NITHYA PREM

Pathology resident
#MAHE🇮🇳
#Ex- Amritian
# ICSK - Kuwait 🇸🇩

[Fatima Shamsuddin @FatimaShamsPath]

🔬 A Cytology Lesson:
One Marker • Two Histories • Three Primaries !!!

👩‍⚕️ Patient
• 72-year-old female with pleural effusion
• Initial history provided: Previous h/o anal squamous cell carcinoma and breast carcinoma

🔍 Cytology Findings
• Highly cellular specimen
• Malignant epithelial cells in clusters and 3D groups
• Marked nuclear atypia
• Occasional vacuolated cytoplasm

🧪 Initial Cell Block IHC
✅ BerEP4 positive
❌ Calretinin negative
✅ CK7 positive
❌ CK20 negative

🎯 Diagnostic Approach Based on Available History
• TTF1 → to exclude primary lung adenocarcinoma
• p63 → to assess squamous differentiation
• TRPS1 → to evaluate possible breast origin

📋 Results
❌ TTF1 negative
❌ p63 negative
✅ TRPS1 patchy positive

⚠️ The Pitfall
With a history of breast carcinoma and a CK7+/TRPS1+ profile, metastatic breast carcinoma seemed highly likely.

🔄 The Turning Point
• TRPS1 positivity was only patchy
• Additional clinical information was obtained
• Histologic correlation was performed

🧩 The Missing History
The patient also had a recently diagnosed endometrial malignancy with frozen pelvis and extensive local spread, a crucial piece of information that was not initially available.

🧬 Further Workup
✅ PAX8 positive - favor mullerian
❌ GATA3 negative - point against breast cancer

📌 Final Interpretation
Metastatic Müllerian carcinoma, with correlation favoring high-grade serous carcinoma.

💡 Take-Home Messages
✔️ TRPS1 is a useful marker, but not entirely specific for breast carcinoma.
✔️ Patchy TRPS1 positivity can be seen in Müllerian serous carcinomas and other non-mammary tumors.
✔️ Never interpret immunostains in isolation.
✔️ Morphology + Clinical History + Imaging + Histology Correlation = Accurate Diagnosis.
✔️ Always question a result that does not perfectly fit the overall picture.

🏆 Lesson Learned
💎 The most important diagnostic tool in this case was not TRPS1—it was the missing clinical history.

#Cytopathology #PleuralFluid #DiagnosticPitfall #TRPS1 #BreastPathology #PathologyPearls #Cytology #ClinicopathologicCorrelation #PathTwitter #MedEd #LearningFromCases

[Janira Navarro @Janiranavarro]

GATA3 is usually positive in breast carcinomas and urothelial carcinomas, but it can also be positive in:

- Cutaneous carcinomas (basal or squamous cell carcinoma)
- Skin adnexal tumors
- Salivary gland tumors
- Pancreatic ductal carcinoma
- Chromophobe renal carcinomas
- Mesothelioma
- Germ cell tumors

Dr. Wen - 2025 Diagnostic Pathology Update #USCAP #pathology #PathX

[Janira Navarro @Janiranavarro]

Sinonasal Adenocarcinoma Classification

Non-salivary gland tumors
- Intestinal type adenocarcinoma
- Nonintestinal type adenocarcinoma
Salivary gland tumors

Dr. Nishino - 2025 Diagnostic Pathologic Update #USCAP #pathology #PathX

[Fatima Shamsuddin @FatimaShamsPath]

CYTOLOGY!

👉 18 YO female, peritoneal fluid. What is your diagnosis?

Provided below are - pap, DQ, cell block and IHC.

Peritoneal Fluid Cytology – Dysgerminoma

Pap stain:
Moderately cellular smears showing predominantly singly scattered large tumor cells. Cells have abundant clear cytoplasm, round nuclei with vesicular chromatin, and prominent nucleoli, in a lymphocyte-rich background with admixed reactive mesothelial sheets.

Diff-Quik:
Highlights basophilic tumor cells, and cytoplasmic vacuolation, with large nucleolated cells standing out against numerous lymphocytes and mesothelial cells.

Cell block:
Shows small nests, clusters and single large cells with clear cytoplasm and prominent nucleoli, intimately admixed with lymphocytes.

Immunohistochemistry:
Tumor cells are OCT3/4 (nuclear)+ and CD117 (c-KIT)+, and negative for calretinin, confirming dysgerminoma and excluding mesothelial origin.

Diagnosis:

Peritoneal fluid positive for malignant cells, consistent with dysgerminoma.

#cytology #fluid #pathology #PathTwitter #gynepath

[NITHYA PREM @NITHYAPREM3]

Composed of hypo cellular hyaline cartilage, lacks atypia, no prominent myxoid matrix.

[NITHYA PREM @NITHYAPREM3]

38 year old female presented with chest wall pain related to lower rib. CT : small exophytic bony lesion with cartilaginous density, no evidence of invasion.
# gross and H&E images

Diagnosis: Enchondroma

[Janira Navarro @Janiranavarro]

Usual ductal hyperplasia with apocrine metaplasia

Exception to the stratification rule
This is benign

Dr. Lerwill - 46th Annual Current Concepts in Surgical Pathology #PathX #Pathology #PathTwitter

[NITHYA PREM @NITHYAPREM3]

@FatimaShamsPath Inflammatory fibroid polyp

[NITHYA PREM @NITHYAPREM3]

@FatimaShamsPath @annsmiley78 differentials
1. mesothelioma
2. lymphoma
3. metastasis

[Fatima Shamsuddin @FatimaShamsPath]

Answer

[Fatima Shamsuddin @FatimaShamsPath]

👉 41 YO male with history of renal transplant.

Histology provided from the native kidney.

What is your diagnosis?

#PathTwitter #GUpath #Surgpath #Pathology #Pathresidents #renalpath

[NITHYA PREM @NITHYAPREM3]

@FatimaShamsPath Acquired cystic disease associated Renal cell carcinoma

[Živa L. Štosir @zivaledinek]

Cute finding in axillary lymph node biopsy ⬇️ those macropages are full silicone droplets 💦 this is a case of silicone lymphadenitis in a woman with breast implants #CytoPath #PathX #BreastPath #PathTwitter @Pathoutlines @IACytology #PathTrainee #ESPAlumni

[Vikram Deshpande @Vik_deshpandeMD]

Sessile serrated polyp, sessile serrated adenoma, sessile serrated lesion, Oh whatever! #Gipath

[Mauro Saieg, MD, PhD, FIAC @MauroSaieg]

Nice example of decoy cell.

[News18 @CNNnews18]

The plane crashed directly on the BJ Medical College UG hostel mess in Meghani Nagar.

Many MBBS students have lost their lives. This is one of the most heartbreaking tragedies the city has seen. 💔

#Ahmedabad #BJMedicalCollege #PlaneCrash #AhmedabadPlanecrash

[NITHYA PREM @NITHYAPREM3]

@FatimaShamsPath Nice post ma’am 👍

[NITHYA PREM @NITHYAPREM3]

@AnupamaArya12 Endometrial cell

[Vijay Shankar S @VijayPatho]

Pathologist's eyes! #pathart This cell was from thyroid aspirate. the other is its mirror image! #pathreidolia @pembeoltulu @smlungpathguy @ariella8 @JMGardnerMD @vi_monappa @prachipath123 @Swathiprabhu5 @DrGeeONE @DrAhmedKalebi @ariella8 @nucleololailo @_SaranyaS_ @Thejaspatho

[NITHYA PREM @NITHYAPREM3]

International Pathology Day 🤩😀😍

#KCIAPM # Pathology in Pictures
#IPD2024