Mark Hubbell

Husband, Dad, AP/CP Pathologist, Deputy Chief of Path at BAMC, and BYU Cougars everything fan!

[Janira Navarro @Janiranavarro]

Pancreas
**Neuroendocrine tumors can have misleading morphology**

- Mucin production
- Cytoplasm clearing
- Glands/pseudoglands
- Necrosis
- Nuclear pleomorphism
- Vascular hyalinization

You can call these adenocarcinomas if unaware of this pitfall.

Dr. Tang #USCAP2026 #pathology #PathX #PathTwitter

[Ankur Sangoi @slusagar]

#GUpath TURBT (h/o urothelial neoplasia):

urothelial carcinoma in situ with superficial LP invasion?

nope!

it's CIS ➕#beautyinb9 nephrogenic adenoma

⏬cont'd⏬

[Felipe Templo Jr. ,MD, MBA 🕊 @thejourneymate]

Algorithm of Immunohistochemistry in Soft Tissue Sarcomas 🔬

(c): Dr Rakesh Kumar

[Janira Navarro @Janiranavarro]

Routine minimum IHC for metastatic tumors - prostate cancer

- Prostate markers: NKX3.1, AR
- Neuroendocrine markers: Synaptophysin, chromogranin, and INSM1
- Others to consider: Ki67, p53, RB

Per NCCN, all metastatic biopsies should undergo NGS testing.

Dr. Chan #USCAP2026 #pathology #PathX #PathTwitter

[Dr. Arkadip MD @pathognosis22]

RCC at a glance ! #updates #WHO #ISUP #RCC #NEETSS #MCQ #molecular #pathology #pathognosis

[Dr. Arkadip MD @pathognosis22]

The #Bethesda System - cervix - squamous cell #TBS #cervix #LSIL #HSIL #SCC #pathology #pathognosis #cytology

[Sanjay Mukhopadhyay @smlungpathguy]

@MaiElzieny 19.
There is a concept PGY1s should know about in lung cancer: "spread through air spaces" or "STAS". This is tumor within alveolar lumens (green circles) beyond the edge of the main mass (red line). Associated with micropapillary growth, lymph node mets & poor prognosis

[Coach AJ 🎯 Mental Fitness @coachajkings]

Mark Few explains the process Gonzaga uses to work on mental toughness and adversity.

"We spend probably 25-30% of the athlete's time now on mental."

Then he explained what that looks like: "We do this thing called PGMs - Personal Growth Mondays."

"We start every Monday with this Personal Growth Monday. Staff, myself, coaches aren't allowed in there. It's just the players and Travis Knight, our strength coach and mental coach."

They invest the time every week. You can't let the mental game be an afterthought.

"They can dive into a myriad of anything that's currently happening or that they've requested...Processing pressure. Processing expectations. Lack of confidence. Hitting adversity. Handling success."

The best teams train the mind, the body, and develop the person.

Your mind is affected by your daily thoughts, habits and unconscious biases.

Mental fitness helps you build resilience and thrive.

Without investing time in mental fitness, managing stress, anxiety, and challenges becomes harder.
(🎥 Walker Webcast)

[Miruna Popescu, MD @MirunaPopescu13]

Updates on tumor deposits in colorectal carcinoma in TNM 9th edition
TDs become way more important
pN1a/b tumors with TDs tend to behave like pN2 tumors (conversely, pN2 tumors without TDs don't behave as aggressive)
Changes of TDs definition in TNM 9th ed below ⬇️

Dr. Rish Pai
#HMAR_DIGESTIVE26 #GIPath #PathTwitter

[Dr. Arkadip MD @pathognosis22]

Some differentials of bone and soft tissue tumor, long list ahead ! #BST #Bone_tumor #soft_tissue #pathology #pathognosis #WHO #Differentials

[Arch Pathol Lab Med @ArchivesPath]

Endometriosis-associated neoplasms - review common diagnostic issues, and clinical, pathologic, and molecular characteristics here 👉 https://t.co/UXbkXMye0Q

#CAP #Archives #GYNPath

[MV Chandrakanth @ChandrakanthMv]

MMR proteins — the simplest way to remember
DNA replication often makes small mistakes (extra or missing bases).
The mismatch repair (MMR) system fixes these errors in two steps:
🔍 MSH2 + MSH6 → detect the error
🔧 MLH1 + PMS2 → repair the error
They work together as a single pathway — first detection, then repair.
If this system fails → errors accumulate → dMMR
And that’s where microsatellite instability (MSI) begins.
Bottom line:
Detection first → then repair
#MVOnco #Oncology #MedEd

[Elon Musk @elonmusk]

🇺🇸🇺🇸 Welcome home! 🇺🇸🇺🇸

[Mark Ong @DrMarkOng]

A reminder that keratins may be expressed in non-epithelial cells

[Yasmine Khosrowshahi @yasminekho]

Viktor Frankl: “Young people don’t need less tension. They need more meaning.”

“Most of us have never been in the concentration camp experience. We’ve never had to go through that horror and tragedy. So one would think that today it would be easier to find meaning in life. And yet, I sense that it’s more difficult in a sense today than it was in years past.”

Frankl explains the paradox of modern life:

“We are living in a society, an affluent society, a welfare state that is virtually out to satisfy and gratify each and every human need except for one need: the most basic and fundamental need of man, the need for meaning.”

