Showing papers in "Archives of Pathology & Laboratory Medicine in 2008"
TL;DR: It becomes even more important for pathologists to familiarize themselves with these protocols and cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.
Abstract: The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary (Checklist)” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.
The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.
473 citations
TL;DR: The differential diagnosis of PCNSL includes central nervous system gliomas, metastatic tumors, demyelinating disorders, subacute infarcts, and space-occupied lesions due to an infectious etiology.
Abstract: Primary central nervous system lymphoma (PCNSL) is an uncommon extranodal non-Hodgkin lymphoma. Its incidence has increased during the last 3 decades and has been reported in both immunocompromised and immunocompetent patients. Immunocompromised patients are affected at a younger age compared with immunocompetent patients. It presents with raised intracranial pressure and focal neurologic and neuropsychiatric symptoms. The lesions are typically solitary. The majority of the lesions are located in the periventricular area, whereas in a few cases they are located in the supratentorial area. Diffuse large B-cell lymphomas constitute most PCNSLs, whereas T-cell, low-grade, anaplastic, and Hodgkin lymphomas are rarely encountered. The morphology of PCNSL shows a characteristic angiocentric pattern and is positive for B-cell markers by immunohistochemistry. The differential diagnosis of PCNSL includes central nervous system gliomas, metastatic tumors, demyelinating disorders, subacute infarcts, and space-occupying lesions due to an infectious etiology. The understanding of the molecular mechanisms involved in the pathogenesis of PCNSL and the identification of molecular biomarkers have lagged behind that of systemic nodal lymphomas. Primary central nervous system lymphomas are treated with combined radiotherapies and chemotherapies. The prognosis for PCNSL is worse than for other extranodal lymphomas.
448 citations
TL;DR: Not surprisingly, different primary cancers tended to metastasize, with differing frequencies, to different sites, which might be helpful in deducing the origins of cancers whose primary sites are unclear at presentation.
Abstract: Context.—Many studies have addressed metastatic patterns seen among various cancers. No recent studies, however, provide quantitative analyses of such patterns arising from a broad range of cancers based primarily on postmortem tissue analyses. Objective.—To provide a quantitative description of metastatic patterns among different primary cancers based on data obtained from a large, focused autopsy study. Design.—Review of data from 3827 autopsies, performed between 1914 and 1943 on patients from 5 affiliated medical centers, comprising 41 different primary cancers and 30 different metastatic sites. Results.—Testicular cancers were most likely to metastasize (5.8 metastases per primary cancer), whereas duodenal cancers were least likely to do so (0.6 metastases per primary cancer). Preferred metastatic sites varied among the primary cancers analyzed. Overall, regional lymph nodes were the most common metastatic target (20.6% of total), whereas testes were the least common (0.1% of total). Conclus...
424 citations
TL;DR: The goals are to provide recommendations that will improve RNA quality for expression profiling from formalin-fixed, paraffin-embedded tissue and highlight areas for additional research.
Abstract: Context.—Expression profiling by microarrays and real-time polymerase chain reaction–based assays is a powerful tool for classification and prognostication of disease; however, it remains a research tool, largely reliant on frozen tissue. Limiting the utility of expression profiling is the isolation of quality nucleic acids from formalin-fixed, paraffin-embedded tissue. The collection, handling, and processing of tissue directly impacts the biomolecules that can be recovered from it. High-quality nucleic acids can be obtained from formalin-fixed, paraffin-embedded tissue, but greater attention to all steps in the process of tissue handling and preparation is required. Objective.—To summarize the current state-of-the-art of preanalytic factors in tissue handling and processing as they impact the quality of RNA obtainable from formalin-fixed, paraffin-embedded tissue. The goals are to provide recommendations that will improve RNA quality for expression profiling from formalin-fixed, paraffin-embedd...
262 citations
TL;DR: An overview of the clinical and pathologic aspects of nontuberculous mycobacteria infection, including diagnostic laboratory methods, classification, epidemiology, clinical presentation, and treatment is provided.
