19 October 2020: Textbook Updates

We have posted updates of the following topics:

Prostate gland & seminal vesicles > Immunohistochemistry
by Brian Ma, M.D., Guang-Qian Xiao, M.D., Ph.D.
Topic summary: Diagnostic biomarker study of prostate tissue is one of the most common applications of immunohistochemistry in surgical pathology, especially for prostate needle biopsies. Most used immunohistochemical stains include basal cell markers and prostate specific markers. Pathophysiology involves survival and growth of normal and prostate cancer cells relying on the constitutive expression of AR and its signaling. For primary atypical prostatic glands: IHCs reveal atypical prostatic glands negative for p63 and 34 beta E12 (absence of basal cells) and positive for AMACR / p504s, supporting the diagnosis of prostatic adenocarcinoma.

Soft tissue > Fibroblastic / myofibroblastic > Superficial CD34+ fibroblastic tumor
by Borislav A. Alexiev, M.D.
Topic summary: Distinctive low grade neoplasm of the skin and subcutis, characterized by a fascicular proliferation of spindled cells with abundant, eosinophilic, granular to glassy cytoplasm, marked nuclear pleomorphism and low mitotic count. Most tumors occurred in middle aged adults (median age 38 years, range 20 – 76 years) with slight male predominance. May occur anywhere in the body but most lesions appear on the lower limbs, particularly the thighs.

Soft tissue > General > Histology-skeletal muscle
by Norbert Sule, M.D., Ph.D.
Topic summary: Specialized contractile tissue responsible for the voluntary movements. Normal skeletal muscle is formed from the primitive mesenchymal element of the paraxial mesoderm (somite) which divides into ventral dorsolateral somite or dermatomyotome. Contraction of skeletal muscle is controlled by large motor nerve fibers of the alpha neuron located in the anterior horn of the spinal cord and motor nuclei of the brain. Only a few residual satellite myoblasts are present in the mature muscle that are able to play a role in the repair and regeneration.

Soft tissue > Uncertain differentiation > CIC-DUX4 fusion tumor
by Borislav A. Alexiev, M.D., Lawrence J. Jennings, M.D., Ph.D.
Topic summary: Undifferentiated round cell sarcoma with capicua-double homeobox 4 (CIC-DUX4) gene fusion. Aggressive sarcoma arising predominantly in soft tissues of children and young adults. MYC amplification in majority of cases. Metastatic disease may be present at initial presentation. Tissue sampling is the gold standard for a definitive diagnosis. Patients treated with neoadjuvant chemotherapy showed an inferior survival compared to patients managed by surgery first.

Stains & molecular markers > SMAD4 / DPC4
by Xiaoyan Liao, M.D., Ph.D., Dongwei Zhang, M.D., Ph.D.
Topic summary: One of the SMAD family of transcription factor proteins, encoded by SMAD4 gene located on chromosome 18q21.1. Immunohistochemical staining for SMAD4 showing loss of nuclear stain is practically a surrogate for SMAD4 genetic mutation. Once in the nucleus, the complex of SMAD4 and 2 R-SMADs binds to DNA and regulates the expression of different genes depending on the cellular context. Nuclear stain if SMAD4 protein intact. Loss of SMAD4 nuclear expression combining with other immunomarkers can be used to determine tumor origin in cases of metastasis of unknown primary.

15 October 2020: Textbook Updates

We have posted updates of the following topics:

Breast > Inflammatory > Lymphocytic / diabetic mastitis
by Kristen E. Muller, D.O.
Topic summary: Histologic triad of keloidal type fibrosis, lymphocytic inflammation and epithelioid myofibroblasts. Young to middle aged women presenting with breast mass(es). Associated with insulin dependent diabetes (type I > II), autoimmune disorders and endocrine disorders. Surgical excision (partial mastectomy, mastectomy) an option if symptomatic, especially if multiple and bilateral masses present.

Kidney nontumor > Glomerular disease > Obesity related glomerulopathy > Obesity related glomerulopathy
by Alireza Samiei, M.D., Jonathan E. Zuckerman, M.D., Ph.D.
Topic summary: Glomerulomegaly with or without accompanying focal segmental glomerulosclerosis occurring in the setting of obesity with or without the metabolic syndrome. Hypertrophied glomeruli that fill the microscopic visual field at 40x objective lens. 46% of patients have class 1 or class 2 obesity and 54% have class 3 obesity. Treatment includes weight loss, renin angiotensin system blockade and bariatric surgery.

