Gumersinda Carnero

Sindy. Médico Anatomopatologo. UCV. 🇻🇪

[Janira Navarro @Janiranavarro]

In the WHO 5th edition (2022), follicular thyroid carcinoma (FTC), invasive encapsulated follicular variant of papillary thyroid carcinoma (IEFVPTC), and oncocytic carcinoma of the thyroid (OCA) are grouped as encapsulated follicular-derived thyroid cancers

They are subclassified as
-Minimally invasive (irrespective of the number of foci, minimal tumor capsular invasion only)→ excellent prognosis (essentially no distant metastases)
-Encapsulated angioinvasive (irrespective of the number of involved vessel foci, angioinvasive carcinoma with no widely invasive growth, see pic)→ intermediate risk
-Widely invasive→ higher risk of recurrence and distant spread.

This stratification is more clinically useful

FTC and IEFVPTC share a similar molecular origin (RAS-like pathway) and biology

OCA is molecularly separate but is still risk-stratified by the same invasion criteria because those criteria best predict outcome

Pic: Dr. Scognamiglio #USCAP #pathology #pathX #pathTwitter

[Janira Navarro @Janiranavarro]

Smooth muscle lesions of the lung

- Benign metastasizing leiomyoma (pic 1)
- Metaplastic smooth muscle nodules (pic 4, not uncommon)
- LAM (lymphagioleiomyomatosis): Pic 3, tends to be more cystic than cellular
- Metastatic leiomyosarcoma
- Primary leiomyoma of lung: Rare

Other spindle cell tumors of lung
- Metastatic endometrial stromal sarcoma of uterus
- SFT, IMT, schwannoma , etc

Dr. Yi #USCAP2026 #pathology #PathX #PathTwitter

[Miruna Popescu, MD @MirunaPopescu13]

Recognizing pT4a in CRC is important
➡️ Tumor continuous w/ serosal surface through loose inflammation/granulation tissue = pT4a
➡️ Tumor separated from serosa only by non-inflamed fibrosis = pT3
➡️ Tumor <0,1 mm from serosal surface, but not continuous through granulation tissue/loose inflammation = pT3 (as recommended by CAP), but these seem to behave like pT4a

Dr. Rish Pai, #HMAR_DIGESTIVE26
#gipath #pathtwitter

[Janira Navarro @Janiranavarro]

Cervical biopsy
What is your diagnosis?
p16 looks block positive

Pitfalls of reflex p16 testing: Potential for upcalling LSIL (-IN1) as HSIL (-IN2)
30-58% expert-adjudicated morphologic LSIL (CIN1) are p16 positive
***Grading should be based on morphology***

Dr. Kong #USCAP2026 #pathology #PathX #PathTwitter #everydayGYN

[Janira Navarro @Janiranavarro]

HSIL (CIN 2) Regression Rates
Spontaneous regression ~50%
Less than 1% progress to invasive carcinoma

Dr. Kong #USCAP2026 #pathology #PathX #PathTwitter #everydayGYN

[Janira Navarro @Janiranavarro]

Endometrial Adenocarcinoma: Depth of Invasion – Challenging scenarios 🔬

✅ Avoid the cornu – naturally thinner, can lead to over-staging

✅ Tumor in a leiomyoma? Include it in your invasion measurement if it’s the deepest point

✅ Invasion from adenomyosis in outer half? Stage as pT1b (per ICCR & ISGyP).

Dr. Joehlin / Dr. McGregor - Short course #USCAP2026 #pathology #PathX #PathTwitter

[La Traumatóloga Geek @traumatogeek]

UN MILITAR LE PUSO UNA PISTOLA EN LA CARA

Lo que respondió este médico debería enseñarse en todas las facultades.

Un tipo con uniforme y fusil le grita en la cara al presidente de Venezuela:
“El mundo es de los valientes.”
Y el presidente, que no era militar, le contesta:

“El mundo es del hombre justo y honrado.”

Era médico. Se llamaba José María Vargas. Y hoy, 10 de marzo, se celebra el Día del Médico en Venezuela por su nacimiento en 1786.

El primer presidente civil de Venezuela. En una época en la que para gobernar necesitabas una espada, él llegó con un bisturí y un microscopio.

