Mesothelioma: diagnostic challenges from a pathological perspective. Naseema Vorajee August 2016

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Mesothelioma: diagnostic challenges from a pathological perspective. Naseema Vorajee August 2016"

Transcription

1 Mesothelioma: diagnostic challenges from a pathological perspective Naseema Vorajee August 2016

2 Pleural diseases (whether neoplastic, reactive or infective) may have similar clinical, radiographic and gross features Common features include pleuritic chest pain, a pleuralbased mass or pleural thickening and pleural effusion Treatment and prognoses of these diverse pleural diseases vary greatly and therefore the correct diagnosis is critical for the patient.

3 Main challenges 1. Mesothelioma vs reactive pleural reactions***** 2. Mesothelioma vs other primary and metastatic neoplasms 3. Immunohistochemistry: Lack of specific and sensitive IHC markers and specific challenges with sarcomatoid mesothelioma Diagnosing a malignant mesothelioma can be most challenging for the pathologist

4 Challenge Mesothelioma vs reactive pleural reactions*****

5 INVASION Proliferations on the surface: may be benign or malignant unequivocal invasion into lung or chest wall (fat and skeletal muscle ) = most diagnostic feature of malignant mesothelioma vs reactive fake fat phenomenon (Churg 2011 )

6 LINEAR ARRAYS Epithelioid mesothelioma vs 1. Mesothelial hyperplasia 2. Entrapped mesothelial cells and mesothelial inclusions

7 CYTOLOGICAL ATYPIA Sarcomatoid mesothlioma vs Chronic fibrous pleuritis Important features of a reactive pleuritis: 1. Zonation = decreasing cellularity with increasing amounts of collagen as you progress from surface to the base of the pleura 2. Capillaries arranged perpendicular to the surface 3. Active inflammation

8 Confounding factor: Open versus closed pleural biopsy and small specimen size (Attanoos and Gibbs 2008) Diagnosis of malignant mesothelioma was attained in 75% of biopsies measuring > 10 mm in size but only 8% when the biopsy < 10 mm 2010 guidelines from the ERS & ESTS: Thoracoscopy is the preferred technique extensive inspection of the pleura multiple and large biopsies that include subpleural tissue to assess invasion

9 Desmoplastic mesothelioma vs pleural plaque vs diffuse pleural fibrosis

10 This is a biopsy from a lesion in the head of the femur from a metastatic desmoplastic mn mesothelioma Patient had a an initial diagnosis a few months earlier of a fibrous pleuritis

11 Challenge Mesothelioma vs reactive pleural reactions***** Mesothelioma vs other primary and metastatic neoplasms Confounder Marked variation in histological patterns of mesothelioma lack of adequate clinical and radiologic information pleural based mass, diffuse pleural thickening with involvement of interlobar fissures Pseudomesotheliomatous carcinoma (Attanoos and Gibbs 2003)

12 Diffuse malignant mesothelioma 1. Epithelioid (50-60%) 2. Sarcomatoid (incl Desmoplastic) (25-35%) 3. Biphasic (mixed) (10-20%)

13 Epithelioid mesothelioma ACINAR type : Lung and other Adenoca Unusual variants: Deciduoid type CLEAR CELL type: Renal cell ca, Clear cell lung/ ovarian ca, Squamous ca SMALL CELL type: SCLC, Lobular breast ca, SRCT, Lymphoma, Melanoma Adenomatoid type

14 Sarcomatoid Mesothelioma Benign and intermediate mn potential spindle cell tumours of the Pleura: Schwannomas, Calcifying fibrous tumours Solitary fibrous tumours (SFT) Inflammatory myofibroblasatic tumours Malignant Primary and metastatic pleural tumours: Mn SFT Mn peripheral nerve sheet tumour Leiomyosarcoma Angiosarcoma

15 BIPHASIC MESOTHELIOMA Tumour with both epithelioid and sarcomatoid components; each component occupying approximately 10% of an adequate biopsy sample. Main DDX: Sarcomatoid ca Synovial sarcoma

16 Challenge 1. Mesothelioma vs reactive pleural reactions***** 2. Mesothelioma vs other primary and metastatic neoplasms 3. Immunohistochemistry: Lack of specific and sensitive IHC markers and specific challenges with sarcomatoid mesothelioma

17 IHC to differentiate mesothelioma from metastatic carcinoma and sarcoma NO IHC marker that is 100% specific / sensitive for mesothelioma Mesothelioma Calretinin WT1 CK5/6 Cam 5.2 Thrombo modulin mesothelin D240 Adenocarcinoma CEA Ber EP4 B72.3 MOC31 CD15 TTF1 Thrombomodulin (D240) and calretinin: highly sensitive but low specificity for DMM (Carbone et al 2016) Calretinin + in 6% adenoca and 23% Squamous ca D240 + in 77% Squamous ca Calretinin also + in sex cord stromal txs, synovial sarcoma, adrenal gland txs and D240 + in urothelial txs WT1: most specific marker for epithelioid mesothelioma but lacks sensitivity

18 Role of Cytology in diagnosing mesothelioma Published sensitivity of cytologic diagnosis of mesothelioma ranges between 32% and 76% high false-negative rate Sarcomatoid mesos do not shed Most useful cytologic feature of epithelioid mesothelioma: = numerous, large (>50 cells) balls of cells with berrylike external contours

19 IHC to differentiate benign from malignant mesothelial cells

20 Electron microscopy

21 P16 FISH

22 More recently published Usefulness of adding BRCA1 associated protein 1 (BAP1) IHC stain to the panel Differentiate reactive mesothelial cells from malignant mesothelioma and mesothelioma from Non Small Cell Lung Carcinoma BRCA1 associated protein 1 (BAP1) genetic mutations recently discovered in familial and sporadic cases of Mn mesothelioma (Carbone 2003, 2016) Loss of nuclear signalling is regarded as positive Caveat: only 63% of malignant mesothelioma show the BAP1 mutation

