10 December 2020: Textbook Updates

We have posted updates of the following topics:

Anus & perianal area > Premalignant > Buschke-Löwenstein tumor
by Phuong Nhat Nguyen, M.D., M.Sc., Lewis A. Hassell, M.D.
Topic summary: Also known as giant condyloma acuminatum, this tumor was first described as a penile neoplasm by Buschke and Löwenstein in 1925; previously considered synonymous with verrucous carcinoma. Condylomatous squamous lesion without high grade dysplasia, with only low risk HPV types present, forming an exophytic mass, usually greater than 3 cm. Pathophysiology is similar to other skin and mucosal HPV induced tumors; viral DNA is incorporated into cellular DNA following exposure, redirecting cellular processes into dysregulated cellular proliferation. Preferred initial therapy: complete excision with wide margins.

Breast > Fibrocystic changes > Adenosis
by Julie M. Jorns, M.D.
Topic summary: Any hyperplastic process displaying increase in glands, typically within terminal duct lobular units. Subtypes include adenomyoepithelial, apocrine, sclerosing, tubular and nodular adenosis. Occurs in wide age range, highest in third and fourth decades, paralleling fibrocystic changes. Diagnosis is based on histologic examination of tissue with or without immunohistochemistry. With some subtypes, the risk of subsequent breast cancer is 1.5 – 2 times higher, as seen with proliferative fibrocystic changes. Does not require treatment unless there is cytologic atypia (rare).

Chemistry, toxicology & urinalysis > Organ specific > Liver > Liver function test panel
by Syeda F. Absar, M.D., M.P.H., Patricia Tsang, M.D., M.B.A.
Topic summary: Used for diagnosing liver disease in patients with history or clinical symptoms of liver dysfunction; aberrant test results may indicate the need for additional testing in order to assess the etiology. Tests in the panel include liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) as well as proteins. ALT is more liver specific than AST, even though both are elevated in liver disease. Graded proficiency testing (PT) provides an external check on a laboratory’s performance of the assays.

Kidney tumor > Childhood tumors > Mesoblastic nephroma
by Ellen D’Hooghe, M.D., Gordan M. Vujanic, M.D., Ph.D.
Topic summary: Mesenchymal / myofibroblastic renal tumor of low grade malignancy that typically occurs in infancy. Represents 3 – 4% of all renal tumors of childhood with median age < 1 month in 63% of cases and 90% of cases diagnosed in the first 9 months of life. 3 histologic subtypes: classic (~25% of cases), cellular (~65%) and mixed (~10%). No recognized risk factors. Imaging techniques cannot distinguish it from other renal tumors. Most important prognostic factor is completeness of surgical resection.

Lymphoma & related disorders > Mature B cell neoplasms > Large B cell lymphomas-special subtypes > ALK+ LBCL
by Nicholas Joseph Dcunha, M.B.B.S., M.D., Marie Therese Manipadam, M.B.B.S., M.D.
Topic summary: WHO defines this entity as an aggressive neoplasm of ALK (anaplastic lymphoma kinase) positive monomorphic large immunoblast-like B cells, which usually have a plasma cell phenotype. It is a very rare lymphoma. Common sites include lymph nodes and mediastinum. Diagnosis is based on a combination of light microscopy and immunohistochemical markers. Most cases are treated with chemotherapy regimens of CHOP or E-POCH / CHOEP; a few patients are also given additional radiotherapy.

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