1
|
Suster DI, Ronen N, Suster S. Pseudosquamous Adenocarcinoma of the Lung: Clinicopathologic and Immunohistochemical Study of 10 Cases. Am J Surg Pathol 2024:00000478-990000000-00354. [PMID: 38764378 DOI: 10.1097/pas.0000000000002242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Pseudosquamous adenocarcinoma of the lung is an unusual morphologic variant of poorly differentiated non-small cell lung carcinoma that superficially resembles a squamous cell carcinoma. We have examined 10 cases of these tumors in 4 women and 6 men, aged 47 to 93 years. The tumors were all peripheral and measured from 1.5 to 5.5 cm. All cases were characterized by solid nests of large polygonal tumor cells containing atypical nuclei with abundant cytoplasm and sharp cell borders, adopting a pavement-like architecture that simulated squamous cell carcinoma. Some cases demonstrated intracytoplasmic hyaline inclusions suggestive of keratinization. The nests of tumor cells often showed central comedo-like areas of necrosis. Intercellular bridges were not seen in any of the cases. The tumors often displayed marked clearing of the cytoplasm enhancing their epidermoid appearance. In 4 cases, the solid pseudosquamous areas were seen to merge with a focal lepidic adenocarcinoma component, and in 1 case, abortive microscopic foci of acinar differentiation were also noted within the tumor. One case showed focal sarcomatoid spindle cell areas. The tumor cells were negative for p40 and CK5/6 and labeled with TTF1 or Napsin-A, confirming an adenocarcinoma phenotype. Clinical follow-up information was available in 8 patients; 6 patients died of their tumors between 6 months to 11 years after diagnosis (mean: 3.1 y). One patient died of complications related to surgery and one patient with a low-stage tumor died at 27 years from other causes. Solid pattern adenocarcinomas can be confused for squamous cell carcinoma and may require immunohistochemistry to determine their true phenotype.
Collapse
Affiliation(s)
- David I Suster
- Department of Pathology, New Jersey Medical School, Rutgers University, Newark, NJ
| | - Natali Ronen
- Department of Pathology, University of Chicago, Chicago, IL
| | - Saul Suster
- Department of Pathology, New Jersey Medical School, Rutgers University, Newark, NJ
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
2
|
Suster D, Mackinnon AC, Ronen N, Mejbel HA, Harada S, Suster S. Non-Small Cell Lung Carcinoma With Clear Cell Features and FGFR3::TACC3 Gene Rearrangement : Clinicopathologic and Next Generation Sequencing Study of 7 Cases. Am J Surg Pathol 2024; 48:284-291. [PMID: 38084010 DOI: 10.1097/pas.0000000000002167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Seven cases of primary lung tumors characterized histologically by clear cell morphology and a distinctive FGFR3::TACC3 gene rearrangement are described. The tumors arose in 4 women and 3 men, aged 47 to 81 years (mean=68). They occurred in peripheral locations, predominantly subpleural, and ranged in size from 1.4 to 6.5 cm (mean=4.1 cm). All tumors showed a solid growth pattern with abundant central areas of necrosis and marked nuclear pleomorphism. The tumors demonstrated clear cell histology, with large cohesive tumor cells displaying atypical nuclei and abundant clear cytoplasm. Immunohistochemical stains identified a squamous phenotype in 5 cases and an adenocarcinoma phenotype in 2 cases. One case was a squamous cell carcinoma with focal glandular component, and one of the squamous cell carcinomas showed focal sarcomatoid changes. Next generation sequencing identified FGFR3::TACC3 gene rearrangements in all 7 cases. One case demonstrated a concurrent activating FGFR3 mutation and a second case demonstrated concurrent FGFR3 amplification. Two cases harbored a concurrent KRAS G12D mutation. One case harbored both KRAS and EGFR mutations, and 1 case had a concurrent TP53 mutation. Non-small cell lung carcinoma harboring FGFR3::TACC3 gene rearrangements is extremely rare, and this rearrangement may potentially be enriched in tumors that demonstrate clear cell histology. Identification of FGFR3::TACC3 in patients with lung carcinomas with clear cell features may be of importance as they could potentially be candidates for therapy with tyrosine kinase inhibitors.
Collapse
Affiliation(s)
- David Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
| | - A Craig Mackinnon
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Natali Ronen
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI
| | - Haider A Mejbel
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Shuko Harada
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Saul Suster
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
3
|
Suster DI, Ronen S, Suster S. Selected Case From the Arkadi M. Rywlin International Pathology Slide Seminar: Involvement of Skin and Soft Tissue by Erdheim-Chester Disease. Adv Anat Pathol 2024:00125480-990000000-00086. [PMID: 38180007 DOI: 10.1097/pap.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Erdheim-Chester disease is a rare form of non-Langerhans cell histiocytosis that preferentially involves long bones but can affect a variety of other organs. Initial presentation with extraskeletal involvement is not unusual and is most commonly observed in the central nervous system, heart, retroperitoneum, lungs, and skin. Initial presentation of the disease as a subcutaneous soft tissue mass is exceedingly rare and may pose difficulties for diagnosis. We describe a case of Erdheim-Chester disease that initially presented as a cutaneous and subcutaneous soft tissue mass in the right posterior shoulder of a 52-year-old man.
Collapse
Affiliation(s)
- David I Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
| | - Shira Ronen
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - Saul Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
| |
Collapse
|
4
|
Suster D, Suster S. On the Histologic Classification of Thymoma. Adv Anat Pathol 2024; 31:22-33. [PMID: 37702296 DOI: 10.1097/pap.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The classification of thymoma continues to be a source of controversy in pathology. The difficulties in histologic classification are evident from the number of proposals that have been offered over the years, as well as for the continuous changes and modifications introduced by the World Health Organization to their classification system over the past 20 years. We analyze here some of the issues involved in the classification of these tumors and the difficulties encountered for practicing pathologists in deciphering the "letters and numbers" system devised by the World Health Organization. We would like to propose an alternate approach to thymoma histologic classification that capitalizes on the basic observation of their cytologic features and incorporates the pattern of growth resulting from the interplay of the tumor cells with other cellular constituents as a secondary characteristic. The proposed histologic classification provides a simplified, reproducible means of histologically categorizing these tumors and can be easily understood by most practicing pathologists in simple and clear morphologic terms.
Collapse
Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University Hospital, Newark, NJ
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
5
|
Suster S. Editorial: Juan Rosai, M.D. (1940-2020). Ann Diagn Pathol 2023; 66:151683. [PMID: 33500221 DOI: 10.1016/j.anndiagpath.2020.151683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Abstract
Thymic hyperplasia is a rare condition generally caused by lymphoid follicular hyperplasia associated with autoimmune disorders. True thymic parenchymal hyperplasia unassociated with lymphoid follicular hyperplasia is extremely rare and may give rise to difficulties in diagnosis. We have studied 44 patients with true thymic hyperplasia (38 females and 6 males) aged 7 months to 64 years (mean, 36 years). Eighteen patients presented with symptoms of chest discomfort or shortness of breath; in 20 patients, the lesions were discovered incidentally. Imaging studies demonstrated enlargement of the mediastinum by a mass lesion suspicious for malignancy. All patients were treated with complete surgical excision. The tumors measured from 3.5 to 24 cm (median, 10 cm; mean, 10.46 cm). Histologic examination showed lobules of thymic tissue displaying well-developed corticomedullary architecture, with scattered Hassall corpuscles separated by mature adipose tissue and bounded by a thin fibrous capsule. No cases showed evidence of lymphoid follicular hyperplasia, cytologic atypia, or confluence of the lobules. Immunohistochemical studies showed a normal pattern of distribution for keratin-positive thymic epithelial cells against a background rich in CD3/TdT/CD1a+ lymphocytes. Twenty-nine cases had an initial clinical or pathological diagnosis of thymoma or thymoma vs thymic hyperplasia. Clinical follow-up in 26 cases showed that all patients were alive and well between 5 and 15 years after diagnosis (mean, 9 years). Thymic parenchymal hyperplasia causing significant enlargement of the normal thymus that is sufficient to cause symptoms or worrisome imaging findings should be considered in the differential diagnosis of anterior mediastinal masses. The criteria for distinguishing such lesions from lymphocyte-rich thymoma are presented.
Collapse
Affiliation(s)
- David Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, New Jersey.
| | - Natali Ronen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Douglas C Pierce
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Saul Suster
- Department of Pathology, Rutgers New Jersey Medical School, Newark, New Jersey; Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
7
|
Suster D, Ronen N, Pierce DC, Suster S. Pulmonary nodular elastosis: The intraparenchymal counterpart of pulmonary apical caps? Ann Diagn Pathol 2023; 63:152107. [PMID: 36638602 DOI: 10.1016/j.anndiagpath.2023.152107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
We have studied six cases in which focal consolidative pulmonary opacities observed on imaging studies led to surgical resection due to the suspicion of malignancy and showed on histopathologic examination a benign process characterized by an expansile tumor-like nodular accumulation of elastotic material. The patients were five women and one man aged 46 to 67 years (mean: 61 years). All lesions were found incidentally on imaging studies done for a variety of reasons, including surveillance for metastatic carcinoma in four patients. The lesions presented as solid nodules within lung parenchyma with irregular borders and spiculated margins and measured between 0.6 and 4.6 cm in diameter. Histological examination showed dense deposits of elastic tissue without evidence of malignancy, similar to those seen in pulmonary apical caps. Clinical follow-up between 5 and 16 years (mean: 10 years) showed that all patients were alive and well without evidence of disease. Pulmonary nodular elastosis is a localized intraparenchymatous process that may be confused clinically and radiographically for a malignant neoplasm and needs to be distinguished from other nodular lesions of the lung. To the best of our knowledge, tumor-forming lesions within lung parenchyma that are predominantly or almost exclusively composed of accumulation of elastic fibers have not been previously described.
