8 December 2022: Textbook Updates

We have posted updates of the following topics:

CNS & pituitary tumors > Gliomas, glioneuronal tumors, and neuronal tumors > Neuronal and mixed neuronal-glial tumors > Dysembryoplastic neuroepithelial tumor
by Chris Dampier, M.D., P.J. Cimino, M.D., Ph.D.
Topic summary: Cortex based glioneuronal neoplasm that is often located in the mesial temporal lobe of adolescents and young adults and associated with medically refractory epilepsy, usually with activating mutations of FGFR1, CNS WHO grade 1. M:F = 1.2:1; 5.9% of epilepsy surgery cases. Most common sites: temporal lobe, especially medial (67%), frontal lobe (16%), other cortex (16.%). Presents clinically with intractable seizures; radiographically is sharply demarcated, nodular, cortical lesion(s) without edema or enhancement. Treatment: surgical resection; radiation or chemotherapy is generally not applicable. Benign lesion with low rate of recurrence after resection; rare case reports of malignant transformation.

CNS nontumor > Toxic and metabolic disorders > Wernicke-Korsakoff syndrome
by Palgun Nisarga, M.D., Kymberly A. Gyure, M.D.
Topic summary: Acute and chronic neuropsychiatric condition secondary to thiamine (vitamin B1) deficiency. Wernicke encephalopathy (WE): short lived and severe condition. Korsakoff syndrome (KS): a disproportionate impairment in memory relative to other features of cognition that is chronic, long lasting and debilitating; usually follows or accompanies Wernicke encephalopathy. Inability to utilize glucose due to deficiency of thiamine, a cofactor for 3 enzymatic processes. < 1 – 3% in autopsies of the general population; increases in cases of alcohol abuse and alcohol related death (12.5% and 29 – 59%, respectively). ~20% mortality rate (without treatment); ~80% of individuals who survive Wernicke encephalopathy will develop Korsakoff syndrome (without treatment). Treatment: parenteral thiamine administration, given before or with intravenous glucose. 

Heart > Systemic conditions > Sarcoidosis
by Matthew G.K. Charles, B.A., Carolyn Glass, M.D., Ph.D.
Topic summary: Cardiac sarcoidosis is a type of infiltrative cardiomyopathy and a potential cause of heart failure. Nonnecrotizing granulomata are classic; presents with symptoms of cardiac dysfunction (arrhythmias, conduction disturbances). Electrocardiogram (ECG): PR lengthening, T wave abnormalities, Q waves; echocardiograms: decreased left ventricular ejection fraction, ventricular aneurysm, regional wall motion abnormality, basal septal thinning. Prognosis is poor if complicated by heart failure; in the U.S., 13 – 25% of deaths from sarcoidosis have been attributed to cardiac sarcoidosis; 5 year estimate of event free survival is 70 – 80%. Management largely involves treatment of underlying cardiac dysfunction and prevention of cardiovascular disease.

Informatics, digital & computational pathology > Fluorescence microscopy > Virtual staining
by Joshua Levy, Ph.D., Louis Vaickus, M.D., Ph.D.
Topic summary: Virtual staining (VS) is the conversion of an H&E (or other common standard stain, e.g., PAS) digital whole slide image (WSI) to a digital prediction of a special stain (e.g., trichrome, CK AE1 / AE3 IHC); the prediction relies on the detection of morphological features (if they exist) of the source WSI, which inform the distribution of a special stain. Virtual staining technologies leverage artificial neural networks (ANN) to generate synthetic images of tissue slides with predictions of the results of special staining reagents (chemical and IHC). Advantage: ameliorates laboratory infrastructure burdens through quick access to reflexive tissue staining at virtually no cost. Disadvantage: generative adversarial networks (GAN) may hallucinate histological features that look real but are incorrectly placed or should not be present.

