28 March 2023: Case of the Month #525

Thanks to Dr. Carlos A. Torres-Cabala, University of Texas MD Anderson Cancer Center, Houston, Texas, USA for the images; Drs. Alessia Cimadamore and Rodolfo Montironi, Polytechnic University of the Marche Region, Ancona, Italy and the Genitourinary Pathology Society (GUPS) for the discussion; and Dr. Jonathan Ho, The University of the West Indies, Mona, Jamaica for reviewing the discussion.

Clinical history:

A 25 year old man presented with a 1 cm, well demarcated, dome shaped, blue-black lesion on his finger, which was excised.

All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page.

To subscribe to Case of the Month or our other email newsletters, visit pathologyoutlines.com/subscribe.html.

Note: This case was originally emailed to our e-newsletter subscribers on March 23, 2023.

24 March 2023: Weekly Roundup #116

Here’s what you need to know about PathologyOutlines.com this week:

1. 2022 Year in Review Video

We have posted a YouTube video highlighting the significant changes that were made to PathologyOutlines.com in 2022. View it at https://www.youtube.com/watch?v=itFpiInjRrQ.

2. What’s New in Bone and Soft Tissue Pathology E-Newsletter

Make sure to sign up for our What’s New in Pathology newsletter at pathologyoutlines.com/subscribe.html. The upcoming newsletter, to be sent out next week, is What’s New in Bone and Soft Tissue Pathology 2023: Guidelines for Molecular Testing. You can view our previous What’s New in Bone and Soft Tissue Pathology newsletter here and our other subspecialty newsletters here.

Read our previous What’s New in Bone and Soft Tissue Pathology newsletter here.

3. Curing Cancer Network: Social Media Accounts

We are now posting interesting images of malignancies on our Curing Cancer Network social media accounts. Follow us on LinkedIn and Twitter.

21 March 2023: Image Quiz #104

Authors: Truong Phan Xuan Nguyen, M.D.Ichizo Nishino, M.D., Ph.D.

Glycogen storage disease type V (GSD V, McArdle disease) causes muscle cramps, muscle fatigue and increased muscle glycogen. Which of the following enzymes is deficient?

Select an answer:

A. Hepatic hexokinase

B. Muscle debrancher enzyme

C. Muscle hexokinase

D. Muscle phosphofructokinase

E. Muscle phosphorylase

To sign up for our biweekly image quiz e-newsletters and more, visit pathologyoutlines.com/subscribe.html.

17 March 2023: Weekly Roundup #115

Here’s what you need to know about PathologyOutlines.com this week:

1. Informatics

We are strengthening our Informatics, digital & computational pathology chapter with our revised topic on AP Laboratory information systems by Drs. Jonah and Parwani. Let Dr. Pernick know of any suggested new topics at Nat@PathologyOutlines.com.

2. Image Contest

We have started a contest for the best Directory image. Instructions and voting are at surveymonkey.com/r/favorite_image. Voting ends on April 30, 2023. Email any questions to Directory@PathologyOutlines.com.

Some of the images from our Directory image contest!

3. Curing Cancer Network: Cancer Prevention

Replacing a poor diet with more nutritious foods has sizable health benefits at any age. The Washington Post (October 18, 2022, O’Connor) reports a study published in The New England Journal of Medicine that shows “people can gain sizable health benefits at any age by cutting back on highly processed foods loaded with salt, sugar and other additives and replacing them with more nutritious foods like fruits, vegetables, nuts, beans, lentils, seafood and whole grains.” In the study, researchers followed roughly 74,000 people between the ages of 30 and 75 for over 2 decades and found that “people who had consistently high diet scores were up to 14% less likely to die of any cause during the study period compared to people who had consistently poor diets.”

Eating fiber alters the microbiome. It may boost cancer treatment too because the composition of the gut microbiome appears to influence whether immunotherapy is successful (The Washington Post: Eating fiber alters the microbiome. It may boost cancer treatment, too. [Accessed 16 March 2023]).