Liver & intrahepatic bile ducts > Other malignancies > Epithelioid hemangioendothelioma
by Tom Liang, M.D., Shefali Chopra, M.D.
Topic summary: A malignant vascular tumor composed of epithelioid cells within a distinctive myxohyaline stroma. Mostly affects middle aged adults (30 – 50 years); rare in children. Multifocal involvement of both left and right hepatic lobes seen in up to 87% of patients. Histological features do not reliably predict outcome but increased cellularity and necrosis may be poor prognostic factors.

Lymphoma & related disorders > Mature B cell neoplasms > Small B cell lymphomas with a circulating component > Hairy cell leukemia
by Buthaina Al-Maashari, M.D., Dietrich Werner, M.D.
Topic summary: Rare indolent lymphoproliferative neoplasm of B cells with a distinct clinical presentation that includes peripheral blood cytopenias, splenomegaly and a minority peripheral blood population of rare circulating neoplastic cells with hair-like cytoplasmic projections. Immunophenotype positive for CD11c, CD19, CD20 bright, CD22 bright, CD25, CD103, CD123 and CD305 (LAIR). Common sites of involvement: bone marrow, peripheral blood and spleen. Not curative; asymptomatic patients usually do not require treatment.

Ovary > Other nonneoplastic > Endometriosis
by Lisa Han, M.D., Rochelle Garcia, M.D., Aurelia Busca, M.D., Ph.D., Carlos Parra-Herran, M.D.
Topic summary: Presence of endometrial tissue outside of endometrium and myometrium, consisting of both endometrial glands and stroma. Ectopically located endometrial tissue consisting of both endometrial type glands and stroma. Retrograde menstruation theory: endometrial lining cells travel backwards through fallopian tubes during menses to reach peritoneal cavity, proliferate and cause chronic inflammation with formation of adhesions. Pain treated with NSAIDs, hormonal contraceptives, GnRH analogues and aromatase inhibitors.

12 October 2020: Textbook Updates

We have posted updates of the following topics:

Gallbladder & extrahepatic bile ducts > Gallbladder benign > Intracholecystic papillary neoplasm
by Gokce Askan, M.D., Olca Basturk, M.D.
Topic summary: Intracholecystic papillary neoplasm (ICPN) is a grossly visible, mass forming, noninvasive epithelial neoplasm arising in the mucosa and projecting into the lumen of the gallbladder. Microscopically reveals papillary, tubular or tubulopapillary growth patterns. More common in the fundus and body of the gallbladder. ICPN associated invasive carcinomas are relatively indolent neoplasms with significantly better prognosis compared with conventional (pancreatobiliary type) gallbladder carcinomas. Treated primarily by surgical resection.

Kidney nontumor > Glomerular diseasenontumor > Diabetic renal diseasenontumor > Diabetic kidney disease
by Khaled A. Murshed, M.D., Noheir M. Taha, M.B.B.Ch., M.D., Mohammed Akhtar, M.D.
Topic summary: Morphologic structural change in the kidney induced by longstanding hyperglycemia manifested as relentless matrix expansion. Characterized by mesangial matrix expansion and diffuse thickening of glomerular, tubular and Bowman capsule basement membranes. Highly susceptible ethnic groups: African Americans, Native Americans and Hispanics. Diagnosis is usually established on kidney biopsy. Strict glycemic control is the mainstay of therapy for both type 1 and type 2 diabetes mellitus.

Lymphoma & related disorders > Mature T/NK cell disorders > Aggressive NK/T cell disorders > Extranodal NK / T cell lymphoma, nasal type
by Mario L. Marques-Piubelli, M.D., Carlos A. Torres-Cabala, M.D., Roberto N. Miranda, M.D.
Topic summary: Aggressive and predominantly extranodal lymphoma of NK / T cell origin characterized by angiotropism and angiodestruction, necrosis and association with Epstein-Barr virus (EBV). Rare: 0.2% of all non-Hodgkin lymphomas and 1 – 2% of all NK / T cell lymphomas. Mainly nasal presentation (65 – 85%) in nasopharynx, paranasal sinuses and orbit, regardless of the dissemination to other sites. Diagnosis is commonly difficult, particularly when atypia is not readily apparent or when only limited viable cells are identified. Treatment includes chemotherapy, radiation therapy and autologous and allogeneic HSCT.