Placenta > Nonneoplastic placental conditions and abnormalities > Placental findings in specific conditions > Toxemia of pregnancy (preeclampsia and eclampsia)
by Khaldoon Aljerian, M.D., M.H.Sc.
Topic summary: Preeclampsia is a pregnancy specific hypertensive disorder diagnosed by the presence of 3 main signs: hypertension, proteinuria and edema. Thrombocytopenia, recalcitrant epigastric pain, progressive renal dysfunction, pulmonary edema; some cerebral and ophthalmic manifestations could be evident. Prevalent within young pregnant women with a tendency to develop hypertension. Eclampsia: preeclampsia + convulsions; ~40% of women with eclampsia do not demonstrate conspicuous preceding symptoms before convulsions start. Treatment: delivery of baby and placenta (most effective); corticosteroids (promote lung maturation of baby); antihypertensives (treat hypertension); anticonvulsants (magnesium sulfate, treat convulsions).

7 December 2022: Prices for Ads on PathologyOutlines.com

Below are the prices for advertising jobs, fellowships and conferences (as well as banners, e-blasts and social media posts) on PathologyOutlines.com starting 1 January 2023. If you are looking to advertise, contact us at Ads@PathologyOutlines.com. We typically respond within 1 business day.

Jobs: $1,000 for a highlighted listing; $550 for a Related position

Fellowships: $750 for a highlighted listing; $450 for a one line listing

Conferences: $750 for a highlighted listing; $450 for a one line listing

Monthly rates for Banners: 

Premium E-Blast: $2,400 per deployment 

Standard E-Blast: $1,200 per deployment 

Social media posts: $1,200 per deployment 

5 December 2022: Textbook Updates

We have posted updates of the following topics:

Anus & perianal area > Premalignant > Squamous dysplasia
by Irene Y. Chen, M.D., Xiaoyan Liao, M.D., Ph.D.
Topic summary: Noninvasive neoplastic proliferation of the anal squamous epithelium with cytologic and architectural abnormalities; associated with human papillomavirus (HPV) infection. Most cases are incidental findings in benign minor surgical specimens such as hemorrhoids. Immunodeficient (HIV and non-HIV immunosuppression) patients are at increased risk and present at a younger age; additional risk factors: anoreceptive intercourse, coinfection with other sexually transmitted diseases and cigarette smoking. High resolution anoscopy with tissue biopsy is the gold standard for diagnosis. Most LSIL will regress in immunocompetent patients; recurrence rate of HSIL after wide local excision ranges between 9 – 63%. 

Bladder, ureter & renal pelvis > Cystitis > Polypoid / papillary cystitis
by Maria Carolina Beeter, M.D., Y. Albert Yeh, M.D., Ph.D.
Topic summary: Exophytic polypoid to papillary structures characterized histologically by normal or mildly hyperplastic urothelium overlying a congested, chronically inflamed and edematous stroma. Dense fibrosis with chronic inflammation in older polypoid cystitis. No association with age, gender or geographic condition; M:F = 3:1. Occurs in more than 80% of patients with indwelling catheters. Catheter associated lesions regress within 6 months of removal of the indwelling catheter; in non-catheter associated lesions, no recurrence is seen in 6 months to 2 years after initial diagnosis. No increased risk for progression to carcinoma. Treatment: removal of the irritating agent.

Breast > Other carcinoma subtypes, WHO classified > Tall cell carcinoma with reverse polarity
by Grace Kwon, M.D., Ph.D., Gahie Nam, M.D., Kamaljeet Singh, M.D.
Topic summary: Rare subtype of papillary carcinoma of breast that histologically resembles tall cell variant of papillary thyroid carcinoma and frequently shows distinct IDH2 R172 hotspot mutations. Solid nodules of columnar epithelial cells, many with thin fibrovascular cores, leading to solid papillary architecture. Pathophysiology still unclear. Typically presents as a mammographic or palpable breast mass. Women of postmenopausal age; median age of 64 (range: 39 – 89). Favorable prognosis with rare reports (2 cases) of metastases to lymph nodes and bone. Surgical excision is mainstay treatment; lack of evidence for sentinel lymph node procedure, radiation or systemic therapy.

Kidney tumor > Adult renal cell carcinoma – rare > Multilocular cystic renal neoplasm of low malignant potential
by Maria Tretiakova, M.D., Ph.D.
Topic summary: Indolent neoplasm composed of low grade clear cells with pure multicystic architecture. Clear cells lining with low grade nuclei (WHO / ISUP grade 1 or 2). Median age: 54 (range: 18 – 84 years), M > F (~2:1). VHL gene alterations or 3p loss in 25 – 77% of cases. 90% are discovered incidentally, on radiology for other purposes. Diagnosis should not be made in needle biopsy alone because of limited sampling. Excellent prognosis with no reports of progression, metastases or cancer related death in multiple case series when diagnosed on strict criteria; recurrence reported in rare cases. Treatment: resection, preferably nephron sparing surgery.

