31 July 2020: Weekly Roundup #18

Here’s what’s new on PathologyOutlines.com this week:

1. Advertising Special

We are currently offering a special on the banner ad spaces at the top and the side of the Jobs Page on our website. These highly visible banner ad spaces normally cost $750 per month. However, if booked before the end of August, we are offering them at $500 per month.

2. Topic Dates

Topics have 2 dates. The “Topic completed” date refers to major updates to the contents of the page or a review of the entire topic by an expert. The “Minor changes” date refers to anything else, often a fixed typo, new image, etc. Our goal is to have every topic reviewed every 2-3 years, so the “topic completed” date will be within 2-3 years of today’s date.

3. What’s New This Week

Click here to see what else is new this week at PathologyOutlines.com.

4. COVID-19 Topic

As of this week we have updated our popular topic on COVID-19 in the lung.

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30 July 2020: Textbook Updates

We have posted updated reviews of the following topics:

Bladder, ureter & renal pelvis > Squamous cell neoplasms > Squamous cell carcinoma
by Susan Prendeville, M.D.
Topic summary: Uncommon subtype of carcinoma showing pure squamous morphology without any component of conventional urothelial carcinoma. Caused by Schistosoma infection, smoking and chronic irritation. Must be distinguished from urothelial carcinoma with squamous differentiation and secondary spread of squamous cell carcinoma primary to cervix, penis or anus.

Bladder, ureter & renal pelvis > Glandular neoplasms > Villous adenoma
by Varsha Manucha, M.D.
Topic summary: Villous adneoma is a rare bladder tumor and even rarer as an isolated lesion in native bladder. Most are diagnosed with coexistant malignancy and recently was reported coexisting with neuroendocrine carcinoma following augmentation cystoplasty.

Bone > Other tumors > Mazabraud syndrome
by Travis H. Johnson, D.O., M.S., Jessica L. Davis, M.D.
Topic summary: Rare disorder due to postzygotic activating somatic mutations in the GNAS gene. The exact presentation and severity depend on the extent of mosaicism and the involved tissues. Most patients are diagnosed in adulthood. Consists of fibrous dysplasia of bone, either polyostotic or monostotic and one or more intramuscular myxomas.

Chemistry, toxicology & urinalysis > General chemistry > Metabolism > Parathyroid hormone
by Patricia Tsang, M.D., M.B.A.
Topic summary: Maintains serum calcium within a tight range of 9 – 10 mg/dL, mobilizes calcium from bone, increases calcium reabsorption from the kidney and stimulates calcium absorption from the gut. 84 amino acids derived from cleavage of prepro parathyroid hormone (PTH); biologic activity due to 34 amino acids at amino terminus; other portions are inert but may give false positives in detection systems.

Colon nontumor > Noninfectious colitis > Lymphocytic colitis
by Martha M. Yearsley, M.D.
Topic summary: Chronic nonulcerating colitis; subtype of microscopic colitis. Common cause of chronic nonbloody diarrhea in older adults with normal or near normal colonoscopy and increased intraepithelial lymphocytes as the histologic hallmark.

We have added new images to the topics:

Oral cavity & oropharynx > Other nonneoplastic > Mucocele
clinical images contributed by Nathan Lee, D.M.D.

30 July 2020: Industry News Updates

Check out our Industry News page. We have updated it with the following article from:

AdvantEdge Healthcare SolutionsFAQs Medicare fee-for-service billing
CMS released an updated COVID-19 FAQ on Medicare fee-for-service billing for COVID-19 related services. The policies in the article are effective for the duration of the PHE unless superseded by future legislation. With 41 sections and over 200 questions and answers, we highlighted key information. Rest of article

27 July 2020: Textbook Updates

We have posted updated reviews of the following topics:

Ovary > Serous tumors > High grade serous carcinoma
by Erna Forgó, M.D., Teri A. Longacre, M.D.
Topic summary: Epithelial carcinoma of serous cell lineage with papillary, glandular and solid growth patterns and high grade cytologic atypia. It is often bilateral with solid and cystic ovarian masses. The most important prognostic factor is stage, ~40% overall 5 year survival. Numerous images are provided.

Stains & molecular markers > TTF1
by Veronica Ulici, M.D., Ph.D., Li Juan Wang, M.D., Ph.D.
Topic summary: Thyroid transcription factor 1, also known as NKX2-1. Nuclear marker with preferential expression in thyroid, lung and brain structures of diencephalic origi. There are 2 commonly used clones and a novel clone with different sensitivities and specificities for pulmonary and extrapulmonary neoplasms. Expressed in a high percentage of lung adenocarcinoma and small cell carcinoma but a variable percentage of extrapulmonary small cell carcinoma. Also CNS chordoid glioma and subependymal giant cell astrocytom.

