28 February 2022: Textbook Updates

We have posted updates of the following topics:

Bladder, ureter & renal pelvis > Urothelial carcinoma – invasive > With trophoblastic differentiation
by Mohammed Alghamdi, M.B.B.S., Judy Sarungbam, M.D.
Topic summary: Urothelial carcinoma with focal or diffuse trophoblastic / syncytiotrophoblastic morphology or beta hCG immunoreactivity. Carries a worse prognosis compared to conventional urothelial carcinoma. Mean age: 63 years (range: 43 – 89 years). Can be seen along the entire urothelial tract, including urinary bladder, prostatic urethra and upper urothelial tract. Prognosis has been associated with higher stage and grade. Depending on the stage of the disease, treatment modalities include transurethral resection, intravesical therapies, chemotherapy, radiotherapy or cystectomy.

Bone & joints > General > Histology-joints
by Lingxin Zhang, M.D.
Topic summary: Articulations that allow bones to move relative to one another. The synovial joint (diarthrosis) is what mainly concerns pathologists. Second most important type of joint is the amphiarthrosis, which consists of flattened attached disc of fibrocartilage between 2 subchondral plates of adjacent bones. Articulates the tubular bones of the extremities; there are varieties of synovial joints in regard to the kind of motion (e.g., hinge joints, pivot joints, ball and socket joints, etc.). Most commonly encountered joint specimens are hips and knees (from arthroplasty).

Gallbladder & extrahepatic bile ducts > General > Anatomy, histology & embryology
by Fernanda Carolina Cordeiro-Rudnisky, M.D., Naziheh Assarzadegan, M.D.
Topic summary: The gallbladder is a pear shaped saccular organ connected to the extrahepatic biliary system via the cystic duct. Gallbladder wall is 1 – 2 mm thick and composed of mucosa, muscularis propria and serosa. Gallbladder stores and releases bile. Gallbladder empties into cystic duct, which connects it to the extrahepatic biliary tree. Extrahepatic biliary tree serves as conduit for bile flow. Cholesterol is eliminated via loss of 0.5 g of bile salts per day.

Kidney nontumor > Monoclonal gammopathy of renal significance (MGRS) / paraprotein-related kidney disease > Monoclonal gammopathy of renal significance (MGRS) / paraprotein related kidney disease – general
by Rajib K. Gupta, M.D.
Topic summary: Monoclonal gammopathy of renal significance (MGRS) is a broad term that includes all kidney diseases caused by a nephrotoxic monoclonal immunoglobulin (mostly immunoglobulin light chains, also known as M protein) secreted by any clonal low grade / smoldering plasma cell disease or low grade B cell lymphoproliferative disease. Kidney biopsy is the gold standard for diagnosis of MGRS. Aim of MGRS treatment is to preserve or improve kidney function by targeting the B cell or plasma cell clone. Current consensus supports clone directed therapy over general immunosuppressive therapy.

Lymphoma & related disorders > Mature T/NK cell disorders > T follicular helper phenotype > Angioimmunoblastic T cell lymphoma
by Mario L. Marques-Piubelli, M.D., Roberto N. Miranda, M.D.
Topic summary: Nodal based, mature T cell lymphoma derived from CD4+ T follicular helper (TFH) cells admixed with a polymorphous infiltrate of reactive cells and prominent proliferation of high endothelial venules and follicular dendritic cells. Patients usually present with lymphadenopathy, systemic disease and immunodysregulation. Usually affects patients in the sixth and seventh decades; median of 65 – 69 years old. Median overall survival: 18 – 29 months; 1, 3 and 5 year overall survival of 66%, 64% and 32% respectively. Treatment: single agent oral therapies or intensive chemotherapy combination followed by autologous stem cell transplantation.

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