Penis & scrotum > General > WHO classification
by Debra L. Zynger, M.D.
Topic summary: WHO classification of tumors of the urinary and male genital tumors; currently on 5th edition, published in 2022. Terminology for squamous cell carcinoma groupings has been changed from non-HPV related to HPV independent and from HPV related to HPV associated. Papillary basaloid carcinoma, warty basaloid carcinoma, pseudohyperplastic carcinoma, pseudoglandular carcinoma, carcinoma cuniculatum and mixed squamous cell carcinoma have been removed as distinct subtypes. Pseudohyperplastic and pseudoglandular patterns are now a part of squamous cell carcinoma, usual type. Carcinoma cuniculatum pattern is now a part of verrucous carcinoma.

2 December 2022: Weekly Roundup #106

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

1. WHO HAEM5 and ICC-B cell Topic

We have a great topic on the new HemePath classification systems, WHO HAEM5 and ICC-B cell, written by Pichayut Nithagon, M.D. and Patricia Tsang, M.D., M.B.A.

2. Curing Cancer Network

Dr. Pernick has updated his strategic plan to substantially reduce cancer deaths at pathologyoutlines.com/ccnstrategicplan.html. This is part of our Curing Cancer Network, which can be followed on LinkedIn and Twitter.

We offer grants of up to $25,000 for research directly related to our strategic plan. The next grant deadline is 15 January 2023. See pathologyoutlines.com/ccngrants.html for more information.

3. Contact Information Update

Will you be changing institutions, or has your contact information changed recently? If so, we can update your Directory profile, any E-blasts you are receiving and your author profile (if applicable). Email us at Directory@PathologyOutlines.com with your updated information and any old emails you are no longer using.

4. Copyright

Many of you want to share great images from our website; however, we usually own the copyrights to these images. Unless you are the contributor, be aware of limitations in your use. For more information, please see pathologyoutlines.com/copyrightinfo.html and https://pathologyoutlinesblog.wordpress.com/2022/11/11/11-november-2022-weekly-roundup-104/

While you can post images from our website for educational purposes to social media, you should also post a link to the source. This is the polite thing to do and also acknowledges who contributed the image as well as provides background information about the disease entity in the image. In general, you cannot post images from our website onto other websites.

1 December 2022: Textbook Updates

We have posted updates of the following topics:

Cervix > Inflammatory / infectious > HPV overview
by Maryam Aghighi, M.D., Teresa M. Darragh, M.D.
Topic summary: Human papillomavirus (HPV) infection of the cervix can cause low grade squamous intraepithelial lesion, cancer precursors (high grade squamous intraepithelial lesion, adenocarcinoma in situ) or cancer (squamous cell carcinoma or adenocarcinoma). Sites: cervix; other anogenital sites (anus, vagina, vulva, perianus, penis) and oropharynx are also possible. Classified as a member of the Papovaviridae family, nonenveloped virus, 55 nm in diameter. Overall, 5 year disease free survival in patients with cervical cancer. Prevention: vaccination against high risk HPV types.

Kidney tumor > Adult renal cell carcinoma – rare > Primary thyroid-like follicular
by Daniel Anderson, M.D., M.B.A., Maria Tretiakova, M.D., Ph.D.
Topic summary: Rare kidney tumor that morphologically mimics well differentiated thyroid follicular neoplasms. Extremely uncommon (~40 cases reported). Predominance in women (2:1). Age range between 10 – 83 years, with mean age of 41 – 44.5 years. Majority appear to have low malignant potential. Treatment: partial or radical nephrectomy.

Lung > General > Biopsies
by Phillip McMullen, M.D., Ph.D.
Topic summary: Precise histologic classification of lung cancer is essential due to advances in tailored therapies for specific subtypes. Diagnosis in small biopsies utilizes morphologic features and judicial immunohistochemical / special stain evaluation in cases with ambiguous morphologies. Up to 90% of lung cancers are directly attributable to smoking. Identification of targetable mutations has led to overall decrease in NSCLC mortality disproportionate to the decrease in incidence.