23 Features not useful in making the diagnosis: 1. History of asbestos exposure 2. Simian virus 40

24 In a NUTSHELL Malignant mesothelioma is a rare tumor that has a grave prognosis and invariably has medicolegal implications Unequivocal invasion into lung or chest wall is the single most reliable diagnostic feature of mesothelioma Caution exercised on being definitive on a small, poorly orientated biopsy and a biopsy with active inflammation Cytology has several limitations Sarcomatoid mesotheliomas have their own set of diagnostic dilemmas There is no Golden IHC stain; a PANEL of IHC stains is always required

25

26 References Aliya N.Husain, Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2012 Update of the Consensus Statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med Vol 137, May 2013 Andrew Churg et al, The Fake Fat Phenomenon in Organizing Pleuritis: A Source of Confusion With Desmoplastic Malignant Mesotheliomas. Am J Surg Pathol 2011;35: Michel Carbone et al, Positive nuclear BAP1 immunostaining helps differentiate nonsmall cell lung carcinomas from malignant mesothelioma. Oncotarget, Advance Publicatns 2016 R L Attanoos & A R Gibbs, Pseudomesotheliomatous carcinomas of the pleura: a 10-year analysis of cases from the Environmental Lung Disease Research Group, Cardiff. Histopathology 2003, 43, R L Attanoos & A R Gibbs, The comparative accuracy of different pleural biopsy techniques in the diagnosis of malignant mesothelioma. Histopathology 2008, 53, Joseph R Testa et al, Germline BAP1 mutations predispose to malignant mesothelioma. Nature genetics; published online 28 August 2011

Biopsy Interpretation of Spindle cell proliferations of the Serosa

Biopsy Interpretation of Spindle cell proliferations of the Serosa Biopsy Interpretation of Spindle cell proliferations of the Serosa Richard Attanoos, Cardiff. U.K. Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee)

More information

Guidelines for Pathologic Diagnosis of Malignant Mesothelioma. A Consensus Statement from the International Mesothelioma Interest Group

Guidelines for Pathologic Diagnosis of Malignant Mesothelioma. A Consensus Statement from the International Mesothelioma Interest Group Guidelines for Pathologic Diagnosis of Malignant Mesothelioma A Consensus Statement from the International Mesothelioma Interest Group Aliya N. Husain, MD; Thomas V. Colby, MD; Nelson G. Ordóñez, MD; Thomas

More information

The pathologic diagnosis of malignant mesothelioma

The pathologic diagnosis of malignant mesothelioma Review Articles Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2017 Update of the Consensus Statement From the International Mesothelioma Interest Group Aliya Noor Husain, MD; Thomas V.

More information

Well-differentiated Papillary Mesothelioma of the Pleura Diagnosed by Video-Assisted Thoracic Surgical Pleural Biopsy : A Case Report

Well-differentiated Papillary Mesothelioma of the Pleura Diagnosed by Video-Assisted Thoracic Surgical Pleural Biopsy : A Case Report Showa Univ J Med Sci 25 1, 67 72, March 2013 Case Report Well-differentiated Papillary Mesothelioma of the Pleura Diagnosed by Video-Assisted Thoracic Surgical Pleural Biopsy : A Case Report Yuri TOMITA

More information

As part of the International Mesothelioma Interest Group

As part of the International Mesothelioma Interest Group Review Articles Guidelines for Pathologic Diagnosis of Malignant Mesothelioma 2012 Update of the Consensus Statement from the International Mesothelioma Interest Group Aliya N. Husain, MD; Thomas Colby,

More information

57th Annual HSCP Spring Symposium 4/16/2016

57th Annual HSCP Spring Symposium 4/16/2016 An Unusual Malignant Spindle Cell Lesion to Involve the Breast Erinn Downs-Kelly, D.O. Associate Professor of Pathology University of Utah & ARUP Laboratories No disclosures Case 39 y/o female with no

More information

Spindle Cell CA SPINDLE CELL LESIONS OF THE BREAST. Mammary Spindle Cell Lesions 04/13/2017

Spindle Cell CA SPINDLE CELL LESIONS OF THE BREAST. Mammary Spindle Cell Lesions 04/13/2017 Melinda F. Lerwill, MD Massachusetts General Hospital Harvard Medical School SPINDLE CELL LESIONS OF THE BREAST Mammary Spindle Cell Lesions Spindle cell carcinoma Fibromatosis Nodular fasciitis PASH Myofibroblastoma

More information

Differential diagnosis of HCC

Differential diagnosis of HCC Hepatocellular Carcinoma Quest for an Ideal Immunohistochemical Panel Sanjay Kakar, MD UCSF Differential diagnosis of HCC Hepatocellular lesions Adenoma, FNH, HG dysplasia Adenocarcinoma CholangioCA, metastasis

More information

Update on Thyroid FNA The Bethesda System. Shikha Bose M.D. Associate Professor Cedars Sinai Medical Center

Update on Thyroid FNA The Bethesda System. Shikha Bose M.D. Associate Professor Cedars Sinai Medical Center Update on Thyroid FNA The Bethesda System Shikha Bose M.D. Associate Professor Cedars Sinai Medical Center Thyroid Nodules Frequent occurrence Palpable: 4-7% of adults Ultrasound: 10-31% Majority benign

More information

Case 18. M75. Excision of mass on scalp. Clinically SCC. The best diagnosis is:

Case 18. M75. Excision of mass on scalp. Clinically SCC. The best diagnosis is: Case 18 M75. Excision of mass on scalp. Clinically SCC. The best diagnosis is: A. Pilomatrical carcinoma B. Adnexal carcinoma NOS C. Metastatic squamous cell carcinoma D.Primary squamous cell carcinoma

More information

Respiratory Interactive Session. Elaine Borg

Respiratory Interactive Session. Elaine Borg Respiratory Interactive Session Elaine Borg Case 1 Respiratory Cytology 55 year old gentleman Anterior mediastinal mass EBUS FNA Case 1 Respiratory Cytology 55 year old gentleman with anterior mediastinal