Collapse
Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University School of Medicine, Newark, NJ, United States of America.
| | - Natali Ronen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Douglas C Pierce
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| |
Collapse
|
8
|
Suster S. The art of surgical pathology interpretation. Ann Diagn Pathol 2023; 63:152124. [PMID: 36775760 DOI: 10.1016/j.anndiagpath.2023.152124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
9
|
Suster D, Suster S. In Reply. Arch Pathol Lab Med 2023; 147:383c-384. [PMID: 36961930 DOI: 10.5858/arpa.2022-0434-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 03/26/2023]
Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University New Jersey Medical School, Newark
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
10
|
Suster DI, Mejbel H, Mackinnon AC, Suster S. Desmoplastic Adamantinoma-like Thymic Carcinoma: Clinicopathologic, Immunohistochemical, and Molecular Study of 5 Cases. Am J Surg Pathol 2022; 46:1722-1731. [PMID: 35993584 DOI: 10.1097/pas.0000000000001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Five cases of a heretofore unreported rare variant of thymic carcinoma characterized by a striking resemblance to adamantinoma of the mandible are described. The tumors occurred in 4 women and 1 man aged 58 to 76 years (mean: 67.8 y); they arose in the anterior mediastinum and measured from 5.3 to 12.0 cm in greatest diameter (mean: 8.9 cm). Presenting symptoms included chest pain, shortness of breath, and in 2 patients, pleural effusion. One tumor was asymptomatic and discovered incidentally. Histologically, the tumors were extensively desmoplastic, and the cellular proliferation was characterized by multiple islands of squamous epithelium with striking peripheral palisading of nuclei and central areas containing clear cells resembling a stellate reticulum. Areas of preexisting spindle cell thymoma were identified in 2 cases; these areas gradually merged with the higher-grade component of the lesion. Cystic changes were noted in 3 cases. Immunohistochemical studies in 3 cases showed the tumor cells were positive for cytokeratins, p40 and p63, and all showed a high proliferation rate (>50% nuclear positivity) with Ki-67. Next-generation sequencing was performed in 2 cases that showed amplification of the AKT1 gene (copy numbers 6 and 13). Clinical follow-up in 3 patients showed recurrence and metastasis after 1 and 2 years; 1 patient passed away 2 years after diagnosis due to the tumor. Desmoplastic adamantinoma-like thymic carcinoma represents an unusual histologic variant of thymic carcinoma that needs to be distinguished from metastases from similar tumors to the mediastinum.
Collapse
Affiliation(s)
- David I Suster
- Department of Pathology, Rutgers University New Jersey Medical School, Newark, NJ
| | - Haider Mejbel
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
11
|
Suster D, Mackinnon AC, Suster S. Thyroid Oncocytic (Hürthle Cell) Nodules With Longitudinal Nuclear Grooves. Arch Pathol Lab Med 2022:485899. [PMID: 36084253 DOI: 10.5858/arpa.2021-0554-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Thyroid nodules with longitudinal nuclear grooves have been widely regarded as synonymous with papillary thyroid carcinoma (PTC). OBJECTIVE.— To study a series of cases of thyroid nodules that exhibited oncocytic (Hürthle cell) features and contained longitudinal nuclear grooves yet failed to display aggressive behavior or the full features of papillary thyroid carcinoma. DESIGN.— The clinicopathologic, immunohistochemical, and molecular genetic features of 15 patients with these features were studied. Next-generation sequencing was performed to examine 161 genes for oncogenic driver alterations associated with thyroid neoplasia. RESULTS.— The lesions occurred in 11 women and 4 men aged 27 to 80 years and measured 0.2 to 2.3 cm in diameter (mean, 1.1 cm). The tumors were well circumscribed and noninvasive and showed a proliferation of large cells with abundant granular cytoplasm and centrally placed nuclei displaying scattered longitudinal nuclear grooves. Immunohistochemical stains were negative for HBME-1, galectin-3, and CK19 in all cases. NRAS pQ61R was detected in 6 cases, KRAS p.Q61E in 1 case, and AKT2 p.E17K in 1 case. None of the genetic changes classically associated with conventional PTC or with high-grade thyroid malignant neoplasms were identified. Clinical follow-up in 9 patients showed no evidence of recurrence or metastases between 2 and 13 years (mean, 5.7 years). CONCLUSIONS.— Longitudinal nuclear grooves can be occasionally encountered in oncocytic (Hürthle cell) tumors and should not lead to a diagnosis of PTC in the absence of other features supporting that diagnosis.
Collapse
Affiliation(s)
- David Suster
- From the Department of Pathology, Rutgers University Medical School, Newark, New Jersey (D. Suster).,The Department of Pathology, Medical College of Wisconsin, Milwaukee (S. Suster)
| | | | - Saul Suster
- From the Department of Pathology, Rutgers University Medical School, Newark, New Jersey (D. Suster).,The Department of Pathology, Medical College of Wisconsin, Milwaukee (S. Suster)
| |
Collapse
|
12
|
Suster S. In-memoriam: Ondrej Hes, M.D. (1968-2022). Ann Diagn Pathol 2022. [PMID: 36114095 DOI: 10.1016/j.anndiagpath.2022.152046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
13
|
Suster S. QUO VADIS AMERICAN ACADEMIC PATHOLOGY? Ann Diagn Pathol 2022; 61:152027. [DOI: 10.1016/j.anndiagpath.2022.152027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
14
|
Suster D, Mackinnon AC, Pihan G, Everts R, Suster S. Lymphocyte-Rich Spindle Cell Thymoma: Clinicopathologic, Immunohistochemical, Ultrastructural and Molecular Genetic Study of 80 Cases. Am J Surg Pathol 2022; 46:603-616. [PMID: 35034040 DOI: 10.1097/pas.0000000000001855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A study of 80 cases of spindle cell thymoma in which the spindle cell component was overshadowed by massive numbers of stromal lymphocytes is presented. The patients were 38 women and 42 men, aged 8 to 81 years (mean=54 y). All tumors presented as an anterior mediastinal mass; 5 patients had myasthenia gravis and one had Good syndrome. The tumors were well-circumscribed, encapsulated, and measured 2.9 to 26.0 cm in greatest diameter (mean=7.3 cm). Using modified Masaoka staging, 66 tumors were stage I, 10 were stage IIa, 2 were stage III and 1 was stage IV. Histologically the tumors were characterized by a predominant lymphocytic population admixed with scattered small spindle epithelial cells. The neoplastic spindle cells in these tumors demonstrated 2 major growth patterns: in 33 cases, the tumors were exclusively composed of dense sheets of lymphocytes containing scattered spindle cells resembling a lymphocyte-rich thymoma (WHO type B1); in the remaining cases the tumors showed admixtures of a predominantly lymphocytic component with areas that were lymphocyte-poor and contained a pure spindle cell population similar to WHO type A. Immunohistochemical stains and electron microscopy corroborated the spindle cell morphology in both types. The GTF2I p.L424H variant was identified in 53 of 63 (84%) cases analyzed. Clinical follow-up in 27 cases showed that most of the tumors behaved in an indolent manner. Our study expands the spectrum of spindle cell thymoma by demonstrating the existence of cases that are predominantly composed of lymphocyte-rich elements and lack areas with a pure (lymphocyte poor) spindle cell morphology.
Collapse
Affiliation(s)
- David Suster
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - German Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
15
|
Suster D, Mackinnon AC, Jarzembowski JA, Carrera G, Suster S, Klein MJ. Epithelioid osteoblastoma. Clinicopathologic and immunohistochemical study of 17 cases. Hum Pathol 2022; 125:68-78. [PMID: 35337839 DOI: 10.1016/j.humpath.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/10/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022]
Abstract
Seventeen cases of epithelioid osteoblastoma were reviewed. The tumors most commonly arose from the vertebrae (7 cases), followed by the mandible (3), sacrum (2), bones of the foot (2), and femur, rib, and scapula (1 each). Patients' ages ranged from 5 to 33 years. The tumors measured from 2.0 to 6.5 cm in the greatest diameter (mean = 4.1 cm) and most patients presented with low-grade pain at the affected site. Imaging studies showed expansile lytic lesions with cortical thickening and a mild rim of sclerosis. Histologically all tumors were characterized by active production of bone with a fibrovascular stroma containing microtrabecular aggregates of bone matrix. The osteoblastic proliferation was atypical and showed enlarged cells with prominent nucleoli and abundant cytoplasm imparting them with a striking epithelioid appearance. Immunohistochemical studies showed variable results that caused difficulties for interpretation; 4 of 12 cases showed strong nuclear positivity for FOS, 2 of 12 cases showed strong diffuse nuclear positivity for FOSB; the remaining cases showed variable, sometimes overlapping patterns, considered to be indeterminate. Ki-67 proliferation marker showed low nuclear positivity (∼2%) in 10 cases and a slight increase (<10%) in two cases. Clinical follow-up was available in 14 patients; one patient experienced a recurrence at six months that was treated with additional curetting; the remainder of the patients were all alive and well without evidence of recurrence from 1 to 22 years (median follow up = 3 years). Epithelioid osteoblastoma is an unusual variant of osteoblastoma that has the potential for simulating a malignancy and does not appear to be associated with a more aggressive behavior.