Abstract: Context.—Nontuberculous mycobacteria include numerous acid-fast bacilli species, many of which have only recently been recognized as pathogenic. The diagnosis of mycobacterial disease is based on a combination of clinical features, microbiologic data, radiographic findings, and histopathologic studies. Objective.—To provide an overview of the clinical and pathologic aspects of nontuberculous mycobacteria infection, including diagnostic laboratory methods, classification, epidemiology, clinical presentation, and treatment. Data Sources.—Review of the pertinent literature and published methodologies. Conclusions.—Nontuberculous mycobacteria include numerous acid-fast bacilli species, many of which are potentially pathogenic, and are classified according to the Runyon system based on growth rates and pigment production. Their slow growth hinders cultures, which require special medium and prolonged incubation. Although such methods are still used, newer nucleic acid–based technologies (polymerase cha...
226 citations
TL;DR: The cases presented here suggest that NAFLD may predispose patients to HCC in the absence of cirrhosis, and further studies are needed to confirm this potentially important observation.
Abstract: Context.—Hepatocellular carcinoma (HCC) is recognized as a complication of cirrhosis related to nonalcoholic fatty liver disease (NAFLD). Diabetes and the metabolic syndrome are also associated with HCC. However, it is not clear whether NAFLD predisposes patients to HCC in the absence of cirrhosis. Objective.—To seek evidence that HCC can develop in NAFLD unaccompanied by cirrhosis. Design.—Retrospective case study was performed on cases from 2004 to 2007 at the University of Illinois at Chicago Medical Center, using the key words hepatocellular carcinoma, liver explant, and liver resection. The diagnosis of HCC was identified and confirmed by hematoxylin-eosin–stained slides in 50 cases. Cause of liver disease was determined by review of liver histology, clinical history, and laboratory data. Results.—Three patients presented with advanced HCC with features of metabolic syndrome, including an elevated body mass index. Each patient had bland steatosis on liver biopsy, without fibrosis or cirrhosi...
195 citations
TL;DR: Current roles of pathology are limited to diagnosing primary or metastatic tumors and identifying features suggestive of malignant potential or hereditary disease, and future roles may involve more definitive assessment of malignancy, genotype-phenotype correlation, and identification of targets for therapy.
Abstract: Context.—Advances in genetics and gene expression profiling have led to new ways of thinking about the pathobiology of pheochromocytoma and extra-adrenal paraganglioma. These developments are concurrent with the publication and dissemination of the 2004 World Health Organization bluebook on pathology and genetics of endocrine tumors. Objective.—To summarize new information required by pathologists for effective participation in patient management and research. Data Sources.—Literature review and primary material from Tufts Medical Center. Conclusions.—The World Health Organization reserves the term pheochromocytoma for tumors arising from chromaffin cells in the adrenal medulla. Closely related tumors in extra-adrenal sympathetic and parasympathetic paraganglia are classified as extra-adrenal paragangliomas. A pheochromocytoma is an intra-adrenal sympathetic paraganglioma. Although arbitrary, this nomenclature emphasizes important distinctive properties of intra-adrenal tumors, including an often...
195 citations
TL;DR: The relative incidence of primary and metastatic lung tumors in children and adolescents through a single-institution case series is determined, to discuss the clinical and pathologic features of primary tumors of the tracheobronchial tree and lung parenchyma in children, and to provide recommendations for handling pediatric lung cysts and tumors.
Abstract: Context.—Primary lung neoplasms are rare in children, but they comprise a broad and interesting spectrum of lesions, some of which are familiar from other tissue sites, and some of which a...
169 citations
TL;DR: The immunohistochemical dissection of undifferentiated tumors on the basis of their morphologic features is outlined, supplemented with algorithmic immunohistsochemical analysis for each morphologic category of small round cell tumors, carcinomatous tumors, sarcomatous (or sarcoma-like) tumors, and tumors with histologically overlapping features.