More information

Immunohistochemistry in Bone and Soft Tissue Tumors. Sahar Rassi Zankoul, MD

Immunohistochemistry in Bone and Soft Tissue Tumors. Sahar Rassi Zankoul, MD Immunohistochemistry in Bone and Soft Tissue Tumors Sahar Rassi Zankoul, MD Introduction Bone tumors represent a wide variety of tumors of various origins and malignant potentials. These different tumor

More information

Cutaneous metastases. Thaddeus Mully. University of California, San Francisco Professor, Departments of Pathology and Dermatology

Cutaneous metastases. Thaddeus Mully. University of California, San Francisco Professor, Departments of Pathology and Dermatology Cutaneous metastases Thaddeus Mully University of California, San Francisco Professor, Departments of Pathology and Dermatology DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY Thaddeus Mully Course C005 Essential

More information

Mody. AIS vs. Invasive Adenocarcinoma of the Cervix

Mody. AIS vs. Invasive Adenocarcinoma of the Cervix Common Problems in Gynecologic Pathology Michael T. Deavers, M.D. Houston Methodist Hospital, Houston, Texas Common Problems in Gynecologic Pathology Adenocarcinoma in-situ (AIS) of the Cervix vs. Invasive

More information

Serous effusion Objectives. Cytology of Serous Effusions From basics to challenges

Serous effusion Objectives. Cytology of Serous Effusions From basics to challenges Cytology of Serous Effusions From basics to challenges Cytology of Serous Effusions From basics to challenges Pınar Fırat, MD, MIAC Department of Pathology, İstanbul University, İstanbul Faculty of Medicine,

More information

Update on 2015 WHO Classification of Lung Adenocarcinoma 1/3/ Mayo Foundation for Medical Education and Research. All rights reserved.

Update on 2015 WHO Classification of Lung Adenocarcinoma 1/3/ Mayo Foundation for Medical Education and Research. All rights reserved. 1 Our speaker for this program is Dr. Anja Roden, an associate professor of Laboratory Medicine and Pathology at Mayo Clinic as well as consultant in the Anatomic Pathology Laboratory and co-director of

More information

Urinary Bladder: WHO Classification and AJCC Staging Update 2017

Urinary Bladder: WHO Classification and AJCC Staging Update 2017 Urinary Bladder: WHO Classification and AJCC Staging Update 2017 Houston Society of Clinical Pathologists 58 th Annual Spring Symposium Houston, TX April 8, 2017 Jesse K. McKenney, MD Classification

More information

Serous Effusions. Spasenija Savic Prince, MD Pathology, University Hospital Basel, Switzerland

Serous Effusions. Spasenija Savic Prince, MD Pathology, University Hospital Basel, Switzerland Serous Effusions Spasenija Savic Prince, MD Pathology, University Hospital Basel, Switzerland Serous membrane Body cavities: Pleural Pericardial Peritoneal Effusion = Excess of fluid 80% Benign 20% Malignant

More information

Effusion Cytology: Diagnostic Challenges

Effusion Cytology: Diagnostic Challenges Effusion Cytology: Diagnostic Challenges Tarik M. Elsheikh, MD Professor and Medical Director, Anatomic Pathology Cleveland Clinic Outside Consult Case 45 year old woman, presented with nausea, dyspnea,

More information

Ascitic Fluid and Use of Immunocytochemistry. Mercè Jordà, University of Miami

Ascitic Fluid and Use of Immunocytochemistry. Mercè Jordà, University of Miami Ascitic Fluid and Use of Immunocytochemistry Mercè Jordà, University of Miami Is It Malignant? Yes? No Ascitic Fluid Cytomorphologic Useful Findings Tight clusters with smooth borders Cellular and nuclear

More information

Leydig Cell Tumors. Sex Cord Stromal Tumors of the Testis. Sex Cord Stromal Tumors of the Testis 6/5/2010

Leydig Cell Tumors. Sex Cord Stromal Tumors of the Testis. Sex Cord Stromal Tumors of the Testis 6/5/2010 Sex Cord Stromal Tumors of the Testis Sex Cord Stromal Tumors of the Testis Charles Zaloudek, M.D. Professor, Department of Pathology University of California, San Francisco 505 Parnassus Ave., M563 San

More information

INDEX. surgpath.theclinics.com. Note: Page numbers of article titles are in boldface type. diffuse pleural fibrosis, pleural plaques,

INDEX. surgpath.theclinics.com. Note: Page numbers of article titles are in boldface type. diffuse pleural fibrosis, pleural plaques, INDEX Note: Page numbers of article titles are in boldface type. A Adenocarcinoma, minimally invasive. See Minimally invasive adenocarcinoma (MIA). Airway-centered interstitial fibrosis, 183 184 ALK (anaplastic

More information

Disclosures. Parathyroid Pathology. Objectives. The normal parathyroid 11/10/2012

Disclosures. Parathyroid Pathology. Objectives. The normal parathyroid 11/10/2012 Disclosures Parathyroid Pathology I have nothing to disclose Annemieke van Zante MD/PhD Assistant Professor of Clinical Pathology Associate Chief of Cytopathology Objectives 1. Review the pathologic features

More information

NEW IHC A n t i b o d i e s

NEW IHC A n t i b o d i e s NEW IHC Antibodies TABLE OF CONTENTS NEW IHC ANTIBODIES from Cell Marque CITED1 (5H6).... 1 Claudin 7 (5D10F3).... 1 GATA1 (4F5).... 1 Transgelin (2A10C2).... 1 NEW IHC ANTIBODIES using RabMAb Technology

More information

Histopathological diagnosis of CUP

Histopathological diagnosis of CUP Histopathological diagnosis of CUP Dr Karin Oien karin.oien@glasgow.ac.uk Disclosure slide Dr Karin Oien has no financial interests in any company mentioned in this presentation. Dr Karin Oien is conducting