Lymphoma & related disorders > Extranodal organ specific lymphoma > Primary CNS lymphoma
by Lena Young, D.O., Elizabeth Courville, M.D.
Topic summary: Rare aggressive large B cell lymphoma occurring predominantly in elderly individuals, with an overall poorer prognosis than systemic diffuse large B cell lymphoma. Occurs first in the brain, eye, spinal cord or leptomeninges, without systemic involvement and not arising in the setting of immunodeficiency. Accounts for < 1% of all non-Hodgkin lymphoma cases and 2 – 3% of all CNS tumors. Majority involve the supratentorial space, with the posterior fossa and spinal cord less frequently involved. High dose methotrexate based regimen is the first line induction therapy.

Soft tissue > Uncertain differentiation > Extrarenal rhabdoid tumor
by Qurratulain Chundriger, M.B.B.S., Nasir Ud Din, M.B.B.S.
Topic summary: Heterogeneous group of neoplasms unified by the presence of globular cytoplasmic inclusions, vesicular nuclei with prominent nucleoli and aggressive behavior. Abundant eosinophilic cytoplasm (due to hyaline globular inclusions of intermediate filaments) with eccentric vesicular nuclei and prominent nucleoli. Genuine rhabdoid tumors exclusively belong to the pediatric age group and are very rare. No definite chemotherapy regimen is available; some cases report successful therapy using alkaloids, platinum agents and combinations of chemotherapy, surgery and radiation.

5 October 2020: Textbook Updates

We have posted updates of the following topics:

Breast > Fibroepithelial tumors > Fibroadenomatoid change
by Melissa Alexander, M.D., Ph.D.
Topic summary: Benign, often incidental finding in a background of fibrocystic changes. Proliferation of intralobular stroma with the formation of stromal nodularity that often appears to blend in with the surrounding breast tissue. Also known as fibroadenomatous change, fibroadenomatoid hyperplasia, fibroadenomatoid mastopathy, fibroadenomatosis, sclerosing lobular hyperplasia. No treatment required.

Cervix > Cytology > Bethesda system
by Rachel Jug, M.B.B.Ch., B.A.O., Sarah M. Bean, M.D.
Topic summary: Framework for consistent interlaboratory terminology for the reporting of cervicovaginal cytology specimens. Interpretations / results include the general categories of negative for intraepithelial lesion or malignancy (NILM), epithelial cell abnormalities and other malignancies. Coexistent squamous and glandular lesions are not uncommon due to similar etiology driving the majority of cases (high risk HPV) or adenocarcinomas may show partial squamous differentiation. Management options include return to routine screening, 1 year or 3 year surveillance, colposcopy or treatment corresponding to a risk stratum.

Liver & intrahepatic bile ducts > Developmental anomalies / cysts > Von Meyenburg complex
by Upasana Joneja, M.D.
Topic summary: Ductal plate malformation of the liver characterized by dilated interanastomosing bile duct structures in collagenized stroma that results from failure of involution of excess embryologic remnants. Common, incidental, small (usually < 0.5 cm), subcapsular or periportal, nodular or cystic lesions; multiple or single. Common incidental finding in liver surgical specimens and autopsies. Benign lesions that require no treatment.

Mandible & maxilla > Other benign tumors / tumor-like conditions > Dentinogenic ghost cell tumor
by Frederic Carr Jewett III, D.O., Brenda L. Nelson, D.D.S., M.S.
Topic summary: Benign, locally aggressive, solid odontogenic neoplasm of maxilla and mandible (up to 73% recur). Solid neoplasms with islands of odontogenic and ameloblastoma-like epithelium. Patients frequently present with asymptomatic swelling of the jaw. High rates of recurrence with simple enucleation (up to 73%). Treatment includes simple enucleation or radical resection.

Skin nonmelanocytic tumor > Adnexal tumors > Sweat gland derived (apocrine & eccrine glands) > Papillary eccrine adenoma
by Masoud Asgari, M.D., Sheng Chen, M.D., Ph.D.
Topic summary: A cutaneous glandular neoplasm, eccrine or apocrine in origin. Solitary nodule, mostly in lower extremity of young black women. Considerable overlap with apocrine tubular adenoma; may be part of the same spectrum. Poorly understood; may be associated with nevus sebaceus. Excellent prognosis; no recurrence following simple conservative complete excision.