Soft tissue > Vascular > Benign > Cystic / cavernous lymphangioma
by Laura Warmke, M.D., Jeanne Meis, M.D.
Topic summary: Benign vascular lesion composed of a collection of dilated lymphatic channels that may be superficial, deep or diffusely involve organ systems. Immunohistochemical expression of CD31 and D2-40. Primarily occurs in children and young adults; majority presents at birth or within first couple of years (~90%). Benign lesions with excellent prognosis; recurrence is high with incomplete removal. Surgical resection may be indicated for large, symptomatic lesions.

Transfusion medicine > Immunotherapy > Monoclonal antibody therapy
by Mrigender Singh Virk, M.D.
Topic summary: Monoclonal antibodies (mAbs) are novel therapeutics that are used in the management of hematologic malignancies, solid tumors, immune disorders, infections and several other conditions. Anti-CD38 and anti-CD47 therapies are currently the most widely used mAbs that cause serology interference and blood banks should have protocols established to manage these patients. Mild allergic infusion reactions are common and can be managed by pausing infusion, slowing infusion and with diphenhydramine. Monoclonal antibodies are usually administered parenterally but can also be administered intravenously, subcutaneously or intramuscularly, depending on the exact therapy and formulation.

29 November 2022: Image Quiz #96

Authors: Juwairiya Arshi, M.B.B.S.Aaron R. Huber, D.O.

Which histological feature is most common in celiac disease?

Select an answer:

A. Crypt hyperplasia

B. Granulomas

C. Intraepithelial lymphocytosis

D. Mucosal eosinophilia

E. Villous atrophy

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

28 November 2022: Textbook Updates

We have posted updates of the following topics:

Coagulation > General > Physiology
by Zoya Gurm, B.S., Zaher K. Otrock, M.D., Ph.D.
Topic summary: Hemostasis is a highly complex process of clot formation in response to blood vessel injury. Hemostasis can be categorized into 3 stages. During injury to vascular endothelium, the first response to prevent blood loss is vasoconstriction which activates endothelial cells. Intrinsic pathway is comprised of factors VIII, IX, XI, XII, prekallikrein and high molecular weight kininogen. Extrinsic pathway is comprised of tissue factor and factor VII. Both the intrinsic and extrinsic pathways of coagulation lead to the activation of factor X.

Coagulation > Hereditary bleeding disorders > von Willebrand disease and testing
by Fatima Aldarweesh, M.D.
Topic summary: Most common inherited bleeding disorder, affecting 1 – 2% of the total population with no gender preference. Gene for von Willebrand factor (vWF) is located on chromosome 12. Symptoms are similar to a platelet function defect (epistaxis, easy bruising, bleeding, menorrhagia). Preliminary testing is recommended as starting points; these include complete blood count (CBC), prothrombin time (PT) and activated partial thromboplastin time aPTT. Repeat testing is often recommended because vWF and factor VIII become elevated during minor illnesses, injury, stress, pregnancy, estrogen use, other acute phase reactions or in newborns.

Kidney tumor > Benign adult tumors > Clear cell papillary renal cell tumor
by Daniel L. Shen, M.D., Gregory MacLennan, M.D.
Topic summary: Indolent tumor with clear glycogen rich cytoplasm, luminal nuclear polarization, inconspicuous nucleoli and with papillary architecture with fibrovascular stroma. Renamed in WHO 5th edition to reflect indolent behavior (previously was designated as a renal cell carcinoma). 3 – 4% of all renal tumors, mean age of 58.2 years. Usually initially identified by radiographic imaging (CT or ultrasound). Prognostic factors: unknown at this time. Radical nephrectomy or nephron sparing surgery, including partial nephrectomy or cryoablation therapy.

Soft tissue > Fibroblastic / myofibroblastic > Myositis ossificans
by Ghazi Zafar, M.B.B.S., Nasir Ud Din, M.B.B.S.
Topic summary: Benign, solitary, localized, self limiting, ossifying soft tissue mass comprising cellular fibrous tissue with metaplastic bone, usually following mechanical trauma. Benign, reactive, ossifying soft tissue mass lesion, associated with trauma and characterized by zonal pattern. Usually physically active young males (second and third decade) with rapid growth of mass; 60 – 75% have history of trauma in prior 4 – 6 weeks. Benign process with excellent prognosis. Treatment: surgical excision.

