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2 July 2020: Textbook Updates

We have posted updated reviews of the following topics:

Bladder, ureter & renal pelvis > Cystitis > Cystitis cystica and cystitis glandularis
by Lindsey Durowoju, M.D., Maria Tretiakova, M.D., Ph.D.
Topic summary: Proliferative or reactive changes occurring in von Brunn nests which acquire luminal spaces, become cystically dilated (cystitis cystica), undergo glandular metaplasia (cystitis glandularis) or intestinal type metaplasia. Extremely common. Benign mimickers of invasive carcinoma.

Breast > Other benign tumors > Myofibroblastoma
by Samaneh A. Motanagh, M.D., Kristen E. Muller, D.O.
Topic summary: Benign spindle cell tumor with fibroblasts and myofibroblasts and recurrent monoallelic loss of 13q14 region including RB1. Well circumscribed with short fascicles of bland spindled cells and dense hyalinized collagen bundle.

Colon tumor > Polyps > Polyps-general
by Anna Sarah Erem, M.D. Candidate 2020, Benjamin J. Van Treeck, M.D., Christopher Hartley, M.D.
Topic summary: Updated topic with extensive discussion of current treatment options.

Liver & intrahepatic bile ducts nontumor > Noninfectious hepatitis > Nonalcoholic fatty liver disease
by Yoshihiro Ikura, M.D.
Topic summary: Nonalcoholic fatty liver disease (NAFLD) is hepatic steatosis generated in association with overweight / obesity, type 2 diabetes mellitus or other metabolic dysregulations. Macrovesicular hepatosteatosis accentuated on zone 3, potentially accompanying fibroinflammatory changes in metabolic patients. Histologic grade is assessed using a scoring system including steatosis, lobular inflammation and ballooning degeneration.

Lymphoma & related disorders > Follicular lymphoma > Primary follicular lymphoma of testis (PFLT)
by Mahsa Khanlari, M.D., Roberto N. Miranda, M.D.
Topic summary: Disease limited to the testis, with favorable course despite aggressive histology. Must distinguish from diffuse large B cell lymphoma and reactive follicular hyperplasia.

29 June 2020: Textbook Updates

We have posted updated reviews of the following topics:

Kidney tumor > General > Grossing
by Debra Zynger, M.D.
Topic summary: This topic describes how to gross specimens obtained from partial and radical nephrectomy procedures for suspected renal cortical tumors. Many high quality gross images are included.

Lung nontumor > Other interstitial pneumonitis / fibrosis > Respiratory bronchiolitis
by William Perry, M.D., M.P.H., Kristine Konopka, M.D.
Topic summary: Usually incidental but occasionally associated with interstitial lung disease. Seen in virtually all smokers. Characterized by lightly pigmented (smoker’s) macrophages in distal airways and peribronchiolar airspaces with variable mild inflammation and fibrosis.

Lymph nodes & spleen, nonlymphoid > Neoplasms (not lymphoma) > Histiocytic sarcoma
by Zenggang Pan, M.D., Ph.D.
Topic summary: Malignant proliferation of mature histiocytes, excluding dendritic cell neoplasms, Langerhans cell neoplasms and myeloid sarcomas with monocytic differentiation. Mostly extranodal. Diagnosis requires confirmation of cell origin by special studies. May mimic pleomorphic or spindle cell sarcoma.

Pleura & peritoneum > Pleura mesothelial tumors > Diffuse malignant mesothelioma
by Anja C. Roden, M.D.
Topic summary: Aggressive neoplasm of mesothelial differentiation- epithelioid, biphasic or sarcomatoid subtype. Most commonly associated with remote (up to 40 years prior) asbestos exposure. Loss of expression of BRCA1 associated protein (BAP1) or methylthioadenosine phosphorylase (MTAP) or homozygous deletion of cyclin dependent kinase inhibitor 2A (CDKN2A) (p16) by FISH helps to distinguish reactive mesothelial proliferation from malignant pleural mesothelioma

Stomach > Carcinoma > Gastric carcinoma with lymphoid stroma (lymphoepithelioma-like carcinoma, medullary carcinoma)
by Carolina Martinez-Ciarpaglini, M.D., Ph.D.
Topic summary: Infrequent gastric carcinoma composed of small nests of cancer cells broadly distributed in a background of dense and prominent lymphoid stroma, histologicically similar to nasopharyngeal carcinoma. Strongly associated with EBV infection and microsatellite instability (mutually exclusive). PDL1 is usually overexpressed, making these tumors prone to immune checkpoint blockade therapy.

