Literature Update - Surgical Pathology
(Snippets in Surgical Pathology)
June 2011
American Journal of Surgical Pathology, Vol. 35, No. 6, June 2011
- Page 783: A contemplative editorial addressing the role of digital slide repositories for
“public” availability. Whole slide imaging (WSI) is now widely available with basic units
available for about $35,000 (and upwards). Imagine reading a paper on a newly described
soft tissue tumor and having access to the WSIs of the cases on a digital slide respository.
The broader scientific community would also benefit with the opportunity to verify research
repositories (some research journals already demand the latter, e.g. tissue microarray slides).
- Page 787: The majority of urachal epithelial neoplasms are adenocarcinomas and may
comprise several morphological subtypes, including enteric (including mucinous, signet) and
non-enteric histologies. CK7 (~50% positive) helps rule out colon (both being CK20
positive). Β-catenin is membrano-cytoplasmic in urachal adenocarcinomas, whilst colon has
both M-C and nuclear immunoreactivity.
- Page 799: Solid-pseudopapillary neoplasms (of pancreas – where else!) are para-nuclear
CD99 positive, whilst pancreatic endocrine neoplasms are membrano-cytoplasmic positive.
(See Hum Path 2001; 42(6):817 SPN DOG-1 positive).
- Page 816: PAX8 IN EPITHELIAL TUMORS (combined with Mod Path 2011; 24(6):751).
PAX-8 is a paired box gene belonging to the family of 9 members (PAX 1-9). PAX8 is a
transcription factor expressed during embryogenesis and maintenance of the thyroid gland,
renal (and upper UT) and Mullerian systems. Hence, thyroid, kidney and Mullerian
epithelial tumors express PAX8 (nuclear immunoreactivity) in approximately 90% of both
primary and metastatic neoplasms. Interestingly, the majority of lymphomas are positive, as
are a subset of thymomas and thymic carcinomas. PAX8 is expressed in both serous and
non-serous ovarian epithelial, cervical and endometrial carcinomas. Importantly, breast,
lung, adrenal, majority of GI and mesothelioma are negative. Hence, PAX8 appears to be a
useful sensitive and specific nuclear marker for thyroid, kidney and Mullerian carcinomas.
Note that previous studies have shown a favorable outcome for a subset of PAX8 positive
pancreatic endocrine tumors.
- Page 827: The combined approach to the diagnosis of renal tumors using both FNA and
needle core biopsy appears to add complementary value to the diagnostic outcome.
- Page 845: Desmoplastic nests/nodules are described in anaplastic oligodendrogliomas.
Majority harbor 1p19q del and behavior is per WHO grade III tumors.
IMP represents insulin-like growth factor II mRNA-binding protein (2 or 3). The following
series of papers exploits the protein expression for diagnostic purposes:
- Page 868: IMP 2: Diffuse strong serous carcinoma
Lost in at least 25% of cells in endometrioid Ca
- Page 873: IMP3: Diffuse strong pancreatic carcinoma
Negative normal or inflamed pancreatic tissue.
- Page 878: IMP3: Diffuse strong (>50% cells) in mesotheliomas.
Negative reactive mesothelial proliferation.
Archives of Pathology and Laboratory Medicine, Vol. 135, No. 6, June 2011
- Page 696: The Korean Association of North American Pathologists reviews the following
subjects:
- Page 698: Four molecular subtypes of CRC.
- Page 704: Precursor/early lesions of HCC.
- Page 716: Molecular signature of pancreatic carcinoma.
- Page 737: Pleomorphic LCIS may recur at the same rate of low-intermediate grade DCIS.
Accordingly, local control with negative surgical excision margins (>2 mm) may be
appropriate for management.
- Page 789: So neuropathology has caught up with synoptic reporting (or is it the other way
around?) of CNS tumors. Review shows it to be succinct, easy to use and comprehensive
(for general surgical pathologists at least!).
