Top Tweets for #PathPitfalls
#GUpath prostate bx
Gleason 4+4 prostatic adenocarcinoma?
nope! this is just #beautyinb9 xanthoma
⏬⏬
#GIPath #PathPitfalls
Thank you @RaulSGonzalezMD for sharing this possible #PathPitfall to be aware of. ↘️
High-grade colonic tubular adenoma with focus of invasive adenocarcinoma? Not quite. This TA is just involving a submucosal lymphoglandular complex. This rare finding should not be mistaken for malignancy. Great recent case series here: https://t.co/1RYqBTF6Uu #pathology #gipath
Endoscopic biopsy of stomach mass in elderly adult.
Favoured diagnosis?
#GIpath #pathX #pathtwitter #pathology
Colonic involvement in Amyloidosis can take many forms, sometimes they can mimic collagenous colitis, as seen in this case. However, those sneaky lamina propria eosinophilic deposits give it away (pic#2). Pictures below-
@CooperPathology
#PathTwitter #GIPath #Amyloid
Time for the last case (case 5) of last week's series of p63 pitfalls. I might include one more in the coming days just for fun.
In this case, we have a proliferation of malignant cells in anastomosing ducts with a desmoplastic response, invasive by H&E in my opinion, but with a population of p63-positive cells around the periphery. So is it invasive or in-situ?
Well, the answer comes from a subsequent biopsy from an axillary lymph node with identical morphology. The kicker? p63 shows the exact same positivity and distribution.
So, unless this is metastatic DCIS (which would be an oxymoron), this is invasive and metastatic carcinoma with peripheral p63 positivity.
Given the apparent layering of p63, my best guess is that this represents adenosquamous carcinoma but of the high-grade variety (low-grade adenosquamous carcinoma is much more bland and difficult to distinguish from benign lesions, unlike this beast).
I do not believe there's much about high-grade adenosquamous carcinoma of the breast in the literature, nor is it a common entity anywhere in the body, which means that the possibility of an extra-mammary tumor should be excluded (no history in this patient). Also, I am widely open to alternative diagnoses by the denizens of X.
At any rate, keep in mind that positivity for p63 does not exclude invasion, nor does the loss of p63 confirm it. Morphology and specific diagnoses, especially in the salivary gland realm of neoplasia, should always be considered, as should aberrant staining patterns in otherwise garden-variety neoplasms.
See you tomorrow with maybe one last bonus case.
@washu_pathology @washupathedu #breastpath #PathTwitter
Pitfalls of p63: Case 2
This is an imaging-detected mass consisting of small irregular glands in a densely fibrous background. IHC showed marked attenuation and loss of p63 in a majority of glands, raising concern for invasive carcinoma.
What is your diagnosis?
@washu_pathology @washupathedu #breastpath #PathTwitter #PathX
Pitfalls of p63: Case 3
This is a spiculated mass detected on imaging. Again, p63 was performed, likely because of the fibrous background and the cribriform features, and it showed positivity.
What is your diagnosis?
@washu_pathology @washupathedu #breastpath #PathTwitter #PathX
One of several gastric biopsies from an elderly female.
What's your diagnosis?
#GIpath #pathology #PathX
1/2. High grade "small round blue cell" sinonasal malignancy in an adult male. Cytokeratin dot positive, synatophysin and CD56 also positive with Ki67 >90% #PathTwitter
Help needed with interpretation of this mismatch repair pattern!
H&E of an upper GI adenocarcinoma 👇
This might LOOK like a metastatic mucinous adenocarcinoma, but it's actually a #glioblastoma. These tumors can be very tricky under the microscope. #pathology #neuropath #PathTwitter
50:ish y/o F, left breast, lumpectomy. Answer the poll first before scrolling further!
@RibianszkyA @natasharekhtman @pathology @PulmPathSoc @MaelleSaliba @mkbaine @smlungpathguy @yro854 @AndreMo77438628 @Path_Matt @SansanoValero @flr7066 @thoracicpath @MSKPathology You can see how i was totally wrong 😂. However, there is no harm in being wrong on #Pathx 😅 I keep learning from the great #pathologists around the 🌍 who are willing to teach and share their knowledge & experience. Great to add this to the many #pathpitfalls
#GIPath #Pathpitfalls
This could be nightmare for someone that has to sign out without IHC 😅
I guess identification of Psamomatous calcification would help.
Interesting to my eye those Cleft-like nuclei
An unusual case - a rectal somatostatin-positive neuroendocrine tumor. Note the psammomatous calcification (arrow), a characteristic feature of somatostatinomas, like their proclivity to form tubules to mimic adenocarcinoma, all described years ago. PMID: 6139028 #UMiamiPath
😨#PathPitFalls Nested Variant of Urothelial Carcinoma
🔬Cytologically bland but same clinical outcome: invasive high grade urothelial cancer
🔬👀 like Florid von Brunn nest
📉Rare; <1% of urothelial ca.
🔬Irregular sized nests, infiltrative (hard to appreciate on small biopsy)
Adenoma with a twist 😊 📹 Attending a Virtual conference: You won’t get to sit at the microscope with the legendary @LizMontgomeryMD, @RaulSGonzalezMD, and @johnhart20. Come down to Boston from October 3rd to 5th, 2024! We still have space for you. We'll show you the mundane 👇 but also the esoteric. https://t.co/9Kz4x56Llt @Mvgs1706
#GIPath #Pedipath #Hemepath #Pathpitfalls #Pathcontaminants
https://t.co/5awEWbRka0
Thank you so much for engaging and input Dr. Rosen, indeed I went through the same-day specimens, and look what I found , an epiglottis lesion, mystery solved 😅, yet amazing the way it finds the perfect neaty place to make a nest
Look at these ↘️↘️
@ariella8 @hematogones @stephen_lagana @Greg_Charville @DrMarkOng @DraEosina @drtimbracey @JLHornick @GIJamesMD @emma_furth @Dr_Brian_Cox @VHNguyenMD @yMDPhD These appear to be malignant cells. I'm thinking of the possibility that they may be from another case and might have been transferred with the microtome blade. Any cases of cancer processed on or around the same day that resemble these cells?
Pitfalls in GI pathology!!!
⚕️Corpora amylacea in the lung (in organising pneumonia).
❎Maltese cross appearance on Congo red under polarized light.
🩸Likely due to localised inflammation (?due to degenerate macrophages).
⚠️NOT amyloidosis (incidental finding).
#Pulmpath #Pathtwitter #Pathresidents
Once in a while gastrointestinal stromal tumors aberrantly express keratin. This one has metastasized to the liver. Yet another pitfall to consider! #UMiamiPath
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