Showing papers by "Saul Suster published in 2014"

Adrenocortical carcinoma: a comprehensive immunohistochemical study of 40 cases.

Abstract: Adrenocortical carcinomas (ACC) are uncommon tumors of the adrenal cortex that are known to follow an aggressive clinical course. The distinction of these tumors from other neoplasms may sometimes prove difficult due to overlapping clinical, morphologic, and even immunophenotypical features. To this end, we performed a comprehensive immunohistochemical analysis using traditional and novel markers in 40 cases of ACC. An immunohistochemical panel consisting of 10 traditional and novel antibodies was applied to whole tissue sections of ACC including high-molecular weight cytokeratin (HMWCK), low-molecular weight cytokeratin (CAM5.2), inhibin-α, melan A, chromogranin A, synaptophysin, calretinin, steroid receptor coactivator-1 (SRC-1), Pax8, and Ki67. The percentage of positive tumor cells as well as the intensity of staining were evaluated and scored; for Ki67 the percentage of positive tumor cells was recorded. Positive staining was observed for SRC-1 (39/40; 97.5%), inhibin-α (37/40; 92.5%), calretinin (32/40; 80%), synaptophysin (29/40; 72.5%), melan A (26/40; 65%), and CAM5.2 (9/40; 22.5%). Rare cases showed positivity for chromogranin A (2/40; 5%) and Pax8 (1/40; 2.5%). None of the cases showed any reactivity with HMWCK. The Ki67 index ranged from <5% to 20%. We conclude that there is no single specific marker to reliably distinguish ACC from other primary or metastatic neoplasms. However, a combination of immunohistochemical stains in a panel consisting of SRC-1, inhibin-α, calretinin, and HMWCK may be of aid in the differential diagnosis of these tumors. In addition, Pax8 is only rarely positive in ACC, which is a useful tool in their separation from renal neoplasms.

[Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy].

Abstract: Thymic malignancies are relatively uncommon, which mandates that the experience from many different institutions be combined to achieve a better understanding of the disease. Nevertheless, this is hampered by many ambiguities in how results are reported and interpreted. This problem is aggravated by the fact that smaller institutions often encounter these tumors only sporadically. A prerequisite to interinstitutional collaboration is a common language and consistency in the definition of findings (e.g., whether a complete resection was accomplished or not). This article summarizes the policies adopted by the International Thymic Malignancy Interest Group (ITMIG) regarding handling of a resection specimen by the surgeon and pathologist and reporting of the surgical and pathologic findings. These policies are based as much as possible on reported evidence, but this is lacking or limited in many areas. Nevertheless, adoption of a consistent approach is crucial to conduct valid studies moving forward that can clarify areas of uncertainty. This publication addresses only how to handle and process the tissue specimen at the time of a resection. It does not address handling and interpretation of biopsies or cytologic specimens, which is an important topic that is addressed in a separate publication.1 This article is limited to an open resection (by sternotomy). Although other approaches are sometimes used (e.g., thoracoscopy), the issues involved are also covered in another publication.2 Furthermore, this article is written with the assumption that resection of a thymoma involves a complete thymectomy along with any adjacent structures that may be involved and that the goal is a complete (R0) resection (i.e., not debulking).

Diagnostic utility and comparative immunohistochemical analysis of MITF-1 and SOX10 to distinguish melanoma in situ and actinic keratosis: a clinicopathological and immunohistochemical study of 70 cases.

