Spoorthy MD, DNB

pathologist and a prolific reader

[Ankur Sangoi @slusagar]

#PathTip #GUpath #LPpath:

when screening prostate biopsies at low power &👁️ small glands traversing from one side of the core to the other ("glands crossing the street"):

definitely🛑stop &📷 go down on high power!

[Dr. Arkadip MD @pathognosis22]

#MMR IHC interpretation guideline from #BAGP #pathology #IHC #MSI #pMMR #dMMR #pathognosis #genetics

[Janira Navarro @Janiranavarro]

Low-grade B-cell lymphomas may present with prominent reactive inflammatory infiltrates or coexist with autoimmune disorders

⚠️ Increased IgG4:IgG ratio? Stop and think before diagnosing IgG4-related disease. Always exclude an associated lymphoproliferative disorder

What is the cause of abundant IgG4 in lymphomas?Possible explanations...
1. Non-neoplastic IgG4 cells within the tumor microenviroment
2. Monoclonal IgG4 production by lymphoma
3. Lymphoma can coexist with IgG4-related disease and other autoimmune disease

Dr. Herrera Hernandez #USCAP2026 #pathology #PathX #PathTwitter

[The British Assoc of Gynaecological Pathology @BAGPGynPath]

#HilaryBuckleyAward Unilateral ovarian metastasis from lung adenocarcinoma with fibroma-like stromal proliferation: A diagnostic mimic of primary ovarian tumour. #BAGP2026

[The British Assoc of Gynaecological Pathology @BAGPGynPath]

#HilaryBuckleyAward Artificial intelligence -assisted triage of endometrial pathology using a DINOv2 vision transformer model #BAGP2026

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

H & E Staining Troubleshooting Atlas🔬

[Modern Pathology @ModernPathology]

Mastocytosis (seen here) is often sought by naive colleagues and seldom seen. Mod Pathol offers a great review:
Panarelli NC, Hornick JL, Yantiss RK. What Is the Value of Counting Mast Cells in Gastrointestinal Mucosal Biopsies? Mod Pathol. 2023 Feb;36(2):100005. PMID: 36853780.

[Tim Bracey @drtimbracey]

Our SW UK trainees asked me to teach for an hour and a half about gastric biopsies, so I short changed them and spoke for 1hr 29mins. Thanks to Shaun Walsh and @LizMontgomeryMD for some of the slides

https://t.co/JoMcDdkns7

[Veli Bakalov, MD @HemeOncBuddy]

#HemeOncHeroes series. Story #6

In 1955, childhood leukemia was almost uniformly fatal.

The pediatric leukemia ward at the National Cancer Institute @theNCI carried the smell of antiseptic, transfusions blood, and infection.

🧵 1/14

pic: Emil J Freireich, MD. The hematologist who refused to accept how children with leukemia died.

[Ducktor Crab 🦆 @ErizoSonico]

La displasia epitelial oral sigue siendo un reto diagnóstico por la subjetividad de varios criterios histomorfológicos.

Comparto un esquema visual basado en OMS 5ª edición y Hankinson et al. para integrar sus principales hallazgos arquitectónicos y citológicos.

[𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 MD, DM @nihardesai89]

36 yr old, presents with anemia on D+80 post 10/10 MUD for AML.

Other lineages normal. Complete donor chimerism at D+60

Hgb: 78 g/L
LDH: 218

BM aspirate shows 👇🏽

📸 @ASH_hematology image bank

[Veli Bakalov, MD @HemeOncBuddy]

Heme/onc fellows starting July — save this.

A free, oncologist-built study + reference platform:
• Trials database
• Board prep notes
• Heme/onc flashcards
• Staging flashcards

20 randomly selected entries verified against OpenEvidence
@EvidenceOpen = no errors

🔗 https://t.co/C3S0IkiCJQ

[pathCast @pathologyCast]

We are excited to launch the new @pathologyCast website:
🌐 https://t.co/YuEvyboogA
A modern, Netflix-style platform for pathology education featuring:
🔹 300+ lectures
🔹 Global expert speakers
🔹 100% free

Built to make pathology learning easier to explore, and enjoy
.

[Papa Heme @Papa_Heme]

CD markers very simplified!

CD34+ = Blast

CD3+ = T-cell
CD19+ = B-cell
CD33+ = Myeloid

CD34+ = Acute leukemia (but which type?)

CD34+ CD19+ = B-ALL
CD34+ CD3+ = T-ALL

CD34+ CD33+ = AML

CD34- CD33+ = APL (promyelocyte differentiated one step above blast)”

[Janira Navarro @Janiranavarro]

Second day of the first weekend of CAP #JobPrepBootcamp!

