excellent review. The clinical
features, radiology, pathology, immunohistochemistry, molecular/cytogenetics are reviewed:
PNET/EWS, small cell osteosarcoma, lymphoma/leukemia, neuroblastoma,
rhabdomyosarcoma, myeloma, and LCH. Small round cell tumors interestingly comprise
40% of all bone tumors.
- Page 12: This review focuses on histiocytic disorders of the lung (of uncertain
histiogenesis): Rosai-Dorfman disease, LCH and Erdheim-Chester disease.
- Page 23: KRAS mutational analysis is critical for targeted anti-EGFR monoclonal antibody
treatment in colorectal carcinomas. This treatment is only effective with wild-type KRAS
gene sequence (and NOT KRAS mutation). This paper reviews the KRAS mutational
analysis.
- Page 33: Another timeous review of lung cancer staging with the release of the new 7th
Edition of AJCC Staging Manual. Please note changes to T1/T2 groups (with respect to
tumor size), affirmation of pleural invasion using an EVG stain, and that staging of
neuroendocrine tumors is useful and appropriate.
Archives of Pathology and Laboratory Medicine, Vol. 134, No. 1, January 2010
- Page 23: The Special Series continues with Insights/Controversies in Pathology. This
special series covers lung pathology with recent perspectives into RB/ILD, LLAM, role of
CT scan in diagnosis of pulmonary diseases, sarcomatoid carcinoma, mixed adenocarcinoma
and EGFR status in lung cancers.
- Page 124: A must read treatise of short “resident reviews” includes Xp11 translocation RCC
(124), basal-like breast carcinoma (130) and GIST review of the literature (134).
Histopathology, Vol. 56, No. 2, January 2010
- Page 167: Following on recent reviews, another on DNA mismatch repair deficiency in
sporadic colon cancer and Lynch Syndrome (as is preferred nowadays over HNPCC).
- Page 251: A superb review of primary cutaneous leiomyosarcomas comprising
morphological subtypes (fasciculated, pilar with interlacing collagen and pleomorphic),
French grading system (differentiation, mitoses and necrosis) and prognostic indicators
(dermal vs subcutaneous invasion). Even minimal subcutaneous invasion impacts on risk of
recurrence. Hence depth of invasion or being confined to dermis is critical to the final report
for long term follow-up for recurrence/metastases.
- Page 263: It seems that p504S/AMACR is not all that specific for papillary renal cell
carcinoma (even though 99% were positive in both type I and II). This study demonstrated
that 56/90 clear cell carcinomas were also immunoreactive (about 20-60% in the current
literature). Note that p504S stains mitochondria in the cytoplasm (with clear/conventional
carcinomas having few organelles in the empty cytoplasm).
Human Pathology, Vol. 41, No. 1, January 2010
- Page 1: An excellent review of PEComas (perivascular epithelioid cell neoplasms).
Pathology and pathogenesis of the spectrum (AML, LAM, CCST, abdomen, soft tissue and
GYN) of the enigmatic neoplasms is reviewed with beautiful color photographs. The criteria
for aggressive behavior is also reviewed: benign: <5 cm, non-infiltrative, absent
cellular/high grade nuclei, mitoses <1/50/HPF; malignant: >5 cm, infiltrative,
cellular/nuclear pleomorphism, mitoses >1/50/HPF, necrosis, LVI. The UMP (uncertain
malignant potential category) is useful for tumors with nuclear pleomorphism/multinucleated
giant cells or >5 cm. Note that the normal counterpart cell of origin has yet to be determined.
The biphenotypic (muscle/melanocytic immunophenotype) is essential to diagnosis, and the
high VEGF expression recruits lymphatic channels. Most PEComas appear to be benign, but
malignant tumors with a fatal outcome have been defined. mTORC1 activation may suggest
a role for mTORC1 inhibitor rapamycin in the management of aggressive tumors.
International Journal of Gynecological Pathology, Vol. 29, No. 1, January 2010
- Page 1: Adverse prognostic factors for stage 1 ovarian cancer include serous histology,
positive peritoneal washings and stage 1c. Tumor rupture, surface involvement and
histologic grade, including clear cell histology do not appear to contribute adversely to stage
1 ovarian cancers.
- Page 44: The diagnosis of chronic endometritis should be made with a “rich” population of
plasma cells (usually associated with increased lymphocytes). A disturbed growth
pattern/maturation is often present, including stromal edema, stromal breakdown and spindle
cell stromal alteration. This study demonstrates a 16% undercall in a review of 105 cases.
Further, there was no correlation between clinical presentation and intensity of pathology.
Only 4% has associated pelvic inflammatory disease.
- Page 51: The atypical cells in symplastic leiomyoma (SL) show proliferative activity
(MIB-1 positive) in about a third of cells, indicating that these cells are proliferating rather
than purely degenerative. Remember that the atypia is usually patchy/focal (with no mitotic
activity) and that leiomyosarcoma may show focal areas resembling SL-like areas. Hence,
extensive sampling is essential before a diagnosis of SL is made.
- Page 69: A clinicopathological review of 56 cases of Paget’s disease of the vulva following
surgery demonstrated the following: about a third recurred (especially with positive
margins), epidermal acantholysis was the only significant morphologic risk factor, about
20% showed stromal invasion (but was not an adverse prognostic factor), the intraoperative
frozen section analysis of margin status did not reduce the recurrence rate, Paget cells are
CK7 positive, CEA positive, and mucin positive (which help distinguish from morphologic
mimics Pagetoid squamous cell carcinoma/melanoma).
Journal of Clinical Pathology, Vol. 63, No. 1, January 2010
- Page 75: The distinction between pigmented villonodular synovitis and hemosiderotic
synovitis is critical for management. Whilst the former is now considered to be neoplastic
(with the potential to recur), the latter is a reactive phenomenon to hemarthrosis. The MIB-1
expression is increased in PVNS and the mono/multinucleated cells express CD51.
Kumarasen Cooper, MBChB
Department of Pathology
University of Vermont
Burlington, Vermont 05401
E-mail address: Kum.Cooper@vtmednet.org