Collapse
Affiliation(s)
- David Suster
- From the Department of Pathology, Rutgers University School of Medicine, Newark, NJ, 07103, USA.
| | - A Craig Mackinnon
- Department of Pathology, University of Alabama at Birmingham, AL, 35249, USA
| | | | - Guillermo Carrera
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Saul Suster
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Michael J Klein
- Department of Pathology, Hospital for Special Surgery, New York, NY, 10021, USA
| |
Collapse
|
16
|
Suster D, Ronen S, Mackinnon AC, Suster S. Immature Chondroid Choristoma: Clinicopathologic, Immunohistochemical, and Molecular Study of an Unusual Benign Skin Tumor. Am J Dermatopathol 2022; 44:148-151. [PMID: 34291748 DOI: 10.1097/dad.0000000000002013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT An unusual benign skin tumor is reported occurring in a 68-year-old woman with no significant medical history. The lesion presented as a small skin nodule in the neck. Histologic examination showed a well-circumscribed superficial dermal nodule composed of a solid proliferation of large, round cells with abundant eosinophilic cytoplasm and small centrally placed nuclei displaying a vaguely chondroid appearance. Immunohistochemical studies showed strong positivity of the tumor cells for S100 protein and vimentin and negative staining for SOX10, melanoma cocktail, HMB45, Melan-A, cytokeratin AE1/AE3, inhibin, desmin, smooth muscle actin, CD68, CD164, and neuron specific enolase. Next-generation sequencing using a panel of 50 actionable genes commonly encountered in human neoplasia did not reveal the presence of any mutations. Owing to the remarkable similarity of the lesion to immature cartilage, we consider this to be a benign tumor, most likely resulting from an embryologic defect. We propose the term immature chondroid choristoma to designate this lesion.
Collapse
Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University Hospital, New Jersey Medical School, Newark, NJ
| | - Shira Ronen
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
17
|
Suster D, Mackinnon AC, Nosé V, Suster S. Solid Thyroid Follicular Nodules With Longitudinal Nuclear Grooves: Clinicopathologic, Immunohistochemical, and Molecular Genetic Study of 18 Cases. Arch Pathol Lab Med 2021; 146:984-993. [PMID: 34739542 DOI: 10.5858/arpa.2020-0816-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Follicular thyroid nodules can be a source of diagnostic difficulties, particularly when they display atypical features commonly associated with malignancy, such as nuclear grooves. OBJECTIVE.— To differentiate lesions with atypical features from similar-appearing benign and malignant lesions. DESIGN.— Eighteen cases of atypical follicular thyroid nodules characterized by a solid growth pattern and prominent longitudinal nuclear grooves were studied and examined for clinicopathologic characteristics. RESULTS.— The lesions occurred in 16 women and 2 men aged 36 to 88 years and measured from 0.2 to 1.5 cm. The tumors were well circumscribed and noninvasive, and histologically characterized by a predominantly solid growth pattern with rare scattered follicles or a combination of solid growth pattern with minor follicular areas. A striking feature seen in all cases was the occurrence of longitudinal nuclear grooves. Immunohistochemical stains showed negativity for cytokeratin 19 (CK19) and HBME-1 in 8 cases; in the other 10, there was focal positivity for HBME-1 in 4 cases and diffuse positivity in 6. All cases were negative for galectin-3 and for CK19, with the exception of 1 case, which was CK19+/HBME-1-. Next-generation sequencing of 16 cases with a 161-gene panel detected 14 single nucleotide variants in 12 cases, predominantly NRAS and HRAS mutations. Clinical follow-up ranging from 18 to 72 months (median, 43.7 months) did not disclose any evidence of recurrence or metastases. CONCLUSIONS.— We interpret these lesions as low-grade, indolent follicular proliferations that need to be distinguished from papillary thyroid carcinoma, follicular adenoma, and noninvasive follicular thyroid neoplasms with papillary-like nuclear features.
Collapse
Affiliation(s)
- David Suster
- From the Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (D. Suster, Nosé)
| | | | - Vania Nosé
- From the Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (D. Suster, Nosé)
| | - Saul Suster
- The Medical College of Wisconsin, Milwaukee (S. Suster). D. Suster is currently at the Department of Pathology, Rutgers University School of Medicine, Newark, New Jersey
| |
Collapse
|
18
|
Suster S. Arkadi M. Rywlin, M.D. (1923-1987) – A Reminiscence. Ann Diagn Pathol 2021. [DOI: 10.1016/j.anndiagpath.2021.151802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Suster D, Miller JA, Pihan G, Mackinnon AC, Suster S. Expression patterns for Bcl-2, EMA, β-catenin, E-cadherin, PAX8, and MIB1 in thymomas. Mod Pathol 2021; 34:1831-1838. [PMID: 34135467 DOI: 10.1038/s41379-021-00839-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 11/09/2022]
Abstract
The expression of immunohistochemical markers has been extensively investigated in thymomas to assist in the differential diagnosis. We have studied six select markers to determine their utility in the evaluation of these tumors. A series of 126 thymomas including 33 type A, 27 type AB, 20 type B1, 22 type B2, and 24 type B3, were examined utilizing a tissue microarray (TMA) technique with antibodies to e-cadherin, β-catenin, PAX8, bcl-2, EMA, and MIB-1. Keratin AE1/AE3 and p63 were used for quality control. A significant finding was strong and consistent positivity for bcl-2 in type A (90%) and type AB (88.8%) thymoma, while 100% of B1, B2, and B3 were negative. The distribution of e-cadherin and β-catenin was not useful for differential diagnosis. E-cadherin and β-catenin were expressed in a high proportion of all the tumors (92-100%), except for B2 thymoma which showed only 45% expression. A significant increase in the expression of the MIB-1 proliferation marker (mean: 12.8% nuclear positivity) was also observed in B3 thymoma compared with the other histologic types. Statistical significance was confirmed using Kruskal's non-parameterized test for distribution. EMA was generally negative except for spindle cells in the fibrous septa in types A and AB thymoma. PAX8 showed less consistent nuclear staining than p63 and was only widely expressed in 55.7% of cases. Bcl-2 may serve as a useful marker to separate spindle cell thymomas (Type A and AB) from the other types, and the MIB1 proliferation index may be of use to differentiate type B2 from type B3 thymoma.
Collapse
Affiliation(s)
- David Suster
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James A Miller
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - German Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A Craig Mackinnon
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
20
|
Suster DI, Suster S. Foreword to the Mediastinal Sarcomas Series. Mediastinum 2020; 4:29. [PMID: 35118297 PMCID: PMC8794342 DOI: 10.21037/med-2020-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 11/06/2022]
Affiliation(s)
- David Ilan Suster
- Department of Pathology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
21
|
Abstract
Liposarcoma is a malignant tumor of adipocytic differentiation that rarely arises within the mediastinum. Most of the existing data available comes from scattered case reports and a few small series. The World Health Organization (WHO) recognizes four basic types of liposarcoma: well-differentiated/atypical lipomatous tumor (ALT), dedifferentiated, myxoid and pleomorphic liposarcoma (PLS). All of these liposarcoma subtypes have been recorded to occur within the mediastinum. On morphologic grounds liposarcoma can present a challenge for diagnosis as it can be difficult to distinguish from benign adipocytic neoplasms, or in the case of dedifferentiated liposarcoma (DDLS), from virtually any other type of sarcoma. Molecularly the most common subtypes of liposarcoma are characterized by specific, recurrent genetic alterations involving amplification events of MDM2 and CDK4 in well-differentiated liposarcoma (WDL) and a recurrent t(12;16)(q13;p11) in myxoid liposarcoma (MLS). MDM2 and CDK4 amplification can be assessed by immunohistochemistry, fluorescence in situ hybridization, or molecular techniques that evaluate copy number alterations and amplifications such as array based assays and next generation sequencing (NGS). In addition to WDL and MLS, a few additional rare subtypes of liposarcoma may occur in the mediastinum including PLS, myxoid WDL, thymoliposarcoma, and sclerosing high-grade liposarcoma. The present review will focus on the clinicopathologic features of the various histologic types of liposarcoma described in the mediastinum and their differential diagnosis. Data is derived from review of the largest series published in the more recent literature on these tumors.
