7 September 2022: A Message from Dr. Pernick

In August 2001, I started PathologyOutlines.com because I believed that professional medical information should be free, easy to access and not require registration. At that time, there were not many sources of professional medical content that met these criteria.

I am pleased that beginning in 2026, academic journals will have to provide immediate access to papers that are publicly funded, which should be very useful in disseminating medical knowledge. See nytimes.com/2022/08/25/us/white-house-federally-funded-research-access.html for more information.

We encourage other businesses to find ways to disseminate important medical knowledge easily and without cost.

Nat Pernick, M.D., President and Founder
PathologyOutlines.com, Inc.
Email: Nat@PathologyOutlines.com

6 September 2022: Image Quiz #90

Authors: Absia Jabbar, M.D.Sonali Lanjewar, M.D., M.B.B.S.Raavi Gupta, M.D.

Exaggerated placental site (shown in the image below) is characterized by which of the following features?

Select an answer:

A. Absence of villi

B. Presence of necrosis and mitoses

C. Proliferation of chorionic type intermediate trophoblasts with invasion of myometrium

D. Proliferation of implantation type intermediate trophoblasts with invasion of myometrium

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

2 September 2022: Weekly Roundup #98

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

1. Pathology Crossword Puzzle

We have published a second pathology crossword puzzle, available at pathologyoutlines.com/crossword.html.

2. New Editorial Board Appointment for Gastrointestinal Pathology

Claudio Luchini, M.D., Ph.D.

Dr. Claudio Luchini was appointed to our Editorial Board for Gastrointestinal Pathology. Dr. Luchini is an Associate Professor of Pathology at University of Verona in Italy. He obtained his M.D. and Ph.D. at the University of Verona. In 2014, he attended the Indiana University School of Medicine as a research scholar. Then, in 2014 – 2015, he completed a research fellowship in Gastrointestinal and Pancreatic Pathology at Johns Hopkins in Baltimore. He has co-authored more than 200 scientific publications and contributions, mainly regarding gastrointestinal and pancreatic neoplasms.

3. Worldwide Directory of Pathologists

We now have 10,000 Directory profiles – do we have yours?

To check if you have a profile, visit pathologyoutlines.com/directory.

To add your profile, visit pathologyoutlines.com/directorysignup.html.

To edit your profile, visit pathologyoutlines.com/directorychange.html.

4. Cookies / Tracking

Our mission at PathologyOutlines.com is to serve the Pathology community and provide services that Pathologists like and find useful. Even though our sole revenue is from advertising, we are not focused on catering to marketing companies. Because of this, we do not publish expandable ads or ads that cannot be removed. We do not require registration and do not collect any personal information about users. We track website page views and banner clicks only, necessary for our ads to sell.

Consistent with our business model and ethics, we are working on eliminating Google tracking and the use of cookies altogether. To avoid the need for cookies, we are exploring other tracking software that counts page views and clicks but does not invade your privacy, either in the cloud or on your device. This is a new approach that may take time and resources to get implemented but it fits our mission.  We will keep you advised.

1 September 2022: Textbook Updates

We have posted updates of the following topics:

Bladder, ureter & renal pelvis > Urothelial neoplasms – noninvasive > Papillary urothelial neoplasm of low malignant potential
by Daniel Athanazio, M.D., Ph.D.
Topic summary: Neoplastic proliferation of the urothelium in a papillary configuration, with no invasion through the basement membrane. Epithelial lining of fibrovascular cores is thicker than normal urothelium. Strong male predominance (M:F = 5:1). This diagnostic category is justified because the recurrence and progression rates of papillary urothelial neoplasm of low malignant potential (PUNLMP) are expected to be higher than urothelial papilloma and lower than low grade noninvasive urothelial carcinoma. Treatment: transurethral resection with no need of further topical treatments.

Cytopathology > Cytopathology techniques > Automation
by Reid Wilkins, M.D., Abdallah Flaifel, M.D., Tamar C. Brandler, M.D., M.S.
Topic summary: Automation in cytopathology refers to the process of slide preparation, image acquisition and image analysis with identification of abnormalities by automated machinery in conjunction with cytologist review. Has mainly been implemented in gynecologic cytopathology with the development of automation systems that utilize liquid based cytologic processing. Advantages: increased productivity, cytotechnologist satisfaction. Effectiveness: MAVARIC trial conducted in England found significantly lower sensitivity of detection of cervical intraepithelial neoplasia grade II (CIN 2) and above (0.92) compared to manual screening; comparable rates of detecting CIN 2 and above.