Stomach > Polyps > Oxyntic gland adenoma
by Natalia Liu, M.D., Hanlin L. Wang, M.D., Ph.D.
Topic summary: Benign gastric neoplasm composed of gland forming epithelial cells with predominantly chief cell differentiation resembling oxyntic gland. Occurs in areas with oxyntic mucosa, mainly in upper third of stomach. Composed of irregular glands lined by columnar cells with a predominant chief cell component, mimicking oxyntic glands. No recurrence following complete endoscopic excision. If submucosal invasion is present, should be classified as gastric adenocarcinoma of fundic gland type.

Transfusion medicine > Transfusion reactions > Delayed hemolytic
by Matthew S. Karafin, M.D.
Topic summary: A delayed hemolytic transfusion reaction is a potentially significant adverse event caused by antibody mediated removal of recently transfused red cells due to an amnestic immune response from antibodies against an incompatible minor red blood cell antigen. Can cause an unexpected drop in hemoglobin 3 – 28 days after a transfusion and can cause clinically observed symptoms, including fever. Diagnosis is supported by a new positive direct antiglobulin test (+IgG or +IgG and C3) and the detection of an alloantibody by antibody screen / panel or elution. Future transfusions should involve red cells that are antigen negative for the detected alloantibody.

24 July 2020: Weekly Roundup #17

Here’s what’s new on PathologyOutlines.com this week:

1. Conferences

Many of our conferences have changed to virtual. Let us know your experiences with virtual conferences, whether they were good or bad, at Nat@PathologyOutlines.com.

2. CME Page

Don’t forget to visit our online CME page for offerings from USCAP, Board Vitals, ARUP and others.

3. Zoom Meetings

We are available to set up a Zoom meeting with your group to discuss our website. We are always interested in your feedback and suggestions. Email Nat@PathologyOutlines.com if interested.

4. Potential Webinar

We are thinking about hosting a webinar – what topics would be of interest to you? Comment on this blog post or email Nat@PathologyOutlines.com to let us know.

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23 July 2020: Textbook Updates

We have posted updated reviews of the following topics:

Breast > Fibroepithelial tumors > Phyllodes tumor
by Joshua J.X. Li, M.B.Ch.B., Gary M. Tse, M.B.B.S.
Topic summary: This is a merger of several previous topics. Phyllodes tumors are biphasic fibroepithelial lesions characterized by a leaf-like epithelial pattern. They are graded and prognosticated by histologic changes of the stromal proliferation. By definition, the epithelial component is benign.

Oral cavity & oropharynx > Papillomas > Squamous cell papilloma
by Ivan J. Stojanov, D.M.D., M.M.Sc.
Topic summary: These are common, small (< 1.0 cm), benign intraoral squamoproliferations associated with HPV 6 and 11 in 50% of cases. They commonly involves soft palate, tongue, lips and tonsils.

Ovary tumor > Germ cell tumors > Teratoma-immature
by Aurelia Busca, M.D., Ph.D., Carlos Parra-Herran, M.D.
Topic summary: Malignant germ cell tumor consisting of a teratoma with variable amounts of immature tissue, typically primitive neuroectodermal. Affects mostly young females < 20 years old. Grading is performed based on the amount of immature neuroepithelium. May have associated nodal or peritoneal gliomatosis (presence of mature neural tissue), which increases risk of recurrence.

Penis & scrotum > General > Anatomy & histology-penis
by Diego F. Sanchez, M.D., Antonio L. Cubilla, M.D.
Topic summary: This revised topic has details about the anatomy and numerous histologic images.

Skin nontumor > Dermal non-granulomatous granulocyte-rich reaction patterns > Neutrophilic eccrine hidradenitis
by Jasmine Saleh, M.D., M.P.H., Jodi Speiser, M.D.
Topic summary: Benign, self limiting chemotherapy associated neutrophilic dermatosis characterized by neutrophilic infiltration of eccrine sweat glands. Presents as a polymorphous eruption consisting of variably asymptomatic or tender erythematous to violaceous macules, papules, plaques, nodules and pustules with neutrophils infiltrating and surrounding the eccrine secretory coils in the deeper reticular dermis or subcutaneous fat. Lesions desquamate and usually heal spontaneously within 1 – 3 weeks.

21 July 2020: Image Quiz #35

Author: Molly Housley Smith, D.M.D.

Which of the following is true about this oral mucosal entity?