Collapse
Affiliation(s)
- David Ilan Suster
- Department of Pathology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
22
|
Suster D, Suster S. The role of needle core biopsies in the evaluation of thymic epithelial neoplasms. J Am Soc Cytopathol 2020; 9:346-358. [PMID: 32467048 DOI: 10.1016/j.jasc.2020.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022]
Abstract
Thymic epithelial neoplasms are rare tumors derived from thymic epithelium that most often present as large anterior mediastinal masses. The vast majority of thymic epithelial neoplasms fall under the diagnostic category of thymoma, with a smaller percentage qualifying for a diagnosis of thymic carcinoma. The ability to render a definitive diagnosis on these tumors is generally hampered by their deep location and close proximity to vital structures, which makes biopsy sampling for histopathologic evaluation difficult. In recent years, the trend in medicine has been to opt for the least invasive procedure to obtain tissue samples that, by definition, implies also obtaining smaller and smaller biopsies, resulting in lesser amounts of tissue available for examination. In the mediastinum, the most common modalities for procuring biopsy samples from mass lesions include fine-needle aspiration, percutaneous core needle biopsy and video-assisted thoracoscopic biopsy. In this review, we will deal only with the role and limitations of percutaneous core biopsies in the interpretation of thymic epithelial neoplasms.
Collapse
Affiliation(s)
- David Suster
- Departments of Pathology, Mount Sinai Hospital and Icahn School of Medicine, New York City, New York
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin.
| |
Collapse
|
23
|
Affiliation(s)
- Saul Suster
- From the Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
24
|
Marchevsky AM, Wick MR, Suster S. Evidence-based pathology practice. Ann Diagn Pathol 2019; 44:151447. [PMID: 31865251 DOI: 10.1016/j.anndiagpath.2019.151447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Alberto M Marchevsky
- Departments of Pathology Cedars, Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Mark R Wick
- University of Virginia, Charlottesville, VA, United States of America
| | - Saul Suster
- Medical College of Wisconsin, Milwaukee, WI, United States of America
| |
Collapse
|
25
|
Suster S, Moran C. Editorial: "Evidence Based Pathology". Ann Diagn Pathol 2019; 43:151435. [PMID: 31848045 DOI: 10.1016/j.anndiagpath.2019.151435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Saul Suster
- Professor and Chairman Emeritus Department of Pathology Medical College of Wisconsin 9200 West Wisconsin Avenue Milwaukee, WI 53226.
| | - Cesar Moran
- MD Anderson Cancer Center 1515 Holmcom Blvd Houston, Texas 77030
| |
Collapse
|
26
|
Abstract
Context.—
Follicular nodules are the most common source of diagnostic difficulties in the practice of surgical pathology of the thyroid. This is due to a variety of factors, the most salient of which is the lack of well-defined criteria and evidence-based data for the diagnosis of these lesions.
Objectives.—
To discuss some of the assumptions that have been accrued over the years regarding the criteria by which we evaluate such lesions.
Data Sources.—
The information presented herein is based on review of the literature and the author's personal experience.
Conclusions.—
Thyroid nodules with a predominant follicular growth pattern span the range from benign lesions (hyperplastic nodules, adenomatoid nodules, follicular adenomas) to malignant neoplasms (follicular carcinoma, follicular variant of papillary carcinoma) with a host of intermediate or indeterminate lesions found in between. Advances in immunohistochemistry and molecular pathology have not yet provided a reliable way of separating the borderline or intermediate cases. Low-grade and intermediate or borderline follicular-patterned thyroid lesions are those most often prone to difficulties for interpretation. Newer and potential future approaches for the evaluation of these lesions are discussed.
Collapse
Affiliation(s)
- Saul Suster
- From the Department of Pathology & Laboratory Medicine, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
27
|
Rothschild M, Ronen S, Mazo E, Suster S. Painful piezogenic pitting of the fingers in older adults: A case series. J Am Acad Dermatol 2019; 85:738-740. [PMID: 31400452 DOI: 10.1016/j.jaad.2019.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Matan Rothschild
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Shira Ronen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elena Mazo
- Department of Dermatology, Barzilai University Medical Center, Ashkelon, Israel
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
28
|
Affiliation(s)
- David Suster
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
29
|
Turk AT, Asa SL, Baloch ZW, Faquin WC, Fellegara G, Ghossein RA, Giordano TJ, LiVolsi VA, Lloyd R, Mete O, Rosai J, Suster S, Thompson LDR, Wenig BM. Interobserver Variability in the Histopathologic Assessment of Extrathyroidal Extension of Well Differentiated Thyroid Carcinoma Supports the New American Joint Committee on Cancer Eighth Edition Criteria for Tumor Staging. Thyroid 2019; 29:619-624. [PMID: 30913992 DOI: 10.1089/thy.2018.0286] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Extrathyroidal extension (ETE) by papillary and follicular thyroid carcinoma can be associated with increased risk of tumor recurrence and mortality. In the seventh edition of its Cancer Staging Manual, the American Joint Committee on Cancer (AJCC) defined minimal ETE as the involvement of skeletal muscle (i.e., strap muscles) or perithyroidal soft tissue. The eighth edition of the AJCC Cancer Staging Manual has changed the criteria so that only grossly evident (macroscopic) ETE involving strap muscles (not microscopic ETE involving perithyroidal soft tissue) affects tumor staging. Summary: Concordance of identifying microscopic ETE (as well as extranodal extension by carcinoma metastatic to lymph nodes) was previously evaluated among 11 expert endocrine pathologists. The overall agreement rate was slight when rendering a diagnosis of ETE. Concordance was highest when pathologists assessed the spatial relationship of carcinoma to skeletal muscle. This article discusses the significance of these findings. It also reviews relevant anatomic and developmental considerations related to the boundaries of the thyroid. Conclusions: The results of the concordance study provide additional rationale supporting stringent criteria for diagnosing ETE, as proposed by the eighth edition of the AJCC Cancer Staging Manual. It is expected that these rigid morphologic criteria will potentially reduce interobserver variability and enhance consistency in the diagnosis and staging of thyroid carcinoma.
Collapse
Affiliation(s)
- Andrew T Turk
- 1 Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Sylvia L Asa
- 2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Zubair W Baloch
- 3 Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia Pennsylvania
| | - William C Faquin
- 4 Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Ronald A Ghossein
- 6 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas J Giordano
- 7 Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Virginia A LiVolsi
- 3 Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia Pennsylvania
| | - Ricardo Lloyd
- 8 Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ozgur Mete
- 2 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Juan Rosai
- 9 International Center for Oncologic Pathology Consultations; Centro Diagnostico Italiano, Milan, Italy
| | - Saul Suster
- 10 Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lester D R Thompson
- 11 Department of Pathology, Woodland Hills Medical Center, Woodland Hills, California
| | - Bruce M Wenig
- 12 Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida
| |
Collapse
|
30
|
Suster D, Ronen S, Peterson JF, Mackinnon AC, Hes O, Suster S, Lin DI. MDM2 amplification and immunohistochemical expression in sarcomatoid renal cell carcinoma. Hum Pathol 2019; 87:28-36. [DOI: 10.1016/j.humpath.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 12/13/2022]
|
31
|
Ronen S, Rothschild M, Suster S. The interstitial variant of granuloma annulare: Clinicopathologic study of 69 cases with a comparison with conventional granuloma annulare. J Cutan Pathol 2019; 46:471-478. [DOI: 10.1111/cup.13455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Shira Ronen
- Department of PathologyMedical College of Wisconsin Milwaukee Wisconsin
| | - Matan Rothschild
- Department of Internal MedicineMedical College of Wisconsin Milwaukee Wisconsin
| | - Saul Suster
- Department of PathologyMedical College of Wisconsin Milwaukee Wisconsin
| |
Collapse
|
32
|
Pivovarčíková K, Martínek P, Trpkov K, Alaghehbandan R, Magi-Galluzzi C, Mundo EC, Berney D, Suster S, Gill A, Rychlý B, Michalová K, Pitra T, Hora M, Michal M, Hes O. Fumarate hydratase deficient renal cell carcinoma and fumarate hydratase deficient-like renal cell carcinoma: Morphologic comparative study of 23 genetically tested cases. Cesk Patol 2019; 55:244-249. [PMID: 31842557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hereditary leiomyomatosis and renal cell carcinoma-associated renal cell carcinoma (HLRCC)/ fumarate hydratase deficient renal cell carcinoma (FHRCC) is an aggressive tumor defined by molecular genetic changes - alteration in fumarate hydratase (FH) gene. The morphologic spectrum of HLRCC/FHDRCC is remarkably variable. The presence of large nuclei and prominent dark red inclusion-like nucleoli and perinucleolar clearing are considered as helpful morphologic clue. We selected 23 renal neoplasms primarily based on their morphologic features suspicious for HLRCC/FHDRCC. Morphological, basic immunohistochemical, and genetic analysis was performed. The tumors were divided in two groups according to the molecular genetic findings. The first group included 13 tumors with detected FH mutation/LOH (compatible with diagnosis FHRCC), and the second group included 10 tumors without FH mutation/LOH (FH-like RCCs). In the FHRCC group, the vast majority of cases (9/13) had mixed morphology with different architectural growth patterns. All cases showed prominent macronucleoli, and perinucleolar clearing was found in 10/13 cases. Immunohistochemically, 6/7 FHRCC cases were negative for FH antibody, while one case showed strong diffuse FH reactivity. The FH-like RCC group showed more uniform architectural growth pattern. All 10 tumors had prominent macronucleoli, and perinucleolar clearing was present in 8/10 cases. Eight FH-like RCC cases showed diffuse strong positivity for FH, although 2 cases were completely negative for FH. It is evident that neither morphologic feature nor immunohistochemical analysis can be reliably used in routine practice for the diagnosis of HLRCC/FHRCC. In suspected cases, the diagnosis of HLRCC/FHRCC can be confirmed by molecular-genetic testing for FH mutation. It should be noted that the traditionally described morphologic features of HLRCC/FHRCC (prominent eosinophilic macronuclei with perinucleolar halos) can frequently be seen in other renal neoplasms.
