7 June 2023: Strategic Plan to Substantially Reduce Cancer Deaths

We have revised our strategic plan to substantially reduce cancer deaths at pathologyoutlines.com/ccnstrategicplan.html. Our plan is summarized at natpernick.substack.com/p/our-strategic-plan-to-substantially and below:

This strategic plan, created in February 2021, aims to substantially reduce cancer deaths in the United States from 600,000 projected for 2023 to 100,000 per year. After 50 years of fighting the War on Cancer, we need to “dare greatly” and to determine our desired cancer related goals and how we might attain them, even if many steps are unknown. Thus, our strategic plan differs from “challenge goals” that are based on “applying known interventions broadly and equitably”.

This strategic plan is essentially a management plan to use all of the treatment and public health approaches possible that may impact cancer deaths. It is not sensible to focus on a “silver bullet” or other miracle treatment. Success will likely arise from combinations of an expanding number of modest improvements.

Our specific strategies are:

  1. Treatment should target as many individual biologic networks as possible that contribute to the cancer itself, directly or indirectly. In addition, our public policies must optimize all aspects of our healthcare system that affect cancer deaths.
  2. Successful treatment will likely require combinations of combinations of therapy, each attacking a different aspect of the malignant process.
  3. We should initially focus on aggressive cancers that cause the most cancer deaths.
  4. We should reduce cancer deaths that occur shortly after diagnosis.
  5. We should incorporate therapeutic strategies that delay cancer deaths.
  6. We should focus on reducing age related cancer deaths.
  7. We should attempt to enroll every patient in a clinical trial so physicians can learn and improve.
  8. We should make our prevention programs more effective.
  9. We should develop better screening programs for cancers with high mortality.

The full strategic plan with references is at pathologyoutlines.com/ccnstrategicplan.html.

Our blog version of this essay is at natpernick.substack.com/p/our-strategic-plan-to-substantially.

Email Dr. Pernick your comments to Nat@PathologyOutlines.com.

6 June 2023: Meet the Editor – Farres Obeidin, M.D.

Please introduce yourself.

Hi there! I’m a current attending pathologist at Northwestern University, Feinberg School of Medicine in Chicago. My main area of expertise is bone and soft tissue pathology, but I also sign out other surgical specialties, including head and neck and thoracic. Originally from Georgia, I decided to brave the arctic chill and move up to Northwestern for residency. My bone and soft tissue fellowship was completed at UCLA in 2020, and since then, I’ve moved back because the West Coast was just a little too nice. 🙂

Why did you become a pathologist?

I entered medical school relatively undifferentiated. I knew I wanted to have a stronger understanding of the underlying disease process, but I wasn’t sure where that would most apply. Going into my clinical years, I realized that I really enjoyed almost all of my rotations, which I thought would make my decision harder! But ultimately, I found that the underlying thread of interest in each of those specialties was the pathology that underpins the practice of medicine. I took a few path rotations from there and was absolutely hooked. I guess I’m also just a very visual and tactile learner, and pathology really fits my style.

What do you like most about being a pathologist?

I love so much of what I do, but if I had to pick one thing that I find most interesting, I would say it’s that moment when you’re sitting down at the scope with a resident, watching them puzzle through what they’re seeing. I get the chance to see where their mindset is at and help them to better organize the information in their head so they can have a deeper understanding of it. And next time, they’ll explain it to their co-residents or to the clinical team! That discussion and interplay at the microscope or grossing bench make it all worth it for me.

What is special about your subspecialty?

Bone and soft tissue pathology has seen a bit of a surge in popularity lately because of the growth of molecular classifications, which give the specialty a complex and rewarding day-to-day experience. It’s a lot of fun to learn about and make these extremely complicated diagnoses.

But I would say the most special thing to me about BST is that it takes a very big-picture approach to understand rather than just looking at a histology slide in isolation. I’m not a detail-oriented person (shocking, I know), and with BST, you can’t just focus on the small, high-power details. At high power, everything in BST looks “wrong”. I like that the focus is architectural and that the radiology and clinical information is often a requirement for making diagnoses.

How does your typical day go?

A typical day on my service is pretty variable, so I don’t always know what to expect when I get into work. I usually sign out with the fellows or residents for about an hour or two in the morning and the same for follow-ups in the afternoons. Throughout the day, I can expect calls from the gross room when there are complex cases and fairly consistent consultations from my colleagues. Because BST is often the wastebasket service, we’ll often be the final step after all other options have been exhausted. Depending on the day, the rest of the time is spent in prep for the next tumor board, meetings for our medical education committee that I chair, or research.