More information

Cytological Sub-classification of Lung Cancer: Morphologic and Molecular Characteristics. Mercè Jordà, University of Miami

Cytological Sub-classification of Lung Cancer: Morphologic and Molecular Characteristics. Mercè Jordà, University of Miami Cytological Sub-classification of Lung Cancer: Morphologic and Molecular Characteristics Mercè Jordà, University of Miami Mortality Lung cancer is the most frequent cause of cancer incidence and mortality

More information

4/12/2018. MUSC Pathology Symposium Kiawah Island April 18, Jesse K. McKenney, MD

4/12/2018. MUSC Pathology Symposium Kiawah Island April 18, Jesse K. McKenney, MD MUSC Pathology Symposium Kiawah Island April 18, 2018 Jesse K. McKenney, MD 1 Urothelial Carcinoma with Alternative Differentiation 2 Urothelial Carcinoma with Alternative Differentiation Recognition as

More information

Prostate Pathology: Prostate Carcinoma, variants and Gleason Grading (Part 1)

Prostate Pathology: Prostate Carcinoma, variants and Gleason Grading (Part 1) Prostate Pathology: Prostate Carcinoma, variants and Gleason Grading (Part 1) Jae Y. Ro, MD, PhD June 7, 2012 Ten Leading Cancer Types for the Estimated New Cancer Cases and Deaths By Sex, United States,

More information

When Immunostains Can Get You in Trouble: Gynecologic Pathology p16: Panacea or Pandora s Box?

When Immunostains Can Get You in Trouble: Gynecologic Pathology p16: Panacea or Pandora s Box? When Immunostains Can Get You in Trouble: Gynecologic Pathology p16: Panacea or Pandora s Box? Teri A. Longacre, MD Stanford Medicine Stanford California pi6 in Gynecologic Pathology: Panacea or Pandora

More information

How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens

How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens Wenxin Zheng, M.D. Professor of Pathology and Gynecology University of Arizona zhengw@email.arizona.edu http://www.zheng.gynpath.medicine.arizona.edu/index.html

More information

5/1/2009. Squamous Dysplasia/CIS AAH DIPNECH. Adenocarcinoma

5/1/2009. Squamous Dysplasia/CIS AAH DIPNECH. Adenocarcinoma Pathological Assessment of Diagnostic Specimens Keith Kerr Department of Pathology Aberdeen University Medical School Aberdeen Royal Infirmary Foresterhill, Aberdeen, Scotland, UK Tumours of the Lung:

More information

SCLEROSING LESIONS OF THE MEDIASTINUM

SCLEROSING LESIONS OF THE MEDIASTINUM SCLEROSING LESIONS OF THE MEDIASTINUM Mark R. Wick, MD Division of Surgical Pathology University of Virginia Health System Charlottesville, VA, USA SCLEROSING MEDIASTINITIS A slowly-evolving tumefactive

More information

Problem 1: Differential of Neuroendocrine Carcinoma 3/23/2017. Disclosure of Relevant Financial Relationships

Problem 1: Differential of Neuroendocrine Carcinoma 3/23/2017. Disclosure of Relevant Financial Relationships Differential of Neuroendocrine Carcinoma Alain C. Borczuk,MD Weill Cornell Medicine Disclosure of Relevant Financial Relationships USCAP requires that all faculty in a position to influence or control

More information

Conflict of interest. Gynecologic Pathology. Gynecologic Pathology

Conflict of interest. Gynecologic Pathology. Gynecologic Pathology The role of immunohistochemistry in surgical pathology of the uterine corpus and cervix, vagina and vulva Conflict of interest None (but the ovary is my favorite organ) Ålborg, June 10, 2015 Prof. Ben

More information

A 70-Year-Old Woman With Dyspnea and Chest Pain

A 70-Year-Old Woman With Dyspnea and Chest Pain CHEST Chest Imaging and Pathology for Clinicians A 70-Year-Old Woman With Dyspnea and Chest Pain Aarthi Ganesh, MD ; Michael Flores, MD ; Isabel Oliva, MD ; and Gordon E. Carr, MD CHEST 2014; 146 ( 1 ):

More information

Renal tumours: use of immunohistochemistry & molecular pathology. Dr Lisa Browning John Radcliffe Hospital Oxford

Renal tumours: use of immunohistochemistry & molecular pathology. Dr Lisa Browning John Radcliffe Hospital Oxford Renal tumours: use of immunohistochemistry & molecular pathology Dr Lisa Browning John Radcliffe Hospital Oxford Renal tumours: the use of immunohistochemistry & molecular pathology Classification of RCC

More information

PAAF vs Core Biopsy en Lesiones Mamarias Case #1

PAAF vs Core Biopsy en Lesiones Mamarias Case #1 5/19/2014 PAAF vs Core Biopsy en Lesiones Mamarias Case #1 Fine Needle Aspiration Cytology of Breast: Correlation with Needle Core Biopsy 64-year-old woman Mass in breast Syed Hoda, MD CD31 Post-Radiation

More information

Pathological Classification of Hepatocellular Carcinoma

Pathological Classification of Hepatocellular Carcinoma 3 rd APASL Single Topic Conference: HCC in 3D Pathological Classification of Hepatocellular Carcinoma Glenda Lyn Y. Pua, M.D. HCC Primary liver cancer is the 2 nd most common cancer in Asia HCC is the

More information

Australasian Dermatopathology Society Perth 2014 Goeffrey Hunter Oration. Artur Zembowicz, MD, PhD

Australasian Dermatopathology Society Perth 2014 Goeffrey Hunter Oration. Artur Zembowicz, MD, PhD Australasian Dermatopathology Society Perth 2014 Goeffrey Hunter Oration Borderline Melanocytic Tumors Artur Zembowicz, MD, PhD Associate Professor of Pathology, Tufts Medical School, Boston, MA Medical

More information

PATHOLOGY OF LIVER TUMORS

PATHOLOGY OF LIVER TUMORS PATHOLOGY OF LIVER TUMORS Pathobasic, 31.05.2016 WHO Classification Approach to a Liver Mass Lesion in a patient with chronic liver disease? Lesion in a patient without chronic liver disease? Malignant

More information

Case 4 Diagnosis 2/21/2011 TGB

Case 4 Diagnosis 2/21/2011 TGB Case 4 22 year old female presented with asymmetric enlargement of the left lobe of the thyroid gland. No information available relative to a prior fine needle aspiration biopsy. A left lobectomy was performed.