28 September 2020: Textbook Updates

We have posted updates of the following topics:

Gallbladder & extrahepatic bile ducts > General > WHO classification
by Raul S. Gonzalez, M.D.
Topic summary: WHO classification of tumors of the gallbladder and extrahepatic bile ducts. Currently on 5th edition, published in 2019. Based on histologic appearance, not molecular characteristics.

Lymphoma & related disorders > General > WHO classification-GI hematolymphoid tumors
by Raul S. Gonzalez, M.D.
Topic summary: WHO classification of hematolymphoid tumors of the digestive system. Hematolymphoid tumors occurring with some frequency in the digestive system. First provided in the Digestive System Tumors, 5th edition, published in 2019.

Pancreas > General > WHO classification
by Raul S. Gonzalez, M.D.
Topic summary: WHO classification of tumors of the pancreas. Currently on 5th edition, published in 2019. Based on histologic appearance, not molecular characteristics.

Stains & molecular markers > Alpha-1 antitrypsin
by Monica Abdelmalak, M.D., Avani Pendse, M.D., Ph.D.
Topic summary: Inhibits neutrophil elastase that causes tissue damage and maintains protease / antiprotease balance in the lung. Intracytoplasmic globules in hepatocytes, preferentially in zone 1 near the portal tracts; can be patchy. Sometimes abbreviated AAT or A1AT. May be difficult to visualize in neonates, who may show finely granular cytoplasmic staining. Used by pathologists to diagnose alpha-1 antitrypsin deficiency in the appropriate clinical context.

Stains & molecular markers > LEF1
by Alessandra C. Schmitt, M.D.
Topic summary: Transcription factor for B and T cells and is involved in the Wnt / CTNNB1 pathway which regulates normal development of airway submucosal glands, mammary glands, teeth and adnexal structures. Helpful when used as a panel. Positive LEF1 weighs against diagnosis of adenoid cystic carcinoma in the setting of basaloid salivary gland neoplasm fine needle aspiration. Focal staining with peripheral accentuation possible in basal cell adenoma and pleomorphic adenoma.

24 September 2020: Textbook Updates

We have posted updates of the following topics:

Breast > Infectious > Cystic neutrophilic granulomatous mastitis
by Jessie M. Wu, M.B.Ch.B., Gulisa Turashvili, M.D., Ph.D.
Topic summary: Inflammatory process of the breast usually due to Corynebacterium species. Most patients are women, parous or currently pregnant. Rare, with at least 141 cases reported since 2002. Most commonly painful breast mass, nipple inversion or sinus formation. Microscopic examination and Gram stain with or without microbiologic culture.

Mandible & maxilla > Benign mesenchymal odontogenic tumors > Cemento-osseous dysplasia
by Nadim M. Islam, D.D.S., B.D.S.
Topic summary: Cemento-osseous dysplasia is a benign fibro-osseous lesion of the jaws. Diagnosis is dependent on clinical, gross description, radiologic and pathologic correlation. Periapical cemento-osseous dysplasia and florid cemento-osseous dysplasia: middle aged females of African descent. Usually asymptomatic, noted as an incidental radiographic finding. Requires no treatment, especially for asymptomatic lesions.

Microbiology & parasitology > Fungi: molds > Dematiaceous
by Alison Burkett, M.D., Sawanan Saitornuang, B.S., Sixto M. Leal, Jr., M.D., Ph.D.
Topic summary: Heterogeneous molds characterized by dark pigmentation of hyphae. Organisms present in soil with worldwide distribution. Systemic or disseminated, especially in immunocompromised hosts. Phaeohyphomycotic cyst: well circumscribed subcutaneous nodule with pigmented hyphae. No standardized treatment; however, itraconazole, voriconazole and posaconazole have been used successfully.

Skin nonmelanocytic tumor > Adnexal tumors > Sweat gland derived (apocrine & eccrine glands) > Cylindroma
by Mary Dick, M.D., Poonam Sharma, M.B.B.S.
Topic summary: Benign tumor with debated origin from eccrine sweat glands or hair follicles. Autosomal dominant, multiple tumors of children / teenagers that may also involve trunk and extremities. Features of cylindroma and eccrine spiradenoma. Typically, solitary exophytic painless tumors. Treatment for cylindromas with CYLD mutations or tumors that are disfiguring or uncomfortable is with surgical excision.

