We have posted updates of the following topics:
Bone marrow neoplastic > Bone marrow – neoplastic myeloid > Recurrent genetic abnormalities > AML with inv(16)(p13.1;q22) or t(16;16)(p13.1;q22)by Shuchi Zinzuwadia, B.S., Angeli Mittal, M.D., Maryam F. Raouf, M.D., Rita Gupta, M.D. , Ameet R. Kini, M.D., Ph.D.
Topic summary: Inv(16)(p13.1;q22) or t(16;16)(p13.1;q22) results in the formation of an abnormal core binding factor beta subunit / myosin heavy chain 11 (CBFB-MYH11) fusion gene. Most cases show myelomonocytic differentiation with presence of abnormal eosinophils. 7% of AMLs in the pediatric age group. Most cases present with involvement of the blood and bone marrow. Diagnosis is based on a combination of morphology, flow cytometry, conventional cytogenetics, real time PCR and FISH analysis. Treatment involves induction chemotherapy with 3 days of anthracycline and 7 days of cytarabine (7+3). Overall prognosis is good compared to other AMLs.
Cervix > General > WHO classification
by Carlos Parra-Herran, M.D.
Topic summary: Updated classification of tumors of the cervix as per the World Health Organization classification of tumors of female reproductive organs, 5th edition (2020). Preinvasive glandular lesions, as well as invasive squamous and glandular lesions, are now classified in 2 main categories: HPV associated and HPV independent. HPV independent squamous cell carcinomas are rare but are included since they may be more aggressive than the more common HPV associated lesions. HPV associated adenocarcinomas can be classified using terminology from previous classification; however, they need to be distinguished from HPV independent tumors. HPV independent adenocarcinomas are most frequently of the gastric type; other distinct types include clear cell and mesonephric.
Oral cavity & oropharynx > Oropharynx squamous cell carcinoma > HPV negative
by Katherine Hulme, M.B.Ch.B., Ruta Gupta, M.B.B.S., M.D.
Topic summary: A subset of oropharyngeal squamous cell carcinomas that are not associated with high risk human papillomaviruses (HPV). Oropharynx includes the soft palate, uvula, palatine tonsils, posterior third (base) of the tongue and posterior wall of the pharynx. Mean age 61 years. Invasive lesion is typically preceded by progressively severe dysplasia. Most commonly caused by chewing or smoking tobacco, heavy alcohol use and poor oral hygiene. Diagnosis is based on clinical examination with biopsy of primary lesion. Treatment involves surgical resection of the primary along with ipsilateral or bilateral elective neck dissection. Adjuvant radiotherapy and platinum based chemotherapy.
Oral cavity & oropharynx > Potentially malignant & dysplasia > Leukoplakia
by Ivan J. Stojanov, D.M.D., M.M.Sc.
Topic summary: Hyperkeratotic (white) plaque / patch of mucosa exhibiting clonality and representing precursor lesion to squamous cell carcinoma. Approximately 40% of leukoplakias exhibit keratinizing dysplasia; the remainder are characterized by hyperkeratosis alone. Worldwide prevalence approximately 0.5%. Associated with smoking / smokeless tobacco, alcohol and areca nut (betel quid) use. Biopsy required for diagnosis and risk stratification. Surgical excision results in 3 times reduction in risk of malignant transformation. Close clinical observation may be appropriate for extensive leukoplakia or patients with comorbidities.
Salivary glands > Primary salivary gland neoplasms > Benign > Sclerosing polycystic adenoma
by Kim A. Ely, M.D.
Topic summary: Rare salivary gland disorder, first described in 1996. Resembles fibrocystic changes and sclerosing adenosis of the breast. Occurs over a wide age range (9 – 84 years); mean: 40 years. Occurs in the parotid gland (around 70%), occasional examples in the submandibular glands and oral cavity. Originally believed to be a reactive, nonneoplastic process resembling fibrocystic changes of the breast but evidence suggests it is likely neoplastic. Slow growing mass, may have pain or altered sensation. Diagnosis best made on histologic examination of excisional material. Treatment involves complete, conservative local resection followed by prolonged surveillance.