He points to the hidden problem beneath comfort:

“Consumer societies are even creating needs. But the need for meaning remains unfulfilled. It is what I have called the unheard cry for meaning.”

Frankl argues that people are often taught to chase the wrong things:

“You scarcely will find any reference to what is the most fundamental and basic concern of man—neither pleasure, nor happiness, nor power, nor prestige but originally and basically his wish, his desire, to find and fulfill a meaning in his life.”

He explains what happens when someone truly sees meaning:

“If there is a meaning to fulfill, if he becomes cognizant of such a meaning, then he is ready to suffer. He is ready to offer sacrifices. He is ready to undergo tension, stress, and so forth without any harm being done to his health.”

Frankl’s point is powerful:

Stress itself is not the enemy.
Meaningless stress is.

When a person knows why they are enduring something, they can carry an extraordinary amount of difficulty without breaking.

But when meaning disappears, even comfort becomes dangerous.

Frankl takes this to its starkest conclusion:

“If there is no meaning, no meaning in his visual field, then he takes his life.”

He then contrasts the most brutal conditions imaginable with modern emptiness:

“Can you imagine a situation for a human being which is more full of stress than Auschwitz? And virtually all neurotic symptomatology disappeared there… On the other hand, in the welfare state of Austria… the top-ranking question among students was suicide among youngsters of 14 to 15 years of age.”

This is the core of his warning:

The human soul does not collapse simply because life is hard.
It collapses when life feels pointless.

Frankl then explains what is missing for young people today:

“There were virtually no tensions because they are pampered. Nobody allows himself to challenge them.”

And then he says the line every parent, teacher, and leader should sit with:

“What young people need are ideals and challenges, personal tasks, and to begin with, in the first place.”

He makes it clear that protection is not always love:

“Neither parents nor school teachers are courageous enough to challenge them… Don’t arouse tensions, don’t create tensions, don’t put stress on them.”

But Frankl disagrees with that instinct entirely.

“People today are not over-demanded. They are under-demanded.”

That may be the diagnosis of our time.

We assume the problem is too much pressure.
Frankl suggests the deeper problem is too little purpose.

Too little responsibility.
Too few ideals worth serving.
Too few examples worth following.
Too little being asked from the human spirit.

Young people don’t only need safety.
They need something worthy of their strength.

Because a person does not become fully alive by being endlessly comforted.
They become alive when life asks something of them and they rise to meet it.

Lessons I'm taking away from this clip:

1. Meaning is a better fuel than comfort.

People don’t break only because life is hard. They break when life feels empty. We live in a world obsessed with convenience, ease, and removing friction but a frictionless life is not always a meaningful one. A lot of people are not exhausted from doing too much. They are exhausted from doing too little that actually matters to them. Purpose gives weight to your effort. It makes sacrifice feel chosen instead of imposed.

2. The real danger is not stress. It’s meaningless stress.

Stress by itself is not the enemy. In fact, some forms of stress are necessary for growth, discipline, achievement, and character building. The real problem begins when a person is carrying pressure without any reason that feels deeply theirs. That’s when stress becomes emptiness. For me, the lesson is to stop asking, How do I remove all difficulties from my life? and start asking, Which difficulties are worth carrying because they are attached to a bigger purpose? That question alone can change how you work, lead, and live.

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

“Starry sky” ≠ Burkitt lymphoma

It reflects:
macrophages clearing apoptotic tumor cells → high turnover

Seen in:
• Burkitt lymphoma
• High-grade B-cell lymphoma (MYC ± BCL2)
• DLBCL
• Reactive germinal center
• Lymphoblastic lymphoma / ALL
• Blastoid mantle cell lymphoma

Key distinction:
Burkitt → BCL2–
Others → often BCL2+ (confirm by FISH)

Same sky 🌌
Different biology

#Lymphoma #Hemetwitter #Hemepath #MedEd

[Vala Afshar @ValaAfshar]

Dear high schoolers, learn:

1 public speaking
2 writing well
3 storytelling (see 1-2)
4 critical thinking (not cynicism)
5 great manners
6 active listening (hear with eyes)
7 networking (trust and giving)
8 good customer service
9 how to sell
10 personal finance and statistics

[Mark Hubbell @markwhubbell]

@Milajoy Spot on

[Janira Navarro @Janiranavarro]

Occasional plasma cells can be seen in:
- Endometrial polyp
- Disordered proliferative endometrium
- Stromal breakdown

This is not sufficient to diagnose chronic endometritis.

Dr. Parra Herran #USCAP2026 #pathology #PathX #PathTwitter

[Janira Navarro @Janiranavarro]

Degenerative joint disease showing focal neutrophil aggregates – osteomyelitis or not?

Subarticular aggregates of neutrophils ('inflammatory pseudoabscesses'), often with bone destruction and cystic changes, can mimic osteomyelitis

In the absence of clinical signs of infection, penetrating trauma, or orthopedic hardware, these likely represent benign non-infectious inflammation, sometimes called "sterile" osteomyelitis

DJG pic: PathOutlineshttps://www.pathologyoutlines.com/topic/jointsDJD.html

Dr Kilpatrick - Interactive Microscopy sessions #USCAP2026 #pathology #BSTPath #PathX #PathTwitter