Collapse
|
33
|
Ronen S, Ivan D, Torres-Cabala CA, Curry JL, Tetzlaff MT, Aung PP, Nagarajan P, Suster S, Prieto VG. Post-radiation vascular lesions of the breast. J Cutan Pathol 2018; 46:52-58. [DOI: 10.1111/cup.13363] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/03/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shira Ronen
- Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Doina Ivan
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | | | - Jonathan L. Curry
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | - Michael T. Tetzlaff
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | - Phyu P. Aung
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| | | | - Saul Suster
- Department of Pathology; Medical College of Wisconsin; Milwaukee Wisconsin
| | - Victor G. Prieto
- Department of Pathology; University of Texas-MD Anderson Cancer Center; Houston Texas
| |
Collapse
|
34
|
Moran CA, Suster S. Reprint of: Unusual non-neoplastic lesions of the lung. Semin Diagn Pathol 2018; 35:339-346. [PMID: 30249369 DOI: 10.1053/j.semdp.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many nonneoplastic conditions that may affect the lung are in reality rare or unusual manifestations of metabolic processes, inflammatory conditions, or unknown etiology. Because of their rarity, they can often be confused with malignant neoplasms. Familiarity with these conditions not only will expedite further treatment for these patients but also will avoid the process of more tests or unnecessary surgical procedures. The nomenclature for some of those conditions is still controversial. The clinical outcome of these conditions can be quite variable, with some patients surviving a long number of years and others eventually succumbing to the disease. We will limit our discussion in this review to four of these conditions, including inflammatory pseudotumor (inflammatory myofibroblastic tumor), placental transmogrification of lung, alveolar microlithiasis, and metastatic calcification. Although these lesions are not part of the gamut of neoplastic conditions affecting the lung, they are nonetheless important to recognize, as their outcome may not necessarily be an innocuous one.
Collapse
Affiliation(s)
- Cesar A Moran
- Department of Pathology, M.D. Anderson Cancer Center, Houston, Texas.
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
35
|
Lang-Piette J, McIntosh J, Rau M, Patton M, Schneider E, Dawson A, Kirkpatrick J, Thom M, Suster S. Building a Bank for the Future: Developing the Maternal Research Placenta and Cord Blood Bank at Froedtert and the Medical College of Wisconsin with Expansion to St. Joseph's Hospital of West Bend, WI. Stem Cells Transl Med 2018. [DOI: 10.1002/sctm.12374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | | | - Mary Rau
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mollie Patton
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | | | - Mónica Thom
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saul Suster
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
36
|
Nasser MW, Datta J, Nuovo G, Kutay H, Motiwala T, Majumder S, Wang B, Suster S, Jacob ST, Ghoshal K. Down-regulation of micro-RNA-1 (miR-1) in lung cancer. Suppression of tumorigenic property of lung cancer cells and their sensitization to doxorubicin-induced apoptosis by miR-1. J Biol Chem 2018; 293:12945. [PMID: 30120149 DOI: 10.1074/jbc.w118.004967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
37
|
Agaimy A, Amin MB, Gill AJ, Popp B, Reis A, Berney DM, Magi-Galluzzi C, Sibony M, Smith SC, Suster S, Trpkov K, Hes O, Hartmann A. SWI/SNF protein expression status in fumarate hydratase-deficient renal cell carcinoma: immunohistochemical analysis of 32 tumors from 28 patients. Hum Pathol 2018; 77:139-146. [PMID: 29689242 DOI: 10.1016/j.humpath.2018.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/13/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Abstract
Fumarate hydratase-deficient renal cell carcinoma (FH-RCC) is a rare, aggressive RCC type, originally described in the setting of hereditary leiomyomatosis and RCC syndrome, which is defined by germline FH gene inactivation. Inactivation of components of the switch/sucrose nonfermentable (SWI/SNF) chromatin remodeling complex is involved in renal medullary carcinoma (SMARCB1/INI1 loss), clear cell RCC (PBRM1 loss), and subsets of dedifferentiated RCC of clear cell, chromophobe, and papillary types (loss of different SWI/SNF components). FH-RCC and SWI/SNF-deficient RCC share anaplastic nuclear features and highly aggressive course. We analyzed 32 FH-RCCs from 28 patients using 7 commercially available SWI/SNF antibodies (SMARCB1/INI1, SMARCA2, SMARCA4, SMARCC1, SMARCC2, PBRM1, and ARID1A). Variable loss of SMARCB1, ARID1A, and SMARCC1 was observed in 1 of 31, 2 of 31, and 1 of 29 evaluable cases, respectively; 3 of these 4 SWI/SNF-deficient tumors had confirmed FH mutations. No correlation of SWI/SNF loss with solid or sarcomatoid features was observed. Two tumors with SMARCB1 and ARID1A deficiency had available SWI/SNF molecular data; both lacked SMARCB1 and ARID1A mutations. The remaining 5 SWI/SNF components were intact in all cases. Especially PBRM1 seems not to be involved in the pathogenesis or progression of FH-RCC. Our data showed that a subset of FH-RCC (12%) have a variable loss of SWI/SNF complex subunits, likely as secondary genetic events. This should not be confused with SWI/SNF-deficient RCC of other types. Evaluation of FH and SWI/SNF together with comprehensive molecular genetic profiling is needed to explore possible prognostic implications of FH/SWI-SNF double deficiency and to better understand the somatic mutation landscape in high-grade RCC.
Collapse
Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital of Erlangen, 91054 Erlangen, Germany.
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences, Memphis, TN 38103, USA
| | - Anthony J Gill
- University of Sydney NSW Australia 2006, Cancer Diagnosis and Pathology Group, Kolling Institute, Royal North Shore Hospital NSW Australia 2065 and NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Bernt Popp
- Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - André Reis
- Institute of Human Genetics, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Daniel M Berney
- Barts Cancer Institute, Queen Mary University of London, London ECIM 6BQ, UK
| | | | | | - Steven C Smith
- Department of Pathology, VCU School of Medicine, Richmond, VA 23298, USA
| | - Saul Suster
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Kiril Trpkov
- Calgary Laboratory Services and University of Calgary, Calgary, Alberta, Canada
| | - Ondřej Hes
- Charles University and University Hospital Plzen, 304 60 Plzen, Czech Republic
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital of Erlangen, 91054 Erlangen, Germany
| |
Collapse
|
38
|
Hernandez-Prera JC, Machado RA, Asa SL, Baloch Z, Faquin WC, Ghossein R, LiVolsi VA, Lloyd RV, Mete O, Nikiforov YE, Seethala RR, Suster S, Thompson LD, Turk AT, Sadow PM, Urken ML, Wenig BM. Pathologic Reporting of Tall-Cell Variant of Papillary Thyroid Cancer: Have We Reached a Consensus? Thyroid 2017; 27:1498-1504. [PMID: 29020884 DOI: 10.1089/thy.2017.0280] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Tall-cell variant (TCV) is widely believed to be a more aggressive subtype of papillary thyroid carcinoma (PTC). Despite the significance of TCV with respect to risk stratification and therapeutic decision making, its diagnosis is subject to inter-observer variability. This study aimed to determine the level of agreement among expert pathologists in the identification and reporting of TCV. METHODS Seventeen surgical resections for thyroid cancer containing the diagnostic term "tall cell" in their pathology reports and 22 cases diagnosed as classical PTC were selected. Cases were digitalized, and 14 expert pathologists reviewed the scanned slides blinded to the original interpretation. Each pathologist designated each case as TCV or not and answered multiple questions about diagnostic histopathologic features of TCV. RESULTS The overall strength of agreement for identifying TCV was fair (Fleiss kappa 0.34), and the proportion of observed agreement was 0.70. Of 22 cases originally diagnosed as PTC classical variant, 15 (68%) were reclassified as TCV by at least one expert pathologist. It was noted that four different definitions for TCV were used by the participants based on various combinations of cell height to width (H:W) ratio and the percentage of tumor cells showing that specific ratio. All pathologists agreed that the diagnosis of TCV does not rely solely on a specific H:W ratio. CONCLUSIONS Pathologic reporting of TCV varies among pathologists. This disagreement is a result of the lack of unanimous diagnostic criteria and variation in individual pathologists' interpretations. These discrepancies lead to over- and under-diagnosis of TCV, which has significant implications in patient management. It is imperative to understand this variability in diagnosis TCV as it relates to risk stratification and interpretation of clinical studies related to this histologic subtype of PTC. Further studies are needed to reach consensus on the diagnostic criteria of TCV.