Laboratory Administration & Management of Pathology Practices > Qualifying board topics > Quality assurance > Validation of reference intervals and reportable range
by Duy K. Doan, M.D., Lewis A. Hassell, M.D.
Topic summary: Reference intervals (RI) are defined as the central 95% of laboratory test results obtained from a healthy reference population. Nearly 80% of physicians’ medical decisions are based on information provided by laboratory reports. Direct approach to establishing reference intervals: subjects representing the reference population are selected and sampled and the specimens are analyzed to determine the reference intervals. Indirect approach: results from specimens collected for routine purposes are used to determine the reference intervals. Validation of reference interval is a study to establish that an assay works as intended.

Prostate gland & seminal vesicles > Atypical / intraductal lesions > HGPIN with adjacent atypical glands
by Aliaksandr Aksionau, M.D., Y. Albert Yeh, M.D., Ph.D.
Topic summary: High grade prostatic intraepithelial neoplasia (HGPIN) with small atypical glands present in adjacent stroma. Adjacent atypical glands stained positive (focal or patchy) on p63 or CK903 immunohistochemical stains. Incidence of HGPIN with adjacent atypical glands (2.5%) is lower than that of HGPIN alone (4.3%). More commonly arises in the peripheral zone of the prostate. Higher cancer detection rates: HGPIN alone (23%), ASAP (37%), HGPIN and ASAP (33%). No definitive treatment for ASAP and HGPIN.

Skin nonmelanocytic tumor > Cysts > Proliferating pilar tumor
by Colleen J. Beatty, M.D., Viktoryia Kazlouskaya, M.D., Ph.D.
Topic summary: Proliferating pilar tumor (PPT) is an uncommon neoplasm within the dermis or subcutis that arises from the isthmus region of the outer root sheath of the hair follicle. Histologically resembles a trichilemmal cyst but with central lobules of squamous proliferation and variable atypia and mitotic figures. Elderly women are most commonly affected (80% of cases arise in females). Nonscalp location, recent rapid growth, size > 5 cm and histologic features of extensive necrosis, high mitotic activity, poor circumscription with areas of invasion and cytologic atypia are all concerning for more aggressive or malignant behavior. Complete surgical excision, either via wide local excision or Mohs micrographic surgery.

30 August 2022: Worldwide Directory of Pathologists Image Contest

We are planning a Directory image contest to celebrate the great images that pathologists take. The 3 winners will get gift cards of $250, $150 and $100 respectively and will be publicized on our website.

The contest also promotes our Worldwide Directory of Pathologists, now with more than 10,000 pathologist profiles and with another 10,000 to be added each year. There is no cost to be in or to use the Directory and we plan to continue it for decades, which means you can confidently use the URL for your Directory profile in your email signature, social media, CV or website(s) indefinitely.

To be eligible for the contest and to vote, you must be a Pathologist with a Directory profile. See pathologyoutlines.com/directory to add or modify your profile. The deadline is September 30, 2022 to add an image to your profile for the contest.

Starting on October 1, 2022, our Editorial Board or others will screen the images and select the top 20 or so for the voting round. Voting is from November 1, 2022 through December 15, 2022.

More details will be forthcoming. For any comments or questions on having a Directory proflie, please email Directory@PathologyOutlines.com.

26 August 2022: Weekly Roundup #97

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

1. Tip of the Month – August 2022

We have posted a YouTube video highlighting the August 2022 PathologyOutlines.com Tip of the Month about website features. View it at https://youtu.be/5REDrg43Mjs.

2. New Editorial Board Appointment for Stains / Immunohistochemistry

Brandon Umphress, M.D.

Dr. Brandon Umphress is a recently appointed member of our Editorial Board, overseeing Stains / Immunohistochemistry. Dr. Umphress is currently an Assistant Professor at Indiana University School of Medicine and IU Health in Indianapolis, where he is both a Surgical Pathologist and board certified Dermatopathologist. Dr. Umphress obtained his medical degree at Indiana University and subsequently completed residency training in Anatomic and Clinical Pathology at Northwestern McGaw Medical Center in Chicago. He received specialized training in oncologic surgical pathology at Memorial Sloan Kettering Cancer Center in New York and further specialized in Dermatopathology at Indiana University, where he now practices full time.

