Tina D.

Pathologist in Alcalá de Henares (Spain)

[Janira Navarro @Janiranavarro]

Ovary
Microcystic stromal tumor
-Microcysts
-Fibrous, thick collagen bands
-Fibrous stroma
➕B-catenin, cyclin D1
➖Inhibin, calretinin
DAPA grand rounds Dr. Oliva #EverydayGYN #gynpath #PathTwitter #pathologists #pathresidents #pathfellow

[David Stockman MD @DavidStockmanMD]

#pathquiz Pseudomyogenic #Hemangioendothelioma #pathology pitfall4 DF #dermpath #bstpath #dermatology #pathologists

[Jerad Gardner, MD @JMGardnerMD]

Masterclass on bone #pathology w special guest Dr. Andrew Rosenberg!
Video: https://t.co/Z3rVipx4y0
He discusses normal bone #Histology, #Embryology, & non-neoplastic pathology, reactive changes, woven bone, fracture callus, & Paget disease. Amazing #meded!

[Katrina Collins, MD || Pathologist @katcollmd]

#slidearchiveseries perinephric myxoid pseudotumor of fat #gupath #pathtwitter #pathoutpic

🔬 fat with lymphoplasmacytic infiltrate and myxoid change
📍non-neoplastic renal disease and transplant
⚠️ mimics WDLPS and IgG4-related sclerosing disease

🔗 https://t.co/0P5xiAh0bu

[Elizabeth Montgomery, MD @LizMontgomeryMD]

A striking case of histoplasmosis. It really is nasty about mimicking Crohn's disease.

[Janira Navarro @Janiranavarro]

What drives local recurrence risk after breast-conserving surgery? The DCIS component—especially when an extensive intraductal component (EIC) is present—is a major driver of ipsilateral breast recurrence

What drives systemic recurrence risk? Primarily the invasive component: size (T stage), histologic grade, lymphovascular invasion, nodal status, and molecular subtype/biomarkers

Dr. Bloom. Microinvasive carcinoma. CAP on demand https://t.co/CFLLpZmOyB #pathology #PathX #breastpath

[Janira Navarro @Janiranavarro]

How to handle cases with microinvasive carcinoma?

-Obtain deeper levels and pay attention to lymphoid inflammation areas around DCIS
- In cases with multiple foci, the sum of the sizes should not be used for determining the pT stage
- Report biomarkers if possible, if exhausted report ER/PR from adjacent DCIS

Dr. Huina Zhang. Microinvasive carcinoma CAP on demand https://t.co/CFLLpZmOyB #pathology #PathX #Breastpath

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

Pathology Bodies 🔬

[Jerad Gardner, MD @JMGardnerMD]

Now THAT's Cherry-Red Nucleoli! (but it isn't melanoma). Large thigh mass in an adult
Answer ✅ https://t.co/vN6bODcYyI
More pics: https://t.co/Hqc8QkCAXA.
How I work up pleomorphic spindle cell tumors: https://t.co/SSY2q2lEhW
#BSTpath #pathologists #pathology #pathTwitter #dermpath #dermatology #dermtwitter

[European Society of Pathology (ESP) @ESP_Pathology]

🔍Prostatic acinar adenocarcinoma involving a Pacinian corpuscle, showing both peri- and intracorpuscular growth.

🔬Every slide deserves careful examination!
📷João Lobo, MD, PhD, Pathologist, Assistant Professor & ESP Alumni, Portugal.

#pathology #EveryDayPathology
#PathX

[Andres Matoso @Andres_Matoso]

Can’t miss our recent publication! @JHUPath #GUpath

[Dr Kamlesh Darji @DrKamleshDarji1]

High-yield information #NEETPG

⚡ Oncogenes

1. RAS (KRAS/NRAS/HRAS) : GTPase in signal transduction; point mutation → constitutively "on." Most commonly mutated oncogene in human tumors → pancreas, colon, lung

2. MYC : transcription factor.
C-MYC → Burkitt lymphoma t(8;14);
N-MYC amplification → neuroblastoma;
L-MYC → small cell lung ca

3. HER2/NEU (ERBB2) : receptor tyrosine kinase; amplification → breast & gastric ca

4. ABL : BCR-ABL fusion from t(9;22) Philadelphia chromosome → CML

5. RET : receptor tyrosine kinase → MEN 2A/2B, medullary & papillary thyroid ca

6. KIT (CD117) : receptor tyrosine kinase → GIST, mastocytosis

7. CYCLIN D1 (CCND1) : drives G1→S; t(11;14) → mantle cell lymphoma

8. BRAF : serine/threonine kinase; V600E → melanoma, hairy cell leukemia, papillary thyroid ca

⚡ Tumor Suppressors

1. RB : governor of G1/S, binds E2F → retinoblastoma, osteosarcoma

2. TP53 (p53) : "guardian of the genome"; arrests cycle + triggers apoptosis. Most commonly mutated gene in human cancer → Li-Fraumeni

3. APC : degrades β-catenin (WNT pathway) → FAP, colorectal ca

4. BRCA1/BRCA2 : DNA double-strand break repair → breast & ovarian ca

5. VHL : degrades HIF → clear cell RCC, hemangioblastoma, pheochromocytoma

6. NF1 : neurofibromin (RAS-GAP) → neurofibromatosis type 1

7. WT1 : transcription factor → Wilms tumor

8. PTEN : inhibits PI3K/AKT → Cowden syndrome, endometrial & breast ca

[Ziad El-Zaatari @ziad_zaatari]