Collapse
Affiliation(s)
| | - Rosalie A Machado
- 2 Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York
| | - Sylvia L Asa
- 3 Department of Pathology, Laboratory Medicine Program, University Health System , Toronto, Canada
| | - Zubair Baloch
- 4 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - William C Faquin
- 5 Department of Pathology, Massachusetts General Hospital , Boston, Massachusetts
| | - Ronald Ghossein
- 6 Department of Pathology, Memorial Sloan-Kettering Cancer Center , New York, New York
| | - Virginia A LiVolsi
- 4 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Ricardo V Lloyd
- 7 Department of Pathology and Laboratory Medicine, University of Wisconsin , Madison, Wisconsin
| | - Ozgur Mete
- 3 Department of Pathology, Laboratory Medicine Program, University Health System , Toronto, Canada
| | - Yuri E Nikiforov
- 8 Department of Pathology, The University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Raja R Seethala
- 8 Department of Pathology, The University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Saul Suster
- 9 Department of Pathology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Lester D Thompson
- 10 Department of Pathology, Woodland Hills Medical Center , Woodland Hills, California
| | - Andrew T Turk
- 11 Department of Pathology, New York-Presbyterian/Columbia , New York, New York
| | - Peter M Sadow
- 5 Department of Pathology, Massachusetts General Hospital , Boston, Massachusetts
| | - Mark L Urken
- 12 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| | - Bruce M Wenig
- 1 Department of Anatomic Pathology, Moffitt Cancer Center , Tampa, Florida
| |
Collapse
|
39
|
Rotterova P, Martinek P, Alaghehbandan R, Prochazkova K, Damjanov I, Rogala J, Suster S, Perez-Montiel D, Alvarado-Cabrero I, Sperga M, Svajdler M, Michalova K, Pivovarcikova K, Daum O, Hora M, Dusek M, Ondic O, Stehlikova A, Michal M, Hes O. High-grade renal cell carcinoma with emperipolesis: Clinicopathological, immunohistochemical and molecular-genetic analysis of 14 cases. Histol Histopathol 2017; 33:277-287. [PMID: 28861890 DOI: 10.14670/hh-11-925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Emperipolesis has recently been described as a constant feature of "biphasic squamoid" papillary renal cell carcinoma (BPRCC). We also noticed this in some high-grade (HG) RCC, which promoted the present study to estimate the incidence of emperipolesis in RCCs and to describe them in further detail. 14 cases of HGRCC showing emperipolesis were retrieved from our registry. Microscopic examination of filed slides was supplemented with immunohistochemical and molecular-genetic analyses using paraffin embedded tissue. 12 of 14 patients were males with a mean age of 58.6 years (range 41-72 years). Tumor size ranged from 6-16.5 cm (mean of 8.8 cm). Follow up data were available for 8/14 patients (range 0.5-10 years). Metastases were documented in 6 cases. All tumors showed solid-alveolar growth patterns with focal pseudopapillary features, and were composed of large cells with bizarre nuclei and eosinophilic rhabdoid-like cytoplasm. Emperipolesis was a constant and prominent feature in large bizarre cells. All cases were positive for OSCAR, CANH 9, vimentin, cyclin D1, INI-1, and myoD1, while negative for melanocytic markers, CK 7, myoglobin, cathepsin K, and TFE3. VHL gene abnormalities were found in 6/9 analyzable cases, of which 2 demonstrated polysomy of chromosomes 7, 17. Emperipolesis is a rare histomorphologic feature which can be seen not only in BPRCCs but also in highgrade CCRCCs. All RCC cases with prominent emperipolesis fulfilled both morphologic and immunohistochemical diagnostic criteria of high-grade CCRCC. The majority of patients with available follow up information developed metastases.
Collapse
Affiliation(s)
- Pavla Rotterova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.,Biopticka laborator Plzen, Czech Republic
| | - Petr Martinek
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Reza Alaghehbandan
- Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, Vancouver, BC, Canada
| | - Kristyna Prochazkova
- Department of Urology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Ivan Damjanov
- Department of Pathology, University of Kansas, Kansas City, KS, USA
| | - Joanna Rogala
- Department of Pathology, Wojewódzki Szpital Specjalistyczny, Wroclaw, Poland
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Delia Perez-Montiel
- Department of Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Maris Sperga
- Department of Pathology, East University, Riga, Latvia
| | - Marian Svajdler
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Kvetoslava Michalova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Kristyna Pivovarcikova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Ondrej Daum
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Milan Hora
- Department of Urology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Martin Dusek
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Ondrej Ondic
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Adela Stehlikova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic. .,Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Plzen, Czech Republic
| |
Collapse
|
40
|
Stemm M, Suster D, Wakely PE, Suster S. Typical and Atypical Granular Cell Tumors of Soft Tissue: A Clinicopathologic Study of 50 Patients. Am J Clin Pathol 2017; 148:161-166. [PMID: 28898987 DOI: 10.1093/ajcp/aqx058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Granular cell tumors are rare neoplasms of neural origin. Despite the mesenchymal nature of these tumors, they rarely occur in the soft tissue, and as a result, this subset is not well characterized. We present the largest case series to date comprising 50 patients with benign and atypical soft tissue granular cell tumors in an effort to better define the pathologic features in this subset of lesions. METHODS All cases of soft tissue granular cell tumors from the Ohio State Medical Center and the Medical College of Wisconsin over a 10-year period were reviewed for histologic and clinical findings. RESULTS The most common location was the upper extremity. The mean age was 38.6 years, and the mean size of the tumor was 2.1 cm. An infiltrative growth pattern was seen in 58.8% of cases, and positive margins were found in 68.2%. Eleven (21.6%) cases showed evidence of cytologic atypia and fulfilled the criteria for a diagnosis of atypical giant cell tumor. Two of 11 patients with long-term follow-up experienced local recurrence. CONCLUSIONS Compared with granular cell tumors overall, the soft tissue subset shows a larger average size and higher propensity for incomplete resections, with atypical features being relatively common. Our findings suggest that soft tissue granular cell tumors may be slightly more aggressive than their dermal or organ-confined counterparts.
Collapse
Affiliation(s)
- Matthew Stemm
- Department of Pathology, Medical College of Wisconsin, Milwaukee
| | - David Suster
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
41
|
Michal M, Kazakov DV, Hadravsky L, Michalova K, Grossmann P, Steiner P, Vanecek T, Renda V, Suster S, Michal M. Lipoblasts in spindle cell and pleomorphic lipomas: a close scrutiny. Hum Pathol 2017; 65:140-146. [PMID: 28546131 DOI: 10.1016/j.humpath.2017.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
The presence and frequency of lipoblasts (LPB) in spindle cell lipomas (SCL) and pleomorphic lipomas (PL) has never been studied in detail on a histologically, immunohistochemically and molecular genetically validated set of tumors. The authors investigated this feature by reviewing 91 cases of SCL and 38 PL. When more than 3 unequivocal LPB were found, the case was regarded as positive for the presence of LPB. All positive cases were then stained with CD34 and retinoblastoma (Rb) protein antibodies and tested by fluorescence in situ hybridization for MDM2 and CDK4 amplifications and the FUS gene rearrangements. The patients with SCL and PL containing LPB were 14 women and 47 men, the rest were of unknown gender. The cases usually presented as superficial, well-circumscribed soft tissue masses and most commonly occurred in the upper back and neck. CD34 was expressed in all cases, while Rb protein was consistently absent in all. Molecular genetic results, when available, were in concordance with the morphological diagnosis of SCL/PL. LPB were found in 37 (41%) cases of SCL and 25 cases of PL (66%). While in many cases they are inconspicuous, in some others they constitute a very prominent component of the tumor. It is important to be aware of this fact in order to avoid misinterpretation as liposarcoma.