More information

Applications of Flow Cytometry in Diagnostic Cytology of Body Cavity Fluids

Applications of Flow Cytometry in Diagnostic Cytology of Body Cavity Fluids Applications of Flow Cytometry in Diagnostic Cytology of Body Cavity Fluids Awtar Krishan, PhD. Professor, Department of Pathology University of Miami School of Medicine akrishan@med.miami.edu Beckman

More information

Salivary Gland FNA ATYPICAL : Criteria and Controversies

Salivary Gland FNA ATYPICAL : Criteria and Controversies Salivary Gland FNA ATYPICAL : Criteria and Controversies W.C. Faquin, M.D., Ph.D. Director, Head and Neck Pathology Massachusetts General Hospital Massachusetts Eye and Ear Infirmary Harvard Medical School

More information

List of Available TMAs in the PRN

List of Available TMAs in the PRN TMA RPCI_BrainCa01 RPCI_BrCa03 RPCI_BrCa04 RPCI_BrCa05 RPCI_BrCa0 RPCI_BrCa07 RPCI_BrCa08 RPCI_BrCa15 RPCI_BrCa1 RPCI_BrCa17 RPCI_BrCa18 RPCI_BrCa19 RPCI_BrCa20 RPCI_BrCa21 RPCI_BrCa24 RPCI_BrCa25 RPCI_BrCa2

More information

Prostate cancer ~ diagnosis and impact of pathology on prognosis ESMO 2017

Prostate cancer ~ diagnosis and impact of pathology on prognosis ESMO 2017 Prostate cancer ~ diagnosis and impact of pathology on prognosis ESMO 2017 Dr Puay Hoon Tan Division of Pathology Singapore General Hospital Prostate cancer (acinar adenocarcinoma) Invasive carcinoma composed

More information

Pitfalls in the Diagnosis of Malignant Mesothelioma

Pitfalls in the Diagnosis of Malignant Mesothelioma 37 Pitfalls in the Diagnosis of Malignant Mesothelioma Donald G. Guinee, Jr. and William D. Travis The pathologic assessment of pleural lesions encompasses a variety of neoplastic and reactive conditions

More information

Bruce W. Case, M.D., Dipl. Occup. Hygiene, M.Sc., FRCP(C)

Bruce W. Case, M.D., Dipl. Occup. Hygiene, M.Sc., FRCP(C) Bruce W. Case, M.D., Dipl. Occup. Hygiene, M.Sc., FRCP(C) With a few things added by the presenter : David M. Bernstein, Ph.D., Consultant in Toxicology, Geneva, Switzerland davidb@itox.ch DAVID M. BERNSTEIN,

More information

Diagnostic challenge: Sclerosing Hemangioma of the Lung. Department of Medicine, Division of Pulmonary and Critical Care, Lincoln Medical and

Diagnostic challenge: Sclerosing Hemangioma of the Lung. Department of Medicine, Division of Pulmonary and Critical Care, Lincoln Medical and Diagnostic challenge: Sclerosing Hemangioma of the Lung. S. Arias M.D, R. Loganathan M.D, FCCP Department of Medicine, Division of Pulmonary and Critical Care, Lincoln Medical and Mental Health Center/Weill

More information

23rd International Academy of Pathology Arab Division. Pleural tumors

23rd International Academy of Pathology Arab Division. Pleural tumors Diagnosis 23rd International Academy of Pathology Arab Division Pleural tumors Francoise Galateau-Salle MESOPATH- IM@EC center MESONAT registry, CHU, CAEN, France ERI3 INSERM, CHU Caen, France. Introduction

More information

Pseudomesotheliomatous Carcinoma of the Lung

Pseudomesotheliomatous Carcinoma of the Lung Pseudomesotheliomatous Carcinoma of the Lung A Variant of Peripheral Lung Cancer T. R. HARWOOD, M.D., D. R. GRACEY, M.D., AND H. YOKOO, M.D. From the Departments of Pathology, and Pulmonary Section of

More information

Classification (1) Classification (3) Classification (2) Spindle cell lesions. Spindle cell lesions of bladder (Mills et al.

Classification (1) Classification (3) Classification (2) Spindle cell lesions. Spindle cell lesions of bladder (Mills et al. Non-epithelial tumours and nonepithelial tumour-like lesions of the bladder Dr Jonathan H Shanks The Christie NHS Foundation Trust, Manchester, UK Classification (1) Myofibroblastic proliferations and

More information

Benign Mimics of Malignancy in Breast Pathology

Benign Mimics of Malignancy in Breast Pathology Arthur Purdy Stout Society of Surgical Pathologists Companion Meeting Benign Mimics of Malignancy in Breast Pathology Stuart J. Schnitt, M.D. Beth Israel Deaconess Medical Center and Harvard Medical School,

More information

Mousa. Israa Ayed. Abdullah AlZibdeh. 0 P a g e

Mousa. Israa Ayed. Abdullah AlZibdeh. 0 P a g e 1 Mousa Israa Ayed Abdullah AlZibdeh 0 P a g e Breast pathology The basic histological units of the breast are called lobules, which are composed of glandular epithelial cells (luminal cells) resting on

More information

Synonyms. Nephrogenic metaplasia Mesonephric adenoma

Synonyms. Nephrogenic metaplasia Mesonephric adenoma Nephrogenic Adenoma Synonyms Nephrogenic metaplasia Mesonephric adenoma Definition Benign epithelial lesion of urinary tract with tubular, glandular, papillary growth pattern Most frequently in the urinary

More information

NPQR Quality Payment Program (QPP) Measures 21_18247_LS.