3. Worldwide Directory of Pathologists

To increase the power of your online presence, we recommend that you link your name in your email signature, on social media and on your website to your Directory profile. We now have profiles for over 75% of U.S. & Canadian academic pathologists and we are happy to add more at pathologyoutlines.com/directorysignup.html. These profiles are free, can be easily updated and exist for the entire life of the pathologist. Contact us at Directory@PathologyOutlines.com with any questions.

25 August 2022: Textbook Updates

We have posted updates of the following topics:

Bladder, ureter & renal pelvis > Urothelial carcinoma – invasive > Micropapillary
by Timothy Isaac Miller, M.D., M.A., Maria Tretiakova, M.D., Ph.D.
Topic summary: Aggressive histologic subtype of urothelial carcinoma (UC) comprised of small papillary clusters of neoplastic cells within lacunae and without fibrovascular cores. If micropapillary urothelial carcinoma (MPUC) is seen on biopsy, it is highly associated with muscularis propria invasive disease. Some studies independently suggest a poorer prognosis than CUC; however, other studies show that this is likely because it is diagnosed at advanced stage, when controlling for pathologic stage, patients have similar outcomes. Early radial cystectomy (RC) may improve survival.

Cervix > Inflammatory / infectious > Trichomonas vaginalis
by Soumya Jaladi, M.B.B.S., Ziyan T. Salih, M.D.
Topic summary: Trichomonas vaginalis is a primitive eukaryotic organism, a parasitic protozoan that causes trichomoniasis, which is a sexually transmitted disease. Trichomoniasis is the most prevalent nonviral sexually transmitted infection in the United States, affecting an estimated 3.7 million persons. Mainly affects women from ages 16 – 35 years but can occur in postmenopausal women. People with trichomoniasis can pass the infection to others, even if they do not have symptoms. Patients and their sexual partners are treated with metronidazole or tinidazole.

Lung > Preinvasive > Atypical adenomatous hyperplasia
by Sherman Lin, Matthew J. Cecchini, M.D., Ph.D.
Topic summary: Atypical adenomatous hyperplasia (AAH) is a small, localized proliferation of atypical pneumocytes (usually ≤ 5 mm) that line intact alveolar spaces. Discrete from alveolar parenchyma with proliferation of atypical pneumocytes. Commonly seen in lung resections as an incidental finding; in some series, AAH has been reported in ≤ 30.2% of female patients undergoing a resection for adenocarcinoma. CT surveillance; frequency and duration dependent on size of nodule. Patients are cured upon resection.

Oral cavity & oropharynx > Soft tissue tumors & proliferations > Ectomesenchymal chondromyxoid tumor
by Molly Housley Smith, D.M.D.
Topic summary: Rare, benign soft tissue tumor with striking predilection for the anterior dorsal tongue. Fewer than 120 well documented cases have been reported. Histopathologically demonstrates a well defined, often multilobulated tumor with ovoid, round, fusiform or polygonal cells within a sometimes myxoid, chondromyxoid or mucoid background. Average age ~40 years. 5 cases (< 10% of reported cases with follow up information) are reported to have recurred. Treatment: conservative surgical excision is recommended.

Soft tissue > Adipose tissue tumors > Other benign lesions > Hibernoma
by Saba Anjum, M.B.B.S., Zoonish Ashfaq, M.B.B.S., Nasir Ud Din, M.B.B.S.
Topic summary: Rare, benign, adipocytic tumor composed of variable proportions of brown fat cells admixed with white adipose tissue. Benign tumor comprising multivacuolated eosinophilic granular fat cells with small, central normochromic nuclei. Usually present from 2 – 75 years. Prognosis is good with no significant potential for recurrence. Treatment: wide local excision with negative margins; for patients not fit for surgery, routine surveillance may be considered.

23 August 2022: Image Quiz #89

Authors: Ruhani Sardana, M.B.B.S.Anil Parwani, M.D., Ph.D., M.B.A.

Which technique is shown in the image below?

Select an answer:

A. Electron microscopy

B. Enzyme linked immunosorbent assay

C. Fluorescent in situ hybridization

D. Immunofluorescence

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

19 August 2022: Weekly Roundup #96

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

1. Anniversary Updates

PathologyOutlines.com is now starting its 22nd year. This year, we plan to accelerate our topic updates, add more Board Review style question features, expand our Worldwide Directory of Pathologists and have more What’s New in Pathology newsletters. Email Dr. Pernick your suggestions on how we can better help pathologists at Nat@PathologyOutlines.com.