***Ovarian tumor frozen sections***

Clear cell carcinoma with adenofibromatous pattern can be signed out on frozen as “atypical epithelial proliferation in an adenofibromatous background”, defer to permanents (especially if atypia is focal)

Helpful tips for real-world practice!

#PathTwitter #JobPrepBootcamp #pathology #pathresidents #pathfellow #NIPPathX

[Dr Kamlesh Darji @DrKamleshDarji1]

Every diagnosis in oncology is a rumor until a pathologist signs it.

[TheBatoolMD @TheBatoolMD]

Sarcomas that metastasize to lymph nodes should “SCARE” you!

These are:

S Synovial sarcoma
C Clear cell sarcoma
A Angiosarcoma
R Rhabdomyosarcoma
E Epithelioid sarcoma

#BST #sarcoma #Dermpath #boards #pathtwitter #pathx #mnemonic

[NotasDePatologia @Notas_Patologia]

Invasive fungal rhinosinusitis 🧫
Focus: what the pathologist must not miss in the report
Brief but potentially lethal: invasive fungal rhinosinusitis (IFR) is the form in which the fungus leaves the mucosa and invades submucosa, vessels, and bone, especially in neutropenic patients, decompensated diabetics, and transplant recipients.

Definition 🧬

IFR is histologically defined by invasion of the mucosa/submucosa by hyphae, with or without angioinvasion, clearly distinguishing it from non‑invasive forms (fungal ball, allergic fungal rhinosinusitis).

Histopathology 🔬

Architecture: nasal/sinonasal mucosa with necrosis and acute or mixed inflammation, often with “empty” areas of necrotic tissue permeated by hyphae.

Hyphae
📌Mucorales: broad, pauciseptate hyphae with irregular, often right‑angle branching (frequently collapsed on H&E).

📌Aspergillus: thin, septate hyphae with dichotomous, acute‑angle branching.

Vessels: thrombosis, necrosis of the vessel wall, and intraluminal invasion are the hallmark of the acute form; this explains the “black turbinate sign” on MRI.

Immunohistochemistry and special stains
H&E + Grocott–Gomori: highlights hyphae and their extent in vessel walls/bone.

PAS: useful, but less sensitive in extensive necrotic fragments.

IHC is occasional (for example, MUC5B, maspin in studies), not routine; the gold standard remains H&E + silver stain.

Diagnostic pitfalls ⚠️

Superficial biopsy with only crust/necrosis and no submucosa: high risk of calling “fungal colonization,” underestimating true IFR.

Necrosis without demonstrable hyphae: cut deeper levels, request Grocott, and if still doubtful, suggest a new biopsy in correlation with clinical/imaging data.

Confusing chronic invasive forms (Aspergillus, mucormycosis in diabetics) with tumor: solid masses with bone invasion can mimic malignant neoplasms.

What must be in the pathologist’s report 🧾

Explicitly state whether there is invasion of mucosa/submucosa and vessels by hyphae.

Suggest the likely genus (Mucorales‑type vs Aspergillus‑type pattern), with a recommendation to correlate with culture/PCR.

Indicate that the finding is compatible with invasive fungal rhinosinusitis and justify the urgency of clinico‑radiologic correlation and combined surgical + antifungal management.

Take-Home Messages NotasDePatologia

📌IFR is, above all, a histologic diagnosis of invasion, not merely of the presence of fungus.

📌Hyphae in vessel walls/lumina explain necrosis and worse prognosis; describe this clearly in the report.

📌Superficial, crust‑only biopsies are the main trap; ask for new material when necessary.

Selected References
Roland LT et al. Int Forum Allergy Rhinol, 2023 – AIFS consensus on pathology, imaging, and management.

Pagella F et al. J Cranio-Maxillofac Surg, 2016 – Acute vs chronic IFRS, clinicopathologic correlation.

Kurokawa M et al. RadioGraphics, 2022 – IFRS routes of orbital/cavernous invasion and imaging–pathology correlation.

⚠️Disclaimer⚠️
This text is an educational summary for healthcare professionals and students; it does not replace full pathology reports, local guidelines, or individualized clinical decision‑making.

#Pathology #HeadNeckPathology #InfectiousDisease #FungalSinusitis #InvasiveFungalRhinosinusitis
#SurgicalPathology #Histopathology #ENT #MedEd #MedicalEducation #NotasDePatologia

[Pathoindia @Patho_India]

Should Pathoindia add an communication platform (e.g., Telegram) alongside the group email?

Please take the 1-minute poll. https://t.co/QQJAn8vQaV

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

The references in this article are very thoughtfully curated. I’d highly encourage you to look them up and read them for a deeper understanding of the topics discussed in this paper.