Testis & paratestis > General > WHO classification
by Debra L. Zynger, M.D.
Topic summary: WHO classification of tumors of the urinary and male genital tumors. Germ cell tumors derived from germ cell neoplasia in situ: teratoma with primitive neuroectodermal tumor (PNET) is now called teratoma with embryonic type neuroendocrine differentiation. Sex cord stromal tumors: signet ring pattern of Sertoli cell tumor is now listed as a separate tumor called signet ring stromal tumor. Myoid gonadal stromal tumor changed from a provisional entity to a confirmed entity. Paratesticular mesothelial tumors: well differentiated papillary mesothelioma was renamed well differentiated papillary mesothelial tumor.

21 November 2022: Textbook Updates

We have posted updates of the following topics:

Eye > Eyelid > Other tumors > Eyelid cysts
by J. Stephen Nix, M.D.
Topic summary: Benign cystic lesions of the eyelid, most of which are caused by blockages of ducts (hidrocystomas) or hair follicles (epidermal cyst) or are consequence of entrapped benign, embryologic tissue (dermoid cyst). Epidermal cysts are common, sporadic lesions that typically affect adults with a slight male predominance. Epidermal cysts typically present as solitary, subcutaneous nodules and keratinaceous contents may appear cheese-like. Diagnosis: histopathologic examination of excised tissue. Treatment: excision is usually curative.

Informatics, digital & computational pathology > Computational pathology > Computational pathology fundamentals & applications
by Yomna Amer, M.B.B.Ch., Anil Parwani, M.D., Ph.D., M.B.A.
Topic summary: Computational pathology is an approach to diagnosis that integrates data from numerous sources (pathology, molecular, radiology and clinical), using mathematical models to generate clinically applicable knowledge; it facilitates the best possible medical decision making by enhancing diagnostic accuracy and reduces cost by improving lab efficiency. Artificial intelligence (AI): a branch of computer science dealing with the simulation of human intelligent behavior in computers; the main goal of pathology AI is to analyze digital slide images via image analysis and machine learning. Digital pathology (virtual microscopy): utilization of microscopy and digital technology to obtain images using whole slide image scanners, analyze them using image viewers (usually computer monitors) and infer digital information.

Lymphoma & related disorders > General > WHO HAEM5 and ICC-B cell
by Pichayut Nithagon, M.D., Patricia Tsang, M.D., M.B.A.
Topic summary: 2 new classification systems for B cell lymphoid neoplasms have emerged in 2022: WHO 5th edition (WHO HAEM5); International Consensus Classification (ICC). Certain newly added categories are specific to only 1 classification system: newly included nonneoplastic tumor-like lesions in WHO HAEM5 include IgG4 related disease and 2 additional types of Castleman disease (unicentric and idiopathic multicentric). 

Ovary > Other nonneoplastic > Polycystic ovary disease
by Krisztina Lengyel, M.D., Krisztina Hanley, M.D.
Topic summary: Polycystic ovarian syndrome (PCOS) is a clinicopathologic syndrome comprising polycystic ovaries and characteristic clinical features. Most common cause of anovulatory infertility. Affects 4 – 12% of women in the U.S., usually of teenage or childbearing ages. Clinical symptoms: oligo or anovulation; androgen excess (hirsutism, acne). Treatment: lifestyle modifications, weight loss.

Skin melanocytic tumor > Melanocytic tumors on acral skin and nail apparatus > Acral nevus
by Gerardo Cazzato, M.D.
Topic summary: Melanocytic nevi on the skin of soles and palms, nail matrix or bed, knees and elbows. Rarely, acral nevi are precursors of melanoma. More common in individuals with higher constitutional pigmentation and many melanocytic nevi on the skin; F > M (2 – 3:1). Benign; rare progression to melanoma. Treatment: excision.