Collapse
Affiliation(s)
- Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic; Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic.
| | - Dmitry V Kazakov
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Ladislav Hadravsky
- Department of Pathology, Third Medical Faculty in Prague, Charles University, 100 34 Prague, Czech Republic
| | - Kvetoslava Michalova
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Petr Grossmann
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Petr Steiner
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Tomas Vanecek
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| | - Valentina Renda
- Department of Pathology and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA 53226-3522
| | - Saul Suster
- Department of Pathology and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA 53226-3522
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, 323 00 Pilsen, Czech Republic
| |
Collapse
|
42
|
Foix MP, Dunatov A, Martinek P, Mundó EC, Suster S, Sperga M, Lopez JI, Ulamec M, Bulimbasic S, Montiel DP, Alaghehbandan R, Peckova K, Pivovarcikova K, Ondrej D, Rotterova P, Skenderi F, Prochazkova K, Dusek M, Hora M, Michal M, Hes O. Morphological, immunohistochemical, and chromosomal analysis of multicystic chromophobe renal cell carcinoma, an architecturally unusual challenging variant. Virchows Arch 2016; 469:669-678. [PMID: 27631338 DOI: 10.1007/s00428-016-2022-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/27/2016] [Accepted: 09/05/2016] [Indexed: 12/11/2022]
Abstract
Chromophobe renal cell carcinoma (ChRCC) is typically composed of large leaf-like cells and smaller eosinophilic cells arranged in a solid-alveolar pattern. Eosinophilic, adenomatoid/pigmented, or neuroendocrine variants have also been described. We collected 10 cases of ChRCC with a distinct multicystic pattern out of 733 ChRCCs from our registry, and subsequently analyzed these by morphology, immunohistochemistry, and array comparative genomic hybridization. Of the 10 patients, 6 were males with an age range of 50-89 years (mean 68, median 69). Tumor size ranged between 1.2 and 20 cm (mean 5.32, median 3). Clinical follow-up was available for seven patients, ranging 1-19 years (mean 7.2, median 2.5). No aggressive behavior was documented. We observed two growth patterns, which were similar in all tumors: (1) variable-sized cysts, resembling multilocular cystic neoplasm of low malignant potential and (2) compressed cystic and tubular pattern with slit-like spaces. Raisinoid nuclei were consistently present while necrosis was absent in all cases. Half of the cases showed eosinophilic/oncocytic cytology, deposits of pigment (lipochrome) and microcalcifications. The other half was composed of pale or mixed cell populations. Immunostains for epithelial membrane antigen (EMA), CK7, OSCAR, CD117, parvalbumin, MIA, and Pax 8 were positive in all tumors while negative for vimentin, TFE3, CANH 9, HMB45, cathepsin K, and AMACR. Ki67 immunostain was positive in up to 1 % of neoplastic cells. Molecular genetic examination revealed multiple chromosomal losses in two fifths analyzable tumors, while three cases showed no chromosomal numerical aberrations. ChRCC are rarely arranged in a prominent multicystic pattern, which is probably an extreme form of the microcystic adenomatoid pigmented variant of ChRCC. The spectrum of tumors entering the differential diagnosis of ChRCC is quite different from that of conventional ChRCC. The immunophenotype of ChRCC is identical with that of conventional ChRCC. Chromosomal numerical aberration pattern was variable; no chromosomal numerical aberrations were found in three cases. All the cases in this series have shown an indolent and non-aggressive behavior.
Collapse
Affiliation(s)
- Maria Pané Foix
- Department of Pathology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ana Dunatov
- Department of Pathology, University of Split, Split, Croatia
| | - Petr Martinek
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Enric Condom Mundó
- Department of Pathology, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maris Sperga
- Department of Pathology, East University, Riga, Latvia
| | - Jose I Lopez
- Department of Pathology, Cruces University Hospital, Biocruces Research Institute, University of the Basque Country, Barakaldo, Spain
| | - Monika Ulamec
- "Ljudevit Jurak" Pathology Department, Clinical Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Stela Bulimbasic
- Department of Pathology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Delia Perez Montiel
- Department of Pathology, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Reza Alaghehbandan
- Department of Pathology, Faculty of Medicine, Royal Columbian Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kvetoslava Peckova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Krystina Pivovarcikova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Daum Ondrej
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Pavla Rotterova
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Faruk Skenderi
- Department of Pathology, Clinical Center of the University of Srajevo, Sarajevo, Bosnia and Herzegovina
| | - Kristyna Prochazkova
- Department of Urology, Medical Faculty and Charles University Hospital, Charles University, Plzen, Czech Republic
| | - Martin Dusek
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Milan Hora
- Department of Urology, Medical Faculty and Charles University Hospital, Charles University, Plzen, Czech Republic
| | - Michal Michal
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, , Medical Faculty and Charles University Hospital Plzen, Charles University, Alej Svobody 80, 304 60, Pilsen, Czech Republic.
- Biomedical Centre, Faculty of Medicine in Lzen, Charles University in Prague, Plzen, Czech Republic.
| |
Collapse
|
43
|
Peckova K, Michal M, Hadravsky L, Suster S, Damjanov I, Miesbauerova M, Kazakov DV, Vernerova Z, Michal M. Littoral cell angioma of the spleen: a study of 25 cases with confirmation of frequent association with visceral malignancies. Histopathology 2016; 69:762-774. [PMID: 27374010 DOI: 10.1111/his.13026] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022]
Abstract
AIMS Littoral cell angioma (LCA) is a rare primary splenic tumour that is frequently associated with internal malignancies. Immunohistochemistry can demonstrate a distinct hybrid endothelial-histiocytic phenotype of littoral cells, and is a helpful adjunct for making the correct diagnosis. The aims of this study were to present a series of 25 LCAs, with an emphasis on the frequent association of the neoplasm with visceral malignancies, and to provide a detailed immunohistochemical analysis by employing new markers. METHODS AND RESULTS All 25 cases with available tissue blocks were immunohistochemically stained for endothelial and histiocytic markers. Clinical and follow-up data were retrieved from the respective institutions. The tumours were obtained from 16 males and nine females, whose age ranged from 32 to 86 years (mean 56.2 years). Clinical information was available for 24 of 25 patients, and follow-up for 11 of 25 patients (range 2-19 years; mean 11.6 years). Immunohistochemically, all cases were positive for LYVE-1, factor VIII, FLI-1, vascular endothelial growth factor receptor (VEGFR)-2, VEGFR-3, claudin-5, ERG, LMO2, CD31, CD163, lysozyme, and CD4, but negative for D2-40, CD8, and factor XIIIa. Fifteen of 25 cases were associated with various malignancies, including epithelial, mesenchymal and haematological tumours. CONCLUSIONS The cohort of 25 patients is the largest series of LCAs published to date. By using antibodies against recently introduced endothelial markers, we have expanded the immunoprofile of LCA. We have further highlighted the clinical significance of LCA, as more than half of the patients in this study also harboured a coexisting visceral malignancy. Therefore, we conclude that the finding of splenic LCA mandates a thorough clinical evaluation for a concomitant malignancy.
Collapse
Affiliation(s)
- Kvetoslava Peckova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic.
| | - Michael Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic.,Biomedical Centre, Faculty of Medicine in Plzen and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Ladislav Hadravsky
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Saul Suster
- Department of Pathology and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ivan Damjanov
- Department of Pathology and Laboratory Medicine, The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Marketa Miesbauerova
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Dmitry V Kazakov
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| | - Zdenka Vernerova
- Department of Pathology, Charles University, Third Medical Faculty and Charles University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Michal Michal
- Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Pilsen, Czech Republic
| |
Collapse
|
44
|
Ruffolo R, Suster S. Diffuse Histiocytic Proliferation Mimicking Mesothelial Hyperplasia in Endocervicosis of the Female Pelvic Peritoneum. Int J Surg Pathol 2016. [DOI: 10.1177/106689699300100202] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Two cases of a diffuse histiocytic proliferation that mimicked mesothelial hyperplasia in the pelvic peritoneum of premenopausal women with endocervicosis are presented. The lesions were found incidentally on laparoscopic examination for pelvic pain and appeared as small friable excrescenses attached to the serosal surface of the pelvis. Histologic examination revealed a dense proliferation of round to oval cells with abun dant eosinophilic cytoplasm and large, hyperchromatic nuclei showing focal invagina tions and occasional mitoses. The cells appeared to infiltrate the surrounding connec tive tissue in single files and were closely associated with sloughed strands of small, cuboidal mesothelial cells as well as with larger glands lined by mucinous epithelium. Immunohistochemical studies showed cytoplasmic staining of these cells with MAC387, HAM56, and alpha-1-antichymotrypsin antibodies, thus supporting their histiocytic nature. The close association of the histiocytic proliferation with the endo cervicotic glands raises the possibility that the process may have resulted as a reaction to rupture and extrusion of the mucous contents of the glands into the surrounding stroma. These lesions must be distinguished from reactive or neoplastic mesothelial proliferations involving the female pelvic peritoneum. Int J Surg Pathol 1(2):101-106, 1993
Collapse
|
45
|
Affiliation(s)
- Cesar A. Moran
- Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, D.C
| | - Saul Suster
- Arkadi M. Rywlin Depanment of Pathology and Laboratory Medicine, Mount Sinai Medical Center and University of Miami School of Medicine, Miami, Florida
| |
Collapse
|
46
|
Du E, Wenig BM, Su HK, Rowe ME, Haser GC, Asa SL, Baloch Z, Faquin WC, Fellegara G, Giordano T, Ghossein R, LiVolsi VA, Lloyd R, Mete O, Ozbek U, Rosai J, Suster S, Thompson LD, Turk AT, Urken ML. Inter-Observer Variation in the Pathologic Identification of Extranodal Extension in Nodal Metastasis from Papillary Thyroid Carcinoma. Thyroid 2016; 26:816-9. [PMID: 27089928 DOI: 10.1089/thy.2015.0551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Extranodal extension (ENE) in lymph node metastases has been shown to worsen the prognosis of papillary thyroid cancer (PTC). Despite the clinical significance of ENE, there are no stringent criteria for its microscopic diagnosis, and its identification is subject to inter-observer variability. The objective of this study was to determine the level of agreement among expert pathologists in the identification of ENE in PTC cases. METHODS Eleven expert pathologists from the United States, Italy, and Canada were asked to review 61 scanned slides of representative permanent sections of PTC specimens from Mount Sinai Beth Israel Medical Center in New York. Each slide was evaluated for the presence of ENE. The pathologists were also asked to report the criteria they use to identify ENE. RESULTS The overall strength of agreement in identifying ENE was only fair (κ = 0.35), and the proportion of observed agreement was 0.68. The proportions of observed agreement for the identification of perinodal structures (fat, nerve, skeletal, and thick-walled vessel involvement) ranged from 0.61 to 0.997. CONCLUSIONS Overall agreement for the identification of ENE is poor. The lack of agreement results from both variation in pathologists' identification of features and disagreement on the histologic criteria for ENE. This lack of concordance may help explain some of the discordant information regarding prognosis in clinical studies when this feature is identified.
