chemily

GU Pathologist, here to see and share interesting #gupath cases and ideas. Tweets not intended to be used for clinical/medical purposes!

[chemily @chemily7]

@slusagar @TheUSCAP Ok ok, you know I can’t stand sad looking pandas. You can go next year!!

[chemily @chemily7]

Finally found the elusive prostate 🐼

[chemily @chemily7]

@ASCOGU. Re: renaming GG1. imo, real pattern 3 is cancer for reasons stated. BUT, perhaps (a middle ground?) we can educate pathologists to stop overdiagnosing cancer when there’s only 1-2 parts with <1mm GG1 in the absence of def infiltration. These should really be ASAPs…

[chemily @chemily7]

@rovingatuscap @slusagar @Gleason4plus5 @priyaraomd @lalpritu @VarshaManuchaMD @LaraHarikMD @drmehrarohit @AkgulMD @h_alahmadie @rajalbshah @StanfordPath @CCFPathRes @JaneNguyen44 Ditto @JaneNguyen44 !

[chemily @chemily7]

@slusagar Please don’t get too excited about these… 😉

[chemily @chemily7]

In a complete 360 from yesterday's case... I thought for sure this was benign (or small focus of ASAP/3+3), BUT it all stains like cancer. 😱 I even told the lab they forgot my basal cell stains but there's some internal +control. aren't those corpora?? #realitycheck #gupath

[chemily @chemily7]

@slusagar was sent in as a right anterior midgland MRI lesion!

[chemily @chemily7]

Almost reflexively called this 3+3 (there was high-grade PCa in every other part of this case). We don't often see adenosis on bx (more often seen in transition zone/TURP), but clues here are: no significant cytologic atypia and basal cells appreciated at higher power #gupath

[chemily @chemily7]

Just like in gyn CCC, recent molecular studies have shows arid1a loss in a subset, which can be helpful if you have the stain available to you!

[chemily @chemily7]

beautiful clear cell adenocarcinoma of the urinary tract (male patient)! essentially equivalent to CCC in gyn world. may mimic nephrogenic adenoma by morphology and IHC but solid areas, cytologic atypia, mites and necrosis are clues. #gupath

[chemily @chemily7]

Remember to look for vein invasion in your partial nephrectomies! What was thought to be a multinodular tumor (left) clearly showed tumor in a major (segmental) vein on b2b (right). Likely call-able w/o b2b but wanted to teach trainee to look for vessel margins on gross #gupath

[chemily @chemily7]

Final impressions: enteric looking yes! but important NOT to topline adenocarcinoma as this could be urothelial ca with glandular diff. primary adeno of bladder will get GI-type chemos vs UCa chemo for UCa. This tumor had TERTp, TP53 and KMT2D alterations, supporting UCa

[chemily @chemily7]

3 mm urinary bladder lesion with surrounding erythema. diagnosis? issues? stains and opportunity to revise impressions tomorrow! #gupath

[chemily @chemily7]

stain update: CDX2 mostly positive, GATA3 patchy/scattered positive, CK7 negative, CK20 patchy positive. assume neuroendocrine and prostate markers negative (male patient). what would you advise? my impressions tomorrow! #GUpath

[chemily @chemily7]

almost forgot to update.. it's a rare case of splenogonadal fusion. cut surfaces may have been more helpful but I thought a giveaway; AND our surgeon actually recognized this as spleen intraoperatively which I found quite impressive! but then again, we have great surgeons! :D

[chemily @chemily7]

undescended testis in a ~1 year old. gross impression? #gupath

[chemily @chemily7]

@rovingatuscap @MichelleDunno17 @JGordetsky @Gleason4plus5 @Williamson_SR @priyaraomd @lalpritu @LaraHarikMD @daniel_berney @evacomperat @drmehrarohit @DrCristinaMagi This is one where I think you’ll get more variability in %4 if you required people to grade and I might go PCa; SC if it’s the only focus in case or might be the highest grade focus. Hard to tell what’s going on but probably not good.

[chemily @chemily7]

@rovingatuscap @uroegg @VickersBiostats @dr_coops @priyaraomd @rajalbshah @daniel_berney @lalpritu @JGordetsky @BehfarEhdaieMD @seanmmcbride I generally reserve PCa; SC for small foci (<0.5 cm) that are difficult to grade (crushed). This one to me, while borderline, is sizable enough to grade as 4+3. We have rare 4+3 on AS, as AS is not just based on GG. (Size, genomic testing, mri, psa, etc!)

[chemily @chemily7]

@rovingatuscap We do neuroendocrine markers/ki-67/AR if asked or if certain features present (sometimes for research protocol, sometimes just because of the way tumor is behaving in patient). We do pten if debating between IDC/AIP/HGPIN in otherwise low-intermediate grade case.

[chemily @chemily7]

@Gleason4plus5 Looks like maybe multiple lesions were put in the same bucket. A papilloma on the right and something more on left (need higher power)