NPQR Quality Payment Program (QPP) Measures 21_18247_LS. NPQR Quality Payment Program (QPP) Measures 21_18247_LS MEASURE ID: QPP 99 MEASURE TITLE: Breast Cancer Resection Pathology Reporting pt Category (Primary Tumor) and pn Category (Regional Lymph Nodes)

More information

Immunohistochemistry in Peritoneal Mesothelioma. A Single-Center Experience of 244 Cases

Immunohistochemistry in Peritoneal Mesothelioma. A Single-Center Experience of 244 Cases Immunohistochemistry in Peritoneal Mesothelioma A Single-Center Experience of 244 Radhika Theresa Tandon, BS; Yuis Jimenez-Cortez, BA; Robert Taub, MD, PhD; Alain C. Borczuk, MD Context. Diagnosis of malignant

More information

Malignant Mesothelioma of the Tunica Vaginalis Testis. Diagnostic Studies and Differential Diagnosis. Seble S. Chekol, MD; Chen-Chin Sun, MD

Malignant Mesothelioma of the Tunica Vaginalis Testis. Diagnostic Studies and Differential Diagnosis. Seble S. Chekol, MD; Chen-Chin Sun, MD Malignant Mesothelioma of the Tunica Vaginalis Testis Diagnostic Studies and Differential Diagnosis N Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor representing 0.3%

More information

Invasion to the visceral pleura is an important component

Invasion to the visceral pleura is an important component Diagnosis of Visceral Pleural Invasion by Lung Cancer Using Intraoperative Touch Cytology Yushi Saito, MD, PhD, Yosuke Yamakawa, MD, PhD, Masanobu Kiriyama, MD, PhD, Ichiro Fukai, MD, PhD, Satoshi Kondo,

More information

The Spectrum of Management of Pulmonary Ground Glass Nodules

The Spectrum of Management of Pulmonary Ground Glass Nodules The Spectrum of Management of Pulmonary Ground Glass Nodules Stanley S Siegelman CT Society 10/26/2011 No financial disclosures. Noguchi M et al. Cancer 75: 2844-2852, 1995. 236 surgically resected peripheral

More information

Greater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy

Greater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy Greater Manchester & Cheshire Guidelines for Pathology Reporting for Oesophageal and Gastric Malignancy Authors: Dr Gordon Armstrong, Dr Sue Pritchard 1. General Comments 1.1 Cancer reporting: Biopsies

More information

Among the benign intraepithelial melanocytic proliferations, Inflamed Conjunctival Nevi. Histopathological Criteria. Resident Short Reviews

Among the benign intraepithelial melanocytic proliferations, Inflamed Conjunctival Nevi. Histopathological Criteria. Resident Short Reviews Resident Short Reviews Inflamed conjunctival nevi (ICN) may suggest malignancy because of their rapid growth and atypical histology. The objective of this study was to characterize the diagnostic features

More information

DIAGNOSTIC DILEMMA. Case Reports Clinical history. Materials and Methods

DIAGNOSTIC DILEMMA. Case Reports Clinical history. Materials and Methods DIAGNOSTIC DILEMMA A Metastatic Renal Carcinoid Tumor Presenting as Breast Mass: A Diagnostic Dilemma Farnaz Hasteh, M.D., 1 Robert Pu, M.D., Ph.D., 2 and Claire W. Michael, M.D. 2 * We present clinicopathological

More information

ASC 58th Annual Scientific Meeting

ASC 58th Annual Scientific Meeting Effusion Cytology: Charting a course through and navigating the waters Michael H. Roh, MD, PhD Claire W. Michael, MD University of Michigan Medical School Conflict of interest The presenters have no conflicts

More information

Reporting of carcinoma of unknown primary tumour (CUP)

Reporting of carcinoma of unknown primary tumour (CUP) Reporting of carcinoma of unknown primary tumour (CUP) Prof John Schofield Kent Oncology Centre with grateful thanks to Dr Karin Oien University of Glasgow Royal College of Pathologists Cancer datasets

More information

Outline 11/2/2017. Pancreatic EUS-FNA general aspects. Cytomorphologic features of solid neoplasms/lesions of the pancreas

Outline 11/2/2017. Pancreatic EUS-FNA general aspects. Cytomorphologic features of solid neoplasms/lesions of the pancreas ENDOSCOPIC ULTRASOUND GUIDED-FINE NEEDLE ASPIRATION CYTOLOGY OF PANCREAS Khalid Amin M.D. Assistant Professor Department of Laboratory Medicine and Pathology University of Minnesota Outline Pancreatic

More information

Lung Cancer Risks. Cancer in the United States, Cancer Death Rates, US The Scheme: From Nicotine Addiction to Lung Cancer

Lung Cancer Risks. Cancer in the United States, Cancer Death Rates, US The Scheme: From Nicotine Addiction to Lung Cancer Cancer in the United States, 2004 Lung Cancer Risks Cigarette Smoking Environmental Tobacco Smoke Other Carcinogens Asbestos, Arsenic, Radon, Bis(chloromethyl) ether, Chromium, Foundry fumes, nickel, mustard

More information

Guideline for the Handling of Pathology Lung Tissue Specimens

Guideline for the Handling of Pathology Lung Tissue Specimens Guideline for the Handling of Pathology Lung Tissue Specimens Version Date Summary of Change/Process 0.1 29.06.11 Produced by Simon Trotter and circulated to Lung Network Site Specific Group for reviewing

More information

* I have no disclosures or any

* I have no disclosures or any Howard Rosenthal, M.D. Associate Professor of Orthopedic Surgery University of Kansas Sarcoma Center I have no disclosures or any conflicts related to the content of this presentation. Objectives 1. Describe

