1 February 2021: Textbook Updates

We have posted updates of the following topics:

Soft tissue > Fibroblastic / myofibroblastic fibrosarcoma > Sclerosing epithelioid fibrosarcoma
by Borislav A. Alexiev, M.D.
Topic summary: Sclerosing epithelioid fibrosarcoma (SEF) is a rare, aggressive, malignant mesenchymal tumor with unique architectural features consisting of cords, nests or sheets of monotonous epithelioid cells within a dense collagenous background. Tumors are deep seated and arise most often in the lower extremities and limb girdles, followed by the trunk, upper limb girdles and the head and neck. Most cases are driven by fusion genes. Most patients present with a mass of variable duration, with 33% reporting recent enlargement or pain. Tissue sampling is the gold standard for a definitive diagnosis. Treatment involves radical resection for localized disease; pre or postoperative radiotherapy for optimal local disease control.

Stains & molecular markers > HPV (Human papillomavirus)
by Sofia Lérias, M.D., Ana Félix, M.D., Ph.D.
Topic summary: Human papillomaviruses (HPVs) are a group of small, double stranded DNA viruses that show tropism for squamous epithelium and infect cells in the basal layer of stratified squamous epithelia. HPV oncoproteins E5, E6 and E7 are responsible for initiation and progression of HPV associated cancers. More than 100 HPV types have been differentiated molecularly and at least 40 of them have a tropism for anogenital mucosa. HPV DNA ISH assay shows punctate and dot-like signals within tumor nuclei, indicating the presence of integrated HPV, while diffuse nuclear staining is thought to indicate the presence of episomal HPV genomes. FDA approved the PCR method to detect E6 / E7 mRNA as the gold standard test for HPV detection, which can be used for viral load quantitation, DNA sequencing and mutation analysis.

Stomach > Carcinoma > Carcinoma-general
by Carolina Martinez Ciarpaglini, M.D., Ph.D.
Topic summary: More than 90% of gastric carcinomas are adenocarcinomas. Most sporadic gastric cancers are now considered to be inflammation driven, usually related to Helicobacter pylori infection. Gastric cancer was the fifth most commonly diagnosed cancer type worldwide in 2018 (5.7% of all cancer cases diagnosed). Most frequent location of gastric adenocarcinoma is the incisura angularis. Diagnosis is routinely made on endoscopic biopsy. Early gastric cancer can be treated through endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) if they are confined to the mucosa, well differentiated, ≤ 2 cm and nonulcerated.

Vulva, vagina & female urethra > Squamous carcinoma and precursor lesions > Condyloma
by Matthias Choschzick, M.D.
Topic summary: Benign HPV related lesion of the anogenital region with warty appearance and histologically bland papillomatous hyperplasia of squamous epithelium. Occurs in sexually active adults (1%), peak incidence between 20 – 29, HIV predisposing. Low risk HPV types 6 and 11 most common; high risk HPV types in up to 42%. Range from only colposcopically visible lesions to small papules to large masses with cauliflower-like appearance, often multiple. Benign process, frequent recurrence, spontaneous regression possible. Diagnosis is made using clinical appearance and punch biopsy. Treatment involves local excision or laser ablation, imiquimod.

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