Carolina Martinez-Ciarpaglini, M.D., Ph.D.

25 June 2020: Textbook Updates

We have posted updated reviews of the following topics:

Bone > Other tumors > Simple bone cyst
by Nasir Ud Din, M.B.B.S.
Topic summary: Cystic bone lesion, usually first 2 decades, with compatible radiological features; cyst lacks epithelial lining. Fibrin-like deposits in cyst wall organize and mineralize, forming immature and mature bone as well as cementum-like structure. IHC has no value.

Breast (malignant & nonmalignant) > Adenosis > Microglandular
by Julie M. Jorns, M.D.
Topic summary: Rare benign lesion of haphazard, irregularly distributed, small, uniform, rounded, open glands with eosinophilic secretions. Mimics invasive carcinoma due to infiltrative stromal growth and single epithelial layer devoid of myoepithelium. S100+, ER-, PR- but invasive ductal carcinoma is opposite.

Esophagus > Benign tumors > Squamous papilloma
by Yukihiro Nakanishi M.D., Ph.D.
Topic summary: Benign esophageal epithelial polyp composed of squamous epithelium with a papillary growth pattern and fibrovascular cores of lamina propria. Due to irritation, infection, genetics. Usually asymptomatic, found incidentally.

Kidney tumor > Benign adult tumors > Mixed epithelial and stromal tumor (MEST)
by Bonnie Choy, M.D.
Topic summary: Uncommon tumor of variable cystic and solid components with diverse epithelial and stromal elements. Part of continuum with adult cystic nephroma. Typically perimenopausal women, often with long term hormonal treatment. Mostly benign, stromal cells are ER+, PR+.

Lung nontumor > Other nonneoplastic disease > Amyloidosis
by Brian D. Stewart, M.D., Andras Khoor, M,D., Ph.D.
Topic summary: Presents as diffuse alveolar septal, nodular or tracheobronchial amyloidosis, all with characteristic amorphous material, Congo red+, bifrefringent with polarization. Usually due to AL deposition (associated with myeloma).

18 June 2020: Textbook Updates

We have posted updated reviews of the following topics:

CD markers > CD47
by Frido Bruehl, M.D., Christian M. Schürch, M.D., Ph.D.
Topic summary: A ubiquitously expressed marker of self that prevents phagocytosis of cells containing it. In oncology, is a promising therapeutic target for advanced solid and hematolymphoid malignancies. In transfusion medicine, is highly expressed on red blood cells and anti-CD47 therapy causes interferences with pretransfusion testing.

Chemistry, toxicology & urinalysis > Thyroid related > Thyroid function panel
by Panudda Srichomkwun, M.D., M.Sc.
Topic summary: Screening algorithm for thyroid dysfunction with detailed description of tests making up the algorithm (TSH, T4, T3, reverse T3).

CNS tumor > Diffuse astrocytic and oligodendroglial tumors > Diffuse astrocytic glioma, IDH wildtype, with molecular features of glioblastom
by John DeWitt, M.D., Ph.D.
Topic summary: Diffusely infiltrating glioma, IDH wildtype status confirmed, typically WHO grade II or III based on histology but survival is equivalent to grade IV.

Colon nontumor > Noninfectious colitis > Common variable immunodeficiency (CVID)
by Benjamin J. Van Treeck, M.D., Christopher Hartley, M.D.
Topic summary: Common variable immunodeficiency disorders are due to B cell impairment causing hypogammaglobulinemia with either IgA or IgM deficiency. These patients may suffer CVID related infectious, inflammatory, autoimmune or malignant GI manifestations with histology resembling inflammatory bowel disease, microscopic colitis or granulomatous inflammation. One third of cases have plasma cells.

Lung nontumor > Cystic disease / congenital anomalies > Bronchogenic cyst
by Laurence M. Briski, M.D., Kristine Konopka, M.D.
Topic summary: Benign congenital malformation arising from abnormal budding of primitive foregut during gestation. Often occurs in mediastinum, lung, head and neck, skin. Unilocular cyst lined by respiratory type epithelium, but cyst wall recapitulates bronchial wall with variable amounts of seromucinous glands, cartilage and smooth muscle.

11 June 2020: Textbook Updates

We have posted updated reviews of the following topics:

Cervix > Carcinoma > Gastric type adenocarcinoma
by Gulisa Turashvili, M.D., Ph.D.
Topic summary: Common subtype of endocervical adenocarcinoma which includes minimal deviation adenocarcinoma. Not associated with HPV. Tumor cells usually contain tall apical mucin. New images, board review questions and more detailed histopathology.