Abstract: Context.—“Undifferentiated tumor” refers to a heterogeneous group of neoplasms with little or no evidence of differentiation on routine light microscopic morphology. Objective.—To identify the true identity of undifferentiated tumors by immunohistochemical analysis. Data Sources.—Review of the pertinent literature and the authors' experience. Conclusions.—For treatment and prognostic evaluation, it is crucial to delineate whether an undifferentiated neoplasm is epithelial, mesenchymal, melanocytic, or hematopoietic in nature. Application of a screening panel to demonstrate the expression of markers of major lineages is fundamental for determination of the broad category of neoplasia. Because poorly differentiated carcinomas and in particular sarcomatoid carcinomas are known to be heterogeneous in their antigen expression, several epithelial markers in combination may be required to establish the carcinomatous nature of tumor. A diagnostic misinterpretation as a consequence of occasional aberrant ...
164 citations
TL;DR: With a panel of immunohistochemical markers, it is possible to distinguish or narrow down most lung neoplasms and separate them into meaningful therapeutic categories.
Abstract: Context.—Immunohistochemistry is a very valuable and often used tool in the differential diagnosis of lung carcinomas whether primary or secondary to the lung. The most useful application ...
161 citations
TL;DR: The pathology, epidemiologic and clinical features, and pathophysiology of coronary artery aneurysm, particularly new research results, are reviewed, drawing out implications for the understanding, diagnosis, and treatment of this condition.
Abstract: Context.—Coronary artery aneurysm is an uncommon condition that can be a cause of death when it thromboses or ruptures. It is always associated with destruction of the tunica media, usually associated with atherosclerosis, and commonly associated with chronic inflammation. Objective.—To review the pathology, epidemiologic and clinical features, and pathophysiology of coronary artery aneurysm, particularly new research results, drawing out implications for the understanding, diagnosis, and treatment of this condition. Data Sources.—Pertinent literature and illustrative cases at our institution. Conclusions.—Inflammation spilling over into the tunica media from the tunica intima may link atherosclerosis to aneurysm formation, but vasculitis without atherosclerosis causes coronary artery aneurysms in young children with Kawasaki disease. Increased proteolysis of extracellular matrix proteins is probably one mechanism of coronary artery aneurysm formation, either due to overactive matrix metalloprote...
TL;DR: Oncocytic cytology is seen in a variety of thyroid conditions that are associated with a broad differential diagnosis and care must be used for accurate diagnosis.
Abstract: Context.—Hurthle cells are eosinophilic, follicular-derived cells that are associated with a variety of nonneoplastic and neoplastic thyroid lesions. The differential diagnosis of Hurthle cell lesions is quite broad. Objective.—To review the pathologic conditions associated with Hurthle cells in the thyroid and to discuss pathology of thyroid lesions associated with oncocytic cytology. Data Sources.—A variety of thyroid nonneoplastic (autoimmune thyroiditis, multinodular goiter) and neoplastic conditions (Hurthle cell adenoma, Hurthle cell carcinoma) are associated with Hurthle cell cytology. In addition, there are several thyroid neoplasms that should be considered when one observes a Hurthle cell neoplasm in the thyroid (oncocytic variant of medullary carcinoma, several variants of papillary thyroid carcinoma). Conclusions.—Oncocytic cytology is seen in a variety of thyroid conditions that are associated with a broad differential diagnosis and care must be used for accurate diagnosis. Newer mol...
TL;DR: The incidence of MFB diagnosis has increased in recent years, likely due to the mammographic screening, and this unusual benign tumor may represent a potential diagnostic pitfall, especially when interpreting fine-needle aspiration and/or needle core biopsy.
Abstract: Context.—Myofibroblastoma (MFB) of the breast is an unusual benign tumor that belongs to the family of the “benign spindle cell tumors of the mammary stroma.” The name MFB reflects its cellular composition, comprising mainly stromal cells with fibromyofibroblastic and, less frequently, myoid differentiation. Since the original description, the morphologic spectrum of MFB has been expanded by the recognition of several unusual morphologic variants, such as the cellular, infiltrative, epithelioid, deciduoid-like, lipomatous, collagenized/fibrous, and myxoid variants. Objective.—To review the literature on mammary MFB, discussing the main clinical, radiologic, and pathologic features helpful for diagnosis. Since MFB may show alarming morphologic features, which can lead to a misdiagnosis of malignancy, histologic figures of this tumor, including its more unusual variants, are provided to offer pathologists a practical approach to a correct diagnosis. Histogenesis and pathogenesis of this tumor are a...