16 March 2023: Textbook Updates

We have posted updates of the following topics:

Breast > Other invasive carcinoma subtypes, WHO classified > Apocrine
by Jonathan Marotti, M.D.
Topic summary: Invasive breast carcinoma comprised of large cells with abundant eosinophilic and granular cytoplasm, enlarged nuclei and prominent nucleoli; apocrine morphology in > 90% of tumor cells. Estrogen receptor (ER) negative, progesterone receptor (PR) negative and androgen receptor (AR) positive. Mean age of diagnosis is typically older than invasive breast carcinoma, NST. Most carcinomas with apocrine differentiation are sporadic; some carcinomas in patients with germline PTEN mutation (Cowden syndrome) display apocrine morphology. Prognosis is based on conventional factors such as grade, tumor size and nodal status. Treatment: surgical excision; chemotherapy and radiation are dependent on stage; neoadjuvant therapy may be considered.

Stains & CD markers > CD10
by Bradford Siegele, M.D., J.D.
Topic summary: Cell membrane zinc dependent metalloendopeptidase that is widely distributed in hematopoietic cells and hematopoietic neoplasms, normal kidney tissue and renal neoplasms, as well as a wide variety of additional tissues. Encoded by MME gene. Critical for use in diagnosis and subclassification of leukemias (e.g., B lymphoblastic leukemia, mixed phenotype acute leukemia, etc.) and lymphomas (e.g., follicular lymphoma, Burkitt lymphoma, diffuse large B cell lymphoma, angioimmunoblastic T cell lymphoma). Bladder: present in 40 – 50% of urothelial carcinoma and squamous cell carcinoma, with CD10 expression strongly correlated with high tumor grade and stage. Stromal expression in invasive breast carcinoma, NST is associated with increased biologic aggressiveness and poor prognosis.

Colon > Infectious colitis > Shigella
by Pauline Shih, M.D., Nicole E. Putnam, Ph.D.
Topic summary: Infectious diarrhea and subsequent colitis caused by bacteria of the Shigella genus. Shigella are highly infective, virulent, invasive, gram negative rods causing watery diarrhea associated with fever and abdominal pain, which may progress to dysentery (severe diarrhea with blood or mucus in stool). Shigellosis is a leading cause of diarrheal death, with most deaths due to Shigella infection occurring in south Asia and sub-Saharan Africa; infection occurs from ingestion of bacteria through fecal contamination of food or water and is linked to poor hygiene and sanitation, overcrowding and lack of access to clean water. Disease is more severe in children, elderly or immunocompromised. Disease may be self limited; oral or intravenous hydration and electrolyte management are essential to replace losses.

Stomach > Carcinoma > Intestinal type adenocarcinoma
by Emma J. Norton, M.B.B.S., Adrian C. Bateman, M.B.B.S., M.D.
Topic summary: Histological subtypes of gastric adenocarcinoma previously grouped under the term intestinal adenocarcinoma; tubular adenocarcinoma represents the most common subtype of this cancer. May express HER2 or PDL1, both of which offer additional treatment options. Gastric adenocarcinoma is the third most common cancer type worldwide. Risk factors include Helicobacter associated gastritis and autoimmune gastritis as well as cigarette smoking, working in the rubber manufacturing industry, Xray radiation and gamma radiation. Tumor stage is the most important prognostic factor, especially nodal status; higher stages are associated with worse prognosis. Tumors identified at a very early stage (i.e., pTis or pT1) may be amenable to local excision at upper gastrointestinal endoscopy.

13 March 2023: Textbook Updates

We have posted updates of the following topics:

Liver & intrahepatic bile ducts > Developmental anomalies / cysts > Simple biliary cyst
by Lokman Cevik, M.D., Wei Chen, M.D., Ph.D.
Topic summary: Unilocular fluid filled intrahepatic cysts that do not communicate with the intrahepatic biliary tree. Most common hepatic cyst, F > M; prevalence increases with age. Pathophysiology unknown; believed to be congenital and formed from bile ducts that do not connect to the biliary system. Typically single and unilocular, rarely multilocular; family history and renal evaluation should be considered for autosomal dominant polycystic disease if the lesion is multilocular. Diagnosis is based on radiologic and clinical findings. Laboratory findings are typically normal; increased gamma glutamyltransferase (GGT) in a minority of cases. Malignancy arising within a simple biliary cyst is thought to be extremely rare. Large, symptomatic liver cysts might need intervention: percutaneous aspiration or surgical intervention.

