Literature Update - Surgical Pathology
(Snippets in Surgical Pathology)
July 2011
Advances in Anatomic Pathology, Vol. 18, No. 4, July 2011
A series of excellent review papers (breast, GI, GU):
- Page 255: Breast classification: morphology vs molecular?
- Page 268: Early gastric cancer
- Page 281: Treatment effects in prostate cancer
- Page 294: Update on steatohepatitis
- Page 301: USUP – handling/staging radical prostatectomy
- Page 306: Iron in liver
American Journal of Clinical Pathology, Vol. 135, No. 7, July 2011
- Page 98: Most of us have been categorizing a cribriform pattern (irrespective of irregular or
rounded borders) as Gleason pattern 4. This study provides affirmation that this pattern
carries an adverse prognosis supported by outcome-based evidence.
American Journal of Surgical Pathology, Vol. 35, No. 7, July 2011
- Page 937: SATB2 is an AT-rich sequence binding protein transcription factor that regulates
epigenetic phenomena. This protein was identified using Ab-based proteomics whilst
screening protein expression patterns in human tissue. Expression was confined to glandular
cells of lower GIT. This study demonstrates this antibody to be a sensitive and specific
marker for colorectal carcinomas with SATB2/CK20 identifying >95% of CRC.
- Page 949: Most needle core biopsies correctly identify RCC type. However, IHC (if
required) is useful as follows: clear (CA1X), p504 (papillary), CD117 (chromophobe), CK7
(papillary/chromophobe), and CD10 (diffuse membranous CC; patchy/luminal in papillary).
- Page 962: This recent study (in contrast to previous studies) demonstrates that sarcomatoid
differentiation is uncommon in chromophobe RCC. Overall survival for chromophobe RCC
is better than CC/papillary RCC. Tumor size, LVI, sarcomatoid differentiation and necrosis
are associated with adverse outcomes. Interestingly, this study demonstrated that the
previously proposed chromophobe specific grading system (although somewhat modified in
this study) did NOT specifically correlate with clinical outcome (see AJSP 2010; 34:1233).
- Page 971: Sinonasal adenocarcinomas (non-salivary gland) are LG (papillary/tubular) or HG
(intestinal CDX-2/CK20+, R/O metastases). This study highlights features of the HG nonintestinal adenocarcinoma with a heterogeneous morphology with cytological pleomorphism,
mitoses and necrosis.
- Page 989: A series of 17 cases of primary schwannomas of bone.
- Page 1038: GEJ hyperplastic polyps associated with BE may occur without gastric
pathology. Most HPs in fundus/antrum usually occur in a backdrop of chronic gastritis.
- Page 1045: Intramucosal esophageal adenocarcinomas vs tumors invading the duplicated
muscularis mucosae (i.e. in between the duplicated layers) carry the same risk of lymph node
metastasis and recurrence-free survival.
- Page 1069: Four cases of LG fibromyxoid sarcoma in the small intestine enter the
differential diagnosis of fibrous/myxoid spindle cell tumors of GIT.
Archives of Pathology and Laboratory Medicine, Vol. 135, No. 7, July 2011
- Page 824: The final update on MELANOMA III.
Histopathology, Vol. 58, No. 7, June 2011
- Page 1001: An excellent review of IHC in soft tissue tumors is presented with recent new
antibodies and innovations.
- Page 1064: Affirmation of the recently described clear-cell papillary RCC. Typically
CK7+, vimentin +, CD10- and p504-, these tumors do not harbor 3p del nor trisomy 7 and
17. This study confirms the absence of any specific chromosomal abnormality in these
tumors using CGH. Note that these cancers are low grade nuclei/stage with a low malignant
potential.
- Page 1117: An interesting study demonstrating nuclear translocation of β-catenin, along
with down-regulation of E-CAD in HPV+ tonsillar carcinomas, implying that this may be an
early event preceding invasion/progression and metastasis (similar to EMT). Note that these
cancers present with early neck lymph node metastases, even though the primary is small and
often undetectable!