What is the most memorable experience you’ve had at work?

It’s tough to pick one particular experience or case since we get so many rare and fascinating cases on this service. Here’s one example that I found really memorable though. A consult was sent in to us for a patient with a history of breast cancer, which they treated with a mastectomy. Years later she presents with a mass in her rib underlying the previous mastectomy site, all signs pointing to recurrence. It was diffusely pankeratin positive with some GATA3 positivity, and the outside favored diagnosis was recurrent carcinoma. Looking through it, a few vacuolated cells and some vague vasoformative features popped out on my review, although the cytology was quite bland and had a prominent myxoid background. Some vascular markers confirmed and we made the diagnosis of an epithelioid hemangioma in the bone. Just reminds me to stay on my toes when it comes to IHC staining in mesenchymal tumors.

What most surprised you about being a pathologist?

The amount of talking, haha. I thought I’d just be hiding behind the scope, but I’m almost always in constant discussion with my colleagues and clinicians about the care of these patients.

Is there anything you know now that you wish you had known when you began working as a pathologist?

To myself as a resident, I would say, “Don’t be afraid of mistakes, don’t be afraid of being wrong, don’t be afraid of learning.”

What do you think you would be doing if you weren’t doing this?

Honestly, not sure. Maybe art? I think it’d be fun to be in animation. That or a career counselor at a university. I like trying to work out with someone what their goals are and how to achieve them.

Could you say a few words about your association with PathologyOutlines.com?

I started contributing to PathologyOutlines.com back in residency through the recommendation of a friend who was an author for the site at the time. I enjoyed the process, and throughout residency, I wrote more topics and participated in the Fellow / Resident Advisory Board. Recently, I was invited to the Editorial Board as a bone and soft tissue content editor. Check out the new update on molecular analysis in BST for my latest work!

You can follow Dr. Obeidin on Twitter / Twitch @anisapling.

To sign up for future Spotlight On e-newsletters and more, visit our Newsletters page and type your email in the box.

Note: This interview was originally emailed to our e-newsletter subscribers on May 4, 2023.

2 June 2023: Weekly Roundup #122

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

1. Worldwide Directory of Pathologists Update

Congratulations to our Image Contest winners! Check out the winning images here.

We are excited about how our Worldwide Directory of Pathologists will help pathologists learn about each other and work better together. However, we are also concerned about keeping information as private as possible despite our free, no registration website. Towards this end, we prohibit anyone from copying or compiling Directory data to create their own databases or the equivalent and will take action against any violators. We intentionally do not provide lists of complete data for any searches and have restricted emails to show up only one at a time on an individual profile, not in any lists. Let us know if you have any comments or questions at Comments@PathologyOutlines.com.

2. Dr. Pernick’s Essay on HPV Related Cancers

Dr. Pernick’s new post on human papillomavirus (HPV) related cancers is important because almost every unvaccinated person who is sexually active will get HPV at some time in their life. Read it at natpernick.substack.com/p/human-papillomavirus-hpv-related and email any comments or questions to Nat@PathologyOutlines.com.

Electron microscopy of HPV type 16 capsid protein (Image sourceWikipedia page)

3. How Do Cancer Metastases Arise?

Dr. Pernick has posted Part 1 of a 4 part series, from a pathologist’s perspective, at pathologyoutlines.com/ccnblog/howmetastasesarise1.html. He welcomes your questions and comments at Nat@PathologyOutlines.com but unfortunately cannot provide medical advice.

31 May 2023: Image Quiz #109

Authors: David Suster, M.D.Alexander Craig Mackinnon, Jr., M.D., Ph.D.

A 62 year old patient presented with a 9 cm anterior mediastinal mass (see image below). What would help differentiate this lesion from a metastasis from a head and neck lymphoepithelioma-like thymic carcinoma?

Select an answer:

A. Detailed clinical history

B. Immunohistochemistry for p63 and cytokeratins

C. In situ hybridization for EBER

D. In situ hybridization for HPV

E. Next generation sequencing

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

Note: This image quiz was originally emailed to our e-newsletter subscribers on May 30, 2023.

22 May 2023: Case of the Month #527

Thanks to Dr. Raul Gonzalez, Emory University School of Medicine, Atlanta, Georgia, USA for contributing this case and discussion and to Dr. Naziheh Assarzadegan, University of Florida, Gainesville, Florida, USA for reviewing the discussion.

Clinical history:

A 45 year old man presents to a gastroenterologist complaining of constipation and rectal bleeding. A single ulcerated rectal lesion is found on colonoscopy and is biopsied.