Select an answer:

A. Immunohistochemistry is necessary to define this process

B. It is found in higher frequency in those who have Lynch and Muir-Torre syndromes

C. Neoplastic transformation occurs in the majority of cases

D. This entity is most frequently found on the tongue

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20 July 2020: Industry News Updates

Check out our Industry News page. We have updated it with the following article from:

AdvantEdge Healthcare SolutionsPathology Billing Tipsheet: 4 Ways to Reduce Billing Errors and Increase Revenue
Pathology billing and coding have complex regulations and rules, and there are many steps involved. Mistakes can occur at many points in “front-end” and “back-end” processes and can reduce collections by five percent or more, costing a typical practice or department hundreds of thousands of dollars, and frequently more. Mistakes also increase days in A/R, delay reimbursement and lead to compliance violations or fines. Rest of article

20 July 2020: Textbook Updates

We have posted updated reviews of the following topics:

CD Markers > CD27
by Frido Bruehl, M.D., Christian M. Schürch, M.D., Ph.D.
Topic summary: CD27 is a costimulatory receptor of the TNF receptor superfamily expressed on lymphocyte, whose ligand is CD70. CD27 deficiency should be considered in patients with immunodeficiencies and CD27 staining in flow cytometry can help detect immunodeficiencies.

Kidney nontumor > Vascular disease > Thrombotic microangiopathy and acute endothelial injury > Scleroderma renal disease
by Christine M. Lee, M.D., Jonathan E. Zuckerman, M.D., Ph.D.
Topic summary: A spectrum of small arterial and arteriolar vasculopathy ranging from mild fibrointimal thickening to thrombotic microangiopathy. Scleroderma related thrombotic microangiopathy is characterized by mucoid intimal edema, onion skin-like intimal proliferation, fibrinoid necrosis and thrombosis. Glomerular changes include ischemic collapse and endothelial swelling and thrombosis, acutely and basement membrane duplication, chronically. Ischemic injury to tubules results in acute tubular injury or necrosis and eventually, interstitial fibrosis and tubular atrophy.

Ovary > Serous tumors > Low grade serous carcinoma
by Erna Forgó, M.D., Teri A. Longacre, M.D.
Topic summary: Epithelial carcinoma of serous cell lineage, usually with distinctive patterns of invasion and low grade malignant cytologic atypia. Often bilateral ovarian masses that are solid or solid and cystic with calcifications. Precursor lesion is often a borderline serous tumor. KRAS and BRAF mutations in 50 – 60% of cases.

Skin nontumor > Infectious disorders > Molluscum contagiosum
by Osward Y. Carrasquillo, M.D., M.P.H., Jorge L. Sánchez, M.D.
Topic summary: Self limited infectious dermatosis that most commonly affects children and immunocompromised patients, usually (98%) caused by MCV1. In contrast to most double stranded DNA viruses, poxvirus replicates in the cytoplasm. Characteristic Henderson-Paterson bodies, also known as molluscum bodies, are large (up to 35 microns) intracytoplasmic eosinophilic inclusion on keratinocytes.

Stains & molecular markers > BCOR
by Isidro Machado, M.D., Ph.D., Antonio Llombart-Bosch, M.D., Ph.D.
Topic summary: BCL6 transcriptional corepressor (BCOR) is located at Xp11.4 locus. Encodes a protein which is involved in transcriptional repression in association with BCL6 and epigenetic silencing through polycomb repressive complex 1 (PRC1). BCOR immunohistochemistry can be used diagnostically to separate tumors with BCOR gene alteration (rearrangement or internal tandem duplication) from their histological mimics (mainly the group of small / ovoid round cell sarcomas).

17 July 2020: Weekly Roundup #16

Here’s what’s new on PathologyOutlines.com this week:

1. Internal Images

While we try to use images posted on our server) for microscopic images, sometimes we use external images that are hosted elsewhere. However, our policy is that external images must be accessible without having to register or pay a fee to see them. Sometimes, determining what is accessible is not obvious. Most (but not all) PubMed images listed as “free full text” or “open access” are truly free but you need to double check. 

2. Welcome to Dr. Julie Jorns

We welcome Dr. Julie Jorns, Medical College of Wisconsin, as the 22nd member of our Editorial Board. She will be working with Dr. Tozbikian on Breast Pathology.

The new combined Breast pathology chapter had an incredible 2,037,043 page views last year, our fourth most popular chapter after Soft tissue (2,456,129 page views), Stains (2,288,574) and Skin nonmelanocytic tumor (2,063,129).

3. Weekly Update Video

Please review our recent What’s New This Week video or peruse the summary. This one lasts 10 minutes; we will aim for 5-7 minutes per video in the future. 

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