Skin nontumor > Dermal perivascular and vasculopathic reaction patterns > Cutaneous vasculitis
by Mariel Molina Nunez, M.D., Jose A. Plaza, M.D.
Topic summary: Vasculitis represents inflammation of the capillaries, postcapillary venules and small, medium and large sized vessels with variable clinical presentation (purpura, erythema, papules, ulcer, etc.). Cutaneous vasculitis can present in several forms: a component of systemic vasculitides, a limited expression of systemic vasculitis or a single organ vasculitis. Systemic vasculitides can involve cranial or peripheral nerves, gastrointestinal tract, retina, aorta, kidneys, oral mucosa and skin, among other organs. Distinction between localized (cutaneous) versus systemic vasculitis is thought to be the most crucial point in determining patient outcome. Most cases of idiopathic cutaneous small vessel vasculitis are self limited, with 90% resolving in weeks to months of onset.

Skin nonmelanocytic tumor > Lymphoma and related disorders > Cutaneous lymphoid hyperplasia
by Yi Ariel Liu, M.D., Woo Cheal Cho, M.D.
Topic summary: Heterogeneous group of disorders with benign T or B cell lymphocytic infiltrates in the skin that mimic cutaneous lymphomas both clinically and histologically. Typically presents as a solitary nodule in the head and neck region; classically characterized by a dermal lymphoid infiltrate composed predominantly of reactive polyclonal lymphocytes with a variable admixture of other inflammatory cells. Can affect all age groups; slight female predilection; M:F = 1:2 – 3. Often idiopathic; various antigenic stimuli or triggering factors (e.g., medications, tattoos, vaccinations, arthropod bites, infections with various pathogens) have been reported. Benign clinical course; spontaneous regression is common following excision or topical / intralesional corticosteroids.

Stomach > Other nonneoplastic > Portal hypertensive gastropathy
by Mohamed Yakoub, M.D., Divya Sharma, M.D.
Topic summary: Portal hypertensive gastropathy (PHG) refers to the pathologic effects of increased portal venous pressure on the mucosal surface of the stomach. Histologic features are nonspecific and show congested capillaries and venules in the gastric mucosa, mainly in the body and fundus, without significant inflammation or fibrin thrombi. 20 – 98% prevalence in patients with liver cirrhosis. Patients with portal hypertensive gastropathy usually present with chronic gastrointestinal bleeding that can result in iron deficiency anemia. Poor prognosis is associated with severe cases presenting with acute bleeding. Treatment: iron supplementation for chronic gastrointestinal bleeding; beta blockers and octreotide to decrease portal blood pressure; transjugular intrahepatic portosystemic shunt (TIPS) procedure.

Testis & paratestis > Nonneoplastic lesions > Hydrocele
by Francesca Sanguedolce, M.D., Ph.D.
Topic summary: Accumulation of serous fluid between visceral and parietal layers of tunica vaginalis. Painless scrotal swelling, feeling of heaviness. Usually unilocular, can be multicameral. Mostly idiopathic, putative causes: excessive secretion or decreased reabsorption of fluid by parietal mesothelial cells, congenital lack of efferent lymphatics; association with inguinal hernia, scrotal trauma, inflammation (epididymoorchitis) or tumors of the testis / paratestis. Thorough macroscopic examination and extensive sampling are needed to rule out mesothelioma. Spontaneous resolution in most cases; some cases require surgical treatment.

10 March 2023: USCAP 2023

PathologyOutlines.com is pleased to attend USCAP 2023 in New Orleans on March 13 – 15. Stop by booth #122 for our great felt tip markers and other giveaways. Review or add your Directory profile and vote for our Directory image contest. Pose for a picture or record a video. Sign up for our What’s New or other newsletters. Learn about becoming an Author. Say hello to Dr. Pernick and our staff. Tell us how we can make the website better.