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 May 18, 2023.

19 May 2023: Weekly Roundup #121

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

1. Tip of the Month – May 2023

We have posted a YouTube video highlighting our comment / feedback features for the May 2023 edition of PathologyOutlines.com’s Tip of the Month. View it at https://youtube.com/shorts/xp1kqW5JJlw.

2. Worldwide Directory of Pathologists Update

We have updated the Directory name search. It now has a left hand match against either the first or last name. This means it will search from the beginning of either of these names. It will not find letters in the middle of these names or in a middle name.

3. PathologyOutlines.com Topics

How can we tell if a topic is available or if it has been assigned? “(Pending)” in the title just means there is no content yet, so that doesn’t tell anything about whether the topic has been assigned. To see if a topic is assigned, view the topic and the “Last staff update” section. If it says “(update in progress)”, then the topic was assigned. If not, it has not been assigned; however, topics are assigned daily, so we need to check again before we assign a topic to you.

4. Diffuse Large B Cell Lymphoma Essay

Rep. Jamie Raskin has been diagnosed with and treated for diffuse large B cell lymphoma. Dr. Pernick’s essay about this disease, from a pathologist’s perspective, is posted at

Malignant cells that are pleomorphic (i.e., they differ from each other), a feature of high grade cancers.

16 May 2023: Image Quiz #108

Authors: Tiffany Sheganoski, D.O.Aaron R. Huber, D.O.

A 48 year old woman with rheumatoid arthritis presents with dyspepsia and bloating. Endoscopy shows erythematous mucosa. Histopathology is significant for serrated gastric pits, foveolar hyperplasia, paucity of mucin in surface epithelial cells and ectatic superficial capillaries (see image). What is the diagnosis?

Select an answer:

A. Gastric antral vascular ectasia

B. H. pylori gastritis

C. Low grade dysplasia

D. Reactive gastropathy

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

5 May 2023: Cookies / Privacy on PathologyOutlines.com

To comply with European Union privacy regulations (as detailed in the General Data Protection Regulation – GDPR) as well as requirements in California and Virginia, PathologyOutlines.com has engaged the services of CookieBot to ensure anyone in these jurisdictions who desires to opt-out of browser cookies may do so.

Only visitors located in affected locations will see this banner at the bottom of their screens:

Site visitors should be aware that denying cookies will disable certain aspects of the PathologyOutlines.com website and you may not receive the full user experience on some pages.

Additionally, our ability to accurately track the number of visitors to our textbook would suffer. We use these numbers to attract advertisers, keeping PathologyOutlines.com free for your use. 

You can view our Privacy page here: pathologyoutlines.com/privacypolicy.html

2 May 2023: Image Quiz #107

Author: Maria Tretiakova, M.D., Ph.D.

Which of the following is true about this encapsulated multilocular cystic renal tumor with clear cell morphology?

Select an answer:

A. Does not require surgical treatment

B. Frequently progresses to conventional clear cell RCC

C. Necrosis, solid growth and invasion are not allowed for diagnosis

D. Often associated with acquired cystic kidney disease

E. VHL mutation or 3p loss are highly unlikely

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

28 April 2023: Weekly Roundup #120

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

1. Worldwide Directory of Pathologists Image Contest

This is your last chance to vote for your favorite Directory image by April 30th! Watch this video to learn more about the contest and vote here: surveymonkey.com/r/favorite_image

2. New Deputy Editor-in-Chief for GI Pathology

We are pleased to announce the appointment of Aaron R. Huber, D.O. as our new Deputy Editor-in-Chief for Gastrointestinal Pathology. Dr. Huber completed his D.O. degree at the University of Health Sciences-College of Osteopathic Medicine in Kansas City, Missouri. He completed his residency in anatomic and clinical pathology at the Naval Medical Center San Diego in San Diego, California and his fellowship in gastrointestinal and hepatobiliary pathology at the University of Rochester Medical Center in Rochester, New York. He is currently the Director of the Surgical Pathology Unit and Co-Director of the Gastrointestinal and Hepatobiliary Pathology Fellowship at the University of Rochester Medical Center.

3. New Informatics Topic

We are currently working on strengthening our Informatics, digital & computational pathology chapter. Check out our new topic on Automated assessment of cytology specimens by Drs. Joshua Levy and Louis Vaickus.

4. New Podcast

Dr. Pernick was recently featured in a podcast with Aleksandra Zuraw, D.V.M., Ph.D. of Digital Pathology Place. Listen at https://bit.ly/PathologyOutlinesComInc or watch here: