18 August 2022: Textbook Updates

We have posted updates of the following topics:

Fallopian tubes & broad ligament > Broad ligament > Wolffian tumor / Female adnexal tumor of probable Wolffian origin
by Elena Lucas, M.D., Wenxin Zheng, M.D.
Topic summary: Adnexal tumor arising from remnants of Wolffian (mesonephric) duct. Heterogeneous histologic appearance. Rare, approximately 130 cases reported; median age 50 years, range 15 – 87 years. Prognostic factors: low malignant potential; most tumors behave in a benign fashion. Recurrence or metastases occur in 11 – 20% of cases; median of 48 months to recurrence (range 13 – 96 months). Treatment: hysterectomy and bilateral salpingo-oophorectomy; tumor debulking.

Microbiology, parasitology & COVID-19 > Filamentous bacteria > Actinomyces
by Natalie Larsen, M.D., Sixto M. Leal, Jr., M.D., Ph.D.
Topic summary: Gram positive genus containing over 40 species; Taxonomy: genera Actinobacteria, family Actinomycetaceae. Anaerobic; modified acid fast stain negative. More common in developing nations. Infection initiated upon access to tissues via trauma, surgical procedures, foreign bodies. Indolent, slowly progressing pyogranulomatous disease. Treatment: susceptible to penicillin and most antibiotics used to treat gram positive bacteria; intrinsic resistance to metronidazole.

Penis & scrotum > Dysplasia / carcinoma in situ > Penile intraepithelial neoplasia (PeIN)
by Diego F. Sanchez, M.D., Antonio L. Cubilla, M.D.
Topic summary: Intraepithelial neoplastic proliferation with variable degree of dysplasia, keratinization and nuclear atypia. Classified as HPV related / dependent or HPV unrelated / independent. Mean age is ~58 years old. PeIN is most commonly found in the glans and foreskin. Frequent recurrence (48%); low rate of progression to invasive carcinoma (2%). Treatment: local excision (Mohs surgery, glans resurfacing, glansectomy) is the most frequent approach.

Salivary glands > Nonneoplastic tumors/tumor-like conditions > Lymphoepithelial cyst
by Zahra Maleki, M.D.
Topic summary: Unilocular cysts that involve the parotid gland. Simple cyst lined by low stratified squamous epithelium surrounded by polymorphous lymphocytes with prominent germinal centers. Almost all arise in parotid gland. Sporadic lymphoepithelial cyst may result from cystic dilation of ducts within intraparotid or periparotid lymph node or branchial cleft remnants. Excellent prognosis. Treatment: conservative therapy, with institution of highly active antiretroviral therapy medication in HIV related cases.

Uterus > Carcinoma > POLE ultramutated endometrial carcinoma
by Lucy Ma, M.D.
Topic summary: Endometrial carcinoma harboring pathogenic mutations in the exonuclease domain of the POLE gene. Carries excellent prognosis compared to the other molecular subgroups, as defined by The Cancer Genome Atlas (TCGA) program. Patients are typically younger (median age ~55 – 60) than patients with non-POLEmut endometrial carcinomas. Treatment: surgery with or without adjuvant therapy (vaginal brachytherapy, pelvic radiotherapy and chemotherapy, depending on stage).

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