Ana-Maria Catana

Specialist Assistant at Comprehensive Cancer Centers (CLCCs)

[Modern Pathology @ModernPathology]

Mastocytosis (seen here) is often sought by naive colleagues and seldom seen. Mod Pathol offers a great review:
Panarelli NC, Hornick JL, Yantiss RK. What Is the Value of Counting Mast Cells in Gastrointestinal Mucosal Biopsies? Mod Pathol. 2023 Feb;36(2):100005. PMID: 36853780.

[Yasamin Mirzabeigi, MD @YMirzabeigi]

Our Gynecologic Pathology cases @UMiamiPathology are fascinating! Here’s a striking example of pilomatrix-like high-grade endometrial carcinoma (PiMHEC), a recently described entity mostly driven by CTNNB1 mutations. Look for solid basaloid growth with conspicuous central tumor cell necrosis, and pilomatrix-like keratinization with the hallmark ghost cells. This case also had a focal conventional FIGO grade 1 endometrioid component. IHC shows diffuse nuclear β-catenin with loss of PAX8 and ER in the pilomatrix-like component. These tumors are believed to behave aggressively.

[Sanjay Mukhopadhyay @smlungpathguy]

1/
Necrosis = cell death (unlike apoptosis, it does not occur naturally and is not programmed)

This short #Tweetorial shows you some of the histologic flavors of necrosis. The stain in each of these pics is hematoxylin-eosin (H&E)

#pathology #pulmpath #pathtweetorial

[Dr Kamlesh Darji @DrKamleshDarji1]

https://t.co/H8RPuUvvZV

[Raza Hoda, MD @RazaHoda]

Fact or artifact? 😰

Poor Fixation 🔬

Underfixation can make perfectly benign TDLUs look discohesive and atypical, mimicking atypical lobular hyperplasia (ALH).

#PathX #PathTwitter #breasthpath

[Fouad Boulos @fouad_boulos]

Not all that has ink is a true margin.

1. Make sure the ink is not in a cleft between fat lobules

2. Make sure you have a full cross-section of the tissue in the block. Tissue disruptions with ink are to be considered artifactual until proven otherwise

3. Check the diagram that shows where the section was taken from

4. If in doubt, walk over to the histology and lab and ask for the paraffin block. Looking at the entirety of the tissue within the block will give you information you cannot easily glean from the two-dimensional slide

#breastpath

[Fouad Boulos @fouad_boulos]

40 year old with a skin mass above sternum, R/O lipoma. Herniated lung??? probably not :)

[Ana-Maria Catana @AnaPath10]

@fouad_boulos Lactating adenoma :o

[Sanjay Mukhopadhyay @smlungpathguy]

New thread: is it consistent with sarcoidosis?

1/
Yes!

[Ana-Maria Catana @AnaPath10]

Asteroid body in a foreign body mutinucleated giant cell.
This is an axillary LB biopsy from a patient w/ breast implant
#pathresidents #pathX

[Elizabeth Montgomery, MD @LizMontgomeryMD]

An example of crystal storing histiocytosis; the patient needs to be evaluated for a plasma cell disorder or other lambda-restricted B cell neoplasm.
Arnold CA, et al. Am J Surg Pathol. 2018 Oct;42(10):1317-1324. PMID: 29878935.

[Mateen Hussain @MateenH79781868]

Appendix

[Ana-Maria Catana @AnaPath10]

“Appendiceal mucinous neoplasm" is being introduced in the WHO 6th ed (beta version) to define a "circumferential proliferation of neoplastic mucinous epithelial cells confined to the mucosa, with an intact muscularis mucosae, originating in the appendix."

Wouldn't exclude SSL w/ dysplasia, but again, it doesn't really matter (and MLH1 loss wouldn't help in the appendix like it does in the rest of the colon).

[Ana-Maria Catana @AnaPath10]

@MateenH79781868 @pepeheffernan @malakbehnas @FionaMacPath @AnupamaArya12 @DrGeeONE I’d call it appendiceal mucinous adenoma, on these images.
Of course, mucinous lesions should be entirely submitted, and if there’s even focal architectural disturbance,I’d call it LAMN. Appendectomy is curative either way. What matters here is the absence of peritoneal disease.

[Janira Navarro @Janiranavarro]

If you submitted all the appendix and you don't see epithelium, just mucin in the lumen, sign it as:
-Dilated appendix with mucin
Comment: The differential includes LAMN or reactive processes
Dr. Umetsu #CAP23 #everydayGI #GIpath #PathX #PathTwitter #pathology #pathologists

[Janira Navarro @Janiranavarro]

Appendix
Postinflammatory mucosal hyperplasia
-Associated with acute/interval appendicitis
-Epithelium looks hyperplastic/serrated near surface
-This is not LAMN ⚠️
#surgpath #pathology #PathTwitter #GIpath
CAP today https://t.co/VzoEnrwt3j
Thanks for sharing @Voltaggiol 🌟

[Janira Navarro @Janiranavarro]

Challenges of staging appendiceal mucinous neoplasms
Mucin outside the appendix in a LAMN case, is it pT4 or not?

-Acellular mucin without inflammatory reaction, mesothelial hyperplasia, or neovascularization is presumed to be a result of carryover during handling or gross examination, and should not be designated as pT4a (Pic A)
- Organizing acellular mucin with neovascularization on the serosal surface is categorized as pT4a (Pic B)

Umetsu et al https://t.co/cdM0816Ac3

[Fouad Boulos @fouad_boulos]

When large nests of tumor surround a completely normal duct, they are much more likely to be invasive cancer or lymphovascular invasion than DCIS. A useful pattern to remember on a biopsy

#breastpath

[Ankur Sangoi @slusagar]

#GUpath prostate bx:

Gleason score 3+4, with pattern 4 comprised of glomerulation and poorly formed glands

[Raza Hoda, MD @RazaHoda]

Pagetoid Spread of ALH ⛏️👷‍♂️🔬

Dyshesive atypical lobular cells undermining and spreading along the undersurface of the ductal epithelium in a pagetoid pattern—subtle and may mimic myoepthelial cell hyperplasia.

#PathX #PathTwitter #breastpath