Collapse
Affiliation(s)
- Eugenie Du
- 1 Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine , Bronx, New York
| | - Bruce M Wenig
- 2 Department of Pathology, Mount Sinai Beth Israel , New York, New York
| | - Henry K Su
- 3 Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York
| | - Meghan E Rowe
- 3 Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York
| | - Grace C Haser
- 3 Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York
| | - Sylvia L Asa
- 4 Department of Pathology, Laboratory Medicine Program, Toronto General Hospital , Toronto, Canada
| | - Zubair Baloch
- 5 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - William C Faquin
- 6 Department of Pathology, Massachusetts General Hospital , Boston, Massachusetts
| | - Giovanni Fellegara
- 7 Centro Consulenze Anatomia Patologica Oncologica, Centro Diagnostico Italiano , Milan, Italy
| | - Thomas Giordano
- 8 Department of Pathology, University of Michigan Medical School , Ann Arbor, Michigan
| | - Ronald Ghossein
- 9 Department of Pathology, Memorial Sloan-Kettering Cancer Center , New York, New York
| | - Virginia A LiVolsi
- 5 Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Ricardo Lloyd
- 10 Department of Pathology and Laboratory Medicine, University of Wisconsin , Madison, Wisconsin
| | - Ozgur Mete
- 4 Department of Pathology, Laboratory Medicine Program, Toronto General Hospital , Toronto, Canada
| | - Umut Ozbek
- 11 Population Health Science and Policy, Mount Sinai Hospital , New York, New York
| | - Juan Rosai
- 7 Centro Consulenze Anatomia Patologica Oncologica, Centro Diagnostico Italiano , Milan, Italy
| | - Saul Suster
- 12 Department of Pathology, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Lester D Thompson
- 13 Department of Pathology, Woodland Hills Medical Center , Woodland Hills, California
| | - Andrew T Turk
- 14 Department of Pathology, New York-Presbyterian/Columbia , New York, New York
| | - Mark L Urken
- 15 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| |
Collapse
|
47
|
Su HK, Wenig BM, Haser GC, Rowe ME, Asa SL, Baloch Z, Du E, Faquin WC, Fellegara G, Giordano T, Ghossein R, LiVolsi VA, Lloyd R, Mete O, Ozbek U, Rosai J, Suster S, Thompson LD, Turk AT, Urken ML. Inter-Observer Variation in the Pathologic Identification of Minimal Extrathyroidal Extension in Papillary Thyroid Carcinoma. Thyroid 2016; 26:512-7. [PMID: 26953223 PMCID: PMC5583558 DOI: 10.1089/thy.2015.0508] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Extrathyroidal extension (ETE) is a significant prognostic factor in papillary thyroid carcinoma (PTC). Minimal extrathyroidal extension (mETE) is characterized by involvement of the sternothyroid muscle or perithyroid soft tissue, and is generally identified by light microscope examination. Patients with mETE, identified pathologically, are automatically upstaged to pT3. However, the prognostic implications of mETE have been a source of controversy in the literature. Moreover, there is also controversy surrounding the identification of mETE on pathological specimens. The objective of this study was to determine the level of agreement among expert pathologists in the identification of mETE in PTC cases. METHODS Eleven expert pathologists from the United States, Italy, and Canada were asked to perform a review of 69 scanned slides of representative permanent sections of PTC specimens. Each slide was evaluated for the presence of mETE. The pathologists were also asked to list the criteria they use to identify mETE. RESULTS The overall strength of agreement for identifying mETE was slight (κ = 0.14). Inter-pathologist agreement was best for perithyroidal skeletal muscle involvement (κ = 0.46, moderate agreement) and worst for invasion around thick-walled vascular structures (κ = 0.02, slight agreement). In addition, there was disagreement over the constellation of histologic features that are diagnostic for mETE, which affected overall agreement for diagnosing mETE. CONCLUSIONS Overall agreement for the identification of mETE is poor. Disagreement is a result of both variation in individual pathologists' interpretations of specimens and disagreement on the histologic criteria for mETE. Thus, the utility of mETE in staging and treatment of PTC is brought into question. The lack of concordance may explain the apparent lack of agreement regarding the prognostic significance of this pathologic feature.
Collapse
Affiliation(s)
- Henry K. Su
- Department of Otolaryngology—Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Bruce M. Wenig
- Department of Pathology, Mount Sinai Beth Israel, New York, New York
| | - Grace C. Haser
- Department of Otolaryngology—Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Meghan E. Rowe
- Department of Otolaryngology—Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation, New York, New York
| | - Sylvia L. Asa
- Department of Pathology, Laboratory Medicine Program, Toronto General Hospital, Toronto, Canada
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eugenie Du
- Department of Otorhinolaryngology—Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - William C. Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Giovanni Fellegara
- Centro Consulenze Anatomia Patologica Oncologica, Centro Diagnostico Italiano, Milan, Italy
| | - Thomas Giordano
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan–Kettering Cancer Center, New York, New York
| | - Virginia A. LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ricardo Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
| | - Ozgur Mete
- Department of Pathology, Laboratory Medicine Program, Toronto General Hospital, Toronto, Canada
| | - Umut Ozbek
- Population Health Science and Policy, Mount Sinai Hospital, New York, New York
| | - Juan Rosai
- Centro Consulenze Anatomia Patologica Oncologica, Centro Diagnostico Italiano, Milan, Italy
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lester D. Thompson
- Department of Pathology, Woodland Hills Medical Center, Woodland Hills, California
| | - Andrew T. Turk
- Department of Pathology, New York-Presbyterian/Columbia, New York, New York
| | - Mark L. Urken
- Department of Otolaryngology—Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York
| |
Collapse
|
48
|
Plaza JA, Bonneau P, Prieto V, Sangueza M, Mackinnon A, Suster D, Bacchi C, Estrozi B, Kazakov D, Kacerovska D, Falconieri G, Suster S. Desmoplastic melanoma: an updated immunohistochemical analysis of 40 cases with a proposal for an additional panel of stains for diagnosis. J Cutan Pathol 2016; 43:313-23. [PMID: 26661921 DOI: 10.1111/cup.12654] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/15/2015] [Accepted: 06/27/2015] [Indexed: 12/31/2022]
Abstract
Desmoplastic melanoma (DM) is histologically characterized by a proliferation of spindle melanocytes dispersed in a collagenous stroma that can be mistaken for a variety of neoplasms. The purpose of this study was to analyze 40 cases of DM with a comprehensive panel of immunohistochemical markers (KBA.62, p16, Ezrin, WT-1, MITF-1, SOX-10, CD117, SOX-2, nestin, PNL2, p75, MART-1, gp100 and S100p) to obtain a more complete understanding of the potential use of these antibodies in the diagnosis of DM. We found that all cases of DM expressed p16, WT-1, SOX-10, nestin and S100p and 95% of cases expressed p75. There was variable expression with Ezrin, SOX-2, KBA.62, MART-1 and HMB-45. Most DMs did not express MITF-1, PNL2 and CD117. Conditions that may enter in the histologic differential diagnosis of DM, including dermal scars, fibromatosis and dermatofibromas were also studied. Nearly all control cases also stained positive for p16 but were negative for WT1, SOX10, nestin, p75 and S-100p, as well as for most of the other markers tested. We conclude that a panel of S-100p, WT1, SOX10, p75 and nestin may constitute the optimal panel with the most sensitive and specific combination of immunostain available for the diagnosis of DM.
Collapse
Affiliation(s)
- Jose A Plaza
- Dermatopathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter Bonneau
- Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Victor Prieto
- Pathology and Dermatology, UT-M.D. Anderson Cancer Center, Houston, TX, USA
| | - Martin Sangueza
- Pathology and Dermatology, Hospital Obrero, La Paz, Plurinational State of Bolivia
| | | | - David Suster
- Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | - Dmitry Kazakov
- Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic
| | - Denisa Kacerovska
- Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic
| | | | - Saul Suster
- Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
49
|
|
50
|
Xia S, Huang CC, Le M, Dittmar R, Du M, Yuan T, Guo Y, Wang Y, Wang X, Tsai S, Suster S, Mackinnon AC, Wang L. Genomic variations in plasma cell free DNA differentiate early stage lung cancers from normal controls. Lung Cancer 2015; 90:78-84. [DOI: 10.1016/j.lungcan.2015.07.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/23/2015] [Accepted: 07/02/2015] [Indexed: 12/15/2022]
|