Eye > Eyelid inflammatory disorders > Chalazion
by Pablo Zoroquiain, M.D.
Topic summary: Very common inflammatory eyelid lesion characterized by granulomatous inflammation with lipogranuloma, a central empty optic space surrounded by an epithelioid granuloma with multinucleated giant cells (foreign body type or touton). All specimens with tissue should be submitted to rule out malignant neoplasms and other masquerading conditions.

Pancreas > Exocrine tumors / carcinomas > Intraductal tubulopapillary neoplasm (ITPN)
by Gokce Askan, M.D., Olca Basturk, M.D.
Topic summary: Rare, intraductal, grossly solid and cystic, tubule forming, epithelial neoplasm with high grade dysplasia and no overt mucin production. Lacks genetic alterations commonly seen in IPMN. Favorable overall outcome even if associated with invasive carcinoma.

Skin nonmelanocytic tumor > Adnexal tumors – eccrine sweat glands > Digital papillary adenocarcinoma
by Haruto Nishida, M.D., Ph.D.
Topic summary: Malignant adnexal tumor with a marked predilection of acral site, usually fingers and toes. Tumor cells are basaloid / cuboidal to low columnar epithelial cells and myoepithelial cells with mild to moderate cytologic atypia.

Stains & molecular markers > PDL1 SP142
by Gary Tozbikian, M.D.
Topic summary: FDA approved companion diagnostic to atezolizumab for advanced / metastatic triple negative breast cancer (TNBC) and urothelial carcinoma. Scoring is evaluated in immune cell component using a proportion of tumor area scoring system; cutoffs are tumor site specific. Not interchangeable with other PDL1 assays (e.g. 22C3, SP263)

9 June 2020: Industry News Updates

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

Change Healthcare – 7 Ways to Help Create a Sustainable Competitive Advantage
Today’s healthcare providers are facing increasing revenue pressure from declining reimbursement, fixed costs, and growing patient responsibility. Labs are no exception. Maintaining existing business while growing new referral sources is essential to long-term viability. It is also important for supporting investments into new technology and systems that will help labs stay competitive. And competition is increasingly a factor as lab groups nationwide are targeting one another’s clients as part of their own growth strategies. Rest of article

8 June 2020: Textbook Updates

We have posted updated reviews of the following topics:

Microbiology & parasitology > Atypical bacteria: Mycoplasma > M. pneumoniae
by Arthur H. Totten, Ph.D., George Andy Farr, M.L.S., Sixto M. Leal, Jr., M.D., Ph.D.
Topic summary: Leading bacterial cause of community acquired pneumonia. Predominately affects children 5 – 18 years. Disseminated infections in immunocompromised. Not seen on H&E or other histologic stains. PCR is the most common and accurate means of diagnosis.

Salivary glands > Cytopathology (Milan system) > Milan system – Malignant
by Jen-Fan Hang, M.D.
Topic summary: Detailed cytology descriptions and many high quality cytology images of malignant entities.

Stains & molecular markers > IMP3
by David Wachter, M.D.
Topic summary: Cytoplasmic marker with expression in many malignancies; tends to have higher expression in more aggressive neoplasms, although not specific for any malignancy.

Stomach > General > Normal histology
by Kelsey E. McHugh, M.D., Thomas P. Plesec, M.D.
Topic summary: Updated topic with new diagrams, significantly more extensive histologic descriptions, new procedural, gross, histologic and cytologic images, as well as three new board review style questions.

4 June 2020: Textbook Updates

We have posted updated reviews of the following topics:

Breast nonmalignant > Benign tumors > Pleomorphic adenoma
by Shabnam Jaffer, M.D.
Topic summary: Similar to salivary gland topic in morphology, immunohistochemistry, prognosis and treatment, except rarer in breast and lacks molecular change. May be a variant of intraductal papilloma.

Breast nonmalignant > Inflammatory > Fat necrosis
by Elizabeth Abels, M.D., Jing He, M.D.
Topic summary: Updated information, expanded microscopic and gross description, new microscopic images, detailed differential diagnoses and board review style questions.

Breast nonmalignant > Nonneoplastic changes > Apocrine metaplasia
by Carlos C. Diez Freire, M.D., Shahla Masood, M.D.
Topic summary: Common metaplastic change characterized by enlarged epithelial cells with abundant granular eosinophilic cytoplasm that can show apical snouting. Nice micro images. Detailed cytology description and list of positive and negative stains.

