4 April 2023: Image Quiz #105

Authors: Sunitha Shankaralingappa, M.B.B.S., M.D., D.M., Arundhathi Shankaralingappa, M.B.B.S., M.D.

A 62 year old woman underwent a core needle biopsy for a lump, 1.2 cm in diameter, detected on mammogram. The histopathology pattern is shown below. Which statement is true regarding this tumor?

Select an answer:

A. Has an increased chance of distant metastasis

B. Lesion is high grade

C. Strong and diffuse positivity for ER

D. Strongly positive (3+) for HER2 by IHC

See the answer

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17 August 2022: Case of the Month #518

Thanks to Drs. Mariel Molina Nunez and Julie Jorns, Medical College of Wisconsin, Milwaukee, Wisconsin, USA, for contributing this case and discussion and to Dr. Kristen Muller, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA for reviewing the discussion.

Clinical history:

A postmenopausal woman, on a screening mammogram, was found to have a 15 mm mass in the lower inner quadrant of the left breast. Breast ultrasound revealed a 1.7 cm complex solid and cystic mass.

Click here for the case

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.

9 August 2022: Image Quiz #88

Authors: Zena Jameel, M.D., Marilin Rosa, M.D.

Which of the following is a relevant feature of invasive papillary carcinoma of the breast?

Select an answer:

A. Commonly encountered breast tumor

B. Graded according to nuclear size

C. May mimic metastases from other organs

D. Myoepithelial cells at the periphery

E. Positive for Napsin A and PAX8

See the answer

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20 May 2022: Weekly Roundup #89

What’s new on PathologyOutlines.com this week?

1. Curing Cancer Network

Dr. Tran has written a new article for our Curing Cancer Network primer, entitled “Summary of worldwide incidence of cancers caused by infectious pathogens in 2018.” Read it here.

2. What’s New in Breast Pathology?

We have posted our most recent What’s New in Breast Pathology newsletter by Kristen Muller, D.O., Julie M. Jorns, M.D. and Gary Tozbikian, M.D. Make sure to subscribe to all our future What’s New in Pathology e-newsletters on this page.

3. Pathology Focus Groups

Are you a pathologist who is interested in participating in pathology focus groups? If so, make sure your Directory profile indicates “yes” to the focus group question. See here to add a Directory profile and email Directory@PathologyOutlines.com or visit pathologyoutlines.com/directorychange.html to make any changes.

How do focus groups work?  When a company contacts us with a specific request, we select all pathologists listed in the Directory that meet this criteria and send them the details – how / when to participate, stipends (if any), other terms, etc. You can accept or decline. We don’t give the companies your email (although you may if you accept). 

Companies typically then set up a 30 – 60 minute virtual meeting with you and any other pathologists that have volunteered to participate.

18 May 2022: Case of the Month #515

Thanks to Dr. Ayesha Farooq, Mayo Clinic, Rochester, Minnesota, USA and Dr. Julie Jorns, Medical College of Wisconsin, Milwaukee, Wisconsin, USA for contributing this case and discussion and to Dr. Gary Tozbikian, Ohio State University, Columbus, Ohio, USA for reviewing the discussion.

Clinical history:

A young woman presented to the emergency department with right breast pain, erythema and drainage. She recently had her bilateral nipples pierced and developed a small sore near the border of her right nipple that progressed to an open wound. She developed fevers, chills and nausea. She had a prior history of breast reduction complicated by skin infection but no personal or family history of breast disease.

Click here for the case

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, click here.

2 May 2022: Textbook Updates

We have posted updates of the following topics:

Stains & CD markers > CD68
by Chiara Caraccio, B.A., Frido Bruehl, M.D.
Topic summary: Lysosomal glycoprotein that is present in a variety of normal and neoplastic cell types and is primarily used as a marker to identify histiocytes and histiocytic tumors. KP1 and PGM1 are the 2 most commonly used antibody clones, with PGM1 being the slightly more specific marker. Dot-like granular or diffuse cytoplasmic stain. Histiocytic malignancies are usually CD68 positive. Elevated numbers of CD68 positive tumor associated macrophages (TAMs) correlate with negative survival outcomes in many cancer types.