Abstract: The histologic assessment of intraepidermal melanocytic proliferations involving sun-damaged skin may be challenging in scant biopsy material. Melanoma in situ may occasionally be confused with intraepidermal melanocytic hyperplasia on sun-damaged skin; thus, dermatopathologists may use immunohistochemical studies to help distinguish these entities. Historically, melanoma antigen recognized by T-cells 1 (MART-1) has been regarded as a valuable stain to confirm intraepidermal melanocytes; however, MART-1 may overestimate the number of melanocytes because it labels the melanoma dendrites and might also label pigmented keratinocytes, including structures mimicking junctional melanocytic nests in the setting of a lichenoid infiltrate. A total of 70 cases were retrospectively chosen, including 50 cases of melanoma in situ and 20 cases of actinic keratoses. SOX10 and microphthalmia transcription factor 1 (MITF-1) were performed in all cases. In all cases, the number of cells within epidermis that were identified as melanocytes by immunohistochemistry was compared with the number of melanocytes observed by morphology on hematoxylin and eosin sections. All cases of melanoma in situ showed expression of SOX10; however, the proportion of atypical melanocytes showing strong nuclear positivity was variable and did not approach that seen in MITF-1. There was no expression of either MITF-1 or SOX10 in adjacent pigmented keratinocytes in the cases of actinic keratoses. Both MITF-1 and SOX10 can be used to differentiate melanoma in situ from actinic keratosis with melanocytic hyperplasia; however, MITF-1 exhibits slight superior sensitivity and seems to be a more effective immunostain than SOX10 for the identification and quantification of melanocytes in the setting of melanoma in situ, especially in cases where there is limited tissue.

The leiomyomatous stroma in renal cell carcinomas is polyclonal and not part of the neoplastic process.

Abstract: Some renal epithelial neoplasms, such as renal angiomyoadenomatous tumor, clear cell papillary renal cell carcinoma and renal cell carcinoma with smooth muscle stroma, contain a variably prominent smooth muscle stromal component. Whether or not this leiomyomatous stroma is part of the neoplastic proliferation has not been firmly established. We studied the clonality status of 14 renal cell carcinomas with a prominent smooth muscle stromal component (four renal angiomyoadenomatous tumors/clear cell papillary carcinomas, five clear cell carcinomas, two papillary carcinomas, and three renal cell carcinomas with smooth muscle rich stroma) using the human androgen receptor assay (HUMARA). We found the leiomyomatous stromal component in all analyzable (8/14) cases to be polyclonal and therefore reactive rather than neoplastic. Based on morphological observations, we propose that the non-neoplastic leiomyomatous stromal component is likely derived from smooth muscle cells of large caliber veins located at the peripheral capsular region or within the collagenous septae of the tumors.

Fibrolipomatous hamartoma of the nerve: A clinicopathologic report of 13 cases

Abstract: Background Fibrolipomatous hamartoma of the nerve is a rare benign infiltrating condition of peripheral nerves with prominent cutaneous findings that has not being well described in the dermatologic and dermatopathologic literature. Objective We sought to evaluate the clinical and histopathological features of this rare condition. Methods We reviewed the clinicopathologic features of 13 cases to delineate their clinical presentation and histopathologic spectrum. Results All patients presented with unilateral lesions on the thenar areas, fingers, or both. In 7 cases the lesions presented congenitally and in 6 cases the lesions presented sporadically. Histologically, we found 2 patterns that have only been rarely mentioned before including cases with intraneural perineurioma-like features and cases with marked nerve hyperplasia. Limitations Only 13 cases were included in our study. Conclusions This condition is an uncommon entity. The diagnosis of this disorder can be highly suspected on its macroscopic features. Predilection of the median nerve and the frequent association with macrodactyly are characteristic clinical findings.

Verrucous localized lymphedema of genital areas: Clinicopathologic report of 18 cases of this rare entity

Abstract: Background Localized lymphedema is a nonneoplastic condition associated with obesity and predominantly involving the legs. This condition has distinctive clinical and histologic features and only rarely has been mentioned in the dermatologic literature. Objective We sought to evaluate the clinical and histopathologic features. Methods The clinicopathologic features in patients with localized lymphedema of the genital region were studied. Results We identified 18 patients with localized lymphedema clinically presenting as large polypoid or verrucous lesions. The patients were 5 men and 13 women with a mean age of 46.5 years. Twelve patients were obese at diagnosis. Thirteen patients presented with tumors involving the vulva, 4 patients with tumors in the penis and scrotum, and 1 patient with scrotal and pubic lesions. Histologically, all cases showed marked dermal edema along with dilated lymphatic spaces, fibroplasia, and verrucous epidermal changes (papillomatous and hyperplastic epidermis). Limitations Only 18 cases were included in our study. Conclusions This condition is an uncommon and recently described entity that could potentially be clinically and histologically misdiagnosed as a neoplasm; thus, it needs to be included in the differential diagnosis of polypoid and verrucous skin tumors with extensive dermal edema and fibroplasia.

