Diffuse Strong BCOR Immunoreactivity Is a Sensitive and Specific Marker for Clear Cell Sarcoma of the Kidney (CCSK) in Pediatric Renal Neoplasia
No abstract available (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Letters to the Editor Source Type: research

Histologic Correlates of Clinical and Endoscopic Severity in Children Newly Diagnosed With Ulcerative Colitis
No abstract available (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Letters to the Editor Source Type: research

Tissue Eosinophilia and Severity of Colitis
No abstract available (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Letters to the Editor Source Type: research

Salivary Secretory Carcinoma With a Novel ETV6-MET Fusion: Expanding the Molecular Spectrum of a Recently Described Entity
Secretory carcinoma of the salivary glands, also known as mammary analogue secretory carcinoma, is a recently described tumor characterized by generally indolent clinical behavior and recurrent ETV6-NTRK3 fusions. However, a small subset of recent cases with high-grade histology, aggressive behavior, or alternate molecular findings are expanding the spectrum of this entity. In this case, a 59-year-old female presented with an infiltrative submandibular gland tumor that was originally classified as a high-grade acinic cell carcinoma, papillary-cystic variant. She developed persistent local disease and, 11 years after initia...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Case Report Source Type: research

The Clinical Significance of a Small Component of Choriocarcinoma in Testicular Mixed Germ Cell Tumor (MGCT)
The clinical significance of limited choriocarcinoma in a malignant mixed germ cell tumor (MGCT) is unknown. Men with a MGCT with ≤5% choriocarcinoma at radical orchiectomy (RO) between 2000 and 2016 from our consult service were studied. Of 50 men in our cohort, we had clinical information for 30 men. Median follow-up was 41 months (1 to 168 mo). Median tumor size was 4.5 cm (1.1 to 8.0 cm). In total, 22/30 (73%) cases were pT1, 6/30(20%) cases were pT2, and 2/30 (7%) cases were pT3. In total, 4/30(13%) cases had lymph node metastases and 2/30 (7%) cases had distant metastases at the time of RO. In...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Pityriasis Lichenoides, Atypical Pityriasis Lichenoides, and Related Conditions: A Study of 66 Cases
Pityriasis lichenoides (PLs) is an uncommon skin disease of unknown etiology. In recent years, an atypical form of PL has been described, showing overlapping features with mycosis fungoides (MF) and lymphomatoid papulosis. We studied 66 patients with an initial histopathologic diagnosis of PL (M:F=34:32; median age, 25 y; range, 7 to 85 y). According to clinical and phenotypic features, cases were classified into 4 categories: (1) Conventional PL (characteristic clinical features of PL without phenotypic aberrations) (n=20; M:F=8:12; median age, 37 y; range, 9 to 74 y); (2) Atypical form of PL (...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Intraobserver and Interobserver Variability in the Assessment of Dysplasia in Ampullary Mucosal Biopsies
Endoscopic mucosal biopsies of the ampulla of Vater (AmpBx) are obtained to histologically assess for dysplasia or carcinoma. However, biopsy material is often scant and a host of factors can induce histologic changes that pose diagnostic challenges. We sought to investigate observer variability in interpretation of AmpBx and the impact clinical data may have on diagnostic interpretation. Thirty-one cases from institutional archives were selected, including 12 cases of reactive atypia (RA), 8 indefinite for dysplasia (ID), and 11 showing low-grade dysplasia (LGD). Slides were independently reviewed at 3 time points with an...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Concordance of PD-L1 Expression Between Core Biopsy and Resection Specimens of Non–Small Cell Lung Cancer
This study aimed to determine whether core needle biopsy provides sufficient tissue for accurate PD-L1 evaluation despite tumor heterogeneity. A retrospective analysis comparing tumoral expression of PD-L1 in 51 lung core biopsies to subsequent resection specimens was performed. Scoring of membranous staining was categorized as 0%, 1% to 49%, and ≥50% of tumor cells. Staining ≥50% tumoral PD-L1 expression was detected in 8/51 (15.7%) of core biopsies and 8/51 (15.7%) of resection specimens. Core biopsy and resection results were concordant in 92.2% of cases (κ, 0.70; 95% confidence interval, 0.43-0.98). Therefo...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Colonic Adenomatous Polyps Involving Submucosal Lymphoglandular Complexes: A Diagnostic Pitfall
In conclusion, adenomas involving LGCs are a rare, clinicopathologically distinct form of pseudoinvasion that mimics invasive adenocarcinoma; histologic features that distinguish them are a well-rounded contour contained within the lymphoid tissue, and lack of infiltrating single cells/small clusters, poorly formed, fused, and irregular glands, solid tumor nests, desmoplastic reaction, and lymphovascular invasion. (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Intraductal Papillary Mucinous Neoplasms of Minor Salivary Glands With AKT1 p.Glu17Lys Mutation
The spectrum of low-grade intraductal papillary proliferations of the salivary glands is heterogenous, and reproducible morphologic diagnostic criteria have not yet been established. Recognized types are sialadenoma papilliferum, inverted ductal papilloma, and intraductal papilloma, but some lesions have been possibly included in the morphologic spectrum of cystadenoma or low-grade intraductal carcinomas. We herein present detailed morphologic, immunophenotypic, and genotypic features of 3 minor salivary gland neoplasms affecting 2 men (aged 65 and 71 y) and 1 woman (aged 78 y). They ranged in size from 1 to ...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Immunohistochemical Detection and Molecular Characterization of IDH-mutant Sinonasal Undifferentiated Carcinomas
Recent studies have identified recurrent isocitrate dehydrogenase 2 (IDH2) mutations in a subset of sinonasal undifferentiated carcinomas (SNUCs); however, the true frequency of IDH mutations in SNUC is unknown. We evaluated the utility of mutation-specific IDH1/2 immunohistochemistry (IHC) in a large multi-institutional cohort of SNUC and morphologic mimics. IHC using a multispecific antibody for IDH1/2 (R132/R172) mutant protein was performed on 193 sinonasal tumors including: 53 SNUCs, 8 poorly differentiated carcinomas (PDCARs) and 132 histologic mimics. Mutant IDH1/2 IHC was positive in 26/53 SNUCs (49%; 20 strongly p...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

PD-L1 Immunohistochemistry Assay Concordance in Urothelial Carcinoma of the Bladder and Hypopharyngeal Squamous Cell Carcinoma
Programmed death ligand-1 (PD-L1) immunohistochemistry is used to guide treatment decisions regarding the use of checkpoint immunotherapy in the management of urothelial carcinoma of the bladder and hypopharyngeal (HP) squamous cell carcinoma. With increasing PD-L1 testing options, a need has arisen to assess the analytical comparability of diagnostic assays in order to develop a more sustainable testing strategy. Using tissue microarrays, PD-L1 expression in tumor cells (TCs) and immune cells (ICs) was manually scored in 197 cases and 27 cases of bladder and HP cancer, respectively. Three commercial kits (Ventana SP263, V...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Primary and Metastatic Melanoma With NTRK Fusions
In this study we report that nonspitzoid metastasizing melanomas of adults may also harbor NTRK fusions and that NTRK expression can be immunohistochemically detected in these tumors. Of 751 melanomas analyzed by next-generation sequencing, 4 metastatic melanomas were identified with NTRK fusions, 3 involving NTRK1, 1 involving NTRK2. They occurred in 3 women and 1 man. Two of the corresponding primary tumors were from the trunk, 1 from an extremity and 1 tumor arose in anal skin. One primary tumor displayed features of superficial spreading melanoma and 3 were nodular melanomas. All tumors were cytologically characterized...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Genomic Fusions in Pigmented Spindle Cell Nevus of Reed
Recent molecular studies of spitzoid neoplasms have identified mutually exclusive kinase fusions involving ROS1, ALK, RET, BRAF, NTRK1, MET, and NTRK3 as early initiating genomic events. Pigmented spindle cell nevus (PSCN) of Reed is a morphologic variant of Spitz and may be very diagnostically challenging, having histologic features concerning for melanoma. Their occurrence in younger patients, lack of association to sun exposure, and rapid early growth phase similar to Spitz nevi suggest fusions may also play a significant role in these lesions. However, to date, there is little data in the literature focused on the mole...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Comedonecrosis Revisited: Strong Association With Intraductal Carcinoma of the Prostate
From the advent of the Gleason grading system for prostate cancer, cancer displaying intraluminal necrotic cells and/or karyorrhexis within cribriform/solid architecture, a phenomenon termed “comedonecrosis,” has been assigned pattern 5. Intraductal carcinoma (IDC-P) shows morphologic overlap with high-grade cribriform/solid adenocarcinoma architecturally and cytologically and may also show central necrosis, yet due to the presence of basal cells at the duct periphery is not currently assigned a grade in clinical practice. On the basis of observations from routine clinical cases, we hypothesized that comedonecr...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

A 3-Protein Expression Signature of Neuroblastoma for Outcome Prediction
In conclusion, we established a robust risk assessment predictor model based on simple immunohistochemistry for therapeutic decisions of NB patients. (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Bronchiolar Adenoma: Expansion of the Concept of Ciliated Muconodular Papillary Tumors With Proposal for Revised Terminology Based on Morphologic, Immunophenotypic, and Genomic Analysis of 25 Cases
In conclusion, we describe a family of putatively benign clonal proliferations with a spectrum of morphology recapitulating various levels of the bronchiolar tree, of which only a minor subset fits the classic description of CMPT. Comparable mutation profiles and partially overlapping morphologic features across the spectrum of these lesions support their nosological relationship. We propose designating this entire family of lesions as BAs, and that lesions currently designated CMPTs represent a subgroup of this family. (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Routine Use of Adjunctive p16 Immunohistochemistry Improves Diagnostic Agreement of Cervical Biopsy Interpretation: Results From the CERTAIN Study
The diagnosis of squamous intraepithelial lesions in cervical tissue specimens is subject to substantial variability. Adjunctive immunohistochemical (IHC) staining for p16 has been shown to add objective biomarker information to morphologic interpretation of hematoxylin and eosin (H&E)–stained tissues. In the CERvical Tissue AdjunctIve aNalysis (CERTAIN) study, we systematically analyzed the impact of adjunctive p16 IHC on the accuracy (agreement with reference pathology results) of diagnosing cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) in the United States. Eleven hundred cervical biopsies wer...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Diagnostic Algorithmic Proposal Based on Comprehensive Immunohistochemical Evaluation of 297 Invasive Endocervical Adenocarcinomas
The International Endocervical Adenocarcinoma Criteria and Classification was developed to separate endocervical adenocarcinomas (ECAs) into 2 main categories on the basis of morphology such as human papilloma virus–associated (HPVA) and non-human papilloma virus–associated adenocarcinomas. We aimed to improve the diagnostic accuracy of International Endocervical Adenocarcinoma Criteria and Classification by performing a comprehensive immunohistochemical evaluation and constructing objective immunohistochemical-based algorithms for the classification of these tumors. Tissue microarrays were constructed from 297...
Source: The American Journal of Surgical Pathology - July 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

The ETV6-RET Gene Fusion Is Found in ETV6-rearranged Low-grade Sinonasal Adenocarcinoma Without NTRK3 Involvement
No abstract available (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Letters to the Editor Source Type: research

Gastric-type Endocervical Adenocarcinoma Involving the Endometrium and Clinically Mimicking Endometrial Neoplasia: A Diagnostic Challenge
No abstract available (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Letters to the Editor Source Type: research

A Newly Recognized Histologic Pattern of IgG4-related Lymphadenopathy: Expanding the Morphologic Spectrum
We report this case because the findings expand the morphologic spectrum of IgG4-related lymphadenopathy. (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Case Report Source Type: research

Urothelial Carcinoma In Situ of the Bladder With Glandular Differentiation: Report of 92 Cases
Urothelial carcinoma in situ (CIS) of the bladder with glandular differentiation (CIS-GL) is rare with some showing an association with small cell carcinoma. There is a paucity of data on whether CIS-GL diagnosed in the absence of invasive carcinoma is associated with an increased risk of developing small cell carcinoma of the bladder. Twenty-seven cases of CIS-GL were identified from the consult files of one of the authors from 2008 to 2015 without prior or coexisting invasive carcinoma at the time of diagnosis. Sixty-five additional cases were identified with concurrent CIS-GL and invasive carcinoma to assess the nature ...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Primary Vaginal Gastric-type Adenocarcinoma and Vaginal Adenosis Exhibiting Gastric Differentiation: Report of a Series With Detailed Immunohistochemical Analysis
We report a series of 11 vaginal glandular lesions exhibiting gastric differentiation, comprising 5 cases of adenocarcinoma and 6 of adenosis. All cases occurred in adults (aged 33 to 69) with no known history of diethylstilboestrol exposure. The vaginal adenocarcinomas exhibited morphologic features identical to gastric-type adenocarcinoma of the cervix, but 1 case additionally demonstrated basaloid and sarcomatoid components, which have not been previously reported in cervical gastric-type adenocarcinoma. Immunohistochemically, the adenocarcinomas were positive for MUC6 (4/5), PAX8 (3/5), CK7 (5/5), CK20 (1/5), CDX2 (5/5...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Hibernoma Mimicking Atypical Lipomatous Tumor: 64 Cases of a Morphologically Distinct Subset
Hibernoma is a benign adipocytic tumor with predilection for subcutaneous tissue of the thigh, upper trunk, and neck of middle-aged adults. 11q13 rearrangement resulting in MEN1/AIP codeletion is characteristic. Hibernomas are composed, in varying proportions, of brown fat cells, mature adipocytes, and microvacuolated lipoblast-like cells. Examples containing predominantly multivacuolated lipoblast-like cells are uncommon and distinction from atypical lipomatous tumor (ALT) is important for clinical management. We herein present the clinicopathologic features of 64 hibernomas histologically mimicking ALT. MDM2 and CDK4 imm...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Genomic Profile and Pathologic Features of Diffuse Large B-Cell Lymphoma Subtype of Methotrexate-associated Lymphoproliferative Disorder in Rheumatoid Arthritis Patients
Rheumatoid arthritis patients often develop the diffuse large B-cell lymphoma subtype of methotrexate-associated lymphoproliferative disorder (DLBCLMTX-LPD). We characterized the genomic profile and pathologic characteristics of 20 biopsies using an integrative approach. DLBCLMTX-LPD was associated with extranodal involvement, a high/high-intermediate international prognostic index in 53% of cases, and responded to MTX withdrawal. The phenotype was nongerminal center B-cell in 85% of samples and Epstein-Barr encoding region positive (EBER+) in 65%, with a high proliferation index and intermediate MYC expression levels. The...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Pan-Trk Immunohistochemistry Identifies NTRK Rearrangements in Pediatric Mesenchymal Tumors
Activating neurotrophic receptor kinase (NTRK) fusions define certain pediatric mesenchymal tumors, including infantile fibrosarcoma and cellular mesoblastic nephroma. Traditionally, molecular confirmation of these fusions has included either fluorescent in situ hybridization for ETV6 rearrangements or reverse-transcriptase polymerase chain reaction for the classic ETV6-NTRK3 fusion. However, these methods overlook variant NTRK rearrangements, which are increasingly appreciated as recurrent events in a subset of pediatric mesenchymal tumors. New therapeutic agents successfully target these fusions and may prevent morbid su...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Improved Progression Prediction in Barrett’s Esophagus With Low-grade Dysplasia Using Specific Histologic Criteria
Risk stratification of patients with Barrett’s esophagus (BE) is based on diagnosis of low-grade dysplasia (LGD). LGD has a poor interobserver agreement and a limited value for prediction of progression to high-grade dysplasia or esophageal adenocarcinoma. Specific reproducible histologic criteria may improve the predictive value of LGD. Four gastrointestinal pathologists examined 12 histologic criteria associated with LGD in 84 BE patients with LGD (15 progressors and 69 nonprogressors). The criteria with at least a moderate (kappa, 0.4 to 0.6) interobserver agreement were validated in an independent cohort of 98 BE...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Are Sporadic Eosinophilic Solid and Cystic Renal Cell Carcinomas Characterized by Somatic Tuberous Sclerosis Gene Mutations?
Eosinophilic solid and cystic renal cell carcinomas (ESC RCC) is a rare, unique tumor type not yet included in the World Health Organization classification of renal neoplasia. Separately, RCCs found in patients with tuberous sclerosis complex (TSC) have recently been categorized into 3 morphologic groups: RCC with a tubulopapillary architecture separated by smooth muscle stroma, chromophobe-like, and eosinophilic-microcytic type. The third classification has been identified in ∼11% of TSC-associated RCC and have histology identical to ESC RCCs. The sporadic form of ESC RCC, not associated with TSC, have only been chara...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Histologic and Outcome Study Supports Reclassifying Appendiceal Goblet Cell Carcinoids as Goblet Cell Adenocarcinomas, and Grading and Staging Similarly to Colonic Adenocarcinomas
Goblet cell carcinoid tumors are amphicrine tumors whose biological behavior ranges from indolent to highly aggressive, depending on tumor grade. Current grading systems for these tumors are based on identifying an adenocarcinoma arising in the setting of a goblet cell carcinoid tumor, which distinguishes this tumor from other gastrointestinal tract adenocarcinomas. Because goblet cell tumors are predominantly tumors of mucin secreting cells, we propose that they be classified as goblet cell adenocarcinomas, and graded using a methodology that has parallels in colorectal adenocarcinoma grading. We graded a large series of ...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Pancreatic Lipomatous Hamartoma: A Hitherto Unrecognized Variant
We present pancreatic lipomatous hamartoma, which has not been reported hitherto. A solid pancreatic mass was detected from a computed tomographic scan check-up in each of 3 cases of Japanese men. Macroscopically, well-demarcated solid lipomatous masses were detected at the uncus, body, and tail of the pancreas, respectively. Microscopically, the masses predominantly consisted of mature adipocytes with no atypia, but contained characteristics components of pancreatic hamartoma, such as small ducts, a well-preserved acinar structure, and/or fibrous stroma. On the basis of the unique features, lack of islets and absence of p...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Frequency of MAP2K1, TP53, and U2AF1 Mutations in BRAF-mutated Langerhans Cell Histiocytosis: Further Characterizing the Genomic Landscape of LCH
Langerhans cell histiocytosis is a proliferative disorder of neoplastic Langerhans cells with activating mutations in the Erk signaling pathway. TP53 and U2AF1 mutations have been implicated in other myelomonocytic malignancies and we hypothesized that mutations in these genes may cosegregate in LCH patients according to BRAF mutation status. Towards this end, we collected cases with a pathologic diagnosis of Langerhans cell histiocytosis from Stanford University Hospital. We analyzed the status of known pathogenic alleles in BRAF, ARAF, TP53, U2AF1, and MAP2K1 on formalin-fixed, paraffin-embedded tissue by direct sequenci...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