Soft tissue > General > Histology-blood vessels
by Norbert Sule, M.D., Ph.D.
Topic summary: The circulatory system facilitates the continuous movement of the body fluid including the blood and the lymph. Development of the vascular system begins in the yolk sac of the embryo with the formation of hemangioblasts, which differentiate into hematopoietic cells and angioblasts, a mesoderm derived precursor of endothelial cells. Endothelial cells: cells are joined by tight, adherens or gap junctions; numerous pinocytotic vesicles, cytoplasmic microfilaments, microvilli, continuous basal lamina and Weibel-Palade bodies (membrane bound organelle which contains von Willebrand factor).

21 September 2020: Textbook Updates

We have posted updates of the following topics:

Anus & perianal area > General > WHO classification
by Raul S. Gonzalez, M.D.
Topic summary: WHO classification of tumors of the anal canal. Currently on 5th edition, published in 2019. Based on histologic appearance, not molecular characteristics.

Lymph nodes & spleen, nonlymphoid > Lymph nodes-infectious / parasitic disorders > Mycobacteria – atypical / other than TB or leprosy
by Ahmed Alrajjal, M.D., Ali Gabali, M.D., Ph.D.
Topic summary: Common cause of granulomatous lymphadenitis in immunocompetent children and immunocompromised adults. Unilateral anterior neck lymph nodes in children (2 – 5 years) and immunocompromised adults. Children ages 2 – 5 are most susceptible. Newly infected macrophages can exit the primary granuloma and establish secondary granuloma in distal tissue.

Lymphoma & related disorders > Mature B cell neoplasms > Small B cell lymphomas with a circulating component > Hairy cell leukemia variant
by Pallavi Khattar, M.D., Puneet Bedi, M.D., Julie Teruya-Feldstein, M.D.
Topic summary: Rare B cell chronic lymphoproliferative disorder. Prolymphocytic variant of hairy cell leukemia. Mainly spleen, bone marrow and peripheral blood. Requires constellation of clinical features, peripheral blood smear, bone marrow, immunophenotyping and molecular studies. Median survival 9 years with only 15% survival over 15 years.

Mandible & maxilla > Odontogenic cysts > Orthokeratinized odontogenic cyst
by Nasir Ud Din, M.B.B.S.
Topic summary: A benign developmental odontogenic cyst, mostly unilocular, with a fibrous tissue wall lined predominantly or entirely by orthokeratinized stratified squamous epithelium. Cystic bone lesion in mandible or maxilla with compatible radiological features.Previously called orthokeratinized variant of odontogenic keratocyst (OKC) (no longer recommended to use by WHO). Requires correlation of orthopantomogram (OPG) findings with histological features.

Pancreas > Pancreatitis > PRSS1 hereditary pancreatitis
by Susan Shyu, M.D., Aatur D. Singhi, M.D., Ph.D.
Topic summary: Autosomal dominant disorder caused by mutations of serine protease 1 (PRSS1), also known as the cationic trypsinogen gene, characterized by progressive irreversible lipomatous atrophy of the pancreatic parenchyma leading to pancreatic insufficiency. Increased risk of pancreatic cancer. Familial pancreatitis, hereditary chronic pancreatitis, autosomal dominant hereditary pancreatitis, recurrent or relapsing acute or chronic pancreatitis. Management is the same as for sporadic disease.

17 September 2020: Textbook Updates

We have posted updates of the following topics:

Bone marrow neoplastic > Bone marrow – neoplastic myeloid > Recurrent genetic abnormalities > AML (megakaryoblastic) with t(1;22)(p13.3;q13.1)
by Hans Magne Hamnvåg, M.D., Kamran M. Mirza, M.D., Ph.D.
Topic summary: Rare type of acute myeloid leukemia (megakaryoblastic) with a megakaryocytic phenotype (AMLK). Occurs most commonly in infants and young children (aged ≤ 3 years) without Down syndrome. Postulated normal counterpart: myeloid progenitor cell with predominant megakaryocytic differentiation. Majority of cases present with marked hepatosplenomegaly. Mixture of small and large megakaryoblasts may be found in the bone marrow and peripheral blood together with more undifferentiated blast cells with high N:C ratio.