Esophagus > Premalignant lesions > Barrett related dysplasia
by Dipti M. Karamchandani, M.D.
Topic summary: Most important risk factor for esophageal adenocarcinoma. Diagnosis and grading can be challenging, especially with coexisting inflammation. Detailed micro description and extensive images.

Laboratory Administration & Management of Pathology Practices > Planning > Creating a business plan
by David A. Novis, M.D.
Topic summary: Important guidelines by an expert to review before you start a business. Detailed road map describing the implementation of an intended business and what you should think about before you take the plunge!

We have added new images to the topics:

Salivary glands > Primary salivary gland neoplasms – benign > Warthin tumor
cytology images contributed by Robin Pike, M.D.

1 June 2020: Textbook Updates

We have posted updated reviews of the following topics:

Kidney tumor > Benign adult tumors > Renomedullary interstitial cell tumor
by Rachelle Gietzen, M.D., Eduardo Eyzaguirre, M.D.
Topic summary: Tumor often found incidentally at autopsy or imaging for other reasons. Arises from medullary interstitial cells, seen as gray-white nodules in renal medulla, composed of spindled cells in basophilic stroma with entrapped tubules.

Microbiology & parasitology > Atypical bacteria: Mycoplasma > M. hominis / Ureaplasma spp.
by Arthur H. Totten, Ph.D., George Andy Farr, M.L.S., Sixto M. Leal, Jr., M.D., Ph.D.
Topic summary: M. hominis / Ureaplasma spp. are atypical bacterial pathogens which stain poorly by the dyes used in Gram stain due to the absence of a cell wal. They cause urogenital syndromes and infections in transplant patients and neonates. Culture requires specialized media conditions.

Oral cavity & oropharynx > Congenital anomalies > Hairy tongue
by Molly Housley Smith, D.M.D.
Topic summary: Hairy appearance of the dorsal tongue due to marked elongation of the lingual filiform papillae. Great clinical and micro images.

Salivary glands > Cytopathology (Milan system) > Milan system – Neoplasm: benign
by Jen-Fan Hang, M.D.
Topic summary: This is the second topic in the Salivary gland chapter regarding the Milan System for Reporting Salivary Gland Cytopathology (see also http://www.pathologyoutlines.com/topic/salivaryglandsmilandiagnostic.html), published in 2018. It describes salivary gland FNA diagnostic of a benign neoplasm (pleomorphic adenoma 60 – 70%, Warthin tumor 20 – 30%). The estimated risk of malignancy by the Milan system is < 5%.

Thyroid gland > Papillary carcinoma > Columnar cell variant
by Shipra Agarwal, M.D., Andrey Bychkov, M.D., Ph.D.
Topic summary: The columnar cell variant of papillary thyroid carcinoma is rare and aggressive. It features columnar cells with nuclear pseudostratification, scant cytoplasm and absent / minimal nuclear features of papillary thyroid carcinoma. It should be differentiated from metastatic colon and endometrial adenocarcinoma .

25 May 2020: Textbook Updates

We have posted updated reviews of the following topics:

Esophagus > Esophagitis > Eosinophilic esophagitis
by Ryan C. Braunberger, M.D., Joshua A. Hanson, M.D.
Topic summary: Multifactorial, chronic eosinophilic inflammatory condition with no known cause. Diagnose if ≥ 15 eosinophils / HPF in proper clinical context. DD includes GERD. Great images and virtual slides.

Lymphoma & related disorders > T / NK cell disorders > Peripheral T cell lymphoma, not otherwise specified
by Matthew M. Klairmont, M.D., John Kim Choi, M.D., Ph.D.
Topic summary: Mature T cell lymphoma not otherwise classifiable within WHO. Aggressive clinical behavior. CD4 > CD8, EMA-, ALK-. DD includes Hodgkin lymphoma, ALK- ALCL. Extensive discussion.

Microbiology & parasitology > Microbiology – viruses > Diagnostic testing of SARS-CoV-2 (COVID-19)
by Samantha C. Wu, B.A., Patricia Tsang, M.D., M.B.A.
Topic summary: Timely topic with regular updates anticipated. Contains testing priorities and a list of commercially available SARS-CoV-2 assays in US with a comparison of their key features.

Vulva, vagina & female urethra > Vulva – carcinoma and precursor lesions > Differentiated type, vulvar intraepithelial neoplasia
by Matthias Choschzick, M.D.
Topic summary: Highly differentiated tumor with aggressive behavior (may become invasive). Has histological overlapping features to reactive or benign vulvar lesions but there is no reliable IHC or molecular markers to establish the diagnosis.