2. Author Recruitment

We invite pathologists to write for our textbook, although either they or someone on their author team must have expertise in the topic they are writing about. The most difficult author qualification is usually: “Within the past 15 years, you must have published at least 5 first or last author journal articles other than case reports, in U.S., European or comparable journals, verifiable on PubMed, about the subspecialty in which you want to write.” See pathologyoutlines.com/authorinformation.html for more information or email Dr. Pernick at Nat@PathologyOutlines.com if interested.

3. Image Contest

Do you have great pathology images? We will soon start a contest to choose the best pathology images, which will be selected from images that pathologists have posted in their Directory profile. We are holding this contest because pathologists love images and because we want to publicize the Directory as a great way to learn about pathologists worldwide.

To participate, you have to create a (free) Directory profile at pathologyoutlines.com/directorysignup.html and add a high quality pathology image. While we are still working out the details, there will likely be prizes of $250, $150 and $100 for the winners. Our Editorial Board or others will screen the images and select the top 20. More details will follow.

Email Nat@PathologyOutlines.com with any ideas on how to make the contest more efficient.

18 August 2022: Textbook Updates

We have posted updates of the following topics:

Fallopian tubes & broad ligament > Broad ligament > Wolffian tumor / Female adnexal tumor of probable Wolffian origin
by Elena Lucas, M.D., Wenxin Zheng, M.D.
Topic summary: Adnexal tumor arising from remnants of Wolffian (mesonephric) duct. Heterogeneous histologic appearance. Rare, approximately 130 cases reported; median age 50 years, range 15 – 87 years. Prognostic factors: low malignant potential; most tumors behave in a benign fashion. Recurrence or metastases occur in 11 – 20% of cases; median of 48 months to recurrence (range 13 – 96 months). Treatment: hysterectomy and bilateral salpingo-oophorectomy; tumor debulking.

Microbiology, parasitology & COVID-19 > Filamentous bacteria > Actinomyces
by Natalie Larsen, M.D., Sixto M. Leal, Jr., M.D., Ph.D.
Topic summary: Gram positive genus containing over 40 species; Taxonomy: genera Actinobacteria, family Actinomycetaceae. Anaerobic; modified acid fast stain negative. More common in developing nations. Infection initiated upon access to tissues via trauma, surgical procedures, foreign bodies. Indolent, slowly progressing pyogranulomatous disease. Treatment: susceptible to penicillin and most antibiotics used to treat gram positive bacteria; intrinsic resistance to metronidazole.

Penis & scrotum > Dysplasia / carcinoma in situ > Penile intraepithelial neoplasia (PeIN)
by Diego F. Sanchez, M.D., Antonio L. Cubilla, M.D.
Topic summary: Intraepithelial neoplastic proliferation with variable degree of dysplasia, keratinization and nuclear atypia. Classified as HPV related / dependent or HPV unrelated / independent. Mean age is ~58 years old. PeIN is most commonly found in the glans and foreskin. Frequent recurrence (48%); low rate of progression to invasive carcinoma (2%). Treatment: local excision (Mohs surgery, glans resurfacing, glansectomy) is the most frequent approach.

Salivary glands > Nonneoplastic tumors/tumor-like conditions > Lymphoepithelial cyst
by Zahra Maleki, M.D.
Topic summary: Unilocular cysts that involve the parotid gland. Simple cyst lined by low stratified squamous epithelium surrounded by polymorphous lymphocytes with prominent germinal centers. Almost all arise in parotid gland. Sporadic lymphoepithelial cyst may result from cystic dilation of ducts within intraparotid or periparotid lymph node or branchial cleft remnants. Excellent prognosis. Treatment: conservative therapy, with institution of highly active antiretroviral therapy medication in HIV related cases.

Uterus > Carcinoma > POLE ultramutated endometrial carcinoma
by Lucy Ma, M.D.
Topic summary: Endometrial carcinoma harboring pathogenic mutations in the exonuclease domain of the POLE gene. Carries excellent prognosis compared to the other molecular subgroups, as defined by The Cancer Genome Atlas (TCGA) program. Patients are typically younger (median age ~55 – 60) than patients with non-POLEmut endometrial carcinomas. Treatment: surgery with or without adjuvant therapy (vaginal brachytherapy, pelvic radiotherapy and chemotherapy, depending on stage).