Histopathology, Vol. 58, No. 6, May 2011
- Page 811: A review of glandular lesions of the urinary bladder includes
proliferative/reactive (cystitis cystica/glandularis), ectopic Mullerian (endocervicosis) and
carcinomas with glandular differentiation (primary urothelial) and metastatic
adenocarcinoma (the greatest challenge). Importantly, the latter should always be ruled out
with an IHC panel. (See AJSP 2001; 35(6):787 urachal epithelial neoplasms.)
- Page 847: Columnar cell lesions (CCL) of the breast are well recognized. However, the
mucinous variant is less common and is seen most often in the context of mucinous
carcinoma (than ductal carcinoma). However, whilst mucinous CCL may play a role in the
mucinous progression spectrum, the short term progression to advanced lesions seems low
(according to this study).
- Page 886: A potential pitfall is metastatic desmoplastic melanoma (DM) in the context of a
spindled cellular neoplasm. Note that the metastases tend to resemble the primary and
consideration must be given to DM when examining spindled neoplasms. Diffuse S-100
highlights the neoplastic cells (but not the desmoplasia) and other melanoma markers are of
no value in this diagnosis.
- Page 919: An interesting study demonstrating that desmoplastic stroma and
microcalcification is predictive of lymph node metastases in papillary thyroid
microcarcinoma (more so with tumor calcification). These authors propose that tumors
without desmoplasia (i.e. no evidence of invasion) NOT be regarded as invasive carcinoma.
The term thyroid intraepithelial neoplasm is proposed.
- Page 925: Previous missives have addressed the similar pathogenetic pathways between
VIN and PeIN (the latter being glans penis). This study demonstrates that the majority of the
penile foreskin lesions follow the LS/dPeIN/SCC pathway (with negative p16).
Human Pathology, Vol. 42, No. 6, June 2011
- Page 770: A timeous update on American Board of Pathology (ABP) certification and
maintenance of certification (MOC). Note that those young pathologists who graduated in
2006 and later would already have completed two cycles of reports (due end of 2010), a
mandatory component of the MOC program, leading up to the recertification examination in
2014. This process/program is designed to encourage a culture of lifelong learning and
quality practice and is based on the very same ACGME six competency domains applicable
to residents. Mandatory reading for recent graduates.
- Page 817: Solid pseudo-papillary neoplasms of the pancreas are positive for DOG-1
(including the centroacinar cells), suggesting a possible origin for these (still) enigmatic
tumors. (AJSP 201l; 35(6):799 SPN is CD99 positive (para-nuclear).)
- Page 924: A comparison between IPMN (intraductal papillary mucinous neoplasms) of the
pancreas and biliary tree (BT). Invasive carcinomas are more common in the BT (60% vs
20%), however the overall three year survival (~64%) is identical. Positive lymph nodes and
significant membranous mucin expression herald a shorter overall survival.
Journal of Clinical Pathology, Vol. 64, No. 6, June 2011
- Page 466: A review of the range of potential pitfalls in lymphoma diagnosis in lymphoid
tissue.
- Page 477: A nice review of adenomyoepithelioma of the breast expanding the diversity of
the morphology (both benign and malignant). These authors emphasize the propensity for
malignant transformation, with the behavior related to the grade of the malignant component.
- Page 485: An important study highlighting the morphological changes in uterine
leiomyomas following progestogen therapy. The infarct-type necrosis (which may
sometimes mimic coagulation tumor-type necrosis) may be surrounded by cellularity,
mitoses, nuclear pyknosis, cytoplasmic eosinophilia, epithelioid morphology, stromal edema,
hemorrhage and myxoid changes. Be careful not to mis-diagnose as LMS or STUMP.
Useful clues are the lack of nuclear atypia and low mitoses AWAY from the abnormal areas.
Kumarasen Cooper, MBChB
Department of Pathology
University of Vermont
Burlington, Vermont 05401
E-mail address: Kum.Cooper@vtmednet.org