Literature Update - Surgical Pathology
(Snippets in Surgical Pathology)
April 2011
American Journal of Clinical Pathology, Vol. 135, No. 4, April 2011
- Page 587: Note that “triple-negative” basal-like adenocarcinomas of the breast are negative
for both mammoglobin and GCDFP-15.
American Journal of Surgical Pathology, Vol. 34, No. 4, April 2011
- Page 474: Lymphoepitheilal-like carcinoma is essentially the prototype of nasopharyngeal
carcinoma (EBV+) and has been described in a wide variety of sites. This study highlights
the urinary bladder experience with about 50% demonstrating a urothelial CIS, p63+ and
FISH abnormalities similar to urothelial carcinoma (UroVysion). However, EBV (and HPV)
were absent. These authors propose this carcinoma to be a rare variant of urothelial
carcinoma.
- Page 484: FOXL2 has recently been described as a characteristic mutation of granulosa cell
tumors. This study investigates the IHC (polyclonal Ab) in sex cord stromal tumors (80%
immunoreactivity), including 95% adult and juvenile granulosa cell tumors, fibromas and
sclerosing stromal tumors. These authors claim a high sensitivity than α-inhibin and
calretinin. Only about 40% of tumors demonstrated mutant FOXL2.
- Page 522: Leiomyosarcoma (LMS) of the uterus carries an overall 15-25% five year
survival, whilst Stage I is between 25-75%. This study attempts to more accurately predict
the latter, with the spindled morphology (over myxoid/epithelioid) carrying a longer survival
and diffuse high grade cytology bearing a poorer outcome.
- Page 537: How often has one had to interpret “strips” of endometrial glands with mucinous
differentiation on scant biopsy material? This study cautions us to the deceptively bland lowgrade mucinous adenocarcinoma of the uterus. These are often bland with low-moderate
architectural complexity, no mitoses, uniform nuclei, little necrosis with voluminous
cytoplasm (endocervical-like proliferation). The practice of this author is to exercise caution
and request a formal full curettage (especially on biopsy material) prior to further
management. Note that the other bland-appearing Microglandular hyperplasia-like gland
proliferation may also appear deceptive (see AJSP 1992; 16:1092-1097).
- Page 553: The IHC profile of penile intraepithelial neoplasia (PeIN) has been dissected
(similar to VIN: differentiated vs usual). The penile lesions with differentiated PeIN are
p53+ (~45%)/p16-, whilst warty basal (usual) are p53+ (~55%)/p16+ and MIB-1
proliferation index increased in both. Squamous hyperplasia is p16/p53- and variable Ki-67
immunoreactivity.
- Page 563: Note that mucosal colonization of GIT by adenocarcinoma is NOT
pathognomonic of primary carcinoma. This study demonstrates in situ growth (resembling
polypoid adenomatous precursor lesions) and tumor spread along intact basement membrane
of villi/crypts of proven metastatic adenocarcinoma to the GIT. This is particularly pertinent
when the primary originates in the GIT.
- Page 599: “Atypical intradermal” smooth muscle tumors (AIDSMT) demonstrate cytologic
atypia, at least 1/10 HPF mitoses, between 0.5-3.0 cm in diameter with possible superficial
subcutaneous extension, and importantly demonstrate a low risk of aggressive behavior.
Such is the proposal of these authors rather than labelling them cutaneous leiomyosarcoma.
Examining their experience of 84 cases of SMT of the dermis (or focal subcutaneous
extension), up to 4 mitoses/10 HPF, 3% with necrosis and mild to moderate cytologic atypia,
there was no evident risk of metastases and a low risk of recurrence. Hence, labelling such
tumors as “sarcoma” is inappropriate and should be called AIDSMT.
Archives of Pathology and Laboratory Medicine, Vol. 135, No. 4, April 2011
- Page 422: Another IHC paper in the “best practice”series: myoepithelial markers in breast
pathology. Comprehensively written and covered, the key conclusion (the “mantra” of IHC)
is a panel of two or more antibodies (in this case SMHC, p63 + calponin) is necessary for the
demonstration of basal-myoepithelial cells in breast tissue. Remember that IHC is always
supplemental, rather than being central to routine morphological interpretation.