NUT Carcinoma of the Salivary Glands: Clinicopathologic and Molecular Analysis of 3 Cases and a Survey of NUT Expression in Salivary Gland Carcinomas
NUT carcinoma (NC) represents a rare subset of highly aggressive poorly differentiated carcinomas characterized by rearrangement of the NUT (aka NUTM1, nuclear protein in testis) gene, most commonly fused to BRD4. Originally described as a mediastinal/thymic malignancy, NC has been reported at a variety of anatomic regions including the upper and lower aerodigestive tract. To date, only 7 NC cases of probable salivary gland origin have been reported. We herein describe 3 new cases (all affecting the parotid gland) in 2 women (39- and 55-y old) and 1 man (35-y old). Histologic examination showed poorly differentiated neopla...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Gastrointestinal Tract Vasculopathy: Clinicopathology and Description of a Possible “New Entity” With Protean Features
We report the clinical and histologic features of 16 cases (excluding 16 cases of immunoglobulin A vasculitis) diagnosed over a 20-year period. Of the 16 patients, 14 presented with symptoms related to the GI vasculopathy (including 2 presenting with a mass on endoscopic examination). The remaining 2 patients presented with incarcerated hernia and invasive adenocarcinoma. The vasculopathy was not associated with systemic disease and appeared limited to the GI tract in 8 patients. Eight had associated systemic disease, but only 6 had a prior diagnosis. The underlying diagnoses in these 6 patients included systemic lupus ery...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

A Point-based Histologic Scoring System for Hepatocellular Carcinoma Can Stratify Risk of Posttransplant Tumor Recurrence
Eligibility for liver transplant is most commonly decided by measuring tumor size and number on radiographic imaging. However, this method often underestimates the extent of disease. Evaluation of tumor histology has been shown to improve risk stratification when compared with imaging-based transplant criteria, but the World Health Organization (WHO) guidelines for grading hepatocellular carcinoma (HCC) are imprecise and require subjective interpretation by the pathologist. We performed a retrospective analysis of 190 explanted livers containing HCC and correlated histologic features with posttransplant recurrence to formu...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

PD-1 Expression in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) and Large B-cell Richter Transformation (DLBCL-RT): A Characteristic Feature of DLBCL-RT and Potential Surrogate Marker for Clonal Relatedness
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a low-grade B-cell neoplasm and ∼2% to 9% patients develop an aggressive lymphoma, most commonly diffuse large B-cell lymphoma (Richter transformation, DLBCL-RT). Programmed death-1 (PD-1) pathway plays a crucial role in tumor host immunity evasion and its blockade has emerged as an effective anti-cancer immunotherapy. PD-L1 and PD-1 expression has shown predictive value in anti-PD cancer immunotherapy; however, it has not been well documented in CLL/SLL and DLBCL-RT. We evaluated PD-1 and PD-L1 expression by immunohistochemistry in 39 CLL/SLL, 15 DLB...
Source: The American Journal of Surgical Pathology - June 12, 2018 Category: Pathology Tags: Original Articles Source Type: research

Noninferiority Diagnostic Value, but Also Economic and Turnaround Time Advantages From Digital Pathology
No abstract available (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Letter to the Editor Source Type: research

Statistics for Pathologists
No abstract available (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Book Review Source Type: research

Phyllodes Tumor of the Prostate With Epithelial Intestinal Metaplasia
Phyllodes tumor of the prostate is a rare mesenchymal tumor conventionally regarded as a stromal tumor of undetermined malignant potential. While the initial presentation is that of urinary obstruction and/or hematuria, the subsequent clinical behavior is thought to be a function of stromal cellularity and cytologic changes of malignancy. Of histologic interest, the epithelial component of this tumor varies, including intestinal metaplasia, as seen in the present case. (Source: The American Journal of Surgical Pathology)
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Case Report Source Type: research