TL;DR: Although heritable causes of P-HPT including multiple endocrine neoplasia 1 and 2A and hyperparathyroidism-jaw tumor syndrome account for a minority of cases, advances in the characterization of the affected genes have provided insights into the genetic basis of sporadic parathyroid neoplasms.
Abstract: Context.—Primary hyperparathyroidism (P-HPT) is one of the most common of all endocrine disorders. Eighty percent to 85% of cases are due to parathyroid adenomas while hyperplasia and carc...
TL;DR: The strong association of mucinous and transitional cell components, similar type of calcification, complementary size distributions, and frequent identification of a transitional component in the face of an exceedingly small estimated proportion of that component suggest that this association has been underestimated.
Abstract: Context.—The origin of and relationship between ovarian mucinous and transitional cell (Brenner) neoplasms are enigmatic. The reported association ranges from 1% to 16%, and whether there ...
TL;DR: GPC3 is a specific immunomarker for HCC that can be used to distinguish HCC from benign hepatocellular mass lesions, particularly hepato cellular adenoma, however, the diagnosis of HCC should not rely entirely on positive GPC3 immunostaining because focal immunoreactivity can be detected in a small subset of cirrhotic nodules.
Abstract: Context.—Histopathologic distinction between hepatocellular carcinoma (HCC) and benign hepatocellular mass lesions, particularly hepatocellular adenoma, can sometimes be challenging. The currently available ancillary tools are suboptimal in terms of sensitivity and specificity. Objective.—To further characterize the diagnostic value of glypican-3 (GPC3), a cell surface proteoglycan that has recently been shown to be overexpressed in HCC, in the distinction between HCC and benign hepatocellular mass lesions. Design.—A total of 221 surgically resected liver specimens were subjected to immunohistochemical staining using a monoclonal antibody specific for GPC3. These included 111 HCCs, 48 hepatocellular adenomas, 30 focal nodular hyperplasias, and 32 large regenerative nodules in the background of cirrhosis. Results.—Cytoplasmic, membranous, and canalicular staining for GPC3 was detected in 84 (75.7%) of the 111 HCCs, among which, 61 (72.6%) of the 84 cases exhibited diffuse immunoreactivity. In cont...
TL;DR: The authors' review supports the use of ancillary techniques involving a panel of antibodies suitable for immunohistochemistry and molecular analysis in the assessment of thyroid nodules that can improve diagnostic accuracy when combined with standard morphologic criteria.
Abstract: Context.—Thyroid lesions with nodular architecture and follicular pattern of growth often pose difficulties in accurate diagnosis during the assessment of cytologic and histologic specimens. The diagnosis of follicular neoplasm on cytology or of follicular tumor of uncertain malignant potential on histology is likely to cause confusion among clinicians and delay effective management of these lesions. Occasionally, thyroid tumors represent unusual or metastatic lesions and their accurate diagnosis requires immunohistochemical confirmation. Objective.—To review the literature on the applications of immunohistochemistry in the differential diagnosis of thyroid tumors. Data Sources.—Relevant articles indexed in PubMed (National Library of Medicine) between 1976 and 2006. Conclusions.—Our review supports the use of ancillary techniques involving a panel of antibodies suitable for immunohistochemistry and molecular analysis in the assessment of thyroid nodules. These tools can improve diagnostic accura...
TL;DR: There is a need for the development of evidence-based or consensus-based guidelines for the diagnosis of MM in different differential diagnosis situations, with no overall consensus about how many and which markers should be used.