- Page 430: Familiar with the indecision regarding dysplasia in Barrett’s esophagus? Well
this study brings some degree of “calmness” to the subject. Clearly for a confident diagnosis
the involvement of the surface is required. Crypts with a negative surface are labelled
“indefinite for dysplasia” (IND). The “calmness” surrounds the clinical
implication/progression rates of IND/LGD (low grade dysplasia), which is the same!
Histopathology, Vol. 58, No. 5, April 2011
- Page 679: Approximately 15-20% sporadic colonic adenocarcinomas harbor BRAF
mutations, CIM hyper-methylation and MSI-H (via methylation of DNA MMR gene MLH).
Morpholgoically, these are so-called serrated adenocarcinomas preceded by the so-called
sessile serrated adenomas. This study demonstrates a high rate of KRAS mutation (in
addition to BRAF mutation).
- Page 750: Ectopic prostatic tissue may occur in the bladder, urethra (in males), are PSA+,
demonstrate basal cells and are indistinguishable from normal prostate acini on histology and
IHC. Note that the cervix (female) is also a described site for ectopic prostate tissue.
- Page 759: A study examining error rates in over 4000 consecutive prostatic biopsies
demonstrated a false-negative rate of 1.7% (0-9.3%) and false-positive rate of 0.5% (0-3.8%)
among both general and specialist urologic surgical pathologists.
Human Pathology, Vol. 42, No. 4, April 2011
- Page 489: Note that ONCOCYTIC adrenocortical neoplasms do not follow the “time-tested”
Weiss criteria for predicting prognoses of adrenocortical tumors. Hence the “modified”
Weiss criteria are proposed for the oncocytic tumors: so-called Lin-Weiss-Bisceglia criteria.
About 50% demonstrate endocrine activity, but >90% need to be oncocytic (for diagnosis) as
demonstrated by the antimitochondrial Ab. Other usual markers of A-CT: synaptophysin,
inhibin, melan-A and calretinin are positive.
- Page 500: About two-thirds of conventional papillary carcinomas of the thyroid carry BRAF
mutations, whilst only a third of the follicular variant harbor this mutation. These authors
propose this mutation as serving a role in thyroid carcinoma development and progression.
- Page 578: Oncocytic neuroendocrine tumors of the lung are mostly low grade, but can be
high grade. Demonstrating the typical oncocytic morphology (antimitochondrial Ab
positive), about 50% may show giant cells.
Journal of Clinical Pathology, Vol. 64, No. 4, April 2011
- Page 303: Approximately 15-30% of HSIL (CIN 2-3) of the cervix regress between biopsy
and LEEP. This study demonstrates that non-HPV16, increased expression of Rb or p53
protein and a higher ratio of CD8+/CD25+ are more likely to undergo spontaneous
regression.
- Page 308: The head and neck oncology community has yet to set a minimum requirement
for assigning “HPV-associated” oropharyngeal squamous cell carcinomas. This is critical to
inform prognosis and stratification in clinical trials. This study recommends a three-tiered
staged algorithm using p16/ISH/PCR approach. (We have similarly recommended and
utilize a similar approach in Vermont.)
- Page 313: Florid mesothelial hyperplasia in the vicinity of peritoneal endometriosis may
comprise tubules, nests, cords and linear arrangements in fibrous tissue causing potential
diagnostic pitfalls: mimicking serous proliferation, mesothelioma and adenocarcinoma.
Modern Pathology, Vol. 24, No. 4, April 2011
- Page 556: The term “eosinophilic gastritis” should comprise >127/mm2 or >30/HPF in 5
HPF with no known cause. Note that Crohn’s disease and post-treatment of Helicobacter
pylori are known to harbor a high eosinophilic count. Significant eosinophilia should involve
the intraepithelial, muscularis mucosa and submucosa. Note that normal counts are usually
<38/mm2.
- Page 579: Ever counted neutrophils/HPF on frozen section to determine prosthetic joint
infection? This study demonstrates that the interface membrane provides the greatest yield
over the pseudocapsule. The interface membrane (>5 neutrophils/HPF) provides a higher
sensitivity and predictive value.
- Page 606: A timeous study demonstrating that a subset of inflammatory myofibroblastic
tumors (IMT) share the IgG4/IgG ratio (>0.10) seen in IgG4 related sclerosing disease,
clearly demonstrating that clinicopathological correlation is essential to conclude either
diagnosis!
Kumarasen Cooper, MBChB
Department of Pathology
University of Vermont
Burlington, Vermont 05401
E-mail address: Kum.Cooper@vtmednet.org