Intradermal spitz nevi: a rare subtype of spitz nevi analyzed in a clinicopathologic study of 74 cases.

Abstract: Spitz nevi are acquired melanocytic lesions with a wide histomorphological spectrum; reliable distinction from spitzoid melanoma is often difficult. Misdiagnoses of benign spitzoid tumors as spitzoid melanomas and vice versa are attributable to a frequently disturbing morphology and inconsistent or poorly defined histological criteria for diagnosis. Many recognized histological variants of Spitz nevi have been described, including the intradermal Spitz. Histopathologic descriptions of intradermal Spitz nevi have been done in the past; however, large studies addressing their histological spectrum have been lacking. We have retrospectively assessed the morphological features in 74 cases of intradermal Spitz nevi, excluding tumors clearly defined as atypical Spitz nevi and Spitzoid melanomas, to further delineate their histological spectrum. The patients' ages ranged from 5 to 81 years (median: 27). Anatomic location included: the upper extremities (27 cases), followed by head and neck (22 cases), lower extremities (9 cases), back (8 cases), buttock (5 cases), chest (1 case), and vulva (1 case). In 1 case, the anatomic location of the lesion was not available. Different histological variants were observed including hyalinized, polypoid, desmoplastic, angiomatoid, and halo Spitz. Morphological features evaluated included symmetry (100%), cell type (epithelioid 42%, spindle 16%, mixed 42%), maturation (85%), pigmentation (26%), chronic inflammation (24%), and mitotic activity (38%). Mild atypia was seen in 36 cases (49%), moderate atypia was seen in 28 cases (38%), and severe atypia was seen in 10 cases (14%). Intradermal Spitz nevus is a distinctive type of Spitz nevus that sometimes can be difficult to define given the unusual features that these lesions can show; thus, strict application of well-defined histological criteria and awareness of their morphological spectrum will facilitate definitive diagnosis.

Can cutaneous low-grade B-cell lymphoma transform into primary cutaneous diffuse large B-cell lymphoma? An immunohistochemical study of 82 cases.

Abstract: Low-grade B-cell lymphomas of the skin, especially, primary cutaneous follicle center cell lymphoma has several distinctive features when compared with nodal/systemic follicular lymphomas, as they are frequently negative for bcl-2 and CD10, and only fewer than 25% of the cases show a bcl-2 rearrangement. The risk of transformation of a cutaneous low-grade B-cell lymphoma, such as primary cutaneous follicle center cell lymphoma, to primary cutaneous diffuse large B-cell lymphomas (PCDLBCL) has not been clearly delineated in the literature. Transformation of systemic/nodal follicular lymphoma into aggressive DLBCL is associated with rapid disease progression, refractoriness to treatment, and poor prognosis. The authors studied 82 cases of primary cutaneous DLBCL using antibodies for follicular dendritic cells (FDCs), CD21, and CD35 to detect networks of FDCs that could possibly indicate transformation of preexisting low-grade B-cell lymphoma to PCDLBCL. All cases were classified as PCDLBCL using strict histologic and immunophenotypic criteria. Fifty-three cases were classified as primary cutaneous DLBCL of "leg type," and 29 cases were classified as primary cutaneous DLBCL, "NOS" category. Immunohistochemical studies were performed in all 82 cases; in 15 cases, a CD21/CD35+ network of FDCs was noted within the tumor, indicating the presence of remnants of residual germinal centers, suggesting the possibility of a transformed low-grade B-cell lymphoma. In summary, the authors' findings seem to indicate that some cases of primary cutaneous DLBCL may result from transformation of a low-grade B-cell lymphoma. Further studies are necessary to evaluate the significance of their findings by using ancillary techniques including genetic analysis.

Policies and reporting guidelines for small biopsy specimens of mediastinal masses

Abstract: Policies and Reporting Guidelines for Small Biopsy Specimens of Mediastinal Masses Alberto Marchevsky, Alex Marx, Philipp Strobel, Saul Suster, Federico Venuta, Mirella Marino, Samuel Yousem, Maureen Zakowski Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California; Department of Pathology, University Medical Center Mannheim, Mannheim, Germany; Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Mil-waukee, Wisconsin; Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Pathology, UPMCPresbyterian University Hospital, Pittsburgh, Pennsylvania; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York