More information

Oncocytic-Appearing Salivary Gland Tumors. Oncocytic, Cystic, Mucinous, and High Grade Salivary Gland Tumors SALIVARY GLAND FNA: PART II

Oncocytic-Appearing Salivary Gland Tumors. Oncocytic, Cystic, Mucinous, and High Grade Salivary Gland Tumors SALIVARY GLAND FNA: PART II William C. Faquin, MD, PhD Professor of Pathology Harvard Medical School Director of Head and Neck Pathology Massachusetts Eye and Ear Massachusetts General Hospital SALIVARY GLAND FNA: PART II Oncocytic,

More information

SCOPE OF PRACTICE PGY-5

SCOPE OF PRACTICE PGY-5 Recognize normal cytomorphology of cells derived from the respiratory, gastrointestinal, and genitourinary tracts, and body fluid (Cerebrospinal fluid, pleural and peritoneal fluid) Recognize normal cytomorphology

More information

History A 89 year old gentleman presenting with a scalp/forehead nodule. Patient had squamous cell carcinoma 18 m at same site, excised. Outside diagn

History A 89 year old gentleman presenting with a scalp/forehead nodule. Patient had squamous cell carcinoma 18 m at same site, excised. Outside diagn Case III History A 89 year old gentleman presenting with a scalp/forehead nodule. Patient had squamous cell carcinoma 18 m at same site, excised. Outside diagnoses: Squamous cell carcinoma. R/O: SCC, Melanoma,

More information

Diseases of the breast (1 of 2)

Diseases of the breast (1 of 2) Diseases of the breast (1 of 2) Introduction A histology introduction Normal ducts and lobules of the breast are lined by two layers of cells a layer of luminal cells overlying a second layer of myoepithelial

More information

Neoplasia part I. Dr. Mohsen Dashti. Clinical Medicine & Pathology nd Lecture

Neoplasia part I. Dr. Mohsen Dashti. Clinical Medicine & Pathology nd Lecture Neoplasia part I By Dr. Mohsen Dashti Clinical Medicine & Pathology 316 2 nd Lecture Lecture outline Review of structure & function. Basic definitions. Classification of neoplasms. Morphologic features.

More information

Update on staging colorectal carcinoma, the 8 th edition AJCC. General overview of staging. When is staging required? 11/1/2017

Update on staging colorectal carcinoma, the 8 th edition AJCC. General overview of staging. When is staging required? 11/1/2017 Update on staging colorectal carcinoma, the 8 th edition AJCC Dale C. Snover, MD November 3, 2017 General overview of staging Reason for uniform staging Requirements to use AJCC manual and/or CAP protocols

More information

Carcinoma of unknown primary origin (CUP) is defined

Carcinoma of unknown primary origin (CUP) is defined REVIEW ARTICLE Metastatic Carcinoma of Unknown Primary: Diagnostic Approach Using Immunohistochemistry James R. Conner, MD, PhD and Jason L. Hornick, MD, PhD Abstract: Carcinoma of unknown primary origin

More information

Grading Prostate Cancer: Recent Changes and Refinements

Grading Prostate Cancer: Recent Changes and Refinements USPSTF: 2012 Report on serum PSA Screening Recommendation rating of D Reduced screening, Reduced biopsies, reduced incidence Refinements currently occurring in 2017. WHY? Grading Prostate Cancer: Recent

More information

Respiratory Tract Cytology

Respiratory Tract Cytology Respiratory Tract Cytology 40 th European Congress of Cytology Liverpool, UK Momin T. Siddiqui M.D. Professor of Pathology and Laboratory Medicine Director of Cytopathology Emory University Hospital, Atlanta,

More information

Unusual Variants of Bladder Cancer Cristina Magi-Galluzzi, MD, PhD

Unusual Variants of Bladder Cancer Cristina Magi-Galluzzi, MD, PhD Unusual Variants of Bladder Cancer Cristina Magi-Galluzzi, MD, PhD Director of Genitourinary Pathology, Professor of Pathology, Lerner College of Medicine Cleveland Clinic Objectives Update on variants

More information

Pathology of the Prostate. PathoBasic Tatjana Vlajnic

Pathology of the Prostate. PathoBasic Tatjana Vlajnic Pathology of the Prostate PathoBasic 24.01.17 Tatjana Vlajnic Overview Adenocarcinoma of the prostate Grading Special variants Mimickers of prostate adenocarcinoma Atrophy Inflammatory conditions Granulomatous

More information

Carcinoma of Unknown Primary (CUP)

Carcinoma of Unknown Primary (CUP) Metasta c Carcinoma of Unknown Primary: Diagnos c Approach Using Immunohistochemistry James R. Conner, MD, PhD Mount Sinai Hospital Toronto, ON Carcinoma of Unknown Primary (CUP) 3-5% of all new malignant

More information

GOBLET CELL CARCINOID

GOBLET CELL CARCINOID GOBLET CELL CARCINOID Hanlin L. Wang, MD, PhD University of California Los Angeles Disclosure of Relevant Financial Relationships USCAP requires that all planners (Education Committee) in a position to

More information

Histopathology: Colorectal polyps and carcinoma

Histopathology: Colorectal polyps and carcinoma Histopathology: Colorectal polyps and carcinoma These presentations are to help you identify, and to test yourself on identifying, basic histopathological features. They do not contain the additional factual

More information

Chapter 3 Metastases and Mimics of Colorectal Carcinoma

Chapter 3 Metastases and Mimics of Colorectal Carcinoma Chapter 3 Metastases and Mimics of Colorectal Carcinoma Abstract Secondary involvement of the colon by other malignant neoplasms may mimic primary colorectal carcinoma and results from direct extension,

More information

Cutaneous Adnexal Tumors

Cutaneous Adnexal Tumors Cutaneous Adnexal Tumors Lesions with Predominant Follicular Differentiation Special Emphasis on Basal Cell Carcinoma 2014-04-01 Prof. Dr. med. Katharina Glatz Pathologie Cutaneous Adnexal Tumors Hair