Breast > Other carcinoma subtypes, WHO classified > Micropapillary
by Ruhani Sardana, M.B.B.S., Kamaljeet Singh, M.D.
Topic summary: Micropapillary carcinoma is characterized by pseudopapillary, tubular and morular epithelial structures with inside out growth pattern characterized by reverse polarity of cells. Pure micropapillary carcinoma is rare, 0.9 – 2% of all breast cancers; often admixed with other histologic subtypes. Almost 90% present as a palpable mass. Tufts of cells arranged in pseudopapillae, hollow tubules and morula that are surrounded by empty clear spaces formed by fibrocollagenous stroma.

Heart > Benign tumors / other nonneoplastic > Papillary fibroelastoma
by Ryan Kendziora, M.D., Melanie C. Bois, M.D.
Topic summary: Papillary fibroelastoma is a benign papillary growth of endocardium and avascular fibroelastic tissue. Benign behavior but may result in morbidity / mortality from downstream (thrombo) embolization. May arise on any endocardial lined surface (e.g. valves, chamber walls). Imaging is the most classic means of diagnosis. Excellent prognosis with surgical removal.

Transfusion medicine > Immunotherapy > Rh immune globulin
by Evelyn M. Potochny, D.O., Melissa R. George, D.O.
Topic summary: Rh (Rhesus) immune globulin (RhIG) is a derivative of pooled human plasma manufactured by cold ethanol fractionation to prevent alloimmunization (antibody formation) to RhD antigen following exposure, such as through a blood transfusion or pregnancy. In cases of fetal maternal hemorrhage, a fetal screen is indicated and if positive, flow cytometry or Kleihauer-Betke testing is performed to estimate appropriate number of additional vials of RhIG. Rh immune globulin is given to RhD negative women. Pregnant women who are considered D variants (weak or partial D) may be capable of forming an anti-D.

Uterus > Carcinoma > Endometrioid carcinoma
by Aarti Sharma, M.D., Ricardo R. Lastra, M.D.
Topic summary: Endometrial endometrioid carcinoma arises in younger women and is considered to be estrogen dependent with a defined precursor lesion. Endometrial endometrioid adenocarcinoma refers to a tumor arising from the endometrium, which resembles proliferative type endometrial glands. Mean age is sixth decade, with a range from the third to ninth decades. Most common site is the uterine corpus – endometrium, endometrial polyps or adenomyosis. Increased endogenous or exogenous estrogen, unopposed by progesterone.

We have added new images to the topics:

Stomach > Other nonneoplastic lesions > Heterotopic pancreas / pancreatic acinar metaplasia
gross and microscopic images contributed by Dennis J. Chute, M.D.

10 September 2020: Textbook Updates

We have posted updates of the following topics:

Hematology > Hemoglobinopathies > Hemoglobin C disease
by Daniel D. Mais, M.D.
Topic summary: Homozygosity for C (βC) allele of hemoglobin beta chain (HBB) gene. Diagnosed by electrophoresis or high performance liquid chromatography (HPLC). Prevalence of hemoglobin C gene in Black Americans approximately 2%. Has poor solubility, leading to precipitation in red blood cells. No treatment required. Genetic counseling may be indicated to address risk of compound heterozygosity in offspring.

Skin nontumor > General > Histology
by Mariantonieta Tirado, M.D.
Topic summary: Largest organ of the body with a weight of approximately 5 kg and an area close to 2 m². Melanosomes: spherical membrane bound particle with periodic longitudinal concentric lamellae.

Small intestine & ampulla > Benign tumors / tumor-like conditions > Lymphangiectasia
by Gagandeep Kaur, M.D., Monika Vyas, M.D.
Topic summary: Dilated small intestinal lacteals, which may be primary or secondary. Lymphagiectasia can be primary or secondary; primary intestinal lymphangiectasia is more common in children, though in rare cases it can present in early adulthood and is usually associated with malabsorption. Primarily affects children (generally diagnosed before 3 years of age) and young adults but may be diagnosed later in adults. To date, the etiology of primary intestinal lymphangiectasia is unknown.