No quería ser presidente. Lo rechazó varias veces. Pero la gente insistió tanto que al final aceptó. Duró un año. Un golpe de estado, lo exilia a una isla del Caribe. Cuando volvió, dimitió porque estaba harto de políticos.

¿Y qué hizo después? Lo que siempre quiso. Medicina. Fundó la Facultad de la Universidad Central de Venezuela. Creó la Sociedad Médica de Caracas.

Durante el terremoto de 1812, con 3.000 muertos en Caracas, estuvo operando sin parar mientras la ciudad se caía.

A veces la historia de la medicina no se escribe en los grandes hospitales. Se escribe en terremotos, en guerras, en islas del Caribe y en aulas con cuatro alumnos.

No hace falta una espada para cambiar un país. A veces es suficiente con un fonendo y ganas.

Feliz Día del Médico a todos los venezolanos.

#LaTraumatologaGeek

[Mamtha Balla, MD, MPH, FACP @MamthaB]

🩸Major WHO Categories of Lymphoid Neoplasms 🩸

Memory pneumonic🧠
"🌃Starry-sky burps (macrophages eat debris), MYC t(8;14) = sugar rush, Ki67=100%, fastest growing toddler ever!"

1. Core Principles of Classification

-Integrated Diagnosis: Combines Morphology (architecture), Immunophenotype (Flow/IHC), Genetics(FISH/NGS), and Clinical Context.
-Arbitrary Boundaries: The distinction between "leukemia" (blood/marrow) and "lymphoma" (tissue/node) is often fluid (e.g., CLL/SLL).

->Major WHO Categories of Lymphoid Neoplasms

1. Precursor lymphoid neoplasmsExample: B-ALL
2. Mature B-cell neoplasms (most common)
3. Mature T/NK-cell neoplasms
4. Hodgkin lymphoma
5. Rare mixed entitiesExample: Mediastinal gray-zone lymphoma

2. Mature B-Cell Neoplasms: Key Entities

##🌿Follicular Lymphoma (FL) ~25% of lymphomas

->🧬: t(14;18) involving BCL2 and IGH. This causes BCL2 overexpression, which prevents apoptosis.
->Phenotype: CD10+, BCL6+, CD19/CD20+, BCL2+.
->Clinical: 🐢Indolent but can transform into DLBCL.
->Neoplastic germinal center B cells with Follicular growth pattern

## Mantle Cell Lymphoma (MCL) : ~6%🛡️
->🧬: t(11;14) involving CyclinD1 (CCND1). Drives the G1 → S cell cycle transition.
->Morphology: Small-medium monomorphic lymphocytes
->Phenotype: CD5+, CyclinD1+, SOX11+. (CD10−), CD19/CD20
->Prognosis 📈: Ki−67 index is the primary driver (>30% is aggressive).

## Marginal Zone Lymphoma (MALT)  ~7%🍕
->Etiology: 🦠Driven by chronic inflammation (e.g., H. pylori in the stomach, Sjögren’s in salivary glands).
->🧬: t(11;18); presence usually predicts failure to respond to H. pylori antibiotics.
->Sites: Salivary glands, Stomach (most common), Thyroid, Lung
->Pathogenesis: Chronic antigen stimulation ex: H. Pylori, Hashimoto thyroiditis, Sjogren syndrome
->Pathologic hallmark🔬: Lymphoepithelial lesions

🥊 3. Diffuse Large B-Cell Lymphoma (DLBCL)
->The most common NHL, now classified by Cell of Origin (COO):
->GCB Subtype: Derived from germinal centers 🏰. Better prognosis.
->ABC Subtype: ⚡"Activated" post-germinal center cells (B-Cells). Worse prognosis; driven by NF−κB.
->High-Grade "Double-Hit" Lymphoma: Defined by MYC plus BCL2 (and/or BCL6) rearrangements via FISH. Extremely aggressive; poor response to standard R-CHOP use R-EPOCH
->Double-Expressor (DE): 🖼️ Protein only by IHC. ⚠️ Intermediate prognosis