More information

Pathology of Lobular & Ductal Preneoplasia. Syed A Hoda, MD Weill-Cornell, New York, NY

Pathology of Lobular & Ductal Preneoplasia. Syed A Hoda, MD Weill-Cornell, New York, NY Pathology of Lobular & Ductal Preneoplasia Syed A Hoda, MD Weill-Cornell, New York, NY Proliferative Epithelial Changes in Breast A wide range of proliferative epithelial changes occur in the breast There

More information

Abid Irshad, MD Director Breast Imaging. Medical University of South Carolina Charleston

Abid Irshad, MD Director Breast Imaging. Medical University of South Carolina Charleston Abid Irshad, MD Director Breast Imaging Medical University of South Carolina Charleston Cases Financial disclosure: I or my family have no financial interest related to the material discussed in this presentation

More information

Thyroid pathology Practical part

Thyroid pathology Practical part Thyroid pathology Practical part My Algorithm After a good macroscopy and a microscopic overview of the lesion, I especially look at the capsule and the thyroid just above and just beneath the capsule.

More information

Disclosure. Case. Mixed Tumors of the Uterine Corpus and Cervix. I have nothing to disclose

Disclosure. Case. Mixed Tumors of the Uterine Corpus and Cervix. I have nothing to disclose Mixed Tumors of the Uterine Corpus and Cervix Marisa R. Nucci, M.D. Division of Women s and Perinatal Pathology Department of Pathology Brigham and Women s Hospital Boston, MA UCSF Current Issues in Anatomic

More information

A neoplasm is defined as "an abnormal tissue proliferation, which exceeds that of adjacent normal tissue. This proliferation continues even after

A neoplasm is defined as an abnormal tissue proliferation, which exceeds that of adjacent normal tissue. This proliferation continues even after NEOPLASIA Neoplasia is a very important topic in pathology because neoplasms are both common and serious diseases. A neoplasm literally means a new growth, and this term is used interchangeably with a

More information

Objectives. Atypical Glandular Cells. Atypical Endocervical Cells. Reactive Endocervical Cells

Objectives. Atypical Glandular Cells. Atypical Endocervical Cells. Reactive Endocervical Cells 2013 California Society of Pathologists 66 th Annual Meeting San Francisco, CA Atypical Glandular Cells to Early Invasive Adenocarcinoma: Cervical Cytology and Histology Christina S. Kong, MD Associate

More information

Update in Salivary Gland Pathology. Benjamin L. Witt University of Utah/ARUP Laboratories February 9, 2016

Update in Salivary Gland Pathology. Benjamin L. Witt University of Utah/ARUP Laboratories February 9, 2016 Update in Salivary Gland Pathology Benjamin L. Witt University of Utah/ARUP Laboratories February 9, 2016 Objectives Review the different appearances of a selection of salivary gland tumor types Establish

More information

Spectrum of Lesions in Cystoscopic Bladder Biopsies -A Histopathological Study

Spectrum of Lesions in Cystoscopic Bladder Biopsies -A Histopathological Study AJMS Al Ameen J Med Sci (2 012 )5 (2 ):1 3 2-1 3 6 (A US National Library of Medicine enlisted journal) I S S N 0 9 7 4-1 1 4 3 C O D E N : A A J M B G ORIGI NAL ARTICLE Spectrum of Lesions in Cystoscopic

More information

Predictive biomarker profiling of > 1,900 sarcomas: Identification of potential novel treatment modalities

Predictive biomarker profiling of > 1,900 sarcomas: Identification of potential novel treatment modalities Predictive biomarker profiling of > 1,900 sarcomas: Identification of potential novel treatment modalities Sujana Movva 1, Wenhsiang Wen 2, Wangjuh Chen 2, Sherri Z. Millis 2, Margaret von Mehren 1, Zoran

More information

2016 WHO CLASSIFICATION OF TUMOURS OF THE PROSTATE. Peter A. Humphrey, MD, PhD Yale University School of Medicine New Haven, CT

2016 WHO CLASSIFICATION OF TUMOURS OF THE PROSTATE. Peter A. Humphrey, MD, PhD Yale University School of Medicine New Haven, CT 2016 WHO CLASSIFICATION OF TUMOURS OF THE PROSTATE Peter A. Humphrey, MD, PhD Yale University School of Medicine New Haven, CT 2016 WHO CLASSIFICATION OF TUMOURS OF THE PROSTATE AUTHORS : PROSTATE CHAPTER

More information

RENAL EPITHELIAL NEOPLASMS: IS THERE A ROLE OF IMMUNOSTAINS IN DIAGNOSIS?

RENAL EPITHELIAL NEOPLASMS: IS THERE A ROLE OF IMMUNOSTAINS IN DIAGNOSIS? RENAL EPITHELIAL NEOPLASMS: IS THERE A ROLE OF IMMUNOSTAINS IN DIAGNOSIS? John C. Cheville, M.D. Mayo Clinic and Mayo Foundation Rochester, MN The majority of renal epithelial neoplasms are diagnosed on

More information

Pathology of the Urachus

Pathology of the Urachus Pathology of the Urachus Gladell P. Paner, MD, (BS) MT Departments of Pathology and Surgery, Section of Urology University of Chicago, Chicago, IL USA Gladell.paner@uchospitals.edu Updates in Epithelial

More information

WT1, Estrogen Receptor, and Progesterone Receptor as Markers for Breast or Ovarian Primary Sites in Metastatic Adenocarcinoma to Body Fluids

WT1, Estrogen Receptor, and Progesterone Receptor as Markers for Breast or Ovarian Primary Sites in Metastatic Adenocarcinoma to Body Fluids Anatomic Pathology / WT1, ESTROGEN RECEPTOR, AND PROGESTERONE RECEPTOR IN CYTOLOGY OF BODY FLUIDS WT1, Estrogen Receptor, and Progesterone Receptor as Markers for Breast or Ovarian Primary Sites in Metastatic

More information