Differentiated Vulvar Intraepithelial Neoplasia-like and Lichen Sclerosus-like Lesions in HPV-associated Squamous Cell Carcinomas of the Vulva
Most human papillomavirus (HPV)-associated vulvar squamous cell carcinomas (VSCCs) originate from high-grade squamous intraepithelial lesions, also named usual type vulvar intraepithelial neoplasia. However, growing evidence suggests that morphologic studies have limitations in predicting HPV status in vulvar lesions. We aimed to evaluate adjacent intraepithelial lesions in a series of DNA HPV-positive VSCCs, focusing on unusual histologic patterns mimicking differentiated vulvar intraepithelial neoplasia (dVIN) or lichen sclerosus (LS). We identified 326 DNA HPV-positive VSCC with at least 1 cm of skin adjacent to ...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Acral Spitz Nevi: A Clinicopathologic Study of 50 Cases With Immunohistochemical Analysis of P16 and P21 Expression
Spitz nevi on acral sites are rare and poorly documented. The combination of Spitzoid cytomorphology and atypical architectural features of the junctional component may lead to an erroneous diagnosis of melanoma. To study the clinicopthologic and immunohistochemical features, 50 Spitz nevi localized on the distal extremities were retrieved from departmental files. Clinical data and follow-up were obtained and the histologic features were analyzed. P16 and P21 immunohistochemical staining of the dermal component was compared with that of 10 acral lentiginous melanomas and 10 acral nevi. Acral Spitz nevi affected young adult...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Fallopian Tube Mucosal Involvement in Cervical Gastric-type Adenocarcinomas: Report of a Series With Discussion of the Distinction From Synchronous In Situ Tubal Lesions
We report 7 cases of cervical gastric-type adenocarcinoma with fallopian tube involvement predominantly in the form of mucosal colonization without underlying invasion. As far as we are aware, this has not been previously described and this report adds to the literature regarding metastatic neoplasms, which may exhibit tubal mucosal involvement and mimic an in situ lesion at this site. In all cases, there was associated ovarian involvement and in 6 of 7 cases, there was endometrial colonization. We speculate that the fallopian tube (and ovarian) involvement is secondary to transuterine spread. Given the occasional occurren...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Inflammatory Myofibroblastic Tumor Associated With the Placenta: Short Tandem Repeat Genotyping Confirms Uterine Site of Origin
We report 2 cases of IMT identified in association with pregnancy; the first was an intrauterine mass delivered entirely separate from the placenta and fetus, and the second was an incidental mass identified within the placental parenchyma following delivery. Short tandem repeat genotyping was used to compare tissue from the tumor and the placenta for both cases. Both tumors were determined to be of maternal origin, confirming that uterine IMTs may present within the placenta or as a separate mass following delivery. This demonstrates the utility of short tandem repeat genotyping in determining the origin of tumors present...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Chronic Myelomonocytic Leukemia With Fibrosis Is a Distinct Disease Subset With Myeloproliferative Features and Frequent JAK2 p.V617F Mutations
A subset of patients with chronic myelomonocytic leukemia (CMML) presents with significance myelofibrosis. In myelodysplastic syndromes, significant myelofibrosis has been associated with adverse outcomes and p53 dysregulation. However, in CMML the clinical and molecular correlates of significant myelofibrosis at presentation remain poorly understood. From a cohort of 651 CMML patients, we identified retrospectively 20 (3.1%) cases with moderate to severe reticulin fibrosis (CMML-F) detected at diagnosis, and we compared them to CMML patients without fibrosis (n=631) seen during the same period. Patients with CMML-F had a ...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