🔬📷 Worm in an Appendix! ~ Enterobius vermicularis parasite seen in the lumen of an appendix ~ #GIpath #Pedipath #Pathology #PathArt

[Sanjay Mukhopadhyay @smlungpathguy]

What would you call this?

https://t.co/vcWv1I8uHK

#Pathbugs #crittersontwitter

[Tina D. @Tinadeneb]

@Notas_Patologia 👏👏👏

[NotasDePatologia @Notas_Patologia]

Solid Papillary Carcinoma of the Breast
(with emphasis on in situ × invasive disease)
🔬 A rare and generally indolent neoplasm, but with one of the most interesting diagnostic pitfalls in breast pathology: absence of myoepithelial cells does NOT, by itself, indicate invasion.🧵

📌 Definition
Solid papillary carcinoma (SPC) is characterized by expansile solid nodules traversed by delicate fibrovascular cores, frequently showing neuroendocrine differentiation.

👥 Epidemiology
Predominantly affects postmenopausal women, usually in the 7th decade of life or later.

📍 Sites
It may occur in any region of the breast, but there is a predilection for the central/subareolar region.

🧬 Pathogenesis
A tumor with a luminal phenotype, generally ER+/HER2−. Reported alterations include 1q/16p gains, 16q loss, and PIK3CA mutations in a subset of cases.

🩺 Clinical Features
It may present as:
• palpable mass;
• mammographic abnormality;
• bloody nipple discharge.

🧪 Laboratory Diagnosis / Core biopsy
Core biopsy may recognize the pattern, but frequently does not adequately sample the tumor periphery, limiting assessment of invasion. Post-biopsy changes may also mimic infiltration.

🔬 Histopathology
• Solid, rounded, expansile nodules.
• Delicate fibrovascular cores, sometimes inconspicuous.
• Monotonous round/oval or spindle-shaped cells.
• Granular or plasmacytoid cytoplasm.
• Nuclear palisading around vessels.
• Intracellular or extracellular mucin may be present.

⚠️ The main pitfall
SPC in situ:
→ smooth, rounded, circumscribed nodules.
→ a peripheral myoepithelial cell layer may NOT be demonstrable.

Invasive SPC:
→ irregular/angulated contours;
→ geographic “jigsaw puzzle” pattern;
→ small infiltrative nests;
→ desmoplasia and/or adipose tissue infiltration.
👉 Therefore: negative p63 ≠ automatic invasion.
In SPC, the morphology of the tumor–stroma interface is fundamental.

🧫 Immunohistochemistry
• ER: usually strong and diffuse.
• PR: frequently positive.
• HER2: usually negative.
• Ki-67: low/intermediate.
• Synaptophysin / Chromogranin / INSM1: frequently positive.
Neuroendocrine differentiation is common, but SPC should not simply be reclassified as a neuroendocrine tumor of the breast.

🔎 Differential Diagnosis
• Papilloma + florid UDH → mosaic CK5/6, heterogeneous ER, preserved myoepithelium.
• Encapsulated papillary carcinoma → cystic space/capsule and more evident true papillae.
• Mucinous carcinoma → carcinoma truly infiltrating mucin pools.
• Invasive lobular carcinoma → evaluate E-cadherin/p120.
• Metastatic NET → absent/weak ER should raise this possibility.

📈 Prognosis
Excellent in the pure/in situ form. Lymph node and distant metastases are essentially related to the presence of an invasive component.

💊 Treatment
SPC in situ is managed as in situ disease. When invasion is present, management follows the principles applicable to the corresponding invasive breast carcinoma.

🎯 Take-Home Messages @Notas_Patologia
• Look for delicate fibrovascular cores within an apparently solid proliferation.
• Absence of myoepithelium does not define invasion in SPC.
• Circumscription favors in situ; irregularity + desmoplasia/adipose infiltration favor invasion.
• Neuroendocrine differentiation is frequent, but does not change the entity.
• For staging, use the size of the invasive component, not the total size of the SPC.

📚 Selected References
• WHO Classification of Breast Tumours, 5th ed.
• Saremian J, Rosa M. Arch Pathol Lab Med. 2012;136:1308–1311.
• Otsuki Y et al. Virchows Arch. 2023;482:687–695.
• Hoda RS, Wen HY. Human Pathology. 2025;162:105759.
• PathologyOutlines �� Solid papillary carcinoma.

⚠️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.

#MedicalEducation #NotasDePatologia #pathology #PathTwitter #BreastPathology #BreastCancer

🖋️ Case and slide coloration courtesy of Dr. Ivison Xavier Duarte - Laboratório Patologika (https://t.co/AmtxJzycUs), as part of an academic partnership project.

[Dr. Megha Lalcheta MD @megha_lalcheta]

Middle thigh mass #BSTPath #PathX
70 years old male

Differential diagnosis?
#Pathologists #PathResidents #Pathology #PathTwitter

[Ali Alzughbi @AliAlzughbi]

High grade adenoid cystic carcinoma in a 73 years old male hard palate lesion
WITH lymph node metastases (the fourth picture)!

extensive peri-neural and ENDO-NEURAL(tumor within the nerve bundles)
#pathed
#pathology #pathx #pathtwitter #entpath #surgpath #HeadAndNeckPathology

[Ziad El-Zaatari @ziad_zaatari]

🔬📸 "Cobblestone Heart" ~ Trichrome stain of myocardium with interstitial fibrosis ~ #Pathology #Autopsy #Cardiac #PathArt

[Surgical Pathology Cases @surgpathcases]

Cervix, 30y

#pathology #patologia #gynpath #gynpathology