Breast > General > Grossing
by Anthony J. Guidi, M.D.
Topic summary: Sampling breast resection specimens with documented, suspected or potential malignancy. Essential clinical history: indication, prior biopsy findings, imaging findings, presence of prior biopsy clips / localization devices, treatment history. Carefully ink specimens and blot dry to avoid inking artifact. Sample all lesions and all margins (perpendicular, not tangential / en face, margins). Some types: excisions with palpable masses, excisions for lesions localized with imaging studies, cavity / shave margins performed simultaneously with primary excisions, re-excision specimens, mastectomy specimens.

Stains & CD markers > Transducin-like enhancer of split 1 (TLE1)
by Anna Dusenbery, M.D., Mark R. Wick, M.D.
Topic summary: TLE1 (transducin-like enhancer of split 1) is one member of a family of genes. TLE1 immunohistochemical staining is most commonly used when synovial sarcoma is a diagnostic consideration. Reasonably sensitive and specific for synovial sarcoma within the appropriate context; this includes its monophasic, biphasic and poorly differentiated forms. Intense, diffuse nuclear staining (with only rare background or cytoplasmic labeling) is typically seen in synovial sarcoma, including in all of its histologic subtypes. Within specific tumor types, there is limited literature available regarding the prognostic significance of TLE1 gene expression levels or immunohistochemical staining.

Stains & CD markers > SOX11
by Anna Dusenbery, M.D., Mark R. Wick, M.D.
Topic summary: SRY (sex determining region Y) related high mobility group (HMG) box 11 (SOX11) is a member of the SOX gene family; specifically a member of the SOXC group of transcription factors. Generally considered to be a marker for mantle cell lymphoma (MCL), although a subset of SOX11 negative MCL cases have also been described. Involved in regulating embryonic development and progenitor / stem cell behavior, including neurogenesis and skeletogenesis. Nuclear expression can aid in the diagnosis of MCL, especially in cyclin D1 negative cases. The prognostic value of SOX11 status in MCL is debated and may vary depending on the clinical presentation (i.e., conventional versus leukemic nonnodal MCL).

 Frido Bruehl, M.D.

Anthony J. Guidi, M.D.

Mark R. Wick, M.D.

Anna Dusenbery, M.D.

1 March 2022: Image Quiz #77

Authors: Carissa LaBoy, M.D., Kalliopi P. Siziopikou, M.D., Ph.D.

What is the most likely hormone receptor profile of the following breast lesion?

Select an answer:

A. ER+, PR+, HER2-

B. ER-, PR-, HER2-

C. ER+, PR+, HER2+

D. ER-, PR+, HER2+

See the answer

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

28 December 2021: Image Quiz #72

Author: Gary Tozbikian, M.D.

A 25 year old woman presents with a 3 cm breast mass. An ultrasound guided biopsy shows a fibroepithelial lesion. Which histologic feature is consistent with a diagnosis of fibroadenoma?

Select an answer:

A. Circumscribed borders

B. Marked stromal cytologic atypia

C. Stromal condensation around glandular structures

D. Stromal mitotic activity (7 – 8/10 high power fields)

E. Stromal overgrowth

See the answer

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

15 September 2021: Pathologists’ Directory Highlights

If you are a pathologist, your colleagues will soon be looking you up regularly on our new Worldwide Directory of Pathologists because they saw your name connected with a surgical pathology report, a topic on our website, a paper, a talk, a committee or otherwise. If you have not yet signed up for the Directory, please click here and fill out our short survey to do so. If you’ve already signed up, please spread the word to your colleagues who have not signed up. Email Dr. Pernick at Nat@PathologyOutlines.com with any questions.

This week we are highlighting image contributions of our Breast Pathology Deputy Editor and Editorial Board members, in the Directory and otherwise.

Favorite Images

Breast perilobular hemangioma (bird) (Courtesy of Julie M. Jorns, M.D.)

Benign breast duct (Courtesy of Kristen E. Muller, D.O.)

PDL1 SP142: positive (IC: 5%), expression observed in both immune cell (lower right) and tumor cell component (upper left). Immune cell staining is punctate and granular. Tumor cell staining pattern is linear, circumferential.(Courtesy of Gary Tozbikian, M.D.)