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).

28 July 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Breast > Fibromatosis

Spindle cells appear bland with no mitotic activity.

Contributed by Carissa LaBoy, M.D.

CNS tumor > Diffuse leptomeningeal glioneuronal tumor

Tumor cells with a low grade, monomorphic appearance showing perinuclear haloes, reminiscent of oligodendroglioma (200x overall magnification).

Contributed by Katherine Schwetye, M.D., Ph.D.

Kidney nontumor > Congenital nephrotic syndrome

Prominent cystically dilated proximal and distal tubules with an attenuated epithelium (periodic acid-Schiff stain).

Contributed by Chunlai Zuo, M.D., M.S. and Jonathan E. Zuckerman, M.D., Ph.D.

Ovary > Serous cystadenoma / adenofibroma

Large serous cystadenoma with localized (less than 10% of sampled cyst wall) epithelial proliferation. No complex papillary growth is seen (H&E, 100x).

Contributed by Catherine J. Roe, M.D. and Krisztina Hanley, M.D.

Stains & CD markers > Special AT-rich sequence-binding protein 2 (SATB2)

Colon neuroendocrine tumor, well differentiated (SATB2).

Contributed by Sepideh Besharati, M.D.

21 July 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Oral cavity & oropharynx > Lingual tonsil

The posterior lateral tongue contains 6 – 8 larger red papules.

Contributed by Molly Housley Smith, D.M.D.

Ovary > Corpus luteum cyst

Intermediate magnification showing bilayered cyst lining with inner granulosa cells (lower part of the image) and outer layer of theca cells (upper part of the image).

Contributed by Aurelia Busca, M.D., Ph.D.

Stains & CD markers > WT1

The tumor cells show strong nuclear positivity for WT1. The necrotic tumor cells lose antigenicity for WT1. The final diagnosis is WT1 positive malignant mesothelioma.

Contributed by Urooba Nadeem, M.D. and Aliya N. Husain, M.D.

Bone marrow neoplastic > Chronic neutrophilic leukemia

Peripheral blood smear shows leukocytosis where almost all the cells are mature neutrophils with normal morphology. It is characteristic of chronic neutrophilic leukemia that no (or at most < 5%) immature cells at earlier stage than neutrophils and bands are noted in the peripheral blood. The neutrophils show adequate segmentation and no dyspoietic features (Wright Giemsa, 400x magnification or 40x objective).

Contributed by Roberto N. Miranda, M.D.

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