18 November 2022: Weekly Roundup #105

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

1. Stains and CD Markers

Adele has a great hit, ‘Rolling in the Deep‘, in which she sings, “We could have had it all”. But that is not true; life is about tradeoffs and we have to make the best deals or compromises that we can.

In that spirit, we are trimming the Stains & CD markers page to focus on those that are most popular or otherwise considered by our editors to be most important. We have removed some of the obscure / low traffic stains and we are no longer planning to update all CD markers. We have also put the low traffic / less important ones under CD markers – other, but we will not be updating them unless one of them becomes important.

Contact Nat@PathologyOutlines.com with any comments or questions.

2. Directory Image Contest

The Favorite Directory Image contest deadline has been extended to November 30, 2022. Visit pathologyoutlines.com/directorysignup.html to add a profile with your favorite image or pathologyoutlines.com/directorychange.html to add / change your favorite image on your existing profile.

The 3 winners will get gift cards of $250, $150 and $100 respectively and will be publicized on our website. Click here for more information.

Email Amal@PathologyOutlines.com with any questions. 

3. Website Header

We have rearranged our website’s headers to put the most important pages on the top line, which remains fixed as you scroll down.

17 November 2022: Textbook Updates

We have posted updates of the following topics:

Chemistry, toxicology & urinalysis > General chemistry > Metabolism > Hemoglobin A1C
by Archana Shetty, M.B.B.S., M.D.
Topic summary: Laboratory test used to evaluate a person’s glucose control. A standard of care (SOC) test for diagnosis and management of diabetes. Formed by the nonenzymatic condensation of the carbonyl group of glucose and the amino group at the N terminus of the beta chain of hemoglobin A inside the red blood cells, resulting in a labile aldimine or Schiff base (this reaction being reversible). Frequency of testing: at least 2 times a year in patients who are meeting treatment goals and have stable glycemic control.

Lymphoma & related disorders > Mature T/NK cell disorders > Cutaneous / soft tissue involvement > Primary cutaneous acral CD8+ lymphoproliferative disorder
by Busra Bacik Goksu, M.D., Carlos A. Murga-Zamalloa, M.D.
Topic summary: Rare indolent lymphoproliferative disorder characterized by slow growing papules or nodules in acral sites with a dermal infiltrate of CD8+ T lymphocytes. Typically occurs in adults older than 50 years, with a male predominance. Usually localized to the dermis in the ear. Recurrences are rare and are limited to the dermis. Treatment: surgical excision or radiotherapy.

Muscle & peripheral nerve nontumor > Metabolic myopathies > Glycogen storage diseases
by Truong Phan Xuan Nguyen, M.D., Ichizo Nishino, M.D., Ph.D.
Topic summary: Glycogen storage diseases (GSD) are inherited metabolic disorders of glycogen metabolism. There are 15 types and most of them are autosomal recessive, except for X linked GSD IXd, phosphoglycerate kinase deficiency. Rare; 1 per 20,000 – 43,000 live births. Infant onset is aggressive and can be fatal in some GSDs. Most treatments involve symptomatic management and surveillance.

Salivary glands > Cytology > Milan system > Nonneoplastic
by Jose Manuel Gutierrez Amezcua, M.D., Tamar C. Brandler, M.D., M.S.
Topic summary: Lacking cytomorphologic evidence of a neoplastic process. The Milan System for Reporting Salivary Gland Cytopathology provides a standardized system for reporting results. Estimated risk of malignancy (ROM) is expected to be low (~10%). Usual management involves clinical follow up with radiologic correlation. Sites: major salivary glands (parotid, submandibular, sublingual), less frequent in minor salivary glands.

Uterus > Smooth muscle tumors > Leiomyosarcoma
by Ashley Monsrud, M.D., Gulisa Turashvili, M.D., Ph.D.
Topic summary: Rare, malignant mesenchymal tumor derived from myometrial smooth muscle. Diagnostic triad: marked cytologic atypia, coagulative tumor cell necrosis and increased mitoses (mitotic count depends on subtype). Peak incidence is > 50 years old; range of 30 – 70 years. Additional prognostic measures include patient age, tumor size, mitotic rate and lymphovascular invasion. Surgical resection (hysterectomy) is standard treatment for patients with localized leiomyosarcoma: adjuvant chemotherapy for early stage disease is controversial.