Abstract: Context.—The diagnosis of malignant mesothelioma (MM) is rendered with the aid of immunohistochemistry to demonstrate the presence of “mesothelial,” “epithelial,” or “sarcomatous” differentiation. Antibody panels that have been proposed for the distinction between MM and other neoplasms usually include 2 or more epithelial markers used to exclude the diagnosis of a carcinoma, such as monoclonal and polyclonal carcinoembryonic antigen, Ber-EP4, B72.3, CD15, MOC-31, thyroid transcription factor 1, BG8, and others, and 2 or more mesothelial markers used to confirm the diagnosis of MM, such as cytokeratin 5/6, calretinin, HBME-1, thrombomodulin, WT-1, mesothelin, D2-40, and podoplanin. In general, most antibody panels provide excellent sensitivity and specificity for the differential diagnosis between MM epithelial variant and adenocarcinoma, particularly of lung origin. However, the accuracy of these markers is lower for the diagnosis of sarcomatous MM and for the differential diagnosis between MM a...
TL;DR: A number of established brain tumors are reorganized, including medulloblastomas and primitive neuroectodermal tumors, in an attempt to more closely align classification with current understanding of central nervous system neoplasia.
Abstract: Context.—The World Health Organization (WHO) recently published its 4th edition of the classification of tumors of the central nervous system, incorporating a substantial number of important changes to the previous version (WHO 2000). The new WHO classification introduces 7 changes in the grading of central nervous system neoplasms, ranging in significance from minor to major, in categories of anaplastic oligoastrocytomas, meningiomas, choroid plexus tumors, pineal parenchymal tumors, ganglioglioma, cerebellar liponeurocytoma, and hemangiopericytomas. The 4th edition also introduces 10 newly codified entities, variants, and patterns, as well as 1 new genetic syndrome. A number of established brain tumors are reorganized, including medulloblastomas and primitive neuroectodermal tumors, in an attempt to more closely align classification with current understanding of central nervous system neoplasia. Objective.—To summarize and discuss the most significant updates in the 4th edition for the practici...
TL;DR: The recently revised WHO Classification of Tumours of the Central Nervous System (4th edition, 2007) follows in the highly successful footsteps of previous editions of this widely used reference and serves as the recommended reference standard for central nervous system tumor research studies and clinical protocols.
Abstract: T recently revised WHO Classification of Tumours of the Central Nervous System (4th edition, 2007) follows in the highly successful footsteps of previous editions of this widely used reference.1–3 The latest version is the product of the combined efforts of an international group of oncologic neuropathologists and brain tumor researchers that culminated in an Editorial and Consensus Conference convened in Heidelberg, Germany, on November 17 and 18, 2006.4 The World Health Organization (WHO) scheme for brain tumor classification and grading has been widely adopted worldwide, and it commonly serves as the recommended reference standard for central nervous system tumor research studies and clinical protocols as, for example, in the ‘‘Protocol for the Examination of Specimens From Patients With Tumors of the Brain/Spinal Cord’’ described by Parisi and colleagues in this issue of the ARCHIVES.5,6 The 2007 WHO Classification includes a number of significant modifications compared with the preceding volume (WHO 2000), which it supplants. Among the modifications are newly introduced tumor entities, variants, patterns, and tumor syndromes, changes in grade for some tumor types, clarification of grading criteria for others, reorganization of
TL;DR: A diagnosis of malignant fibrous histiocytoma based solely on morphology is no longer acceptable and identification of a line of differentiation should be sought and a diagnosis of MFH should be made only for pleomorphic sarcomas in which no specific line of differentiate is discerned.
Abstract: The precise nature and diagnostic concept of malignant fibrous histiocytoma (MFH) has been debated for years Currently, a histiocytic lineage of the tumor cells is no longer favored The nomenclature and classification of MFH and its subtypes have also been changed The MFH pattern, especially that of storiform-pleomorphic variant, is viewed as a morphologic pattern shared by a number of sarcomas as well as by other nonsarcomas Therefore, a diagnosis of MFH based solely on morphology is no longer acceptable and identification of a line of differentiation should be sought A diagnosis of MFH should be made only for pleomorphic sarcomas in which no specific line of differentiation is discerned Precise categorization of MFH-like tumors may require thorough sampling of the tumor and judicious use of immunohistochemistry and/or electron microscopy Familiarity with the current terminology and classification of MFH and its subtypes is of paramount significance in the modern practice of pathology
TL;DR: The current knowledge of immunohistochemistry of the lesions of the female genital tract is presented in a readily accessible form to help in reaching a conclusive diagnosis in a variety of problematic lesions seen in gynecologic pathology.