Stomach > Infections > Helicobacter pylori
by Tanner Storozuk, M.D., Namrata Setia, M.D.
Topic summary: Helicobacter pylori gastritis is the most frequent and treatable form of gastritis, affecting more than half the world’s population. Most patients are asymptomatic or have mild self limited dyspeptic symptoms but some present with abdominal pain with or without peptic ulcer disease. More than half the world’s population is infected. Asymptomatic or mild self limited dyspeptic symptoms with transient hypochlorhydria – acute gastritis.

Transfusion medicine > Transfusion reactions > Febrile nonhemolytic
by Hanqiao (Ciao) Zheng, M.D., Ph.D., Reggie Thomasson, M.S., M.D.
Topic summary: Acute reaction that occurs during or within 4 hours of cessation of blood product transfusion. Common acute transfusion reaction, roughly 0.62% of transfusions. Detect with direct antiglobulin test (DAT) / Coombs test. Due to pyrogenic / inflammatory cytokines (e.g. IL1β, IL6, TNFα) released from activated leukocytes, commonly from donor during product storage. Reaction workup negative (clerical check, direct antiglobulin test, visual hemolysis inspection, ABO confirmation).

3 September 2020: Textbook Updates

We have posted updated reviews of the following topics:

Cervix > Squamous cell carcinoma > Squamous cell carcinoma and variants
by Gulisa Turashvili, M.D., Ph.D.
Topic summary: An invasive epithelial tumor composed of neoplastic cells with varying degrees of squamous differentiation. Nearly all cases are associated with high risk human papillomavirus (HPV) and arise from a precursor lesion, high grade squamous intraepithelial lesion (HSIL). Second most common type of cancer (17.8 per 100,000 women) and cause of cancer mortality (9.8 per 100,000 women) worldwide. Treatment includes conization or loop electrosurgical excision procedure for low stage (IA) tumors.

Nasal cavity, paranasal sinuses, nasopharynx > Benign tumors > Salivary gland anlage tumor
by Josephine K. Dermawan, M.D., Ph.D., Laura O. Rabinowitz, M.D.
Topic summary: Extremely rare, benign, congenital, biphasic tumor with mixed epithelial and mesenchymal elements of midline nasopharynx. Presents within first 6 weeks of life with a midline nasopharyngeal mass and symptoms related to airway / nasal. Congenital / developmental anomaly, likely represents hamartoma of minor salivary gland origin. Treatment involves simple surgical excision.

Stains & molecular markers > HER2 stomach/GE junction
by Numbereye Numbere, M.B.B.S., Aaron R. Huber, D.O.
Topic summary: HER2 testing identifies tumors that may respond to HER2 targeted therapy with trastuzumab. Receptor overexpression or gene amplification identifies tumors that might respond to HER2 targeted therapy with trastuzumab. Protein has variably been termed CD340, HER-2, HER2 and HER2 / neu. In many studies, HER2 overexpression in untreated gastric and gastroesophageal cancers has been found to be associated with more aggressive biologic behavior, shorter survival, serosal invasion, higher stage and higher rates of lymph node and distant organ metastasis.

Thyroid gland > Papillary thyroid carcinoma > Main variants > Tall cell
by Livia Florianova, M.D., M.Sc., Marc Pusztaszeri, M.D.
Topic summary: Papillary thyroid carcinoma (PTC) variant characterized by presence of ≥ 30% of tall cells (2 – 3 times taller than wide) with abundant granular eosinophilic (oncocytic-like) cytoplasm and the typical nuclear changes of PTC. Usually requires more aggressive treatment and closer disease surveillance. Exceedingly rare at other sites, e.g. ectopic thyroid tissue in thyroglossal duct. Persistent or recurrent disease can be monitored by serum thyroglobulin.

Transfusion medicine > Transfusion therapy > Cryoprecipitate use
by Hope Hastings, M.D., Jose A. Cancelas, M.D., Ph.D.
Topic summary: Cryoprecipitate is the insoluble byproduct of fresh frozen plasma (FFP) when thawed at 1 – 6 oC and contains concentrated amounts of fibrinogen (factor I), factor VIII, factor XIII, von Willebrand factor and fibronectin. Primary use of cryoprecipitate is treatment of patients with acquired fibrinogen deficiency, with a goal of at least 100 – 150 mg/dL in the bleeding patient. Fibrinogen levels of more than 50 mg/dL are considered sufficient to support physiologic hemostasis; adequate transfusion should be given to maintain the fibrinogen level above 100 mg/dL.