feb11 by nuhman10


									                           Lite rature Update - Surgical Pathology
                               (Snippets in Surgical Pathology)
                                        February 2011

American Journal of Surgical Pathology, Vol. 35, No. 2, February 2011
- Page 161: Epithelioid angiomyolipomas are potentially malignant mesenchymal tumors and
  therefore need to be recognized (as part of the PEComa family) to avoid diagnostic pitfalls
  with renal cell carcinoma (especially eosinophilic variants of the clear cell and chromophobe)
  and oncocytic neoplasms. This study of 41 cases reviews the morphology and r isk
  stratification with a follow- up of about 34 months. Overall 17% recurred, ~50%
  metastasized, and about a third of the patients were dead from the disease. The five adverse
  prognostic parameters appear to be necrosis, >7 cm, renal vein invasion, carcinoma-like
  growth pattern and tuberous sclerosis.
- Page 190: Another enigmatic newly described soft tissue tumor to add to the repertoire of
  tumors to inspire general surgical pathologists! So-called pseudomyogenic
  hemangioendotheliomas (perhaps previously labeled as “fibroma-like” variant of epithelioid
  sarcoma) is a morphologically and clinically distinctive entity characterized by multifocal
  tumors occurring in multiple tissue planes (dermal, subcutaneous, muscle and even bone) in
  the extremities of young (~30 yrs) men. It is an average of ~2 cm, with infiltrative margins
  comprising sheets/fascicles of plump spindle cells with vesicular nuclei and bright
  eosinophilic cytoplasm with a rhabdomyoblastic appearance, hence “pseudomyogenic”. The
  diffuse FLI-1 and ~50% variable CD31 immunoreactivity justifies the
  “hemangioendothelioma” tag. Somewhat confusing is the diffuse AE1/AE3 (pan-keratin)
  (although not surprising in vascular neoplasms). Ruling out epithelioid sarcoma is an intact
  INI-1, negative CD34. Overall an indolent clinical course with a small risk of metastasis.
- Page 212: Quiz: How many villi make up a tubulovillous adenoma? Answer: Any villous
  change, as supported in this study demonstrating KRAS and BRAF mutations characteristic
  of TVAs in adenomas with any villous change.
- Page 276: Metastatic mucinous tumors to the ovary are frequently bilateral, <10 cm,
  multinodular and demonstrate an infiltrative pattern, and may even show borderline and
  cystadenomatous pattern (so-called maturation phenomenon) making the recognition of
  metastases an ongoing challenge. This study demonstrates the loss of DPC4 (deleted in
  pancreatic carcinoma) to be useful to establish a pancreatobiliary origin, rather than a
  primary ovarian tumor.
- Page 289: Ever faced with the difficulty of determining whether an endometrial carcinoma
  involved the endocervix? Well you are not alone, since even the experts show a significant
  interobserver variation. Problems include deciding between lower segment uterus versus
  endocervix; “floater” versus true involvement of endocervix; cervical glandular versus
  cervical stromal involvement; tumor versus reactive glandular changes. Clearly an important
  staging decision!

Archives of Pathology and Laboratory Medicine, Vol. 135, No. 2, February 2011

An entire volume is dedicated to reviewing pathology in resource-poor nations (especially
Africa). Volunteer groups (173) viz “Pathologists Overseas” valiantly share their 19 year
experience. A retired neuropathologist (179) recalls his selfless experience in Afgahnistan and
the West African situation is reviewed (183). These and other groups (e.g. USCAP-sponsored
Friends of Africa) are constantly exploring ways to assist our colleagues in poverty stricken and
war-torn countries.
Histopathology, Vol. 58, No. 1, January 2011
This entire issue is dedicated to the changing practice in Hematopathology, specifically
addressing the impact of new technologies and better understanding pathogenesis.

Human Pathology, Vol. 42, No. 2, February 2011
- Page 166: Oncocytic carcinoma of the breast (28 cases) has to comprise >70% oncocytic
  cells (mitochondrial antibody positive) and are often grade III. There are no distinctive
  behavioral characteristics since they behave as usual carcinomas matched grade and stage.
- Page 301: IHC ALK expression (anaplastic large cell lymphoma and inflammatory
  myofibroblastic tumors) may also be expressed in neuroblastomas which correlate with the
  gene copy number. Although not very common, they do impart a poor prognosis, carrying a
  four times greater mortality rate.

Journal of Clinical Pathology, Vol. 64, No. 2, February 2011
- Page 97: A treatise on endometrial metaplasia – a subject not often discussed. Regarded as
  a hormonal or irritative induction, some are now being suspected of mutational origin
  (reactive, degenerative and preneoplastic, respectively). Tubal and mucinous occur in simple
  or complex glands with the latter (complex mucinous) held to the same architectural
  prognostic changes as hyperplastic endometrioid lesions. Clearly complex mucinous
  metaplasia (usually surface of endometrial polyps) versus mucinous carcinoma is often a
  difficult differential diagnosis. Whilst squamous metaplasia is the result of chronic irritative
  lesions (must rule out HPV-associated cervical carcinoma), the morular metaplasia is a
  marker of complex endometrial glandular architecture associated with preneoplasias. Note
  that surface papillary syncytial metaplasia may be p16 positive and should not be confused
  with serous carcinoma (MIB-1 is helpful in this instance).

Modern Pathology, Vol. 24, No. 2, February 2011
- Page 157: An excellent review of the basal- like and triple negative breast cancers. Basal- like
  is based on gene expression analysis (with correlative immunohistochemistry) and does not
  necessarily reconcile with triple negative cancers. This review discusses the relationship
  between these breast cancers.
- Page 297: A superb study that many of us have observed in recent years addressing the
  notion that differentiated VIN (dVIN) is a frequent finding in lichen sclerosis (LS) that has
  progressed to squamous cell carcinoma (SCC). Note that this “limb” of the dualistic VIN
  pathway is presumably HPV-negative, in constrast to the HPV-associated usual VIN (uVIN)
  pathway. The authors reiterate the difficulty in diagnosing dVIN, but acknowledge its direct
  precursor role to SCC. dVIN is characterized by elongated rete with anastomosing strands,
  disorderly basal layer with atypia, parakeratosis, prominent nucleoli and atypical mitoses.
  Although only about 2-5% of LS progress to SCC, the average duration is about 84 months,
  in contrast to dVIN, which averages about 28 months. So the take home message is to have a
  high index of suspicion for dVIN and, importantly, any LS with dyskeratosis, parakeratosis,
  hyperplasia, with/without basal atypia (that falls short of dVIN) should be followed closely
  for potential progression to dVIN.

Kumarasen Cooper, MBChB
Department of Pathology
University of Vermont
Burlington, Vermont 05401
E- mail address: Kum.Cooper@vtmednet.org

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