Hans Algorithm (IHC): Uses CD10, BCL6, and MUM1 to approximate COO..
Algorithm:
1️⃣ CD10+ → GCB
2️⃣ CD10− + MUM1+ → non-GCB
3️⃣ CD10− + MUM1− + BCL6+ → GCB
Otherwise → non-GCB

Important DLBCL Variants

->Double-Hit Lymphoma
->Genetics: MYC + BCL2 rearrangements
->Very aggressive. Often treated with R-EPOCH rather than R-CHOP.
->Double-Expressor Lymphoma
->Protein overexpression: MYC, BCL2, Detected by IHC, not genetics.
->Prognosis: Intermediate

Treatment

BTK inhibitors → ABC
EZH2 inhibitors → GCB

Other Important Subtypes

->Primary mediastinal large B-cell lymphoma- Young women, large mediastinal mass, Pathways involved: JAK-STAT, NF-κB, PD-L1 overexpression. Important because:→ responds to PD-1 inhibitors
-> Primary CNS lymphoma
-> Intravascular large B-cell lymphoma
->T-cell/histiocyte-rich DLBCL

🌌 4. Burkitt Lymphoma

->Morphology: "Starry-sky" pattern (tingible body macrophages)(Macrophages = stars; Tumor = sky)
->🧬 : t(8;14) involving MYC.
->Phenotype: Ki−67≈100% (Fastest growing)
->Variants: Endemic (EBV+, jaw), Sporadic (Abdominal), and Immunodeficiency-associated (HIV)🎗️.

🤺 5. T-Cell and NK-Cell Neoplasms
Less common but very heterogeneous.
1️⃣ Leukemic/disseminated
2️⃣ Extranodal
3️⃣ Cutaneous
4️⃣ Nodal

1. Peripheral T-Cell Lymphoma (PTCL-NOS)-Common nodal TCL: Divided into GATA3 (poor prognosis) and TBX21 (better prognosis) subtypes.

2. Angioimmunoblastic T-Cell Lymphoma (AITL)
->(TFH origin)🔍 CD10+, PD−1+. Associated with TET2/DNMT3A mutations. 🧬 Patients at risk for B-cell lymphoma/MDS/AML
->Morphology: Vascular proliferation, clear cytoplasm T cells with pin back ground
->Multi-step Model: Often starts with clonal hematopoiesis mutations (TET2, DNMT3A,IDH2) in stem cells, differentiation to TFH (RHOA)Mutation—> Lymphoma development

3. Anaplastic Large Cell Lymphoma (ALCL)🐎
->"Hallmark" cells (Horseshoe nuclei)
->ALK-Positive: Mostly young patients; t(2;5) NPM1−ALK; excellent prognosis. CD30 +,
->ALK-Negative: Older patients; prognosis depends on genetics, Morphology similar to ALK+ but ALK negative (DUSP22 = good; Triple neg-intermediate, TP63 = poor).
->Primary cutaneous ALCL : Larger tumors >1.5cm, persistent lesions
->Breast Implant-Associated (BIA-ALCL): Occurs in the capsule/seroma around textured implants; CD30+, ALK−, late serum around the implant.
#InstaMed #TwitterMD #XMed #ReelMedEd #PathReel #OncoReel #HemeReel
#Lymphoma
@ASH_hematology @ASHClinicalNews @JCO_ASCO @BloodJournal @NEJM @LancetHaematol @NatureMedicine @VJHemOnc @HemOncToday @TargetedOnc @OncLive @TheLancet @mpnvoice @oncodaily @realbowtiedoc @IMG_Oncologists @OncoAlert @ASCOPost @LymphomaHub @SocietyofHemOnc @OncBrothers @ASCOPost 🩸🩸

[Katrina Collins, MD || Pathologist @katcollmd]

New in @Human_Pathology: ✌🏻 reviews in the 2026 Pathology Updates issue on GU pathology—bladder, prostate, kidney, testis, and penile tumors.

Grateful to great co-authors—hope it’s useful for pathologists and trainees!