NTRK Fusions Define a Novel Uterine Sarcoma Subtype With Features of Fibrosarcoma
Tropomyosin receptor kinase (Trk) inhibitors have shown high response rates in patients with tumors harboring NTRK fusions. We identified 4 NTRK fusion-positive uterine sarcomas that should be distinguished from leiomyosarcoma and undifferentiated uterine sarcoma. NTRK rearrangements were detected by fluorescence in situ hybridization (FISH) and/or targeted RNA or DNA sequencing in 4 undifferentiated uterine sarcomas with spindle cell morphology. Because of histologic overlap with leiomyosarcoma, TrkA and pan-Trk immunohistochemistry was performed in 97 uterine leiomyosarcomas. NTRK1 and NTRK3 FISH was performed on tumors ...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Histopathologic Features of Postablation Tubal Sterilization Syndrome
Postablation tubal sterilization syndrome (PATSS) is an uncommon complication of endometrial ablation in patients with antecedent tubal ligation characterized by cyclic pelvic pain. Recurrent tubal distention resulting from retrograde menstruation into occluded proximal fallopian tube segments by residual/regenerated cornual endometrial tissue is postulated to be the cause. Reports of PATSS have largely focused on the clinicoradiologic and operative findings. Detailed descriptions of the gross pathologic findings of PATSS are sparse and rarer still are examples in which the histologic manifestations are discussed. Three pa...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Superficial Solitary Fibrous Tumor: A Series of 26 Cases
We describe the largest series to date of superficial SFT. For inclusion, SFT had to arise in dermis or subcutis. Twenty-six cases were identified. Patients ranged from 16 to 80 years (mean, 47 y) with a marked female predominance (19 F; 7 M). Tumors involved the head (11), thigh (7), back (3), shoulder (2), upper arm (1), ankle (1), and great toe (1). Mean size was 2.9 cm (range, 1.0 to 7.0 cm). The majority (n=19) had typical histologic features (cellular SFT) with irregular fascicles of spindled cells, staghorn-like blood vessels, and variable amounts of collagen. Necrosis was evident in 3 cases (al...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Distinct Genomic Copy Number Alterations Distinguish Mucinous Tubular and Spindle Cell Carcinoma of the Kidney From Papillary Renal Cell Carcinoma With Overlapping Histologic Features
Mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney is a rare type of renal cell carcinoma that frequently exhibits histologic and immunophenotypic features overlapping with type 1 papillary renal cell carcinoma (PRCC). To clarify molecular attributes that can be used for this difficult differential diagnosis, we sought to delineate the genome-wide copy number alterations in tumors displaying classic histologic features of MTSCC in comparison to the solid variant of type 1 PRCC and indeterminate cases with overlapping histologic features. The study included 11 histologically typical MTSCC, 9 tumors with overl...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Mediastinal Synovial Sarcoma: Clinicopathologic Analysis of 21 Cases With Molecular Confirmation
Synovial sarcoma (SS), a translocation-associated sarcoma characterized by SS18-SSX1/2 fusion, presents most often in the extremities of young adults. While SS regularly occurs in the pleuropulmonary parenchyma, the mediastinum is an exceedingly rare primary site; the literature on this subject is predominantly composed of case reports and small series, mostly without molecular confirmation. Cases of mediastinal SS were selected from our institutional and consultation archives. Diagnoses were confirmed by either SS18 fluorescence in situ hybridization (n=6) or reverse transcription polymerase chain reaction for SS18-SSX1/2...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research

Next-generation Sequencing Reveals Recurrent Somatic Mutations in Small Cell Neuroendocrine Carcinoma of the Uterine Cervix
Small cell neuroendocrine carcinoma (SCNEC) of the uterine cervix is a rare but extremely aggressive tumor. While high-risk human papillomavirus (HPV) is involved at an early stage of oncogenesis in many tumors, additional driving events have been postulated to facilitate the progression of SCNECs. Identification of oncogenic drivers could guide targeted therapy of this neoplasm. Clinicopathologic features of 10 cervical SCNECs are reported. Analyses included immunohistochemical evaluation of p16, p53, synaptophysin, and chromogranin expression; in situ hybridizations and polymerase chain reaction for high-risk HPV and/or ...
Source: The American Journal of Surgical Pathology - May 10, 2018 Category: Pathology Tags: Original Articles Source Type: research