Abstract: Context.—A large variety of tumors and lesions arise in the female genital tract. Although the majority of these can be correctly recognized on routine hematoxylin-eosin– stained slides, occasional cases present a diagnostic challenge. Immunohistochemical stains are extremely useful in resolving many of these problematic cases. As the knowledge in this area is constantly expanding, it is useful to have this updated information in a review form for easy access. Objective.—To present our current knowledge of immunohistochemistry of the lesions of the female genital tract in a readily accessible form. Data Sources.—The review is based on previously published articles on this topic. Conclusions.—Immunohistochemical stains help in reaching a conclusive diagnosis in a variety of problematic lesions seen in gynecologic pathology. As in any other system, immunohistochemical findings need to be interpreted in light of the clinical history and morphologic findings.
TL;DR: A practical approach to the diagnosis of uterine leiomyosarcoma based on a systematic assessment of histologic parameters as well as a systematic approach to its differential diagnosis based on histologic and immunohistochemical features is provided.
Abstract: Smooth muscle tumors (SMTs) are the most frequent mesenchymal tumors of the uterus. The majority of the uterine SMTs are readily classificable as benign or malignant based on their gross and microscopic appearances. However, when unusual features are seen in some leiomyoma variants, the differential diagnosis with a leiomyosarcoma may become challenging. Moreover, diagnostic criteria for the different subtypes of leiomyosarcoma are not uniform. Finally, non-smooth muscle tumors that originate in the uterus may show overlapping histologic and even immunohistochemical features with uterine SMTs, more commonly with the spindle and epithelioid variants, complicating their correct classification. The diagnosis of malignant uterine SMTs has important prognostic and therapeutic implications. This review provides a practical approach to the diagnosis of uterine leiomyosarcoma based on a systematic assessment of histologic parameters as well as a systematic approach to its differential diagnosis based on histologic and immunohistochemical features.
TL;DR: A limited subset of gastric polyps, representing the most common or, sometimes, challenging, are reviewed, recognized and generally divided into nonneoplastic and neoplastic.
Abstract: Gastric polyps can be broadly defined as luminal lesions projecting above the plane of the mucosal surface. They are relatively frequent in routine pathology practice, where the main goal is to rule out the possibility of malignancy. Various subtypes of gastric polyps are recognized and generally divided into nonneoplastic and neoplastic. We will review herein only a limited subset of gastric polyps representing the most common or, sometimes, challenging.
TL;DR: The findings indicate MS involves both the IEL and media with calcification in spite of inconsistencies on this point in the medical literature, which is of great interest to investigators and clinicians.
Abstract: Context.—Medial calcification of muscular arteries is known as Monckeberg sclerosis (MS). Although this was first described in 1903, disagreement persists over its precise histologic appearance. Some, including Monckeberg, have written that the media alone are calcified, whereas others maintain that both the media and internal elastic lamina (IEL) are involved. Since vascular calcification is of great interest to investigators and clinicians, defined criteria for classifying calcified arterial lesions are important. Objective.—To clarify the histologic definition of MS with regard to calcification of the IEL. Design.—We reviewed slides from 14 incisional and excisional surgical biopsies and autopsy specimens containing arteries with previously diagnosed MS. We looked specifically for medial and IEL calcification and used von Kossa, alizarin red, and trichrome/elastic stains to confirm our findings. We also performed a literature search on the histologic appearance of MS. Results.—Both medial and ...
TL;DR: Current clinical, morphologic, immunophenotypic, genetic, gene expression profiling, and prognostic (studies before and after the addition of rituximab) features of de novo diffuse large B-cell lymphoma are reviewed.