🔗 https://t.co/SyMpuDkWsZ
🔗 https://t.co/oVPOcn0YmB

[Gumersinda Carnero @gumersindac]

@AmalioBelmonte Oposición que nunca puede ser mayoría o es declarada en desacato. ¿ Fue acertado suspender la proclamación de los diputados electos de Amazonas en 2015? La pureza política es ir pasando por el filtro de la servilleta los nombres que no incomodan al poder?

[Janira Navarro @Janiranavarro]

If an endometrial tumor involves the underlying connective tissue below the mesothelium (subserosa), it is considered serosal involvement for staging purposes, even if the uterus is grossly intact.

pT3a
FIGO 2023: IIIA2: Involvement of uterine subserosa or spread through the uterine serosa.

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

[Pathology mcqs @Pathology_mcqs]

📊 Staging Cancer in Colonic Polyps 🔬

1️⃣ Polyp type: Stalked vs Sessile 🧐
2️⃣ Classification: Haggitt 🏷️ | Kikuchi 📏
Master staging &amp; predict invasion risk like a pro! 🩺✨

#ColorectalPathology #Histopathology #FRCPathPrep #PolypCancer #ExamPrep #PathologyMastery

[Carlos Alvarez @duemed]

My table on histologic subtypes of urinary tract tumors during #simposioSOGUG25 @sogug1

🔸 UC with mixed HS has different biological behaviors.

🔸 Mixed variants are managed (so far) as conventional UC with the exception of small cell. #bladdercancer

[Pathology mcqs @Pathology_mcqs]

WHO 2021 Thymoma Classification in a Glance! 🔬
Master Type A, B (B1-B3), AB, and Metaplastic variants with our simple memory tricks. Essential for surgical pathology!

Follow us for more daily high-yield tips! 👇

#Thymoma #WHO2021 #Pathology #Oncology #MedEd #SurgicalPathology

[esanum @esanum]

🔴 Diagnosis: Granulomatosis with polyangiitis (Wegener)
📍 Recurrent crusted, ulcerative lesions around the nasal vestibule in multiple patients
🔷 Biopsy: dense mixed inflammatory infiltrate with necrotizing granulomatous vasculitis pattern
🧠 Chronic “sore/crusting nose” + destructive changes → always consider GPA and screen lungs/kidneys

[Janira Navarro @Janiranavarro]

Breast-What about the term Invasive Papillary Carcinoma (IPC)?

WHO 6th edition (expected change-not published yet)
- Most cases reported as IPC are in fact Encapsulated Papillary Carcinomas (EPC) or Solid Papillary Carcinomas (SPC) or mets
- Carcinomas with growth pattern similar to EPC, high nuclear grade, increased mitotic activity, triple negative or HER2 positive may be pseudopapillary high grade invasive carcinoma
- Recommendation would be to call it EPC (stage it as DCIS) with a note commenting unusual features
***Controversial topic at WHO***

Dr. Brogi- Contemporary Issues in Breast Pathology #USCAP #pathology #PathX

[Janira Navarro @Janiranavarro]

Mucinous carcinoma- Breast
Definition changes-6th edition (not published yet)

- Special type of breast carcinoma caracterized by clusters of epithelial tumor cells suspended in pools of extracellular mucin with low to intermediate grade nuclei and no features of other IBC types
- ER positive HER2 negative
- Invasive carcinoma with mucin production with high nuclear grade or HER2 positivity are to be classified as invasive breast cancer of no special type with mucin production, as these are more aggresive tumors

Dr. Tan- Contemporary Issues in Breast Pathology #USCAP #pathology #PathX

[Janira Navarro @Janiranavarro]

Encapsulated Papillary Carcinoma (EPC) almost 100% infacted after core needle biopsy could be misdiagnosed as infarcted intraductal papilloma

Lesson: Always evaluate infarcted areas and any residual viable cells

Dr. Brogi- Contemporary Issues in Breast Pathology #USCAP #pathology #PathX

[Abhijit Das, MD @AbhijitSurgPath]

Skin: Pemphigus (Basic facts for residents)

#pemphigus
#basicfactsforresidents
#makesurgipatheasy

[Janira Navarro @Janiranavarro]

ADH↔Low grade DCIS
Practical tips for diagnosis

Dr. Cimino-Matthews. Contemporary issues in Breast Pathology #USCAP #PathX