- Page 1167: IDH1 (Ab to isocitrate dehydrogenase) (see J Path, July 2011) highlights
chondroid tumor, gliomas (II/III) and AML. The antibody was negative in over 1800
carcinomas, lymphomas and sarcomas.
Human Pathology, Vol. 42, No. 7, July 2011
- Page 913: You would all have heard of “Dabska’s tumor”, an unusual rare
hemangioendothelioma described by Dr. Dabska, a Polish pathologist, in a report of six
cases. This dedication celebrates her 90th birthday and highlights her other contributions.
Parenthetically, Dr. Dabska is the only woman to have her name attached to a tumor.
- Page 918: An excellent review from the authors who proposed the dual pathogenetic
pathways of ovarian epithelial cancers (types I and II). For those of you not familiar with
this fascinating story that has unfolded over the last few years, this is a must read. A further
proposal to the dualistic pathways is that ovarian epithelial tumors may originate outside the
ovary and involve it secondarily, thereby implying conservation of ovarian function in future
surgery of the GYN tract. In fact, according to this proposal, the only “true” primary ovarian
neoplasms would be the sex-cord/stromal group.
- Page 939: Extrauterine endometrial stromal sarcomas rarely (1/6 in this series) harbor the
t7;17 (JAZF1/JJAZ1). You will recall that approximately 50% of primary ESS harbor this
translocation.
- Page 998: Atypical stromal fibroblasts in ductal breast carcinoma following neoadjuvant
treatment are significantly associated with tumor recurrence and tumor-related death.
International Journal of Gynecological Pathology, Vol. 30, No. 4, July 2011
- Page 317: Stem cells in the endometrium are not only an excellent insight into this particular
organ, but also a superb review of stem cells in general: embryonic, fetal, germ, cancer and
somatic.
- Page 340: Mullerian adenosarcomas with unusual growth patterns (e.g. arising in
adenomyosis) may cause difficult and challenging issues regarding staging criteria. This
paper (albeit with a small series) proposed reporting nomenclature for such cases.
- Page 407: p16, ProExC and Ki-67 in combination improves the diagnosis accuracy of
“glandular dysplasia” and AIS of the endocervix. Note that tubal metaplasia may be focally
p16 positive (as are normal endocervical cells).
Journal of Clinical Pathology, Vol. 64, No. 7, July 2011
- Page 599: What are the histological characteristics of chronic HB hepatitis that predisposes
to HCC? Advanced fibrosis and severe lobular activity seem to be the key features in this
well-monitored 700 patient follow-up.
Journal of Pathology, Vol. 224, No. 3, July 2011
- Page 306: Isocitrate dehydrogenase (IDH 1/2) gene is mutated in >50% cartilaginous tumors
(negative in other sarcomas), high-grade gliomas (~65%) and AML (~15%). Note that other
metabolic pathway gene mutation includes succinate dehydrogenase in hereditary GIST and
paragangliomas. What does this all mean? A search for targeted therapy!
Modern Pathology, Vol. 24, No. 7, July 2011
- Page 892: Laryngeal mucosal lesions still pose interpretation difficulties (even to
experienced pathologists), as shown in this study with less than acceptable interobserver
variability using different classification systems (two vs three-tiered). It appears that the
three-tiered system is easier to correlate with clinical decision. In any event, these authors
(correctly) suggest showing suspected dysplasia/CIS to a colleague.
- Page 917: Interobserver variability for ADH of breast has not improved since Dr. Rosai’s
study in the early 90s. Only 11% of cases reached complete agreement in this study (of nonexpert breast pathologists). This study proposes a CK cocktail to help with the diagnosis of
ADH.
- Page 1004: The two panel (PMS2 and MSH6) MMR protein IHC recommended for
colorectal cancer screening in Lunch Syndrome is also proposed for extraintestinal tumors
(endometrial, upper UT, sebaceous tumors).
Kumarasen Cooper, MBChB
Department of Pathology
University of Vermont
Burlington, Vermont 05401
E-mail address: Kum.Cooper@vtmednet.org