Be sure to also stop by our poster, abstract #2492, poster #93, “The Pathology Job Market Post-COVID: Where are We Now?,” on Monday, March 13, from 1:00 p.m. – 4:30 p.m. at the New Orleans Convention Center in Exhibit Hall B, authors Debra Zynger and Nat Pernick.

We look forward to meeting you!

7 March 2023: Image Quiz #103

Author: Sarah H. Glass, D.D.S.

A biopsy of a lesion from the lateral border of the tongue in a 63 year old man demonstrates the histopathology seen below. What is the diagnosis?

Select an answer:

A. Epithelial dysplasia

B. Granular cell tumor

C. Mucoepidermoid carcinoma

D. Squamous cell carcinoma

To sign up for our biweekly image quiz e-newsletters and more, visit pathologyoutlines.com/subscribe.html.

3 March 2023: Weekly Roundup #114

Here’s what you need to know about PathologyOutlines.com this week:

1. Worldwide Directory of Pathologists

Our Directory profiles now have links for the institutions and subspecialties selected. For example, our Editor-in-Chief Dr. Raul Gonzalez has links on his profile for Emory University and GI / liver that show all other pathologists in the Directory who are at Emory or specialize in GI / liver subspecialty. See the blue box at pathologyoutlines.com/directory for information on adding or changing your free Directory profile.

2. PathologyOutlines.com E-Newsletters

Are you getting the e-newslettters from PathologyOutlines.com that you want? The list of available e-newsletters / e-blasts is at pathologyoutlines.com/subscribe.html. You can try subscribing or editing your entry. For some people, however, that does not work. If not, email Comments@PathologyOutlines.com and tell us what emails you want to receive.

3. Curing Cancer Network: American Cancer Society – Annual Report

The American Cancer Society published its annual report to the nation on the status of cancer on October 27, 2022. It concludes that “Cancer death rates continued to decline overall, for children, and for adolescents and young adults, and treatment advances have led to accelerated declines in death rates for several sites, such as lung and melanoma.” See Cancer 2022;128:4251 for the remainder of the report.

24 February 2023: Weekly Roundup #113

Here’s what you need to know about PathologyOutlines.com this week:

1. New Editorial Board Appointments

Kimberley J. Evason, M.D., Ph.D.

Dr. Kimberley Evason was recently appointed to our Editorial Board for Gastrointestinal Pathology. Dr. Evason is a physician-scientist and Associate Professor of Pathology at the University of Utah. She obtained her M.D. and Ph.D. through the Medical Scientist Training Program at Washington University in St. Louis. She then completed her Anatomic Pathology residency, fellowship in Gastrointestinal and Liver Pathology, and postdoctoral research training at University of California, San Francisco.

Dr. Jared Ahrendsen was recently appointed to our Editorial Board for Neuropathology. Dr. Ahrendsen is an Assistant Professor of Pathology of Neuropathology at Northwestern University Feinberg School of Medicine in Chciago. He earned his M.D. and Ph.D. from the University of Colorado Anschutz Medical Campus. He then completed a combined Anatomic Pathology / Neuropathology residency and fellowship at Beth Israel Deaconess Medical Center, Harvard Medical School in Boston, where he also served as Chief Resident. He also completed a fellowship in Forensic Pathology at the Oklahoma Office of the Chief Medical Examiner. His research interests include molecular diagnostics of brain tumors, trauma related neuropathology and the utilization of postmortem tissue to better understand human neurologic disease.

2. Informatics

Learn about Informatics, digital & computational pathology at pathologyoutlines.com/informatics.html. Make sure to read our topic on Computational pathology fundamentals & applications, written by Yomna Amer, M.B.B.Ch. and Anil Parwani, M.D., Ph.D., M.B.A.

3. Potential PathologyOutlines.com App

We are considering setting up a free mobile app. It would resemble what is currently available when using the website on mobile but, at least initially, the topics would be limited to the most important sections and we would try to improve formatting. Email Nat@PathologyOutlines.com with any suggestions.

For mobile use of the website, there is no option to convert to the standard home page, header and footer. Our decision to have mobile pages conform to the screen size apparently eliminated that option. We have added more links to the “Other links” tab on our homepage so you should be able to access all important pages.