Abstract: Diffuse large B-cell lymphoma is the most common lymphoma worldwide. Both morphologically and prognostically it represents a diverse spectrum of disease. Traditional morphologic subclassification often results in poor interobserver reproducibility and has not been particularly helpful in predicting outcome. Recent gene expression profiling studies have classified diffuse large B-cell lymphoma into 2 main subtypes, germinal center B-cell and activated B-cell, with the germinal center type showing an overall better survival. Validation of these subtypes has become possible for the practicing pathologist with the use of surrogate immunohistochemical markers. Importantly however, these prognostic studies were performed on material from the pre-rituximab treatment era. With the now well-accepted addition of rituximab (anti-CD20 antibody) to the typical large B-cell lymphoma chemotherapeutic regimen, a revalidation of any survival differences between the large B-cell lymphoma subgroups is necessary. This short review covers the current clinical, morphologic, immunophenotypic, genetic, gene expression profiling, and prognostic (studies before and after the addition of rituximab) features of de novo diffuse large B-cell lymphoma.
TL;DR: The complex subclassification of pituitary adenomas is now recognized to reflect specific clinical features and genetic alterations that predict targeted therapies for patients with pituitsary disorders.
Abstract: Context.—The sellar region is the site of frequent pathology. The pituitary is affected by a large number of pathologic entities arising from the gland itself and from adjacent anatomical ...
TL;DR: In patients with pancreatic mass lesions and suspicion of cancer, an IgG4 level measuring between 135 and 200 mg/dL should be interpreted cautiously and not accepted as diagnostic of autoimmune pancreatitis without further evaluation.
Abstract: Context.—Autoimmune pancreatitis is an uncommon, inflammatory disease of the pancreas that presents with clinical features, such as painless jaundice and a pancreatic mass, similar to those caused by pancreatic cancer. Patients with autoimmune pancreatitis frequently have elevated serum immunoglobulin G fraction 4 (IgG4) levels, and their pancreatic tissue may show IgG4-positive plasma cell infiltration. It is imperative to differentiate autoimmune pancreatitis from pancreatic cancer because autoimmune pancreatitis typically responds to corticosteroid treatment. A previous Japanese study reported that serum IgG4 greater than 135 mg/dL was 97% specific and 95% sensitive in predicting autoimmune pancreatitis. Objective.—To prospectively measure serum IgG4 levels in pancreatic cancer patients to ascertain whether increased levels might be present in this North American population. Design.—We collected blood samples and phenotypic information on 71 consecutive pancreatic cancer patients and 103 healt...
TL;DR: Surgical excision is indicated for all PCBs diagnosed as lobular neoplasia diagnosed as ALH or LCIS, as a significant percentage will show carcinoma at excision.
Abstract: Context.—Both atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) have traditionally been considered to be risk factors for the development of invasive carcinoma and are followed by close observation. Recent studies have suggested that these lesions may represent true precursors with progression to invasive carcinoma. Due to the debate over the significance of these lesions and the small number of cases reported in the literature, the treatment for lobular neoplasia diagnosed by percutaneous core biopsy (PCB) remains controversial. Objective.—To review our experience with pure LCIS or ALH diagnosed by PCB and correlate the radiologic findings and surgical excision diagnoses to develop management guidelines for lobular neoplasia diagnosed by PCB. Design.—We searched the pathology database for patients who underwent PCB with a diagnosis of either pure LCIS or ALH and had subsequent surgical excision. We compared the core diagnoses with the surgical excision diagnoses and the rad...
TL;DR: One of the most common and important pitfalls in soft tissue pathology are the so-called pseudosarcomas; however, their rapid growth, hypercellularity, cytologic atypia, and mitotic activity makes them prone to be misinterpreted as sarcoma.
Abstract: One of the most common and important pitfalls in soft tissue pathology are the so-called pseudosarcomas. These lesions are nonneoplastic; however, their rapid growth, hypercellularity, cytologic atypia, and mitotic activity makes them prone to be misinterpreted as sarcoma. The most common of these lesions are fibroblastic/myofibroblastic and matrix-forming proliferations, including nodular fasciitis, proliferative fasciitis and myositis, ischemic fasciitis, massive localized edema, myositis ossificans, and bizarre parosteal osteochondromatous proliferation and related entities. Most of these lesions rarely recur following simple excision; therefore, their accurate recognition helps prevent excessive therapy.